How much does med school reputation matter for top-tier competitive specialty residency?

[basophilic]

For top-tier residency programs in competitive specialties like ortho/opthalmo/derm/plastics/rad-onc, how much does the difference between a low-tier vs. top-tier med school make? And in what sense specifically? And is there anything that the low-tier med student can do to compensate?

On one hand, I read on several forums that the med school reputation is make-or-break for the top-tier residency programs; on the other hand, on these programs' webpages, many residents are from mid-tier or low-tier state schools (the majority, of course, were still from big-name institutions).

I checked the NRMP; it ranks med school reputation at 23rd, but it only gives averages of all residency programs across and within specialties.

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[grt398]

It matters in terms of research opportunities available and the personal connections your faculty may have to those residencies due to having trained there or having friends who now run the programs. That said, plenty of people from "low-tier" med schools do things like HHMI or PhD's or just spend several years in some famous lab to make up for it. You can get to a top tier residency in a competitive specialty from any US med school, but it will be easier if you have the aforementioned benefits. You still need to perform well on boards/sub-I's/clinical rotations and earn good letters from your faculty.

 

[basophilic]

It matters in terms of research opportunities available and the personal connections your faculty may have to those residencies due to having trained there or having friends who now run the programs. That said, plenty of people from "low-tier" med schools do things like HHMI or PhD's or just spend several years in some famous lab to make up for it. You can get to a top tier residency in a competitive specialty from any US med school, but it will be easier if you have the aforementioned benefits. You still need to perform well on boards/sub-I's/clinical rotations and earn good letters from your faculty.

So it is possible to get into a top-tier residency from a low-tier medical school.

But is it possible to do so within 4-5 years? Like by sticking to a single lab long-term and getting as many 1st/2nd author pubs as possible.

And, from what I understand, the advantage of top-tier med schools is the pedigree AND the availability of high-profile connections; is it possible to get such high-profile connections within my desired field from a low-tier med school? I'm guessing away rotations allow this?

 

[chronicidal]

You can get a good sense by quantifying the number of high vs low-tier medical schools represented at the top tier residencies (if the website doesn't list medical schools, search the names on Doximity, LinkedIn, Healthgrades, etc.).

Then do Pubmed/Scopus searches for those residents, especially ones from lower tier schools, to see how much research productivity they had prior to residency. Pay attention to where they did the research vs. their medical school.

In addition, look up each resident in the AOA website. Be sure to click all members, not just active members.

 

[basophilic]

You can get a good sense by quantifying the number of high vs low-tier medical schools represented at the top tier residencies (if the website doesn't list medical schools, search the names on Doximity, LinkedIn, Healthgrades, etc.).

Then do Pubmed/Scopus searches for those residents, especially ones from lower tier schools, to see how much research productivity they had prior to residency. Pay attention to where they did the research vs. their medical school.

In addition, look up each resident in the AOA website. Be sure to click all members, not just active members.

Thanks for the suggestion; I'll certainly do those searches.

Though this sort of raised a tangential question. If my low-tier institution has a basic science lab on, say, the molecular physiology of musculoskeletal development, would that be relevant to a competitive research-demanding specialty like orthopedic surgery (at top residencies)? Or does OS-relevant research necessarily have to be in musculoskeletal procedures? I know I can find this out in better detail from the PubMed/Scopus search you recommended, but just wanted to know your general opinion for now.

 

[Law2Doc]

You can definitely get to a top residency from any US allo med school in the normal 4 years. They are all good launching pads. PDs annually complete surveys that make clear that med school pedigree is not a particularly high factor in their decisions. Premeds on SDN prefer to ignore that on here though. However grt398's point is fair -- you MAY theoretically have better access to research opportunities and big name faculty at the bigger name programs.

 

[TBV]

Not as much as your reputation but it matters a little bit

 

[Psai]

You can definitely get to a top residency from any US allo med school in the normal 4 years. They are all good launching pads. PDs annually complete surveys that make clear that med school pedigree is not a particularly high factor in their decisions. Premeds on SDN prefer to ignore that on here though. However grt398's point is fair -- you MAY theoretically have better access to research opportunities and big name faculty at the bigger name programs.

