how to get top residency

[cookiegrub]

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Hi guys, I am interested in a subspecialty in IM and would like to see what you wished you had known after going through your program. I want to do a name-brand IM residency mainly for the prestige and research opportunities. I am a DO student so fellowship will depend largely on the residency platform. I hope that some of you would care to share Step scores and activities that helped you stand out. I would also like to know about job opportunities if for some reason I don't get to pursue fellowship. I would love to form a plan B and so I want to try to get into the best residency place I could provided if plans change. Thank you.

 

[whoknows2012]

Hi guys, I am interested in a subspecialty in IM and would like to see what you wished you had known after going through your program. I want to do a name-brand IM residency mainly for the prestige and research opportunities. I am a DO student so fellowship will depend largely on the residency platform. I hope that some of you would care to share Step scores and activities that helped you stand out. I would also like to know about job opportunities if for some reason I don't get to pursue fellowship. I would love to form a plan B and so I want to try to get into the best residency place I could provided if plans change. Thank you.

Already it’ll be a slightly uphill battle for you but here are some things that are universally helpful presuming you are at some point in the middle of med school;

1) get good grades including honoring IM clerkship and sub I
2) Do well on steps. Normally I’d say 240+ on both, for you I’d say aim for 250+
3) get involved with research that at least leads to poster presentation at a national meeting if not a publication. This is doable if you plan far enough in advance
4) make meaningful connections during clerkships so you can get good letters. As a DO may be worthwhile to consider programs that are worth doing subspecialty aways early in the academic year (July/aug).


I agree with you that ultimately where you do residency will likely dictate what your fellowship options are. All of this will not be easy to do but I think if you can meet some of the above you’ll be in at least a decent spot.

 

[throwaway1000000]

Depends on what you mean by top programs. If you mean, top 20 it's very hard.
For me, from a low-tier MD, I got mid 250s and mid 260s on step 1 and 2 and nearly all honors. But the most important key to break into top 20 is AOA. I didn't get any t-20 interviews so far and I don't think I will.
The research, LORs, evals etc are all stuff that are not super important at top programs unless you have AOA (I had excellent evals and LORs which I read but no one seems to care unless I have AOA).
So bottom line for low-tier MD to get t-20 is not just 250+ and 260+ step scores but also AOA.
If I went to a mid-tier or high-tier school, I would have no doubt gotten t-20 interviews but not from a low-tier MD without AOA

 

[cookiegrub]

Depends on what you mean by top programs. If you mean, top 20 it's very hard.
For me, from a low-tier MD, I got mid 250s and mid 260s on step 1 and 2 and nearly all honors. But the most important key to break into top 20 is AOA. I didn't get any t-20 interviews so far and I don't think I will.
The research, LORs, evals etc are all stuff that are not super important at top programs unless you have AOA (I had excellent evals and LORs which I read but no one seems to care unless I have AOA).
So bottom line for low-tier MD to get t-20 is not just 250+ and 260+ step scores but also AOA.
If I went to a mid-tier or high-tier school, I would have no doubt gotten t-20 interviews but not from a low-tier MD without AOA

coming from a DO program, we don't have AOA. We do, however, have a honor society of sorts but I didn't apply to it and it wasn't necessarily worth the one time payment. My school has a higher standard for acceptance into it so looking back I do think I should have spent the time but I've heard other schools hand it out less selectively ergo my reluctance. More importantly though, my step score is not high and it is pretty average. I plan to take some time off to do research and already have some work at a top program in the specialty I want to do fellowship in. I am currently betting my chances on the letters I hope to receive from my research experiences. So far, I do however think that most PDs put a lot of emphasis on Step scores as opposed to the things some bigwig may have to say about a candidate unless the candidate is from a top program already.

 

[throwaway1000000]

coming from a DO program, we don't have AOA. We do, however, have a honor society of sorts but I didn't apply to it and it wasn't necessarily worth the one time payment. My school has a higher standard for acceptance into it so looking back I do think I should have spent the time but I've heard other schools hand it out less selectively ergo my reluctance. More importantly though, my step score is not high and it is pretty average. I plan to take some time off to do research and already have some work at a top program in the specialty I want to do fellowship in. I am currently betting my chances on the letters I hope to receive from my research experiences. So far, I do however think that most PDs put a lot of emphasis on Step scores as opposed to the things some bigwig may have to say about a candidate unless the candidate is from a top program already.

