How to approach pre-clinical years for Psych?

[Sidus1011]

I'm going to be starting my first year this fall at a D.O. school and just wanted to get a sense of how to approach my interest in psychiatry. I have been working as a guardian advocate at a local mental health facility where I get to see some of the psychotherapy and clinical aspects of psych, and I really find it interesting and something I might want to pursue. I think last year only 74% of D.O.'s got to match psych, but it was 85% in 2020. While I know that many end up changing their specialty choice, Psych and Family Med are my favorites at least for right now. I know that this thread has been repeated elsewhere, but I just want some advice as to what I'm supposed to do in my preclinical years to improve my chances of potentially matching psych? A lot of people are saying research isn't really that important for psych and volunteering doesn't really do much apparently either for match? Everyone talks about showing a genuine interest, but how am I supposed to do that if activities like those above don't seem to matter to much? Sorry if this type of thread is tiresome on these forums, I just see some conflicting info and am just trying to get a gist of a sort of roadmap.

Thanks

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[Cath Up]

I am a 4th year DO student submitting a (hopefully adequately long) rank list in the coming weeks. You're correct that psych has been more competitive for DO applicants in the recent past. I am curious to see what the next Charting Outcomes shows for us later in 2022. While there is some anti-DO bias, there's also likely a fair bit of self-selection that mitigates this. I imagine there are still a number of applicants who apply to programs they're not competitive for and pay the price. But I also had very similar stats across the board as an MD this cycle and viewing their # and quality of interviews was just mind mindboggling. Didn't feel fair. But oh well, no sense in my dwelling on that right now.

Entering a DO school right now and ~expecting~ any moderately competitive specialty, at this point, is quite risky in my opinion (step 1 going P/F, proliferation of DO schools, persistent MD graduate pressure). Psych seems to be flirting with being "moderately" competitive- it used to be non-competitive as I understand it. I encourage any new DO student to think long and hard about if they would be truly miserable in FM/peds/non-academic IM. If yes, they should re-evaluate the risk of 200k+ debt for a career that makes them miserable. Now onto your question.

I went into med school wanting to do EM. I decided on psych about 2/3 through third year. I deliberately participated in 0 school affiliated extracurricular activities during medical school, to focus on what would get my foot in the door for interviews but also sub internships (AKA Sub-I, acting internship, away rotation): step 1 (for you, it will be step 2). Studying hard for step 1 is probably the best setup you can give yourself for excelling at step 2 though.

Aside from that, how "showing interest" manifested for me was:
Pre-ERAS:
-pursuing psych related research
-pursuing non psych related research (likely not super impactful)
-doing well on 3rd year psych rotation
-applying to sub internships early and thoroughly (complete any "why this program?" questions thoughtfully. Perhaps have someone proofread if you are a poor writer or something).
-reach out to programs with questions and express specific interest
-A PD told me longitudinal psych-related volunteering is beneficial. I didn't have this. They didn't interview me. Maybe start this right after step 2 (do not let it interfere with your step 2 performance).
Intra- and Post-ERAS:
-do well on step 2
-absolutely destroy sub-Is. Show up early. Stay late. Be personable and always in a good mood. Help residents. Psych knowledge is important but it is low on the list of attributes (teachability and interest in learning appear to far eclipse this). Proactively ask for feedback, additional opportunities (<-doing this got me a letter that I was told multiple times by seasoned interviewers is the best letter they have ever read), questions about the program. Express your sincere interest in the city and program.
-attend all social events during interview season. These are soul sucking but I have been told important at certain programs.
-send letters of interest to at least some subset of programs early on in the cycle (these are basically emails saying "I'm great, you're great, please consider my application for interview")

Tl;dr: doing well on step 1 will improve your chances of doing well on step 2. Studying hard for these exams is the most important thing you can do preclinically, for any specialty, including psychiatry. Also discussed clinical activities that would help, as they makes up the majority of additional ways of showing interest.

 

[Sidus1011]

I am a 4th year DO student submitting a (hopefully adequately long) rank list in the coming weeks. You're correct that psych has been more competitive for DO applicants in the recent past. I am curious to see what the next Charting Outcomes shows for us later in 2022. While there is some anti-DO bias, there's also likely a fair bit of self-selection that mitigates this. I imagine there are still a number of applicants who apply to programs they're not competitive for and pay the price. But I also had very similar stats across the board as an MD this cycle and viewing their # and quality of interviews was just mind mindboggling. Didn't feel fair. But oh well, no sense in my dwelling on that right now.