I'm of the impression that if you're a superstar then you'll be a superstar anywhere. But I do think that going to a top medical school makes it easier to open doors, whether it is due to a solid track record of providing great residents, perceived prestige to residency from the medical schools that their residents attended or more letters from big wigs that are friendly with their big wigs

 

[grt398]

So it is possible to get into a top-tier residency from a low-tier medical school.

But is it possible to do so within 4-5 years? Like by sticking to a single lab long-term and getting as many 1st/2nd author pubs as possible.

And, from what I understand, the advantage of top-tier med schools is the pedigree AND the availability of high-profile connections; is it possible to get such high-profile connections within my desired field from a low-tier med school? I'm guessing away rotations allow this?

The only thing I wanted to add is your away rotations are not going to allow you to develop "high-profile connections." It's important to keep in mind that faculty are regular people too, and they're no more inclined to put their professional reputation on the line or expend political capital for someone they've known superficially for 1-4 weeks than you would be. The connections I'm talking about come from years of getting to know someone, showing them you're a reliable person who produces good work, and someone they would personally want to work with/train. That's what garners phone calls and advocacy on your behalf come match time. I've seen people most commonly do this at their home institution, or even by spending 2 years in someone's lab at another institution, but it's not something you can do in a few weeks.

 

[235009]

A lot of it comes down to your numbers. If you are at a top tier school you get more leeway. If you are at a low tier school you'll need a higher step score, more honors, and/or a higher class rank than the guy coming from the top tier school.

The stuff about the research opportunities is overblown on sdn IMO. There's research available at every US MD school and if you are motivated you can seek it out and be productive.

 

[Etorphine]

.

 

[Merely]

General advice is that it matters but not as much as a lot of the other stuff that has been mentioned.

 

[charmiedermie]

You can definitely get to a top residency from any US allo med school in the normal 4 years. They are all good launching pads. PDs annually complete surveys that make clear that med school pedigree is not a particularly high factor in their decisions. Premeds on SDN prefer to ignore that on here though.

Sorry but I think that has changed a lot. Maybe 10-15 years ago that was the case, but not anymore. You're given a lot of benefit of the doubt when you go to a prestigious school. Also, depending how the survey question is worded, I don't think PDs will readily admit that prestige of med school doesn't factor in because then they look bad.

 

[Law2Doc]

Sorry but I think that has changed a lot. Maybe 10-15 years ago that was the case, but not anymore. You're given a lot of benefit of the doubt when you go to a prestigious school. Also, depending how the survey question is worded, I don't think PDs will readily admit that prestige of med school doesn't factor in because then they look bad.

Um no. I'm not 10-15 years out writing about days of yore -- it really hasn't changed at all. PDs are pretty honest at what they prioritize in these surveys. I've seen both sides of the process and the pedigree issue really truly is one of the more overstated things you might see on SDN.

 

[masaraksh]

Um no. I'm not 10-15 years out writing about days of yore -- it really hasn't changed at all. PDs are pretty honest at what they prioritize in these surveys. I've seen both sides of the process and the pedigree issue really truly is one of the more overstated things you might see on SDN.

Except, coming out of of X random med school and aiming for an IM spot at Mass Gen is tough. Whereas coming out of HMS, you're basically guaranteed an MGH or Brigham IM slot

 

[TwinsFan]

If only for institutional and regional inbreeding at similar caliber schools, prestige certainly is a factor for many students.

 

[Law2Doc]

...Whereas coming out of HMS, you're basically guaranteed an MGH or Brigham IM slot

Except no, you aren't.

This is the kind of exaggeration you see a lot on SDN, but it doesn't make it true. These programs certainly try to keep their stars, but I'm betting the other hundred plus grads each year are wondering what happened to their supposed "guaranteed slot".

 

[chronicidal]

Except no, you aren't.

This is the kind of exaggeration you see a lot on SDN, but it doesn't make it true. These programs certainly try to keep their stars, but I'm betting the other hundred plus grads each year are wondering what happened to their supposed "guaranteed slot".

Here is HMS 2015 IM match list

Internal Medicine
BWH
BWH
BWH
BWH
BWH
Columbia
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MGH
MT Sinai
Northwestern
Stanford
Stanford
Stanford
UCSF
UCSF
UChicago
UMichigan
UWashington
Vanderbilt
Yale

 

[J ROD]

it certainly does not hurt......

