How much does medschool prestige matter for residency?

HumbleMD

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It seems like there's been a lot of mixed info on this lately and over the past year. I have to say I keep hearing a mixed bag both on SDN and from others I talk to. I'm curious to see if the deciding factor is where someone is in their medical education/career. From what I've gleaned, 1st-3rd year med students are freaking out about loans and usually say just go somewhere cheaper. All the 4th years applying to residency, however, seem to be reporting that prestige matters "more than I ever realized" (from a 4th year at U of M the other day). Finally, I hear a lot of (through the grapevine heresay) that many accomplished docs say go with the cheaper school (of course, many went to prestigious schools so maybe have no idea the merits it earned them).

Anyone else have input? If you could include where you are (pre-med, M1, M2...) and/or where you got your info from, it would help elucidate more meaningful input.
 
E

Eric Lindros

It seems like there's been a lot of mixed info on this lately and over the past year. I have to say I keep hearing a mixed bag both on SDN and from others I talk to. I'm curious to see if the deciding factor is where someone is in their medical education/career. From what I've gleaned, 1st-3rd year med students are freaking out about loans and usually say just go somewhere cheaper. All the 4th years applying to residency, however, seem to be reporting that prestige matters "more than I ever realized" (from a 4th year at U of M the other day). Finally, I hear a lot of (through the grapevine heresay) that many accomplished docs say go with the cheaper school (of course, many went to prestigious schools so maybe have no idea the merits it earned them).

Anyone else have input? If you could include where you are (pre-med, M1, M2...) and/or where you got your info from, it would help elucidate meaningful input.


You're going to continue to hear the same mixed bag. Some will tell you it makes a difference, some will tell you not. Not sure you're going to get anything useful beyond the million other posts about this topic. Although I'm sure this thread will cause a ruckus, as usual.....

-worthless advice from Eric, M0
 

HumbleMD

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You're going to continue to hear the same mixed bag. Some will tell you it makes a difference, some will tell you not. Not sure you're going to get anything useful beyond the million other posts about this topic. Although I'm sure this thread will cause a ruckus, as usual.....

-worthless advice from Eric, M0

Could you describe the ruckus?
Breakfastclubhall_180.jpg
 
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I think it depends on what you want to go into and where you might want to do your residency. I've been scanning match lists and talking to a lot of the 4th years here at it seems that there is often quite a bit of in-breeding. Granted most of my friends are people who want to go into NS or neurology -- so maybe this is just typical of those fields -- but it has given me something else to think about when picking a school. Is it going to be a huge factor? No, not really... because I don't know for certain what I want to do at this point, but I do know that I'll probably want to stay East Coast and knowing that whichever school I choose has history of sending students into great EC residency programs would give me some peace of mind.

Then again, I could just be full of crap. It would be nice to have some adcoms/med students jump in here.


It seems like there's been a lot of mixed info on this lately and over the past year. I have to say I keep hearing a mixed bag both on SDN and from others I talk to. I'm curious to see if the deciding factor is where someone is in their medical education/career. From what I've gleaned, 1st-3rd year med students are freaking out about loans and usually say just go somewhere cheaper. All the 4th years applying to residency, however, seem to be reporting that prestige matters "more than I ever realized" (from a 4th year at U of M the other day). Finally, I hear a lot of (through the grapevine heresay) that many accomplished docs say go with the cheaper school (of course, many went to prestigious schools so maybe have no idea the merits it earned them).

Anyone else have input? If you could include where you are (pre-med, M1, M2...) and/or where you got your info from, it would help elucidate meaningful input.
 

Stolenspatulas

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This is the ULTIMATE QUESTION!

You'll always hear a mixed bag. Many accomplished doc's say to go cheaper but they don't know the updated medical school landscape of today. Also, they kicked butt in med school so it probably didnt matter that much in terms of residency. If you go to the cheaper state school and want a top residency, be ready to overachieve like its your job.

Im not good at overachieving, I rather have the strength of prestige to benefit me. My opinion. Flame on.
 

HumbleMD

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This is the ULTIMATE QUESTION!

You'll always hear a mixed bag. Many accomplished doc's say to go cheaper but they don't know the updated medical school landscape of today. Also, they kicked butt in med school so it probably didnt matter that much in terms of residency. If you go to the cheaper state school and want a top residency, be ready to overachieve like its your job.

Im not good at overachieving, I rather have the strength of prestige to benefit me. My opinion. Flame on.