Yeah t-20 is probably not likely for you. Mid-tiers can be still be a possibility if you continue to work hard and get good step 2 ck and grades.
I will be honest step 2 ck and grades will matter more for IM than research and LORs. I have excellent LORs and decent research but don't see it helping me very much without filling their checkbox of "AOA". For you those checkboxes will also include step 2 ck and clinical grades. Without those two, it is hard.

 

[cookiegrub]

Yeah t-20 is probably not likely for you. Mid-tiers can be still be a possibility if you continue to work hard and get good step 2 ck and grades.
I will be honest step 2 ck and grades will matter more for IM than research and LORs. I have excellent LORs and decent research but don't see it helping me very much without filling their checkbox of "AOA". For you those checkboxes will also include step 2 ck and clinical grades. Without those two, it is hard.

that's interesting to hear that research makes minimal difference to an application. Nevertheless, I am pulled towards spending the extra time simply because I do see some value in it for my personal growth. I also am stubborn because I want to get a publication and seeing so many people around me get pubs with minimal effort makes me think that I have been constantly wronged as I seem to put way too much effort and have received little in return. For someone interested in academia, publication is currency and to have none is quite disheartening. Although I do not want to add anymore time to my training, I do think that I would make more meaningful connections through research than at my DO school where connections seem much more regional. On top of that, I don't imagine myself having as great of an impression on the faculty that do have some bearing on recs for out of region programs that are more DO friendly and are among the elite.

 

[rokshana]

Depends on what you mean by top programs. If you mean, top 20 it's very hard.
For me, from a low-tier MD, I got mid 250s and mid 260s on step 1 and 2 and nearly all honors. But the most important key to break into top 20 is AOA. I didn't get any t-20 interviews so far and I don't think I will.
The research, LORs, evals etc are all stuff that are not super important at top programs unless you have AOA (I had excellent evals and LORs which I read but no one seems to care unless I have AOA).
So bottom line for low-tier MD to get t-20 is not just 250+ and 260+ step scores but also AOA.
If I went to a mid-tier or high-tier school, I would have no doubt gotten t-20 interviews but not from a low-tier MD without AOA

She’s a DO, so top 20 is highly unlikely.

AOA is only for US MD students ( LCME).

 

[cookiegrub]

She’s a DO, so top 20 is highly unlikely.

AOA is only for US MD students ( LCME).

In that event, do you guys know of any programs that could lead to a top 20 fellowship but aren't necessarily the obvious picks just because they might be community programs? For example, any programs that have affiliation and accreditation through top 20s. If you guys know of any site that shares minimal step scores and has all this information, I would love to do my research and figure out where I stand. I am not your regular DO student, I have a strong interest in academia and am gearing my career towards it. My scores are not as competitive as the average student but I am willing to compensate through other avenues. In the end, I would love to end up at a top 20, but I realize that there are more deserving candidates that are in the running so I am not tunnel-visioned for that level of prestige.

 

[DrStephenStrange]

Hi guys, I am interested in a subspecialty in IM and would like to see what you wished you had known after going through your program. I want to do a name-brand IM residency mainly for the prestige and research opportunities. I am a DO student so fellowship will depend largely on the residency platform. I hope that some of you would care to share Step scores and activities that helped you stand out. I would also like to know about job opportunities if for some reason I don't get to pursue fellowship. I would love to form a plan B and so I want to try to get into the best residency place I could provided if plans change. Thank you.

If you're looking into a competitive IM fellowship (Cards, GI, Pulm, Onc), where you do residency matters, but as a DO you also have to be realistic. No matter how hard you work in school, you probably will never be able to reach a name-brand top IM residency program, but that's ok and it's not gonna kill you. Your best bet will be a Mid to low tier University IM programs, and some of the great Community programs that matches well into the subspecialty you want or have in-house fellowship programs. With that said, some research/presentation/pubs are important, USMLE Step 1 and Step 2 CK is necessary, and Sub-Is with LORs are important as well. Aim for the 240s in Steps, but 230s won't kill you for some low tier University programs, and the 220s won't kill you for the good community programs. When in residency you also have to be proactive about research/presentation/pubs opportunities as well, and also consider doing a chief year if possible. I'm telling you all this as a DO student who has been doing research on how to make myself competitive to ultimately end up in a Cards or Pulm IM fellowship.