 

[Slack3r]

Um no. I'm not 10-15 years out writing about days of yore -- it really hasn't changed at all. PDs are pretty honest at what they prioritize in these surveys. I've seen both sides of the process and the pedigree issue really truly is one of the more overstated things you might see on SDN.

You've seen both sides of this process in IM, where you have, what? 20+ spots to fill per class? In the small competitive subspecialties, prestige matters for sure. This is pretty apparent when you're interviewing for 1 or 2 spots and >2/3rds of the interviewees are from top 10 schools.

 

[Law2Doc]

Here is HMS 2015 IM match list...

The Harvard match day 2015 website indicates that approximately half of their med school grads end up at Harvard affiliated programs. So that's high, but not a guaranty. (Also we are assuming arguendo that everyone is getting the specialty they choose and not defaulting to IM because they couldn't get derm etc).

 

[masaraksh]

The Harvard match day 2015 website indicates that approximately half of their med school grads end up at Harvard affiliated programs. So that's high, but not a guaranty. (Also we are assuming arguendo that everyone is getting the specialty they choose and not defaulting to IM because they couldn't get derm etc).

Yeah, I'm so far off.

 

[Law2Doc]

Yeah, I'm so far off.

You are -- 50% is a coin flip -- that's kind of the opposite of a "guaranty". And this is at one of the more inbred places.

 

[Moko]

From my experience (n=1), the overwhelming majority of applicants interviewing at "top tier" programs for IM came from rather prestigious schools. I would have expected to see a more diverse representation of schools had programs been blinded to the applicants' home institutions.

This isn't to say that pedigree trumps everything, as average students from even the most prestigious schools will not be getting "their pick" of schools; nevertheless, imo they are in a much better place than a similarly average student coming from a lesser known program. At the very least even without prestige factoring in, their recommenders may be better known nationally, and their home PD can help make calls, etc. If the worst a Harvard grad can do is match at Yale or Mt Sinai (randomly chosen non-HMS schools), that ain't too shabby.

I think that at the most competitive places, pedigree can be a deciding factor when all applicants have otherwise very similar stats and accomplishments. JMT

 

[masaraksh]

You are -- 50% is a coin flip -- that's kind of the opposite of a "guaranty". And this is at one of the more inbred places.

Since when are we plainly assuming that 100% of HMS class wants to do residency at Harvard-affiliated programs?

 

[Law2Doc]

From my experience (n=1), the overwhelming majority of applicants interviewing at "top tier" programs for IM came from rather prestigious schools. I would have expected to see a more diverse representation of schools had programs been blinded to the applicants' home institutions.

This isn't to say that pedigree trumps everything, as average students from even the most prestigious schools will not be getting "their pick" of schools; nevertheless, imo they are in a much better place than a similarly average student coming from a lesser known program...

I think that at the most competitive places, pedigree can be a deciding factor when all applicants have otherwise very similar stats and accomplishments. JMT

Meh, I think a lot of us know plenty of people who ended up with top tier residencies from more average med schools. The factors listed by PDs as most important (step scores, clinical year evaluations, research, etc) are accurate, and if you have the more important ones of those, pedigree is much further down the list and simply doesn't come into play. It's remarkable that PDs come out each year and say "these are the factors we look at, in this order" and SDN students come back each year and say "no, you're lying".

But you have to bear in mind that people who have the high MCAT scores, GPA, interview skills, and amazing research and other things Adcom members covet often are able to keep it all going and STILL have amazing step 1 scores, honors, interview skills and research when they apply to PDs at the next level a few years later. A lot of people at the top schools got in because they were superstars and remain superstars a couple of years later. It's just not the pedigree.

In the rest of your post you essentially suggest that if you are going to be the bottom of your class, it's better to do it at a top school, and I don't really disagree, although I've definitely known people who have ended up in some pretty weak paths from better starting points, so I believe this is exaggerated on here as well.

 

[musicalfeet]

Meh, I think a lot of us know plenty of people who ended up with top tier residencies from more average med schools. The factors listed by PDs as most important (step scores, clinical year evaluations, research, etc) are accurate, and if you have the more important ones of those, pedigree is much further down the list and simply doesn't come into play. It's remarkable that PDs come out each year and say "these are the factors we look at, in this order" and SDN students come back each year and say "no, you're lying".