Wow, big font. Yeah, I'd prefer actual meaningful responses, rather than people overpersonalizing the question and giving answers to defend/justify their own decisions (you'll see it on the D.O. forum all the time).
 

fotografía

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When I interviewed at Stanford, I had some time to wander around and explore. I came across a facebook poster that showcased Stanford's new interns, which included where they went to med school. I have to say, I was pretty shocked at how narrow the range of schools was. Grads from Harvard, Penn, Hopkins UCSF, Yale etc. primarily made up the list. There were a few less prestigious state schools, but they were definitely the minority. Which makes me think that reputation does matter, as I think it matters for UG --> med school as well. Basically, I think that if you don't attend a top school, you can still be just as successful, but you have to really shine at the institution you're at, because name and rep alone isn't going to open doors. So at every stage, there are a handful of top students from less prestigious schools that land amazing med school/residency spots etc. But, if there's one trend I saw while interviewing at prestigious med schools, it's that by and large, the interview group was always something like 75% ivy league, with Harvard, in particular, being disproportionately represented (you Harvard kids were everywhere!). So does which med school you attend make a difference? I personally think going to a reputable school will help you, but that if you're smart enough and driven to achieve top placements, then you're going to do it no matter where you go.
 

Stolenspatulas

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Wow, big font. Yeah, I'd prefer actual meaningful responses, rather than people overpersonalizing the question and giving answers to defend/justify their own decisions (you'll see it on the D.O. forum all the time).

We all know both sides of the debate. If there was a clear cut choice it would have been figued out by now, and everyone would be largely acting in a similar way. (its my understanding that there are many people take both sides and act accordingly)

Since it is a debate, you have to balance both sides of the issues. In the end, you will realize that it all depends on the individual's PERSONAL weighting of the issues that determines which way he/she will tip.

HumbleMD, I know you know both sides of the debate well; I know you know that this thread comes up every other day; do you really expect to be somehow enlightened?
 
E

Eric Lindros

Could you describe the ruckus?
Breakfastclubhall_180.jpg

Classic controversial topic where people spew venom back and fourth about whether school prestige matters.

I can give you a summary if you like:

1) People will assert that going to Harvard is very very important in landing an awesome residency. They may cite sources such as match lists or average Step 1 scores, etc.

2) Advocates of state schools and lower tier schools will likely counter by asserting that schools don't matter and it's more important to save your money and reduce your debt. In this case, it's a "you make your own way" argument and "the education learned at all schools is the same" etc. They may cite residency programs and say hey, look at this, Joe S at Duke Surg went to AMC or hey look, Jane D at Harvard derm went to Drexel!

3) People from both sides are likely to throw in anecdotes arguing for either side, all of which may or may not be true.
 

PeripateticMD

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I work with one of the heads of Harvard's Brigham & Women's ER residency, and he says it just matters than you do well. They have students from Wayne State, SLU and AECOM with a smattering of the big ones too. But he was saying that as long as it's a solid school, it's fine.

Stanford is notorious for having snot doctors come out of residency. Go figure :). They may be the researchers and leaders in innovation but they're usually sub-par colleagues...
 
E

Eric Lindros

HumbleMD, I know you know both sides of the debate well; I know you know that this thread comes up every other day; do you really expect to be somehow enlightened?

Exactly.

Humble, you need to be more creative. This topic has been beaten to a pulp. I liked the "When do we give the bad news" thread much better ;)
 

HumbleMD

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Exactly.

Humble, you need to be more creative. This topic has been beaten to a pulp. I liked the "When do we give the bad news" thread much better ;)

I'd rather not remember that thread. Oh, update, she's not pre-med anymore. Anyway, I was hoping to see some anecdotes that may at least form into somewhat of a meaningful sample, rather than the premeds talking out thir asses with zero knowledge and justifying their own decisions to go to whatever school they've already decided.
 
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Eric Lindros

I'd rather not remember that thread. Oh, update, she's not pre-med anymore. Anyway, I was hoping to see some anecdotes that may at least form into somewhat of a meaningful sample, rather than the premeds talking out thir asses with zero knowledge and justifying their own decisions to go to whatever school they've decided.

And I understand exactly what you're looking for and agree that pre-meds generally do talk out their asses....I just don't think you're going to get the help you're looking for here in pre-allo and are more likely to get "ruckus"

The catch 22 is that pre-allo is far and away the most active forum on these boards...
 

