How far down THEIR rank list

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It's concerning that you think this matters because it implies you don't understand how the match works. It is imperative that you rank the programs in the order you wish to attend and NOT factor this sort of data into your thinking. Otherwise you are doing yourself a big disservice. I remember being amazed how many people I met while applying that believed it was possible to "waste" your top ranks.


Yup... Just rank them in the order you want to go. If those programs don't rank you it won't affect you. But the futher down you rank a program you want to be at, the less likely you will match there.

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Here's a hypothetical example... and I'm just making up the number of spots because I have no idea...

Let's say you're a good candidate and you interview at several top 10 programs.

You really like lets say Duke, but you think it's a reach but it's your dream program. You also like Hopkins, UCSF and UPenn. You also are worried about NOT matching so you also interview at a few safe schools like BFE University.

So hypothetically let's say that each program has 8 spots.

Duke ranks you 12th on their list.
Penn ranks you 19th on their list.
UCSF ranks you 16th on their list.
Hopkins ranks you 7th on their list.
BFE Univ ranks you within their 8 spots cause they can't believe such an amazing candidate would interview there, but you had an ex-girlfriend who lives there and worst comes to worst you can stalk her...

So now you've interviewed at 12 places and you have your reaches and your safe schools. But you're SCARED TO DEATH of not matching cause Penn, Hopkins and Duke are supercompetitive. Now granted you don't officially know where they are ranking you, although some may "illegally" tell you that they are ranking you high. But they could be just saying that to protect their own asses, cause they don't want to get a possible scrambler.

So you're scared, so you decide to rank your list as:
1. Duke
2. Penn
3. BFE Univ (cause you know you're gonna match there... right?!)
4. UCSF
5. Hopkins

Well the fact that Hopkins ranked you within their 8 spots you are GUARANTEED to match there as long as you rank them anywhere. Problem is you may match somewhere else earlier. So hypothetically Duke could somehow match their top 8 people. Penn might lose a few early spots but fill right before you at 18th. UCSF actually lost 2 of their top ten to Penn, 2 of their top ten to Duke, 2 of their top ten to Mayo and 2 more before you to Brigham. That's 8 candidates they lost cause those people ranked other places higher. That leaves 1, 2, 3... 8 spots which would include you at 16th!!! But wait... you were scared to not match and decided to play it safe with BFE and since you missed out on Duke and Penn you move down to BFE who obviously ranked you high. If you had just ranked them the way you wanted, then even if UCSF had filled, then at worst you'd drop to your 4th actual favorite place in Hopkins.

TL,DR? Rank where you want to go. Put your safe schools as far down your list as possible. If they are "lower tier" programs then you will likely be higher on their rank lists, and even if you are a little lower, the people they rank above you will likely be lost to better programs.
 
hey guys, thanks for the replies. Yes, I understand to just rank how you want. I just wanted to be a little neurotic and see how many people that places typically need to rank and see how many I have to outrank. Let's say a program interviews 100. but they only have to go 50 deep to get their spots. meaning I have to be ranked by the program better than 50 peoples. Just was wondering for no good reason. Also, I did do a search but i couldn't find anesthesia specific data. Thanks anyways
 
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The problem is I don't think the NRMP will disclose how each program made their rank list. Duke might rank 20 or 50 or 100... and again it really doesn't matter. Even if you knew Duke ranked 25 people every year, unless they show you where you are on that rank list there's no way of knowing if you will match there if yuo're outside there designated spots. They could have you ranked 1st or 25th and you still could match (albeit much more difficult). The only way to know for sure if you will or won't match is if said program says you are intheir top X spots (which is technically illegal...) or they flat out tell you that they aren't ranking you, which would probably only happen if you made a complete jackass of yourself at the interview. Don't understand why a department would interview someone and then not rank them unless they just came across as so completely different from their CV. Or they knew you as a med student who rotated their and did the courtesy interview since you're there anyways, but in reality they think you're a ******* and would hinder the program if somehow they actually fell to their 99th spot and you matched. In which point they'd not rank people and would rather take a flier on a scrambler possibly someone who didn't match in a more competitive specialty who was really bright.
 
hey guys, thanks for the replies. Yes, I understand to just rank how you want. I just wanted to be a little neurotic and see how many people that places typically need to rank and see how many I have to outrank. Let's say a program interviews 100. but they only have to go 50 deep to get their spots. meaning I have to be ranked by the program better than 50 peoples. Just was wondering for no good reason. Also, I did do a search but i couldn't find anesthesia specific data. Thanks anyways

It doesn't matter. Even if you knew the numbers there would be nothing you can do about it. There's no way to game the match system. Just rank in your personal preference.
 