But you have to bear in mind that people who have the high MCAT scores, GPA, interview skills, and amazing research and other things Adcom members covet often are able to keep it all going and STILL have amazing step 1 scores, honors, interview skills and research when they apply to PDs at the next level a few years later. A lot of people at the top schools got in because they were superstars and remain superstars a couple of years later. It's just not the pedigree.

In the rest of your post you essentially suggest that if you are going to be the bottom of your class, it's better to do it at a top school, and I don't really disagree, although I've definitely known people who have ended up in some pretty weak paths from better starting points, so I believe this is exaggerated on here as well.

Could the fact the more "prestigious" schools place more students in competitive residencies also be attributed to the fact that these students that get into these prestigious institutions tend to be, on the whole, better/higher caliber students to begin with? At least when it came to career-changing post-bacs, I thought it was the "name" of the big 4 that helped students get where they got, but in reality, the type of students that get into the biggest name career-changing post-bacs were the kind that would have gotten into really highly ranked med schools without a formal program. When I think of some of my classmates that got into UCSF, UCLA, etc, they were really just that much "better" at school than I was; they made it in all on their own. Could this phenomenon also happen at the medical school --> residency level?

 

[Cytarabine]

Pedigree matters. How much it matters is going to be specialty and program dependent. If you think a Harvard grad and a bumfuc* grad are going to have a comparably difficult time matching ortho with a 220 step you're deluded. I'm a bumfuc* 4th year and have gotten a few interviews with top tier programs for my specialty (and historically we've had some people land impressive matches), but I think you definitely have to do more to pave your way. The cost benefit of going to state U vs a big name for med school is a personal decision. I applied early decision to state u, but I was primarily interested in less competitive specialties going in (and I wouldn't have been a strong applicant for any of the really big name med schools regardless). If you're fairly unsure what you want or think you might want to do one of the supercompetitive specialties, it might be worth looking into going the other route

Edit: and I think it's completely fair / reasonable for there to be added value to an applicant coming from a top tier med school

 

[235009]

Let's assume for a second that all students applying in IM wanted to stay at Harvard.

That match list means that even MGH and Brigham's table scraps all matched at top 5 to 10 medicine programs.

Typically if you want to stay at Harvard and you're MGH and Brigham's table scraps you go to BI (i.e. you still stay at Harvard).

The point that was very nicely illustrated by Harvard's match list is that coming from a top school gives you a lot more wiggle room with all the other more important factors. It's disingenuous to try and argue that 75% of the students applying to IM are in the top 25% of the class (cause that's absolutely where you needed to be to even be considered for an interview at most of the places on that list coming from my school)

 

[Flamen04]

Assume applicant A and B have similar grades, steps, aoa status, and rank. Applicant A went to state school and applicant B went to prestigious school. They are pretty much on equal footing. However, 2 things differentiate the two: research experience and letter writers. One can argue that applicant B would have an edge because of better research opportunities available and relative popularity of faculty/letter writers at the more prestigious school. Not to say that state school applicant is not as smart, charming and hardworking as applicant B, but just like in real life, who you know can matter. It might depend on what specialty you're applying to, but my friends definitely have been invited to interview at places because their letter writers were famous in their fields.

In the end though... you have to consider what's important to you. Do you care about prestige or not? You can go to state medical school and average residency and still have a great career and life.

 

[VisionaryTics]

Honestly pedigree matters, if not for connections, then for perceived prestige. Yes, an applicant from a good medical school can get interviews at some top places. But applicants from top medical schools will get more leeway and more likely to match to a top program.

I noticed it when I was interviewing. I went to an average state medical school, and at some of the places I interviewed at (top 5 programs), I was the only person in a room of 15-20 applicants from a state medical school.

In the end, I really don't care. My goal is to be a good otolaryngologist, which going to a good state medical school allowed me to do, not whack off to my diploma.

 

[Germanicus89]

Incoming ignorant pre-med questions: what exactly does going to a prestigious residency get you on the other end once you're a practicing physician? Do you have more job options? Do you have a better foundation for academic positions? What's the attraction?