Entering a DO school right now and ~expecting~ any moderately competitive specialty, at this point, is quite risky in my opinion (step 1 going P/F, proliferation of DO schools, persistent MD graduate pressure). Psych seems to be flirting with being "moderately" competitive- it used to be non-competitive as I understand it. I encourage any new DO student to think long and hard about if they would be truly miserable in FM/peds/non-academic IM. If yes, they should re-evaluate the risk of 200k+ debt for a career that makes them miserable. Now onto your question.

I went into med school wanting to do EM. I decided on psych about 2/3 through third year. I deliberately participated in 0 school affiliated extracurricular activities during medical school, to focus on what would get my foot in the door for interviews but also sub internships (AKA Sub-I, acting internship, away rotation): step 1 (for you, it will be step 2). Studying hard for step 1 is probably the best setup you can give yourself for excelling at step 2 though.

Aside from that, how "showing interest" manifested for me was:
Pre-ERAS:
-pursuing psych related research
-pursuing non psych related research (likely not super impactful)
-doing well on 3rd year psych rotation
-applying to sub internships early and thoroughly (complete any "why this program?" questions thoughtfully. Perhaps have someone proofread if you are a poor writer or something).
-reach out to programs with questions and express specific interest
-A PD told me longitudinal psych-related volunteering is beneficial. I didn't have this. They didn't interview me. Maybe start this right after step 2 (do not let it interfere with your step 2 performance).
Intra- and Post-ERAS:
-do well on step 2
-absolutely destroy sub-Is. Show up early. Stay late. Be personable and always in a good mood. Help residents. Psych knowledge is important but it is low on the list of attributes (teachability and interest in learning appear to far eclipse this). Proactively ask for feedback, additional opportunities (<-doing this got me a letter that I was told multiple times by seasoned interviewers is the best letter they have ever read), questions about the program. Express your sincere interest in the city and program.
-attend all social events during interview season. These are soul sucking but I have been told important at certain programs.
-send letters of interest to at least some subset of programs early on in the cycle (these are basically emails saying "I'm great, you're great, please consider my application for interview")

Tl;dr: doing well on step 1 will improve your chances of doing well on step 2. Studying hard for these exams is the most important thing you can do preclinically, for any specialty, including psychiatry. Also discussed clinical activities that would help, as they makes up the majority of additional ways of showing interest.

Thank you so much for responding! I do understand the tax I have to pay going to D.O. school, and if it comes down to it, I know a lot of my interest in behavioral and mental health can also be appeased in Family Med. However, I will try my hardest to follow much of what you have listed out, and I really appreciate your advice. I will study for step 1 like its scored and be sure to take it, hopefully that can help me do well on Step 2 since that seems like the new decider for a lot things. I hope you match where you want, you seem genuinely passionate and someone who I could look up to. Good luck!

 

[BobbyKoch]

@Cath Up thanks for your thoughtful reply. do you mind if I hit you with some follow up questions from a 3rd year perspective?

How many programs did you apply to? What was your interview distribution like (mostly programs that you would have expected, ie in your range of scores/activities, or were you surprised be attention from your reaches)? Did you have a notable geographic preference in who offered you interviews? If so, is it based on school location or your home town?

After interviews, were there any features/aspects of a program that were enticing or a turn-off that you wouldn't have known to look for pre-interview?

Just trying to get a sense of how to evaluate programs since they all have similarly generic descriptions on their websites. So far I have been looking at biological vs psychosocial emphasis, access to training in psychotherapy, call schedules/rotation structure, patient population, etc.

 

[kelminak]

Just gonna throw out there that you should apply BROADLY compared to previous years. I don't know if it's the virtual thing or not, but I had good board scores and they did not help me secure a sufficient amount of interviews when I applied to 48 programs. I wish I had been more flexible and applied to 100, but I truly did narrow down to programs that I would want to go to.

 

[Sidus1011]

Just gonna throw out there that you should apply BROADLY compared to previous years. I don't know if it's the virtual thing or not, but I had good board scores and they did not help me secure a sufficient amount of interviews when I applied to 48 programs. I wish I had been more flexible and applied to 100, but I truly did narrow down to programs that I would want to go to.

I read somewhere that there is a geographic preference at play for a lot of residencies. I'm probably going to end up going to school either in the south east or midwest, but I am originally from FL. Does the hometown you put in ERAS help in terms of securing interviews or is it solely dependent on school?