We used to rank 1/3 of the people we interviewed, which was about 4x the number of slots. So interviewed ~12x the number of spots, maybe slightly higher. So far as I know, they usually went about 2x the number of slots on the list, sometimes almost to 3x the number.

It really doesnt matter though, you are just stressing yourself learning about a system that doesnt effect you. The only people that should care about that data should be the program directors/interview committees. Just like you, they should rank everyone they want.
Scrambling hurts you the next year slightly, but you may actually end up with a decent candidate.



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I agree with everyone that it doesn't really matter, but we usually interview 7-10x total number of spots and will rank about 1/2 of those.

How far down the list we go is super variable and really hasn't been consistent at all over the past 5 years for us particularly for advanced spots.
 
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The problem is I don't think the NRMP will disclose how each program made their rank list. Duke might rank 20 or 50 or 100... and again it really doesn't matter. Even if you knew Duke ranked 25 people every year, unless they show you where you are on that rank list there's no way of knowing if you will match there if yuo're outside there designated spots. They could have you ranked 1st or 25th and you still could match (albeit much more difficult). The only way to know for sure if you will or won't match is if said program says you are intheir top X spots (which is technically illegal...) or they flat out tell you that they aren't ranking you, which would probably only happen if you made a complete jackass of yourself at the interview. Don't understand why a department would interview someone and then not rank them unless they just came across as so completely different from their CV. Or they knew you as a med student who rotated their and did the courtesy interview since you're there anyways, but in reality they think you're a ******* and would hinder the program if somehow they actually fell to their 99th spot and you matched. In which point they'd not rank people and would rather take a flier on a scrambler possibly someone who didn't match in a more competitive specialty who was really bright.

It is perfectly legal for a program to tell the applicant how they will be ranked.
 
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That would be manipulative. It is surprising that we have a process as foolproof and outstanding an "un-game-able" as the match and programs still try to manipulate and applicants still do not understand.

Truly, if you just rank in the order you prefer, you are doing it correctly. If you rank 10, and your 1-9 all don't rank you, guess what, number 10 becomes your number 1. You do not disadvantage yourself for less preferred programs by ranking your "reach" and more preferred programs higher. If any PD or program attempts to convince you otherwise, take that as a sign that they are more interested in their own well-being than yours. You can expect such behavior to extend into your residency training. The only reason any program would use this tactic is to convince you to rank them higher (therefore ensuring that they have a better chance of filling).

Neither group is at an advantage (programs or applicants), there is no strategy for ranking other than order of true preference. In a better world this thread would be completely unnecessary.
 
It is perfectly legal for a program to tell the applicant how they will be ranked.

I was always told that they aren't allowed to tell applicants where they are ranking them. Almost like insider trading. Regardless if they can or can't, you should NEVER listen to them. Even if they say you are their #1 they might just be saying that so you rank them higher when in reality maybe you're actually their #10 and they are worried 1-9 would rather go elsewhere. But even if they do put you #1 or "very highly" "wink wink" then if you have a place you prefer over them then rank the other place, cuase even if you don't match there, you're guaranteed to match at the other place.
 
It is perfectly legal for a program to tell the applicant how they will be ranked.
I have been doing this NRMP thing a long time. The above statement is true and always has been. As has been stated, both sides may be telling their own versions of the truth or each side can misinterpret what was actually said. It is prudent to be honest on both sides, since the community is relatively small and word can get out that someone is not being honest and it could affect future fellowship chances if it is the candidates lying or give a bad reputation if it is the program lying.
 
I have been doing this NRMP thing a long time. The above statement is true and always has been. As has been stated, both sides may be telling their own versions of the truth or each side can misinterpret what was actually said. It is prudent to be honest on both sides, since the community is relatively small and word can get out that someone is not being honest and it could affect future fellowship chances if it is the candidates lying or give a bad reputation if it is the program lying.

