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How important is "Top 1/3 of class" rank?

Discussion in 'Medical Students - MD' started by PokerDoc, Dec 9, 2008.

  1. PokerDoc

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    I am a first year who is very interested in radiology. So far I cant seem to do any better than a bit above average through my first 10 exams or so. The way my school does it is that they only recognize the top 3rd in the dean's letter but beyond that, no distinction is made for the bottom 2/3s of those who passed. I know i have boards to look forward to along with rotations that will probably matter than my class rank being out of the top 1/3 in first year but how important will it be when I am applying for residencies, provided I can perform good enough on boards?

    btw, if it helps, i am doing a long term project with a pediatric radiologist while in school for the first 2-3 years and for the next two summers I am doing a pretty in depth research project with an interventional radiologist who is chief of radiology at my hospital, which will help me graduate with an MD with distinction in research (not PhD).


    Im just looking for general points of reference here, anything helps.. thanks.
     
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  3. njbmd

    njbmd Guest
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    This year, we are looking at more residency applicants (general surgery residency) who have come from P/F schools that do not include ranking and therefore, I am thinking that ranking doesn't carry as much weight as in previous years. By the time you get to the point of application, class rank may carry even less weight. Is rank important? Yes to a degree but it's not the end all that it once was.

    If you can do better and get into that top 1/3rd, then I guess that you will shoot for the top 1/3rd but if that doesn't happen, you still have your research, good letters of recommendation for the good performance you are going to do during third year and your excellent board scores. In short, you have some things in front of you that you CAN control should you not make the top 1/3rd.

    Do your best but at this point you can only do what you can do. You CAN work hard on board prep and get a strong score here in addition to making sure that you have a strong third year. If you have passed everything comfortably in addition to strong boards and third year grades, I am sure that your Deans letter will be quite positive even without the top 1/3rd ranking. This may be more than enough to get you into a competitive residency (perhaps not Derm but there are more Rads than Derm out there).
     
  4. PokerDoc

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    Thank you very much for that insightful response. You bet I will do my best to get top 1/3 but its refreshing to know that 3rd year and board scores will hold far more weight than first year so while I'll continue to work hard now, I'll save my best for last.
     
  5. TMP-SMX

    TMP-SMX Senior Member
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    I guess this depends on your ranking system and how your grades are calculated. At Wayne, we have Honors (top 15%) for each class, Pass, and Fail. The way our percentiles are relayed to residencies is through quintiles. So the top quintile is between 100-80, then 80-60, and so on. I'm definitely not going to be above 80, but I'll be content in that second group for sure. In order to get into that top group you need to have honors on just about every class. You have to be on top of things all the time and if that's how you want to live for four years go for it. You'll notice that your Step I score will dwarf your M1/M2 grades. Your rotation grades will be more important than the first two years and a good rotation at the hospital you want to do a residency with is a plus.

    So I would think if your school does the top 1/3, which is quite generous, then strive to do that. Being at the 66th percentile shouldn't be that difficult as long as you don't have too many low grades. (Last year anatomy and biochem dropped my percentile). Just do your best.
     
  6. WellWornLad

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    Reminds me of something a doctor told me once:

    The top 1/3 of your class will be the best teachers, the middle 1/3 will be the best doctors, and the bottom 1/3 will be richer than either of them.
     
  7. Pinkertinkle

    Pinkertinkle 2003 Member
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    Probably because they end up in residencies and practicing in parts of the country where the cost of living is very low.
     
  8. TexasPhysician

    Moderator Physician 10+ Year Member

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    I actually know a number of med students at the bottom of their respective classes because they manage to run/help run a business at the same time. You better believe those business skills will come in handy.
     
  9. SoCuteMD

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    Honestly, my class rank has been commented on at many of my interviews. I'm really not sure how important it is, though.

    However, you'd be surprised how far you can get by doing "slightly" above average consistently. I was not a superstar (at all!) but I tried to keep my test grades above average . I usually beat the average while other people were less consistent. I ended up ranking very well class rank-wise.
     