 

[kelminak]

I read somewhere that there is a geographic preference at play for a lot of residencies. I'm probably going to end up going to school either in the south east or midwest, but I am originally from FL. Does the hometown you put in ERAS help in terms of securing interviews or is it solely dependent on school?

My school is in the Southeast, and the farthest I've made it to is the Northeast. I couldn't even secure midwest interviews, but I was selective as I mentioned before and I might have been able to if I loosened my criteria. I had a massive spreadsheet my wife helped make to narrow things down.

 

[Sidus1011]

My school is in the Southeast, and the farthest I've made it to is the Northeast. I couldn't even secure midwest interviews, but I was selective as I mentioned before and I might have been able to if I loosened my criteria. I had a massive spreadsheet my wife helped make to narrow things down.

Well I sincerely hope you match and into the location you desire most! This whole process blows, but I'm sure when we look back in 30 years it'll just be another story. Thanks for responding!

 

[Cath Up]

@Cath Up thanks for your thoughtful reply. do you mind if I hit you with some follow up questions from a 3rd year perspective?

How many programs did you apply to? What was your interview distribution like (mostly programs that you would have expected, ie in your range of scores/activities, or were you surprised be attention from your reaches)? Did you have a notable geographic preference in who offered you interviews? If so, is it based on school location or your home town?

After interviews, were there any features/aspects of a program that were enticing or a turn-off that you wouldn't have known to look for pre-interview?

Just trying to get a sense of how to evaluate programs since they all have similarly generic descriptions on their websites. So far I have been looking at biological vs psychosocial emphasis, access to training in psychotherapy, call schedules/rotation structure, patient population, etc.

Of course you may reach out, anytime. I'll PM you answers to your questions.

 

[Cath Up]

Last cycle the average # of progams applied to was 74 for DOs I believe. Quality and match up of interview is important but high selectivity when determining programs to apply to is incomprehensibly risky in my opinion. It is a "basically no career versus being a psychiatrist" wager.

 

[Sidus1011]

Last cycle the average # of progams applied to was 74 for DOs I believe. Quality and match up of interview is important but high selectivity when determining programs to apply to is incomprehensibly risky in my opinion. It is a "basically no career versus being a psychiatrist" wager.

So I'm taking a guess and saying a more shotgun approach and basically applying anywhere that takes DOs can only help you?

 

[Cath Up]

So I'm taking a guess and saying a more shotgun approach and basically applying anywhere that takes DOs can only help you?

Apply to at least the average # of applied to programs. Apply to programs that accept DOs with stats as good as yours or worse that are in your region. Apply to all programs you have a regional or personal connection to. Apply to programs in places you would want to live, with training you would be okay receiving. Include some reach programs that you think you'd be really happy at.

There is a big problem with application proliferation in ERAS right now. I don't think ERAS has much incentive to fix it; they make a ton of money from more applications. A decade ago, I think you could get away with like 80% fewer applications in many specialties. I don't want to counsel others to contribute to application bloat, but applying to at least the average from the prior cycle is likely prudent to secure one's highest chance of matching.

 

[Sidus1011]

Apply to at least the average # of applied to programs. Apply to programs that accept DOs with stats as good as yours or worse that are in your region. Apply to all programs you have a regional or personal connection to. Apply to programs in places you would want to live, with training you would be okay receiving. Include some reach programs that you think you'd be really happy at.

There is a big problem with application proliferation in ERAS right now. I don't think ERAS has much incentive to fix it; they make a ton of money from more applications. A decade ago, I think you could get away with like 80% fewer applications in many specialties. I don't want to counsel others to contribute to application bloat, but applying to at least the average from the prior cycle is likely prudent to secure one's highest chance of matching.

Ok cool thanks for the advice, I'm definitely interested to see what the match results will be this year

 

[djiboutiman]

The most important thing to do in your pre-clinical years is to pass your classes. Once you are comfortable passing your classes, then start exploring your interests. Definitely join the Psychiatry club at your school, sign up for a free APA membership, join PsychSIGN, also your local Psychiatry society. These are some easy ways to learn about the field, find events, network with Psychiatrists, etc. Finding a Psychiatry mentor would be helpful too. If your school has Psychiatry research, you could try to get involved in a project. You could also try reaching out to local psychiatry programs to see if there are any projects you could help with. There are also some interesting summer programs that you could check out between your first and second year (AACAP and SAMHSA). Psych-related volunteering would be great as well. All the above advice is great when you get a little further in medical school, but these are things you could start working on in year 1. Feel free to explore other fields as well, as you never know what might capture your interest. Good luck with everything!