Sorry I didn't mean illegal, just very looked down upon. I think the best thing for candidates is to just say that they will be ranking you "very highly". The whole thing is just a game in the end. Both sides jsut trying to get a bigger advantage in order to get their top candidate/spot.

I'm assuming programs aren't able to see each candidates rank list after the fact. So even if you tell let's say Duke you are ranking them "Very highly" and end up ranking them 10th (while they rank you 1st), and then end up matching at your 8th ranked place they would have no clue whether you ranked them 2nd or 99th... In the end the only way to be completely guarantee anything is to get in outside the match. Or if both sides are 100% honest that they will rank the other #1.
 
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Sorry I didn't mean illegal, just very looked down upon. I think the best thing for candidates is to just say that they will be ranking you "very highly". The whole thing is just a game in the end. Both sides jsut trying to get a bigger advantage in order to get their top candidate/spot.

I'm assuming programs aren't able to see each candidates rank list after the fact. So even if you tell let's say Duke you are ranking them "Very highly" and end up ranking them 10th (while they rank you 1st), and then end up matching at your 8th ranked place they would have no clue whether you ranked them 2nd or 99th... In the end the only way to be completely guarantee anything is to get in outside the match. Or if both sides are 100% honest that they will rank the other #1.

The head of the NRMP told a room full of program directors that it was fine for them to tell candidates where they are ranked or for the candidates to tell the program where they are ranked with the caveat that neither party should count on the other one absolutely telling the complete truth.
With regards to the "very highly" rank comment, getting ranked number 10 is extremely high, especially considering that so many programs have >10 spots available. A program with 15 spots theoretically has 15 number one ranks, even though one of them will actually be number 15.
The confusion comes in the wording of ranked to match. It could mean different things to different program directors.
 
With the caveat... exactly.

That's why I'd tell every applicant to just rank how they want to based on where they want to go. Don't listen to anything the PDs say and tell every single one that you will be ranking them highly. If they want to be precise, then they can say top 3 for all I care even if they are ranking the program 25th... Cause in the end they'll never know if you ranked them 2nd, 3rd or 25th if you don't match there.

I just feel like applicants have much more to lose by not matching, so I tell them to rank how they want and game the system so that PDs might rank them higher.
 
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I advise students every year and my advice is for them to be honest. They should not be asked the question, so it is their choice to volunteer the information if they wish. An experienced PD will know when they are being sincere. It is better to volunteer no information than to lie. I wish I could say that all PD's follow the rules, but they do not. If they imply that their rank list is conditional upon where you will rank them, then they deserve to be lied to.
 
So what is a safe number of places to rank? for USMD? and for a nonUS IMG?
 
I agree with everyone that it doesn't really matter, but we usually interview 7-10x total number of spots and will rank about 1/2 of those.

How far down the list we go is super variable and really hasn't been consistent at all over the past 5 years for us particularly for advanced spots.

That seems like a lot of people interviewed who end up not getting ranked. What are things applicants do during interview day that would result in them not being ranked?
 
I agree with everyone that it doesn't really matter, but we usually interview 7-10x total number of spots and will rank about 1/2 of those.

How far down the list we go is super variable and really hasn't been consistent at all over the past 5 years for us particularly for advanced spots.

But unless you are a top/even mid tier place, don't you risk few of your spots going unmatched this way?
 
That seems like a lot of people interviewed who end up not getting ranked. What are things applicants do during interview day that would result in them not being ranked?

Yeah, our program is definitely stingy on who we actually rank so we rank about 60-75% of people we interview which I think is lower than the average. It has absolutely bitten us in the past with unmatched spots (typically with advanced spots where there is much less interest, and we are transitioning away from them)

Decisions not to rank almost always come from interview impressions, and sometimes dinner issues. You can count on one applicant getting overly liqurored up every couple of weeks, or the applicant who brags about all the interviews he or she has gotten, or overall arrogance/extreme awkwardness (difficult to define, but you'd know it if you saw it). Basically we ask ourselves at the recap meeting, could we be on a team with this person? Can we count on them?

To reassure some: no one gets a non-ranking for stats/scores, we dont interview them. The exception here is a failed CS or very low CS which we hear about after you've interviewed. Might be able to talk us out if it if we liked you, though.
 