Sent from my SM-G973U using SDN mobile

 

[cookiegrub]

If you're looking into a competitive IM fellowship (Cards, GI, Pulm, Onc), where you do residency matters, but as DO you also have to be realistic. No matter how hard you work in school, you probably will never be able to reach a name-brand top IM residency program, but that's ok and it's not gonna kill you. Your best bet will be a Mid to low University IM programs, and some of the great Community programs that matches well into the subspecialty you want or have in-house fellowship programs. With that said, some research/presentation/pubs are important, USMLE Step 1 and Step 2 CK is necessary, and Sub-Is with LORs are important as well. Aim for the 240s in Steps, but 230s won't kill you for some low tier University programs, and the 220s won't kill you for the good community programs. When in residency you also have to be proactive about research/presentation/pubs opportunities as well, and also consider doing a chief year if possible. I'm telling you all this as a DO who has been doing research on how to make myself competitive to ultimately end up in a Cards or Pulm IM fellowship.

Sent from my SM-G973U using SDN mobile

Thanks, I have research experience and my step is >220 but less than a 230. I don't plan on chief year just because I am taking time off now as a medical student and would rather just speed through to fellowship after residency. I have been fortunate to have had a prestigious research fellowship in the area I want to specialize in and I keep wondering why that has gone unappreciated whenever I bring it up to a PD. In my experience, as people on this board mention, no one in medicine cares about the extraneous things except for scores, particularly for a DO, and even then it isn't good enough. Now that the damage is done, I can't undo it but hopefully some of you can share where I can do some damage control while I still have time. I appreciate all of your responses!

 

[DrStephenStrange]

An old but good thread on what programs you need to target as a DO. I'm not sure how true everything in the thread is nowadays, but still a good start.

DO friendly internal medicine university programs

For prosperity sake and to aid future internal medicine applicants, the following are university programs that have taken at least one DO for internal medicine. Whether or not the acceptance of 1 DO into a program constitutes a "DO friendly" designation remains to be debated, but for reference...

forums.studentdoctor.net

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[candbgirl]

If you're looking into a competitive IM fellowship (Cards, GI, Pulm, Onc), where you do residency matters, but as DO you also have to be realistic. No matter how hard you work in school, you probably will never be able to reach a name-brand top IM residency program, but that's ok and it's not gonna kill you. Your best bet will be a Mid to low University IM programs, and some of the great Community programs that matches well into the subspecialty you want or have in-house fellowship programs. With that said, some research/presentation/pubs are important, USMLE Step 1 and Step 2 CK is necessary, and Sub-Is with LORs are important as well. Aim for the 240s in Steps, but 230s won't kill you for some low tier University programs, and the 220s won't kill you for the good community programs. When in residency you also have to be proactive about research/presentation/pubs opportunities as well, and also consider doing a chief year if possible. I'm telling you all this as a DO who has been doing research on how to make myself competitive to ultimately end up in a Cards or Pulm IM fellowship.

Sent from my SM-G973U using SDN mobile

I think OP has taken at least step 1 but hasn’t shared the score.

 

[DrStephenStrange]

Thanks, I have research experience and my step is >220 but less than a 230. I don't plan on chief year just because I am taking time off now as a medical student and would rather just speed through to fellowship after residency. I have been fortunate to have had a prestigious research fellowship in the area I want to specialize in and I keep wondering why that has gone unappreciated whenever I bring it up to a PD. In my experience, as people on this board mention, no one in medicine cares about the extraneous things except for scores, particularly for a DO, and even then it isn't good enough. Now that the damage is done, I can't undo it but hopefully some of you can share where I can do some damage control while I still have time. I appreciate all of your responses!

With those scores your chances will be best at low tier University programs and good community programs. No matter what anyone said, I think Research is still important for University programs and for fellowship match later on, not necessarily publications, but at least presentations at national conferences. I think of research like volunteering when I was applying for medical school, having it is not gonna automatically get you in, but not having it is concerning because most of every other applicants will have some type of research activity on their CV.