Stolenspatulas

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I'd rather not remember that thread. Oh, update, she's not pre-med anymore. Anyway, I was hoping to see some anecdotes that may at least form into somewhat of a meaningful sample, rather than the premeds talking out thir asses with zero knowledge and justifying their own decisions to go to whatever school they've already decided.

Whoa, dont get overly aggressive and hot-tempered. No need for that.

People may contribute their own ''experiences'' but in the end what will you have? a sleu of "meaningful experiences." Oh this doctor said this, this doctor said that, this med student chose this, this resident chose that? Does that give you the answer? It wont. I cant help myself... I have to be blunt about this.

I haven't decided what I'll do for certain. I'm not debating the cheap state school vs the high ranked school.... im probably going to have some trouble over financing issues/living issues among high ranked schools. thats another debate that goes nuts. Should I take the scholarship at Michigan or go to Harvard. I won't have that awesome choice, but I see that clearly -- Definitely a scholarship to a top 20 is worth it. Now if you dont get a scholarship but a partial scholarship/good fin aid at the lower ranked school, thats when it gets interesting. There is no definite answer. I'm looking forward to confusing myself with this scenario come March. Hopefully I have that oppurtunity. :)
 

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what i've heard is not as important as med school. Rather, it's about WHO you work with in residency.

just what i've heard
 

Boris Badenov

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All the 4th years applying to residency, however, seem to be reporting that prestige matters "more than I ever realized"
That describes me and my opinion on the subject perfectly.

I've posted my thoughts on this matter a few times, but this post:

fotografía;4707295 said:
When I interviewed at Stanford, I had some time to wander around and explore. I came across a facebook poster that showcased Stanford's new interns, which included where they went to med school. I have to say, I was pretty shocked at how narrow the range of schools was. Grads from Harvard, Penn, Hopkins UCSF, Yale etc. primarily made up the list. There were a few less prestigious state schools, but they were definitely the minority. Which makes me think that reputation does matter, as I think it matters for UG --> med school as well. Basically, I think that if you don't attend a top school, you can still be just as successful, but you have to really shine at the institution you're at, because name and rep alone isn't going to open doors. So at every stage, there are a handful of top students from less prestigious schools that land amazing med school/residency spots etc. But, if there's one trend I saw while interviewing at prestigious med schools, it's that by and large, the interview group was always something like 75% ivy league, with Harvard, in particular, being disproportionately represented (you Harvard kids were everywhere!). So does which med school you attend make a difference? I personally think going to a reputable school will help you, but that if you’re smart enough and driven to achieve top placements, then you’re going to do it no matter where you go.

about sums it up. The reputation of your med school is super important.
 

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This "less debt and less prestige vs. more debt and more prestige" debate has been raging in my head for the last several months now, with no answer. How much prestige is $150,000 worth? The difference between #1 and #15? Or the difference between #1 and #50? Or none of the above?

My gut feeling is that the debt scares me more than the lack of prestige.

I'm rapidly going insane.
 

Chulito

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I have two board-of-directors colleagues who are residency directors, and I have asked them this question. They both claim that amongst the great schools the flashy names (Harvard, Stanford) will not get a candidate any further than the less flashy names (U of Michigan, U of Washington). Schools with huge name cachet will put a gleam in their eye when first perusing the applications, but not much more. Applicants from these schools all start out in the A pile and are evaluated based on the same criteria. Applicants from lesser-ranked schools, on the other hand, have a little more to prove with USMLE scores and evaluations, etc., but in the end not much more. For both of these residency directors, the interview counts for A LOT. They both say that great board scores and clerkship evaluations overwhelm institution prestige. Those are two views from the inside.
 

Stolenspatulas

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This "less debt and less prestige vs. more debt and more prestige" debate has been raging in my head for the last several months now, with no answer. How much prestige is $150,000 worth? The difference between #1 and #15? Or the difference between #1 and #50? Or none of the above?

My gut feeling is that the debt scares me more than the lack of prestige.

I'm rapidly going insane.

I bet in your onslaught of awesome acceptances you likely will land top scholarships. You seem to be ''that guy'' with the washu full-ride or penn full-ride. haha
 

PeripateticMD

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This "less debt and less prestige vs. more debt and more prestige" debate has been raging in my head for the last several months now, with no answer. How much prestige is $150,000 worth? The difference between #1 and #15? Or the difference between #1 and #50? Or none of the above?