To reassure some: no one gets a non-ranking for stats/scores, we dont interview them. The exception here is a failed CS or very low CS which we hear about after you've interviewed. Might be able to talk us out if it if we liked you, though.
But CS is pass/fail? Unless you're talking about CK
 
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Sorry autocorrect - a failed CS is a gigantic red flag since the passing rate is so ridiculously high, especially for US grads. A relatively low CK can easily be overcome by strong performance elsewhere.
 
Two years ago, they increased the fail rate on the CS and caught some off guard. I think it used to be 99% pass rate. I think it is around 95 or 96% now. Still high, but not a complete gimmee.
It's an exam that should not exist and they are increasing the fail rate to try and justify its existence.
 
We typically rank 90% of those we interview. The last quarter of the list gets pretty rough. I can definitely understand the idea of not ranking them. Luckily, we have never gotten down that far.
 
At my program, a big name desirable program, they would interview about 12x spots and rank maybe half of them, the app got your foot in the door and the interview was a chance to feel you out and see how well you'd fit in. Historically they wouldn't go any lower than 2x spots down their list, but it's really a crapshoot year to year. My program made their rank list exactly how they liked the applicants, which I appreciate, and they didn't have any post-interview communication, which was nerve-wracking at the time, but in hindsight I respect as they let the match work itself out. I know some programs show strong interest to get applicants to rank them highly and provide a more favorable match for the program and I know of at least one big name program that shows interest and subtly encourages applicants to let the program know of their top choice and then the program makes their rank list (and basically determines the incoming class) based off of that, which is something I disagree with.
 
Two years ago, they increased the fail rate on the CS and caught some off guard. I think it used to be 99% pass rate. I think it is around 95 or 96% now. Still high, but not a complete gimmee.
It's an exam that should not exist and they are increasing the fail rate to try and justify its existence.


10% Failure rate for DOs taking the Step 2 CS

20% Failure rate for IMGs taking the Step 2 CS

http://www.usmle.org/performance-data/default.aspx#2015_step-2-cs

Based on the published data DOs have a higher failure rate on the Step 2 CS than any other section of the USMLE (using an average passing score over the past 3 years). This indicates the Step 2 CS exam is a real exam for DOs and IMGs.
 
10% Failure rate for DOs taking the Step 2 CS

20% Failure rate for IMGs taking the Step 2 CS

http://www.usmle.org/performance-data/default.aspx#2015_step-2-cs

Based on the published data DOs have a higher failure rate on the Step 2 CS than any other section of the USMLE (using an average passing score over the past 3 years). This indicates the Step 2 CS exam is a real exam for DOs and IMGs.
DO's would be foolish to take the CS exam. Cannot help them, could hurt them, and not required. So, it should not be surprising that there is a high fail rate, since signing up for it was a pretty good test of the intellect. IMG's should be the only ones taking the exam, period. That was how it was initially designed, but they figured out that the exam would be expensive to administer and the cost per person would be too high, so they made it required for everyone in order to bring down the cost per person. Now it has its own bureaucracy and cannot be abolished, even though it should be. Would be akin to congress voting for term limits for themselves.
My understanding is that the fail rate for MD students has gone up by a few percentage points as well, in order to help justify the purpose of the exam. It used to be that 98% of MD students passed. More recently, it has become 95-96%. So, not a huge difference, but several students felt the pinch. We faced that a few years back with the ABA recertification exam. The American Board of Medical Specialties demanded that the fail rate be higher than 1% or risk losing the ABMS status for the ABA. It is always hard on the first couple of rounds because it is not like they announce that they are stiffening up the test beforehand. They just do it. Catches a few borderline people off guard until everyone gets the message.
 
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DO's would be foolish to take the CS exam. Cannot help them, could hurt them, and not required. So, it should not be surprising that there is a high fail rate, since signing up for it was a pretty good test of the intellect. IMG's should be the only ones taking the exam, period. That was how it was initially designed, but they figured out that the exam would be expensive to administer and the cost per person would be too high, so they made it required for everyone in order to bring down the cost per person. Now it has its own bureaucracy and cannot be abolished, even though it should be. Would be akin to congress voting for term limits for themselves.
My understanding is that the fail rate for MD students has gone up by a few percentage points as well, in order to help justify the purpose of the exam. It used to be that 98% of MD students passed. More recently, it has become 95-96%. So, not a huge difference, but several students felt the pinch. We faced that a few years back with the ABA recertification exam. The American Board of Medical Specialties demanded that the fail rate be higher than 1% or risk losing the ABMS status for the ABA. It is always hard on the first couple of rounds because it is not like they announce that they are stiffening up the test beforehand. They just do it. Catches a few borderline people off guard until everyone gets the message.