Sent from my SM-G973U using SDN mobile

 

[jhamaican]

Lots of strikes against you:
DO
Low step score
bad attitude
where the publications at?

You need some serious research (talking like high impact journals first author stuff) if you want to make it to the top of the ivory castle.

Hell, you are gonna need lots of research to match into a decent university program.

Not hating, just telling you the truth. Honesty is the best policy.

Thanks, I have research experience and my step is >220 but less than a 230. I don't plan on chief year just because I am taking time off now as a medical student and would rather just speed through to fellowship after residency. I have been fortunate to have had a prestigious research fellowship in the area I want to specialize in and I keep wondering why that has gone unappreciated whenever I bring it up to a PD. In my experience, as people on this board mention, no one in medicine cares about the extraneous things except for scores, particularly for a DO, and even then it isn't good enough. Now that the damage is done, I can't undo it but hopefully some of you can share where I can do some damage control while I still have time. I appreciate all of your responses!

You should fix that attitude... bad attitude in many regards. Let me guess you want cards/gi while "speeding through to fellowship after residency". PD pay you no mind because you haven't shown enough skin. Big hat no cattle. Your competition is people who busted their ass to get into a MD school and then also scored higher than you on step. You need chief year, published research in high impact journals (not just experiences). Gotta bleed a little if you want the top broski. Particularly with your above deficiencies. Adjust your attitude. Perhaps your username is fitting...

 

[jdh71]

I’ve given this advice more than once

1. Find orphanage
2. Set orphanage on fire
3. Save orphans

This kind of publicity will guarantee a cardiology spot

 

[cookiegrub]

Lots of strikes against you:
DO
Low step score
bad attitude
where the publications at?

You need some serious research (talking like high impact journals first author stuff) if you want to make it to the top of the ivory castle.

Hell, you are gonna need lots of research to match into a decent university program.

Not hating, just telling you the truth. Honesty is the best policy.




You should fix that attitude... bad attitude in many regards. Let me guess you want cards/gi while "speeding through to fellowship after residency". PD pay you no mind because you haven't shown enough skin. Big hat no cattle. Your competition is people who busted their ass to get into a MD school and then also scored higher than you on step. You need chief year, published research in high impact journals (not just experiences). Gotta bleed a little if you want the top broski. Particularly with your above deficiencies. Adjust your attitude. Perhaps your username is fitting...

wait what? I am sorry if you are reading too much into what I have researched. I appreciate your perspective but I am shocked by your attitude. The mere fact that this forum reads about DOs having stellar step but still matching much lower than their MD counterpart proves my point. We don't often hear this on sdn but I am very proud of my score and I made a marked improvement from baseline while studying for comlex (but this is the wrong forum to share that; and yes there were several DOs who outperformed me with similar circumstances and will beat me on the numbers game). Truth is that there are people out there, several in fact, who go into a lab and work their butt off but then get ignored come publication time, I am not bitter, in fact unlike the average candidate I try to fill my deficits and work even harder (that's not attitude, it's called grit). I do appreciate that you summed up what eveyrone has been saying but I do have to disagree on how far you take the topic of "research". I also have to disagree strongly with how you have demonstrated my stance and to refute your opinion here are all the sentences you missed while skimming my post:

I realize that there are more deserving candidates that are in the running so I am not tunnel-visioned for that level of prestige.

I can't undo it but hopefully some of you can share where I can do some damage control while I still have time. I appreciate all of your responses!

I would request that people don't dissolve this thread into a meaningless platform where everyone goes onto judge me for being a DO. I am really just looking for any ideas on how you think I can improve to salvage what I have. I can't promise to be perfect but I will take your suggestions and work on them with all my due diligence.

 

[throwaway1000000]

wait what? I am sorry if you are reading too much into what I have researched. I appreciate your perspective but I am shocked by your attitude. The mere fact that this forum reads about DOs having stellar step but still matching much lower than their MD counterpart proves my point. We don't often hear this on sdn but I am very proud of my score and I made a marked improvement from baseline while studying for comlex (but this is the wrong forum to share that; and yes there were several DOs who outperformed me with similar circumstances and will beat me on the numbers game). Truth is that there are people out there, several in fact, who go into a lab and work their butt off but then get ignored come publication time, I am not bitter, in fact unlike the average candidate I try to fill my deficits and work even harder (that's not attitude, it's called grit). I do appreciate that you summed up what eveyrone has been saying but I do have to disagree on how far you take the topic of "research". I also have to disagree strongly with how you have demonstrated my stance and to refute your opinion here are all the sentences you missed while skimming my post:

I don't think you are undeserving. Most people aren't but when there is so much demand from applicants, programs can cherry pick the applicants.
That's how the process works.