 

[Reckoner]

Incoming ignorant pre-med questions: what exactly does going to a prestigious residency get you on the other end once you're a practicing physician? Do you have more job options? Do you have a better foundation for academic positions? What's the attraction?

A prestigious fellowship. Followed by a prestigious academic faculty position. Followed by a prestigious assistant deanship. Eventually the chronic ego inflation will take its toll and necessitate a stay in a (highly selective) nursing home for the prestiged. You'll linger there awhile, publishing review articles until your h-index creeps above 100. Then comes the real endgame: burial in a prestigious cemetery. Only the most tasteful marble gravestones, with space for all your diplomas. You wouldn't believe the waiting list.

 

[Radiologyreviews2015]

A prestigious fellowship. Followed by a prestigious academic faculty position. Followed by a prestigious assistant deanship. Eventually the chronic ego inflation will take its toll and necessitate a stay in a (highly selective) nursing home for the prestiged. You'll linger there awhile, publishing review articles until your h-index creeps above 100. Then comes the real endgame: burial in a prestigious cemetery. Only the most tasteful marble gravestones, with space for all your diplomas. You wouldn't believe the waiting list.

salivating at that h-index

 

[Radiologyreviews2015]

n=1, but as a below avg candidate (in my field) who's at a top 10 school, i'm certainly grateful for it. I can't prove some of the interviews I've gotten were based on it, but I certainly haven't regretted it for a minute. I'm looking to end up in PP so for me it's just a means to an end, not trying to stay on the prestige train as reckoner alluded to.

 

[Señor S]

Of course it matters. I don't know why people pretend that it doesn't. Is it ego?

Anyone who has spent time around graduates of prestigious schools knows that they strongly prefer their own and generally have a mild disdain for the hoi polloi. Now whether you want to spend a lot of time with people like that is a different question.

 

[Law2Doc]

Of course it matters. I don't know why people pretend that it doesn't. Is it ego?...

Program directors annually rank the factors they use, and consistently put this one toward the bottom. So I find it curious that folks on SDN think they know better -- that's the only "ego" I see in play here.

 

[piii]

Incoming ignorant pre-med questions: what exactly does going to a prestigious residency get you on the other end once you're a practicing physician? Do you have more job options? Do you have a better foundation for academic positions? What's the attraction?

Mostly resources. Top institutions will have the most profile cases, the best technology, the most cutting edge research.

 

[Psai]

Op is asking about top tier competitive specialties. They have small classes and amazing applicants so I think school name has a disproportionate effect here

 

[Señor S]

Program directors annually rank the factors they use, and consistently put this one toward the bottom. So I find it curious that folks on SDN think they know better -- that's the only "ego" I see in play here.

http://www.nrmp.org/wp-content/uploads/2013/08/programresultsbyspecialty2012.pdf

Percentage of Programs Citing Each Factor in Selecting Applicants to Interview
Graduate of highly regarded U.S. medical school: 53%

Mean Importance Ratings* of Factors in Ranking Applicants
Graduate of highly regarded U.S. medical school: 3.6

It's "toward the bottom" of a fairly limited range, and still above AOA membership and research involvement (inter alia). Not to mention that the question was whether it helps with a "top-tier competitive specialty residency." Most residency directors don't have the luxury of selecting applicants from highly regarded schools, so asking them is a bit like asking me if I care whether a potential girlfriend is a Victoria's Secret model.

 

[Vain Brother]

You can definitely get to a top residency from any US allo med school in the normal 4 years. They are all good launching pads. PDs annually complete surveys that make clear that med school pedigree is not a particularly high factor in their decisions. Premeds on SDN prefer to ignore that on here though. However grt398's point is fair -- you MAY theoretically have better access to research opportunities and big name faculty at the bigger name programs.

it doesn't matter so much as a data point itself, but as others have mentioned attending a top medical school has all sorts of benefits that will come in handy come residency time. also, students at top schools tend to have been better/more productive undergraduate students, will likely score better on step 1, etc. it's hard to disentangle one factor from another

 

[DokterMom]

Research on med school admissions showed that high-ranking private medical schools preferred graduates of "elite" private colleges. Public medical schools showed no such preference. Kind of makes sense, right? "Elite Privates" believe they're better; Public schools feel they're as good as anyone -- each avoids cognitive dissonance.