I appreciate the reply. But, are you saying that only the stupid DOs take the CS exam? I would think the exact opposite was true: those who think they are bad asses would take the CS exam to prove parity with the MDs. If I was in the bottom half of my DO class there is no way in hell I would take the CS exam. Now, if I had crushed Step 1 and Step 2 CK then I would be likely to take Step 2 CS followed by Step 3.

Anyone have data on how many DOs sit for the CS each year?
 
I appreciate the reply. But, are you saying that only the stupid DOs take the CS exam? I would think the exact opposite was true: those who think they are bad asses would take the CS exam to prove parity with the MDs. If I was in the bottom half of my DO class there is no way in hell I would take the CS exam. Now, if I had crushed Step 1 and Step 2 CK then I would be likely to take Step 2 CS followed by Step 3.

Anyone have data on how many DOs sit for the CS each year?
I don't know the data, but some take only step I or only step II. Many take both and some take neither. Honestly, I think very few DO's take the CS exam. It really has no chance of helping them. If they are bottom of their class, they are in trouble anyway and a passing score on an exam that 95-97% of MD students pass is not going to impress anyone. Some osteopathic schools (especially the ones opened in the past 10 years), in my experience, do a poor job of advising their students to be competitive in an allopathic match. On the contrary, many purposely try to get their students to only consider osteopathic and, in the past, have actively discouraged them from sitting for the USMLE at all, which puts them at a huge disadvantage. However, because they have no mentors, they don't realize it until it is too late or they sign up for the exam and are unprepared for it. These are typically the students in the third and fourth quartiles of their class, so it further submarines their efforts. I think the lack of mentors for the match process is the single biggest hindrance for osteopathic students because they are forced to figure things out on their own after being farmed out to small rural clinical rotations with private practice docs who are far removed from the process.
The outstanding top of the class DO students are self-starters who typically do not need someone to tell them how to stay on top of the process. They ace their exams and get excellent grades and great residency spots and turn out to be some of the best residents I have ever worked with. The bottom half of the classes could benefit greatly from a better mentor system, in my opinion.
 
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Anyone have data on how many DOs sit for the CS each year?
This is from the link you provided:
2013-2014- 56 DO's took the CS exam
2014-2015- 62 DO's took the CS exam
**This is compared to about 3000 who took step I and 2000 who took step II

So, the sample size for DO's taking the CS exam is super small. It is not too far fetched to believe my theory that the DO's who took it tend to be the ill-advised ones who did not know enough not to take it (ie, that it could not help them but could definitely hurt them).
 
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Now, if I had crushed Step 1 and Step 2 CK then I would be likely to take Step 2 CS followed by Step 3.
DO's almost never take step III. They don't need it because they have to take all three of the COMLEX steps. It serves no purpose for them. This is confirmed in your link that shows that about 25 DO's per year take the step III exam for USMLE.
So, if I was advising a DO student, I would say take usmle steps I and II to give yourself the best chance of getting the residency that you want. The CS exam will likely not help you and may hurt you. The usmle step III will serve no purpose for 99% of DO's and money and time should not be wasted on this.
 
DO's almost never take step III. They don't need it because they have to take all three of the COMLEX steps. It serves no purpose for them.

It may be different now, but this was not true when I was licensed. I was licensed via the USMLE pathway and never took COMLEX III.
 