  10. 45408

    45408 aw buddy
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    So everybody in the class can be at the 66th percentile?? 2/3 of the class won't be good enough to be that good.
     
  11. TMP-SMX

    TMP-SMX Senior Member
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    It's like they say. 50% of doctors were at the bottom half of their class.

    Anyway, I was just speaking about the OP. I'm not in the top 1/3. I'm at about the 60th percentile right now since I was in less than the 20th percentile for anatomy and biochem. The OP has the motivation and if he/she is consistently getting above average then you can do better on some subjects and even on your poorer subjects if you keep it around average you will be fine. You will find subjects that you love, you can keep up on, and you will excel in. You will be in the top 15% for those courses and if you are consistent it is definitely possible. Think of it this way. For every class you are at the 50th percentile you need to be at the 85th percentile. If you are consistently above the 60th percentile then it makes it a whole lot easier to do with some in the 60s and 70s.
     
  12. docscience

    docscience AZCOM (Junior Member)
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    TMP-SMX What a cool/nerdy name.

    At our school, we don't have class ranking at all. They do send out graphs at the end of the year and point to where you fell in the course H, P, or F. They will show a relative proportion of how the class did also:
    So basically a PD can look to see that 10% of the class honored a certain course...and if you honored that...your arrow will be pointing at the H.

    Class ranking (at my school anyway) is only put on the Dean's Letter if the student requests that it be on there (and usually only the top 10-15% want to show their class rank). This makes someone who got 1 point below honors and someone who barely passed, look almost alike.

    However, I suppose if you were close to getting honors in a lot of courses and only got all passes, the dean's letter would reflect that your academic standing was "solid" or something like that.

    I don't think it matters at all really. Do you think a PD has the time to consider that you passed all your classes but didn't honor? Perhaps the PDs that receive tons of competitive applicants do separate on that basis.


    Just as a side anecdote (take that for what it is worth)...I know a kid who failed two courses, made them up during 3rd and 4th year, did decent on the boards, get into a decent IM residency, busted his butt and is now a cardio fellow.
    He did have some really cool extra curricular activities though.
     
  13. TMP-SMX

    TMP-SMX Senior Member
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    Trimethoprim Sulfamethoxazole doesn't fit. ;)
     
  14. Kongakut

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    There's always Bactrim.
     
  15. TMP-SMX

    TMP-SMX Senior Member
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    Not until after Step I. Maybe I can change it after that.
     
  16. meister

    meister Senior Member
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    TMP-SMX looks way cooler. Besides, I was always a Septra man myself.
     
  17. Dedikated2liftn

    Dedikated2liftn Bodybuilder
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    This is the same at my school and drives me ****in' nuts (I generally score in the 25% of my class but honors goes to the top 10%). I know a lot of people bitch about the H/HP/P/LP/F system, but in retrospect, I'd go for it in a heartbeat.
     
  18. mikedc813

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    I don't get this at all...


    Top third of your class is relatively important. While there are likely no strict cutoffs, being in the top third or quarter gives you the most competitive chance to be seen as a good candidate for certain specialties. While you can match into derm or rad onc without being in the top third, it sure puts you a more of a disadvantage compared to the other applicants if you are not.
     
  19. PeepshowJohnny

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    I think the issue is, how important is high rank INDEPENDENT of other things like strong Dean's letter/LOR and high board scores. I think it's difficult to pick apart because those things all tend to associate together. It'd take like a prospective study where you send out two identical pool of applicants except one is top of the class and the other is bottom (otherwise same board scores, etc.) and see how they'd do, and that'd never happen.

    Personally, I don't think it matters much. I've seen people come from the middle of the pack because they had a rough first or second year, but killed Step 1, did great clinically and matched very well. Now, first disclaimer is that this happens a lot less than people want to have happen (See: all the posts on here talking about being an average student but sure they can get a 245+ on Step 1). Second disclaimer: thse have always been good students who took a while to hit ther groove and shine. I've never seen someone from the bottom third turn it around to this degree so I'm not sure what would importance class rank would matter to such individual if such an improbable thing happened.
     