 

[Sidus1011]

The most important thing to do in your pre-clinical years is to pass your classes. Once you are comfortable passing your classes, then start exploring your interests. Definitely join the Psychiatry club at your school, sign up for a free APA membership, join PsychSIGN, also your local Psychiatry society. These are some easy ways to learn about the field, find events, network with Psychiatrists, etc. Finding a Psychiatry mentor would be helpful too. If your school has Psychiatry research, you could try to get involved in a project. You could also try reaching out to local psychiatry programs to see if there are any projects you could help with. There are also some interesting summer programs that you could check out between your first and second year (AACAP and SAMHSA). Psych-related volunteering would be great as well. All the above advice is great when you get a little further in medical school, but these are things you could start working on in year 1. Feel free to explore other fields as well, as you never know what might capture your interest. Good luck with everything!

Awesome thanks a ton! I'll look into those programs and organizations. Ik it's early and I might end up changing my mind, but it's nice to have an idea of what I can do. I'll also make sure I have my stuff together academically first, definitely not gonna underestimate how difficult the classes are going to be. Hopefully I can figure out what works for me within the first month or two. Thanks for responding!

 

[FutureDoctor5000]

LOL at the sky is falling on this thread , the last match was obviously impacted by Covid.. things should get back to normal by the time your applying OP(hopefully )...psych isn't derm or ortho, and cares way less about stats and more about the soft stuff like fit. The key is to do well in school and get good LOR's and do a few psych SubI's... MD's have to apply to less programs to get a simmilar or better quality of programs as DO's and that's always been the case... the same way DO's have to apply to wayyyy less programs and need lower scores to get a simmilar/better invites than FMG's and Carib IMG's.. it's just the pecking order.. the good news is that many good psych programs(even top tier programs) outside of say the top 4 do consider DO's and this aspect is improving for DO's and step 1 going p/f or school expansion won't have too much of an impact on this.. the focus will shift to step 2 and clinical grades and extracurriculars, psych cared little about stats anyways... there are many very good programs that consider DO's and the step1/level1 pass fail won't change much imo... stop acting like psych is even remotely as competitive as derm or surgical subs.. very doable for DO's to land a very good academic program as long as everything else is ok on the app and a good application strategy.. I.e not applying to like 20-30 programs lol..(many people who don't listen to advisors or get poor advising do this.. you'd be surprised... this also contributes to the 74% match rate)

 

[Sidus1011]

LOL at the sky is falling on this thread , the last match was obviously impacted by Covid.. things should get back to normal by the time your applying OP(hopefully )...psych isn't derm or ortho, and cares way less about stats and more about the soft stuff like fit. The key is to do well in school and get good LOR's and do a few psych SubI's... MD's have to apply to less programs to get a simmilar or better quality of programs as DO's and that's always been the case... the same way DO's have to apply to wayyyy less programs and need lower scores to get a simmilar/better invites than FMG's and Carib IMG's.. it's just the pecking order.. the good news is that many good psych programs(even top tier programs) outside of say the top 4 do consider DO's and this aspect is improving for DO's and step 1 going p/f or school expansion won't have too much of an impact on this.. the focus will shift to step 2 and clinical grades and extracurriculars, psych cared little about stats anyways... there are many very good programs that consider DO's and the step1/level1 pass fail won't change much imo... stop acting like psych is even remotely as competitive as derm or surgical subs.. very doable for DO's to land a very good academic program as long as everything else is ok on the app and a good application strategy.. I.e not applying to like 20-30 programs lol..(many people who don't listen to advisors or get poor advising do this.. you'd be surprised... this also contributes to the 74% match rate)

Thanks for responding! Yeah I was just looking for a sense of what exactly was important and I got the answer. It's just confusing with P/F, virtual interviews, and the increased number of AMGs each year. The landscape has changed so much in the past 5 years that even looking at a thread from 2017 is almost a world's away. I definitely don't think psych is hitting Derm or Ortho levels, its still looked more as a black sheep to every person I've spoken with, but it's good to know how people are dealing with the increase in difficulty that the field is facing. Either way I'm still years away, the landscape may change again or maybe I'll lose interest to find something else I like. But I'm happy I got a bit of a roadmap from the experienced users above if I do end up sticking with it, it's really helpful. I appreciate you trying to cool the neuroticism, we need more level-headed people like u!