I imagine residency in highly competitive fields will show similar thought patterns. Elite-private-affilliated hospitals would tend to believe that graduates of elite private medical schools would be the "cream of the crop". Hospitals affiliated with "just as good" publics would maintain public medical school graduates are "just as good".

 

[chronicidal]

Research on med school admissions showed that high-ranking private medical schools preferred graduates of "elite" private colleges. Public medical schools showed no such preference. Kind of makes sense, right? "Elite Privates" believe they're better; Public schools feel they're as good as anyone -- each avoids cognitive dissonance.

Source or it didn't happen. I never really understood why people look at public vs private status. For instance, admins like to say, we compare benchmarks among the 13 school consortium, a group of private medical schools. But that group ranges from Harvard to U Rochester. What difference does it make that they don't include UCSF or U Washington or U Michigan?

 

[DokterMom]

Hopefully someone knows where this is -- has been posted on SDN several times already, and I couldn't find it in 15 minutes -- so believe me or not, as you will... It was a table in the AMCAS material listing the importance of various factors, and the discrepancy was commented on.

BUT what it said was that Private medical schools considered the selectivity of an applicant's undergrad school as a highly important factor and that Public medical schools did not. And the differences were quite large.

I imaging that still applies in residency selection since the mindset responsible for the one would be, I presume, still there... Again, when you're an "elite" institution publishing your residency list, would you prefer to list John Doe, Podunk State or John Doe, Harvard ?

 

[Germanicus89]

Research...

More ignorant questions: DokterMom, who are you? Are you a physician? Are you somewhere in the medical school process? Do you have healthcare experience? Are you the mother of a doctor? I've seen several of your posts giving out advice and was always curious how much weight I should give them. Thanks.

 

[Rekt]

More ignorant questions: DokterMom, who are you? Are you a physician? Are you somewhere in the medical school process? Do you have healthcare experience? Are you the mother of a doctor? I've seen several of your posts giving out advice and was always curious how much weight I should give them. Thanks.

The same weight you should give any post on SDN.

We're all anons in the end.

 

[Psai]

The same weight you should give any post on SDN.

We're all anons in the end.

Not true, some posters have a history that makes me trust what they say and that they are who they claim to be. A random person coming on here with 2 posts claiming to be an attending will be met with skepticism

 

[WedgeDawg]

Hopefully someone knows where this is -- has been posted on SDN several times already, and I couldn't find it in 15 minutes -- so believe me or not, as you will... It was a table in the AMCAS material listing the importance of various factors, and the discrepancy was commented on.

BUT what it said was that Private medical schools considered the selectivity of an applicant's undergrad school as a highly important factor and that Public medical schools did not. And the differences were quite large.

I imaging that still applies in residency selection since the mindset responsible for the one would be, I presume, still there... Again, when you're an "elite" institution publishing your residency list, would you prefer to list John Doe, Podunk State or John Doe, Harvard ?

https://aamc-orange.global.ssl.fast...5b5844a/mcatstudentselectionguide.pdf#page=12

Page 12.

 

[DokterMom]

https://aamc-orange.global.ssl.fast...5b5844a/mcatstudentselectionguide.pdf#page=12

Page 12.

Thanks @WedgeDawg !

More ignorant questions: DokterMom, who are you? Are you a physician? Are you somewhere in the medical school process? Do you have healthcare experience? Are you the mother of a doctor? I've seen several of your posts giving out advice and was always curious how much weight I should give them. Thanks.

This is the internet and as @Rekt points out, I'm just another anonymous voice. As @Psai so rightly observes, give my posts as much or as little weight as YOU feel they're worth. I will say that I'm involved in the process to some degree but NOT an AdCom member, so do not give my personal opinions as much weight as you would those of the good folks who are.

 

[Goro]

Apologies for hijacking the thread, but Doktermom is one of the people whose posts I look for each AM when I sit down with my chai tea and read SDN!

We now return you to your regularly scheduled SDN thread.

Thanks @WedgeDawg !



This is the internet and as @Rekt points out, I'm just another anonymous voice. As @Psai so rightly observes, give my posts as much or as little weight as YOU feel they're worth. I will say that I'm involved in the process to some degree but NOT an AdCom member, so do not give my personal opinions as much weight as you would those of the good folks who are.