  20. Textuality

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    Do they give any consideration to what med school you're coming from? Or does top third of class mean the same across the board?

    Haha, after this semester (which is pass/fail and covered) I'll be happy with top half :)
     
  21. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    Shhh!

    This is Darwinism in action. Let the people trying to convince themselves that grades don't matter believe it and go down with the ship. There aren't enough rad onc lifeboats for everyone, might as well let the ones who are nonchalant about it get screwed.
     
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  22. docscience

    docscience AZCOM (Junior Member)
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    I think you make good points man. However, you say "I've never seen someone from the bottom third turn it around to this degree..." Do you have access to peoples grades and STEP 1 scores? I hope this is just a generalization/assumption that you are making.

    I say just have a genuine interest for medicine and appreciate how many things could go wrong. It is up to the physician to be as knowledge as possible to make sure he/she knows all the possible ways to help their patient....not to be in the top third of your class. I think if you have the passion/interest, the grades usually follow.
     
  23. docscience

    docscience AZCOM (Junior Member)
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    This isn't very "Lebowski" like dude. I think you should help others in your class as much as you can so they can learn also. Have old exams/quizzes? Share the wealth and help your fellow student physician. Don't let them "go down with the ship." I am the biggest liberal on this board?

    "Lebowski: Not a man, a way of life."
     
  24. cgk

    cgk Member
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    I am really getting worried, so please be honest. I'm an MSIII with 265 on step 1, approx top 15% after MSI&II years, lot's of research experience including a 2 year stint at the NCI. One first authorship in JCO and a second authorship in journal of cell and molecular biology.However this year has been a blowout where so far I've gotten only passes in peds and surgery. These clerkships are so subjective with so many moving parts, and no matter how hard I try to please, I keep getting screwed. I am going to continue to try my best for the duration and not get demoralized. Please be my friend and level with me, should I bag my dream of RAD/ONC if things continue like this for the remainder of my third year? please advise. thanks
     
  25. Dedikated2liftn

    Dedikated2liftn Bodybuilder
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    You just had to go there; thank God there are no more tools on SDN!!!
     
  26. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    No where did I suggest that you shouldn't help out your fellow man. Of course you should. But heck, it's no one's job to convince people to acknowledge common sense. Since it's your opinion that it doesn't matter at all, I'm not going to argue with you. I'm just going to follow my own plan, you follow yours.

    Not to mention, this topic has been discussed in about 2 dozen threads on SDN, you would think a search would turn that up.

    And just by way of summary (in case this needs to be reiterated here again):
    1) Yes of course grades matter. The extent to which they matter depend on the program and specialty. They are generally not as important in PD decisions as Step I & clinical rotations performance. But yes, they matter. You can find little pockets of people & programs that "don't care" (because my brother's friend said a PD at Random Univ. Hospital EM program said he doesn't care), but to generalize, of course they care.

    2) No applicant is a series of numbers. Yes, you can overcome an unimpressive GPA/class rank. This isn't rocket science, it's common sense. Keep in mind that some programs don't have to look beyond the numbers, though, because they have a million applicants just like you who have impressive numbers all around. Which are these? Man, the only way you can figure that out is by applying and seeing which ones still like you. Which brings me to #3...

    3) Don't make a decision about what your CAREER for the REST OF YOUR LIFE is going to be based on one factor. Or two factors. Just make it happen. Don't make excuses and don't try to justify unimpressive performance by writing it off as "it doesn't matter. Just go out there and show them what you've got, because if you really are fit for the field or fit for the program, just being yourself will be enough. If you've got enough to make up for it, you'll match. The only way you'll know is if you try. Sure, test out the waters by talking to as many people as you can, but as far as "is _____ field still open to me" questions go, there's absolutely no way to answer that question other than with flimsy anecdotal support from random anonymous people with a million application factors you have no idea about. Just follow your heart man. Hopefully your heart shows you a view that makes the most of your potential, that pulls you to know what you want, to always do your best, and have no regrets as a result.