My gut feeling is that the debt scares me more than the lack of prestige.

I'm rapidly going insane.

I'd stick with rules of 20 (to be arbitrary), top 20, go to cheapest. If it's a top 20 and a top 50, i'd go with a top 20 (which Towelie, I think all of yours are top 20s - and has Vanderbilt given you any scholarship love yet? They will.). It's not a bad idea to go to a school that is in a location you may want to end up in... Look at match lists. Do externships in your fourth year to the hospitals you may want to do your residency at - you may have to set them up yourself, but it would be worth it. Keep (or start) your residency (not medical residency but where you live residency) at where you want to end up...
 
4

45408

It's going to be a pretty individual thing. What does the RD think of your school? End of story. If the RD for the program you want thinks that all the students he's had from your school are ignorant/douches/caring/brilliant, that might have an effect on whether or not you get in. Or if it's his alma mater. Or if he got rejected from there for that faculty spot, and now it's sour grapes.

Personally, I don't really care how prestigious my residency is. I just want it in the field that I want (which I don't know yet :p). I want to stay in the city I'm in now, so that's kind of a deciding factor. ;)
 

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Wow, big font. Yeah, I'd prefer actual meaningful responses, rather than people overpersonalizing the question and giving answers to defend/justify their own decisions (you'll see it on the D.O. forum all the time).

That's about as meaningful as you're going to get. After asking at interviews, asking docs, asking med students, I haven't gotten a consistent answer. Go to a school you feel comfortable at, do your best, and hope for the best.
 
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It's going to be a pretty individual thing. What does the RD think of your school? End of story. If the RD for the program you want thinks that all the students he's had from your school are ignorant/douches/caring/brilliant, that might have an effect on whether or not you get in. Or if it's his alma mater. Or if he got rejected from there for that faculty spot, and now it's sour grapes.

Personally, I don't really care how prestigious my residency is. I just want it in the field that I want (which I don't know yet :p). I want to stay in the city I'm in now, so that's kind of a deciding factor. ;)

I think the bolded statement is very important. Why does it matter how prestigious your medical school is? So you can get a more prestigious residency? Why does that matter?

IMHO, you need to ask yourself this question: Do I want to do academic medicine? If the answer is no, then prestige doesn't really matter at all. Case in point, you can even be a DO and still do fine once you are practicing.
 

UMP

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I think the bolded statement is very important. Why does it matter how prestigious your medical school is? So you can get a more prestigious residency? Why does that matter?

IMHO, you need to ask yourself this question: Do I want to do academic medicine? If the answer is no, then prestige doesn't really matter at all. Case in point, you can even be a DO and still do fine once you are practicing.

look at some of the competitive residency specilaty boards on this site and see how people tend to fare in those fields... radiation oncology, you're f'ed... ortho, you're facing an uphill battle... etc., etc...

DO's will generally end up in primary care, which according to some in the salary threads is a death-sentence especially with the high cost of these DO schools
 

Darkshooter326

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If you subsribe to the USnews rankings, you can get a rating of each medical school by residency directors. That could help you get a feel for residency success.
 

Falco2525

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It does make somewhat of a difference when it comes to getting residency positions; however, any residency can be reached from any school...the advantage of presitgious schools makes a difference when competing for the spots at the top residency positions in the specialty...although location of the schools also makes a difference
 

Stolenspatulas

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I think the bolded statement is very important. Why does it matter how prestigious your medical school is? So you can get a more prestigious residency? Why does that matter?

IMHO, you need to ask yourself this question: Do I want to do academic medicine? If the answer is no, then prestige doesn't really matter at all. Case in point, you can even be a DO and still do fine once you are practicing.

YOUR RESIDENCY IS YOUR CLINICAL TRAINING! of course you want to go to the best damn residency out there! It doesn't matter if you want to go into academic medicine OR private practice.... you still want to learn the best you can so that you can be the best doctor possible (it does matter more for academic medicine of course, but that doesnt nulify the importance of residency in general for any physician that wants to treat patients)
 

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Here's a better question:

MD from Johns Hopkins or MD/PhD from Iowa or Alabama?

Chew on that, biyatches.
 

Falco2525

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Here's a better question:

MD from Johns Hopkins or MD/PhD from Iowa or Alabama?

Chew on that, biyatches.