I don't know the data, but some take only step I or only step II. Many take both and some take neither. Honestly, I think very few DO's take the CS exam. It really has no chance of helping them. If they are bottom of their class, they are in trouble anyway and a passing score on an exam that 95-97% of MD students pass is not going to impress anyone. Some osteopathic schools (especially the ones opened in the past 10 years), in my experience, do a poor job of advising their students to be competitive in an allopathic match. On the contrary, many purposely try to get their students to only consider osteopathic and, in the past, have actively discouraged them from sitting for the USMLE at all, which puts them at a huge disadvantage. However, because they have no mentors, they don't realize it until it is too late or they sign up for the exam and are unprepared for it. These are typically the students in the third and fourth quartiles of their class, so it further submarines their efforts. I think the lack of mentors for the match process is the single biggest hindrance for osteopathic students because they are forced to figure things out on their own after being farmed out to small rural clinical rotations with private practice docs who are far removed from the process.
The outstanding top of the class DO students are self-starters who typically do not need someone to tell them how to stay on top of the process. They ace their exams and get excellent grades and great residency spots and turn out to be some of the best residents I have ever worked with. The bottom half of the classes could benefit greatly from a better mentor system, in my opinion.
I think every one of your comments has been pure gold and paints a very very accurate picture of the DO education. Just a few thoughts I wanted to add.

I agree that if a DO is taking CS, they're foolish and misinformed. It is made clear by every program I applied to that this is not requisite. It's an expensive mistake to make (>$1500 after travel is added in).

I'm afraid MY osteopathic school (the original) does a very poor job of advising students in this regard. The actively recommended AGAINST taking the USMLE, stating it was unnecessary. I was pretty uncertain of my future specialty, and saw a lot of changes going on with the AOA/ACGME merger, and thankfully I read SDN frequently, which all motivated me to take Steps 1 and 2 (CK). Several of my classmates went and took Step 1 6-9 months later. Many of us have recommended to the school that they change their tune, as with the merger, I think the USMLE is going to be near essential if you want anything that is not primary care.

A good mentor system would be very valuable and is very much needed at DO schools. I'm grateful for the many active members on this forum, as they kind of serve as my mentors and keep me grounded.
 
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I appreciate the reply. But, are you saying that only the stupid DOs take the CS exam? I would think the exact opposite was true: those who think they are bad asses would take the CS exam to prove parity with the MDs. If I was in the bottom half of my DO class there is no way in hell I would take the CS exam. Now, if I had crushed Step 1 and Step 2 CK then I would be likely to take Step 2 CS followed by Step 3.

Anyone have data on how many DOs sit for the CS each year?

DOs have their own version of the CS exam called the PE. The ONLY reason I know of for a DO to take CS is to be eligible to sit for Step 3. Probably one of the only reasons for a DO to even take step 3 is for some fellowships requiring a step 3 score. Therefore, I would assume the reason the DO Pass for CS is lower is due to the fact that they probably take it once they figure out they want to go into the fellowship that requires a step 3 score, which at that point they are so far removed for OSCEs and medical school patient encounters, they are less prepared than when they had taken it in medical school where they had OSCEs to help practice.
 
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I think every one of your comments has been pure gold and paints a very very accurate picture of the DO education. Just a few thoughts I wanted to add.

I agree that if a DO is taking CS, they're foolish and misinformed. It is made clear by every program I applied to that this is not requisite. It's an expensive mistake to make (>$1500 after travel is added in).

I'm afraid MY osteopathic school (the original) does a very poor job of advising students in this regard. The actively recommended AGAINST taking the USMLE, stating it was unnecessary. I was pretty uncertain of my future specialty, and saw a lot of changes going on with the AOA/ACGME merger, and thankfully I read SDN frequently, which all motivated me to take Steps 1 and 2 (CK). Several of my classmates went and took Step 1 6-9 months later. Many of us have recommended to the school that they change their tune, as with the merger, I think the USMLE is going to be near essential if you want anything that is not primary care.

A good mentor system would be very valuable and is very much needed at DO schools. I'm grateful for the many active members on this forum, as they kind of serve as my mentors and keep me grounded.


Very similar experience at my osteopathic school. They seem to push FM pretty hard and most of the advisers are FM docs so I guess it can be hard to blame them for something that they do not know but I feel like it leaves those who don't want to do IM or FM hanging in the wind to just figure it out. Less than 5 in my class are going gas and I end up getting most of my information from here and my friend who is also applying anesthesia. My school seemed to be a little more straight forward with the USMLE and told us to take it if we were scoring well on our qbank and comlex practice tests. I took both step one and two. I never even considered taking the CS so that was news to me that DOs actually sat for it. I'll echo abolt in saying that everything blanten said seemed spot on.
 
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