    If you want to know the actual numbers, go look up Charting Outcomes of the Match. You'll see (among other things):
    900+ U.S. seniors applied in 2006
    25% of U.S. seniors who matched were AOA (usually depends on grades)
    3% of U.S. seniors who didn't match were AOA
    But...99% of AOA applicants matched
    .......88% of non-AOA applicants matched
    Average Step I for U.S. seniors who matched was 235
    Only 7 people out of 300+ failed to match if they scored over 240

    And it goes on. So what you're left with is you're stuck with interpreting these numbers and the anecdotal testimonies of whatever dozen people you hear from telling stories about people with a 2.0 matching Harvard rads or 4.0 260 having to scramble and "this PD said he doesn't care" and "yeah but this other PD says he really likes AOA" and blah blah blah. It's up to you to gauge where you stand, but in the end you have to just end up using all that melange of perspective to forge a solid plan that allows you to follow your heart.
     
  27. Pinkertinkle

    Pinkertinkle 2003 Member
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    I have some sympathy for your plight but you're going to get mostly flames for this. You aren't in the flawless situation you were at a few months ago, however you are still in a very enviable position. Keep trying to honor every rotation and be comforted by the fact that even if you don't honor any you'll still match.
     
  28. cgk

    cgk Member
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    Please, I don't mean to sound stupid(just very concerned).Do you mean I'll still match in Rad/ONC in your opinion, or do you mean that I'll still match if I change to a field that is less competitive?
     
  29. Pinkertinkle

    Pinkertinkle 2003 Member
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    I think you'll match radonc without a problem. I wouldn't count on any one program however.
     
  30. cgk

    cgk Member
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    Sorry for my stupidity again. but I didn't understand what you meant by the second half of your response. Could you please elaborate? thanks
     
  31. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    I can't believe you're encouraging this, Pinker.
     
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  32. PeepshowJohnny

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    You'll match somewhere, but not guaranteed to match at any one place (which no one really is in any competitive specialty).

    And for the person who asked if I have access to others boards/grades, no. So this is all hearsay and conjecture. But people talk and so you tend to hear about how your classmates are doing or did on big exams.
     
  33. themudphud

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    In my experience, I think as long as you score well clinically in whatever you want to do for residency, score well on step 1, have good letters of recommendation and do some research, you should be fine. Of course it doesn't hurt to be in the top third of your class, but as long as you nail those other things, you should be fine.
     
  34. HPSPpayissue

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    Unless you go to Harvard or Hopkins or something, if you are bottom half of your class, it is very unlikely that you will turn it around and kill step 1 and start honoring your rotations
     
  35. Random Anesthesiologist

    Random Anesthesiologist Random Anesthesiologist
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    I would like to know how the OP got a 265 on step I. :eek:
     
  36. EBI831

    EBI831 legend in the making
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    i disagree with one condition. if the issue is time ie you are at the bottom b/c it takes you a while to learn things and frequency of tests , new material etc makes it hard for you to master it before the exams. in this case, for step 1 you can just start prepping maybe 6 months in advance as opposed to 4 -6 weeks and perhaps do much better than u would do for your classes...but at the cost of some class material studying time i guess.
     
  37. docscience

    docscience AZCOM (Junior Member)
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    I might be the hippie of the board, but I suppose I fall into the category of people who don't think grades matter all that much.

    My theory is supported by a few things:

    -I think most agree on a three tiered system:
    1) those that kick ass academically (AOA)
    2) the rest
    3) those that fail a class or two/fail a year

    - My school does not put class rank on the MSPE unless requested by the student (and why would you request if you were not in the "upper 1/3"?)
    This may be different at other schools. But there is a graph of the class provided with your grade (H/P/F) and the graph shows how many (relatively) honored, passed, and failed.