It totally depends on what your goals are...if you want to focus a career in research then the MD/PHD is the way to go...if you are more interested in clinical medicine and treating patients...MD at hopkins
 

QuantumMechanic

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They both claim that amongst the great schools the flashy names (Harvard, Stanford) will not get a candidate any further than the less flashy names (U of Michigan, U of Washington).

all 4 of those are top 10 schools...how about U of Michigan vs. NYMC?
 

BNSN

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I have two board-of-directors colleagues who are residency directors, and I have asked them this question. They both claim that amongst the great schools the flashy names (Harvard, Stanford) will not get a candidate any further than the less flashy names (U of Michigan, U of Washington). Schools with huge name cachet will put a gleam in their eye when first perusing the applications, but not much more. Applicants from these schools all start out in the A pile and are evaluated based on the same criteria. Applicants from lesser-ranked schools, on the other hand, have a little more to prove with USMLE scores and evaluations, etc., but in the end not much more. For both of these residency directors, the interview counts for A LOT. They both say that great board scores and clerkship evaluations overwhelm institution prestige. Those are two views from the inside.

In what planet is this where Michigan and U of Washington are less flashy than Harvard and Stanford?
 
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45408

I think the bolded statement is very important. Why does it matter how prestigious your medical school is? So you can get a more prestigious residency? Why does that matter?
Well, I actually picked the lower-ranked (US News) school that I was accepted to, but there's a chance that your med school's prestige will help you get the SPECIALTY you want, prestige of the program notwithstanding.
 

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I asked this same question to an attending at the HAEMR residency at MGH, and he said it mattered a lot. Apparently a couple of years ago they had an applicant from Mississippi, and the only reason they accepted him (he went on to be Cheif) was that he absolutely blew Step I of the USMLE away (250+). The attending basically said how you do on the USMLE helps ("can't fake it" were his exact words) but all things being equal, the kid from Harvard gets in over the kid from Mississippi. The premise is that its harder to be at your class rank at Harvard than it is at Mississippi. This premise might be flawed (I'm sure people are gonna flip out at me for saying it), but considering at attending at MGH said it, you know people feel it.
I'm not ragging on Mississippi, but this was the school the attending mentioned, and he kept using it in his examples.
 

emrevue

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i think there's a lot to be said for picking the place where you think you will be the happiest, which is obviously different things for different people. where do you think you will succeed? you may do better academically in that type of enviroment.

match lists can help a lot, especially if you think you want to go into a competitive field.

for the record, i am from a top 40 state school who applied for emergency medicine this year, applied to 22 places, and got 22 interviews. this includes so called "top programs." most other students at my interviews were not from harvard, stanford, etc. it seemed to me that they invited people who had strong applications, not strong medical school names.
 

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i think there's a lot to be said for picking the place where you think you will be the happiest, which is obviously different things for different people. where do you think you will succeed? you may do better academically in that type of enviroment.

match lists can help a lot, especially if you think you want to go into a competitive field.

for the record, i am from a top 40 state school who applied for emergency medicine this year, applied to 22 places, and got 22 interviews. this includes so called "top programs." most other students at my interviews were not from harvard, stanford, etc. it seemed to me that they invited people who had strong applications, not strong medical school names.

i think this raises the interesting point that the value of med school prestige may vary by specialty. em docs who post in the em residency forum make the point ad naseum that em tends to be anti-prestige. they ridicule folks who ask for em residency rankings, for example.
 

dasacohen

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we also are forgetting that those people who you saw on the poster (from ivy league schools) went to ivy league schools because they were good students (and therefore good doctor candidates) in the first place--to be honest is seems that getting into a good residency program involves a balance between doing well, and being an awesome person. If you go to a famous school, of course you'll get a little snuggle room, but as it is with applying to medical school, plenty of kids get into great schools from random colleges...it's just a lot more difficult

in essence, you have to think to yourself what will be better for you. Go to a great school and risk the chance of being mediocre, or have the pressure of having to be the best at a lower ranked school...
 

emrevue

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i think this raises the interesting point that the value of med school prestige may vary by specialty. em docs who post in the em residency forum make the point ad naseum that em tends to be anti-prestige. they ridicule folks who ask for em residency rankings, for example.

yeah, maybe. i see what you are saying. em is different compared to most specialties, and it is the one i know the best, so i'm at a loss to compare other fields.

i think this is why it helps to look at the match list also. e.g. there are many people in previous classes from my school who have matched in derm, ortho, ent, etc, at places that are not our home school.

if you are competitive in terms of AOA, board scores, grades, research, likely you will have no problem getting a spot wherever, regardless of where you came from. if you are from a state school, finish last in your class, and want to do derm, well, it's probably not going to happen. if you are in the same situation from an ivy league, you probably won't match either.

truth is somewhere in the middle, which is why i stand by my statement of pick the place you'll be happiest and most likely to succeed.
 