 

[cookiegrub]

I’ve given this advice more than once

1. Find orphanage
2. Set orphanage on fire
3. Save orphans

This kind of publicity will guarantee a cardiology spot

thanks but I am not going after the top competitive specialties in IM, never been my interest so I hope that helps. Anyways, I am just focused on a good IM program so not really focused on fellowship as long as that residency program can launch me in whichever direction.

 

[jdh71]

thanks but I am not going after the top competitive specialties in IM, never been my interest so I hope that helps. Anyways, I am just focused on a good IM program so not really focused on fellowship as long as that residency program can launch me in whichever direction.

Orphans dogg, orphans.

 

[rokshana]

In that event, do you guys know of any programs that could lead to a top 20 fellowship but aren't necessarily the obvious picks just because they might be community programs? For example, any programs that have affiliation and accreditation through top 20s. If you guys know of any site that shares minimal step scores and has all this information, I would love to do my research and figure out where I stand. I am not your regular DO student, I have a strong interest in academia and am gearing my career towards it. My scores are not as competitive as the average student but I am willing to compensate through other avenues. In the end, I would love to end up at a top 20, but I realize that there are more deserving candidates that are in the running so I am not tunnel-visioned for that level of prestige.

Then frankly you should have gone to an MD programs.

People love to think there is no difference, especially now with the merged match...once in the world of clinical, you find out the reality...it’s hard for DOs to get elective at top programs to audition...and look at the residency classes at the top
Programs...rarely a DO present. And if your scores aren’t competitive for the average DO student, then you will have even more issues.

Part of getting a top fellowship is going to the right school and the right residency...the HMS student is going to have a lot more doors opened to them because of where they went to school...even if they have lower scores.

Part of getting fellowship is who you know and how you do in residency...depending o the fellowship, you can get into a top program...of course this depends on the fellowship...GI...difficult and unlikely...nephrology...not a problem...

You need to start focusing on improving your application as much as you can...if you haven’t take. The steps, then you potentially could rock those and that could help...course it’s a double edge sword...mediocre score will just seal the deal in the wrong way.
Try to get a publication to help with making your application stand out...present at a national conference

Apply to the big programs...you never know and you can’t get an IV if you do t apply...but apply to other programs that are more within your reach and if you end up doing your residency there, be the best intern and resident possible...make connections, do research that gets published and have posters at national meetings, go to national meetings.

Research really only has an impact if it’s published ...anyone can hang out in a lab or say they did research...

 

[cookiegrub]

Then frankly you should have gone to an MD programs.

People love to think there is no difference, especially now with the merged match...once in the world of clinical, you find out the reality...it’s hard for DOs to get elective at top programs to audition...and look at the residency classes at the top
Programs...rarely a DO present. And if your scores aren’t competitive for the average DO student, then you will have even more issues.

Part of getting a top fellowship is going to the right school and the right residency...the HMS student is going to have a lot more doors opened to them because of where they went to school...even if they have lower scores.

Part of getting fellowship is who you know and how you do in residency...depending o the fellowship, you can get into a top program...of course this depends on the fellowship...GI...difficult and unlikely...nephrology...not a problem...

You need to start focusing on improving your application as much as you can...if you haven’t take. The steps, then you potentially could rock those and that could help...course it’s a double edge sword...mediocre score will just seal the deal in the wrong way.
Try to get a publication to help with making your application stand out...present at a national conference

Apply to the big programs...you never know and you can’t get an IV if you do t apply...but apply to other programs that are more within your reach and if you end up doing your residency there, be the best intern and resident possible...make connections, do research that gets published and have posters at national meetings, go to national meetings.

Research really only has an impact if it’s published ...anyone can hang out in a lab or say they did research...

Thank you for all your points. This thread has distilled some of my misconceptions and made me aware of the flaws in my application. I dont imagine getting into a low tier even is going to be easy but atleast now I know where to put my funds when applying.