    - A note about AOA...most schools are only allowed to pick the top 15% for AOA nomination and 12% for actual induction into AOA. Once again this may differ per school. 12% of a theoretical 150-200 student class makes a 18-24 person AOA. I think the rest of the class (i.e. 132-176 students) match just fine! Or are the 132 students delegated to primary care?? LOL

    - Do you think PDs (in average to fairly competitive residencies) really care about what your class rank was (i.e. 53/150 vs. 72/150)? This is really a question that I have. Has anyone been asked their specific rank?

    I obviously believe that grades and rank do matter to an extent and one should learn as much as possible. However for non competitive specialties such as IM, FP, Peds, perhaps other somewhat competitive specialities like EM, Gas, etc. probably don't care too much.

    Also, advice for M1s....even if you did average, you can still do a lot to help your rank....you have the whole M2 year and then M3 which counts for quite a bit (sometimes M1 and M2 combined).
    Make sure you kiss butt/get to know the people who are writing your MSPE...in my case it is the vice dean and one of the support staff in student affairs. They will try to "sell you to residencies" with good anecdotes to write about you....make sure they know how you stand out.

    Also, be passionate about medicine and find your calling...get to know physicians and mentors who will be able to write really good letters on your behalf.

    Anyone want to add? Rip me a new one? :)
    Thanks for the healthy convo!
     
  38. quideam

    quideam Too tired to complain
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    A lot of people don't do well during the first two years but then shine during third year. And a lot of people who are constantly pulling off honors during the first two years sink, or become just average, third year. You've probably heard that along the way, and it's absolutely true - there are very few people who will be rockstars in both. Honestly, while being in the top 1/3rd (or at least half) of your class is important, it's FAR more important (for the majority of specilaties, anyway) to get honors in as many of your clinical clerkships as possible. If you just "pass" ALL of your basic sciences but honor and high pass all of your clerkships, you'll do great. Also, many schools put more weight on your clinical grades than the basic sciences, so if you pull it together during 3rd year you could significantly improve your class standing.

    At the end of the day, don't sweat it too much, but just try not to be in the bottom quartile or whatever your school divides you by.
     
  39. SouthernSurgeon

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    I really don't think this is all that common.

    The top students (at least at my school) tend to have two common traits: (1) they are intelligent and (2) they work very very hard.

    Those two traits lend themselves to success in both the pre-clinical and clinical years. The top students don't all of a sudden stop working hard when they hit the wards - in fact, they seem to work even harder.

    Sure, every once and a while you get someone who is a great book learner but is socially inept, and they struggle during third year, but that is the exception, not the rule.
     
  40. PeepshowJohnny

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    Not the experiences of the majority on this board and DEFINITELY not my experience. The superstars continue to shine all through medical schools and the guy who barely passed anatomy is the one who's flubbing his presentations to the attending.

    This "the top become bottom and bottom become top" is an urban myth propogated by first and second years.
     
  41. quideam

    quideam Too tired to complain
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    Hey, you guys are welcome to disagree, but as a current 4th year, I can honestly say that i've seen quite a few people flip-flop - i'm not saying everyone, but a significant number. I'm not talking about people nearly failing basic sciences suddenly shining on the floors, i'm just saying that people who find themselves being "just average" or even below that on basic science exams may find that their interaction/clinical skills are far better and they're able to shine. I also know people who are great test takers and did well during the first two years, but then either didn't approach third year well or just weren't as well suited to the delicate balance required 3rd year. Take it or leave it, by all means - it's just my experience.
     
  42. JeffLebowski

    JeffLebowski Just got Nard-dogged
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    I agree with the PeepShow guy. While I'd say it definitely does happen that people perform better M3 year even if they didn't perform well M1/2, I'd say it's more rare than people seem to say on SDN. And it typically accompanies a statement about how M1/2 grades don't matter, that in order to have all the success in the world all you need to do is cram your ass off for Step I and let your personality & "ability to reason clinically instead of all this silly memorization" carry you into clinical honors.