MonkeyNuts!

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Apparently UTSW's name still carries lots of weight. Might depend on school to school.
 

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You guys are scaring me :(

I basically have to go to a school in one city for family reasons and I happen to be OOS in that city. It looks like I will be going to a school that most SDNers do not think is very prestigious. I thought getting in to med school was the big hurdle. I just want to be a doctor, not a famous doctor or an innovative researcher-just a doctor. I could see myself doing a residency in Internal Medicine, neurology, psych or maybe radiology. Am I screwed? Not that I have any other options at this point
 

MonkeyNuts!

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You guys are scaring me :(

I basically have to go to a school in one city for family reasons and I happen to be OOS in that city. It looks like I will be going to a school that most SDNers do not think is very prestigious. I thought getting in to med school was the big hurdle. I just want to be a doctor, not a famous doctor or an innovative researcher-just a doctor. I could see myself doing a residency in Internal Medicine, neurology, psych or maybe radiology. Am I screwed? Not that I have any other options at this point

Dude you havent even matricked yet. Just do your best.
 

emrevue

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You guys are scaring me :(

I basically have to go to a school in one city for family reasons and I happen to be OOS in that city. It looks like I will be going to a school that most SDNers do not think is very prestigious. I thought getting in to med school was the big hurdle. I just want to be a doctor, not a famous doctor or an innovative researcher-just a doctor. I could see myself doing a residency in Internal Medicine, neurology, psych or maybe radiology. Am I screwed? Not that I have any other options at this point

of course you aren't screwed. do your best and work hard. when you graduate you will be a doctor and you will get a residency spot, most likely in whatever you want.

i think we are debating the extremes of this issue, like, could a student from xyz med school get a residency spot in neurosurgery at a particular program in boston.
 

morriske

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Dude you havent even matricked yet. Just do your best.

I'm not a dude :) I just feel like maybe I could've gone to a ranked school if I could have applied to schools in any geographical location. Oh well, I'm grateful to have an acceptance....
 

Bubblehead-to-MD

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we also are forgetting that those people who you saw on the poster (from ivy league schools) went to ivy league schools because they were good students (and therefore good doctor candidates) in the first place--to be honest is seems that getting into a good residency program involves a balance between doing well, and being an awesome person. If you go to a famous school, of course you'll get a little snuggle room, but as it is with applying to medical school, plenty of kids get into great schools from random colleges...it's just a lot more difficult

in essence, you have to think to yourself what will be better for you. Go to a great school and risk the chance of being mediocre, or have the pressure of having to be the best at a lower ranked school...

A very good point...
 

Bubblehead-to-MD

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I'm not a dude :) I just feel like maybe I could've gone to a ranked school if I could have applied to schools in any geographical location. Oh well, I'm grateful to have an acceptance....

I know you're not a dude! And, I am in a very similar situation - location restrictions dictated by my wife's career are going to ultimately determine which med schools I can choose from.
 

Boris Badenov

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in essence, you have to think to yourself what will be better for you. Go to a great school and risk the chance of being mediocre, or have the pressure of having to be the best at a lower ranked school...
That sounds like a pre-med kind of an answer.

There's nothing wrong with being 'mediocre,' as you put it, at a great school. It still takes you farther than you would have gone at the 'lower ranked' school. Eventually, as a med student, you'll learn that the strength of your competition really does little to impact your overall application portfolio. It's not like your competitors are taking your board scores, research, clinical evals (which are largely based on your people skills), and ECs away from you.

The decision shouldn't be difficult at all.
 

Bubblehead-to-MD

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That sounds like a pre-med kind of an answer.

There's nothing wrong with being 'mediocre,' as you put it, at a great school. It still takes you farther than you would have gone at the 'lower ranked' school. Eventually, as a med student, you'll learn that the strength of your competition really does little to impact your overall application portfolio. It's not like your competitors are taking your board scores, research, clinical evals (which are largely based on your people skills), and ECs away from you.

The decision shouldn't be difficult at all.

Pre-med answer or not, haven't we all determined that to be the reality - that to match into a competitive residency program from a lower ranked school, you have to be at the top of your class?
 
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