    ...although, frankly I have no idea whether people flip-flop or not, because I don't know have a record of the grades & evals of my classmates. But again, in my experience, it seems uncommon.
     
  43. SouthernSurgeon

    Physician Lifetime Donor Classifieds Approved 7+ Year Member

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    Agree - it is a crutch/self-defense mechanism that people use during 1st and 2nd year to soothe their wounded pride over not being at the top of the class like they were in undergrad.

    Edit: and I'm one of the people who was guilty of using it first year, until I got over it
     
    #42 SouthernSurgeon, Jan 4, 2009
    Last edited: Mar 8, 2015
  44. SoCuteMD

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    I pretty much agree. Most of my friends who are clinical rockstars did very well in the preclinical years as well. I suppose there are some exceptions, but I don't think I've witnessed any firsthand.
     
  45. Excelsius

    Excelsius Carpe Noctem
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    So even when the rest of the application is great, you think that someone still can't match into derm without honors? How come? What about NS?

    I think it would also help to be more specific. If honors doesn't matter much, then how low can you go? Will bottom 1/3 really suffice?
     
  46. docscience

    docscience AZCOM (Junior Member)
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    I know you weren't asking me (an M2) but I will put in my $0.02:

    Once again, if you are trying to get a derm residency, which is highly desired by many, then you will have to stand out...when comparing someone who is in the top third, and you (hypothetically the bottom third), it is easy to say who they will pick. Since it is so competitive, then no you can't match easily without any honors. They would much rather take someone who honored everything vs. someone who didn't honor anything. It is going to be really hard to offset/shine vs. someone who has all honors.

    Now, I think for other specialties (not so competitive) other aspects of the application are sought. You could have all honors in preclinical courses and then do piss poor on your IM sub I. PDs probably don't like to see that.

    I think it is best to picture what you would do if you were a PD given the competitive nature of certain specialties.
     
  47. Excelsius

    Excelsius Carpe Noctem
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    Is neurosurgery like derm? And what happens if your school doesn't have Honors or AOA? If there are specialties that will almost for sure drop you if you don't honor all or at least one quarter, then we should list them. I thought that research is not that common among med students and that it should offset not honoring all your classes. Maybe we should list all the super-competitive specialties that will make it almost impossible for you to get in if you don't honor part or the entirety of your medical education.

    By the way, if these super-competitive specialties are willing to drop good applicants with great Step I and research, it is not really that far fetched to assume that the school name will play an important role as well. Then this raises the question whether that advantage won't be worth the extra $80K that some of these private schools cost. It just seems that the probability of failure is too great and you need to do whatever you can to decrease that probability, even if by a small amount at a high price.
     
  48. Excelsius

    Excelsius Carpe Noctem
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    It strikes me as bemusing: it seems that to go into derm you have to really bust your ass and be the best. Then these very same students choose to select a specialty with the least possible amount of work!

    I don't know if matching into derm means that someone is very intelligent. What is your observation? Do you think we are wasting our brightest output of doctors on relatively unimportant professions like Derm or plastics? Sometimes this supply and demand process really screws things up.
     
    #47 Excelsius, Jan 5, 2009
    Last edited: Jan 5, 2009
  49. Sol Rosenberg

    Sol Rosenberg Long Live the New Flesh!
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    I have no idea about neurosurgery, but I remember reading that of those that matched into derm, < 50% were AOA, so if you are gunning for derm, all is not lost if you are not AOA (or your shcool does not have AOA.)

    Of course school name matters. It all matters, it's just a question of how much, so your best chance is to go to the best school that you can and do the best that you can in preclinical classes, on the boards, in rotations, etc.
     
  50. Noeljan

    Noeljan Senior Member
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    The problem is that many people trying to get into such spots like derm will have the grades and research and board scores (so I don't think it is so much that they think one is greater than the next, it is that you will be competing with people who do have all of those things)
     
  51. docscience

    docscience AZCOM (Junior Member)
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    well said my man/woman!
     

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