How to Match to a Top Neuro Residency

[Ijustwannabeadoctor]

So I’m a MS2 interested in neuro, I’m trying to make the best appicatjon I can and hopefully maybe even match at a top residency program. I know the higher the step score the better, but what about everything else? I know research helps but how much do you need for a top program? Any other tips?

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[Postictal Raiden]

The question is, why do you want to match a “top residency program”?

Unless you’re into research, I doubt your clinical experience is going to be different going to a top program vs some state university program

 

[Thama]

The question is, why do you want to match a “top residency program”?

Unless you’re into research, I doubt your clinical experience is going to be different going to a top program vs some state university program

I don't think that's really true. "State university" programs vary wildly (don't forget that UCSF is a state program), but many middle of the road neurology departments have only 1 or 2 faculty in major sub-specialties (like neuromuscle or movement) and may not have any representation in some smaller subspecialties (say neuro-onc or neuro-ophtho). Your experience admitting and discharging strokes will likely not be all that different, but educational opportunities at larger places are likely to be far more expansive. Plus you learn a lot from your co-residents, who are not going to be identical in ambition or talent between programs.

"But the big name researchers that define department reputation aren't going to do any teaching" is usually the counterargument - but that's only sometimes true. The very best and the very worst educators I've worked with have been those big name researchers. Having been taught by all sorts in my residency and fellowship, my advice would be that if you have the chance to go somewhere where you'll be taught cognitive neurology by a Bruce Miller, or movement disorders by a Stan Fahn, or neuromuscle by an Alan Pestronk, etc, then it's absolutely worth it.

 

[neglect]

So I’m a MS2 interested in neuro, I’m trying to make the best appicatjon I can and hopefully maybe even match at a top residency program. I know the higher the step score the better, but what about everything else? I know research helps but how much do you need for a top program? Any other tips?

It is variable. When I went through, long ago, the highest tier programs looked at MD-PHD's, and MD-only residents were a slim minority.

If I were you I'd look inward and evaluate your goals and fundamental definitions. What does "top residency program" even mean? Does it mean a place that will train you broadly in neurology, or a deep dive in _____ sub-specialty? Or a place where all your friends and family goes "wow, IJWBaDr is awesome," or is it a place that's a good fit all around: where you can meet/keep a partner, or get into city/mountain/shore life, or explore an entirely new area?

As luck will have it, there are many dozens of top residency programs. Some are in awesome and interesting places. Enjoy yourself.

 

[oopsy]

I don't think that's really true. "State university" programs vary wildly (don't forget that UCSF is a state program), but many middle of the road neurology departments have only 1 or 2 faculty in major sub-specialties (like neuromuscle or movement) and may not have any representation in some smaller subspecialties (say neuro-onc or neuro-ophtho). Your experience admitting and discharging strokes will likely not be all that different, but educational opportunities at larger places are likely to be far more expansive. Plus you learn a lot from your co-residents, who are not going to be identical in ambition or talent between programs.

"But the big name researchers that define department reputation aren't going to do any teaching" is usually the counterargument - but that's only sometimes true. The very best and the very worst educators I've worked with have been those big name researchers. Having been taught by all sorts in my residency and fellowship, my advice would be that if you have the chance to go somewhere where you'll be taught cognitive neurology by a Bruce Miller, or movement disorders by a Stan Fahn, or neuromuscle by an Alan Pestronk, etc, then it's absolutely worth it.

I completely agree. Residency is ultimately an apprenticeship---it is simply not true to say that you can get the same overall education everywhere. We may all be doing neurology, but frankly, not at the same level. And I dont mean that hospital X is just killing people and hospital Y is just saving people all the time. It's developing consistent excellence, being a really solid neurologist, across the board. That's hard to do. It's comparing 95 and 98% accuracy/success, or something probably smaller than that. It cant be done by one person, it takes a department to help develop a resident. That's why it's one thing to learn in a department where the attendings have passing familiarity with the guidelines and quite another where they are the ones writing it. So yes, it matters who trains you. I can speak to this on both sides. I did residency at one of the big named places where senior faculty were invested in my education, and then fellowship elsewhere. Not in a million years would I consider doing my neurology residency at the elsewhere location, and it has a perfectly fine national reputation. It's simply not comparable.

A lot of it is fit and culture, but there is no question that if you have an opportunity to train with leaders within the field, particularly those who care about teaching, then it's an experience that's very different. You will often be told that if you're going to end up in community practice, it doesn't matter. I disagree. It wont help get you an academic/research job you dont want, but you will simply be better prepared for your neurology career from some places. This is why those jobs are routinely offered to those graduates first. Nevertheless, the list of good neurology programs is longer than you think (it's not 4 places), but it is not infinite.

As for access, part of it is leveraging your school's contacts to make introductions, part of it is you demonstrating interest with research etc, and finally aptitude as measured in boards and ward evaluations. Beyond that, a lot of it just interviewing where the main question is usually, are you a normal human being?

 

[Telamir]

I agree. I did my residency and fellowship at a "brand name place". The connections gained from it, or simply the clout of "Oh you trained at X?" have been helpful when finding a job. You also start at a "higher standing" with people, if that makes sense. I also agree it was very helpful to train with people writing guidelines, or people who were big in their field. It was an enormous advantage to have all subspecialties present, even the rare ones (neuro-otology, neuro-ophthalmology, neuro-oncology). I feel now that I am in practice (epilepsy trained, practicing as neurohospitalist) it has made me a great general neurologist and I can tell when compared to my colleagues. I have run into vascular neurologists who only do stroke and don't know how to manage myasthenia, or their management of seizures/status runs out after Keppra and Vimpat are used.

The one caveat to this perhaps would be programs where the departments are enormous, and you compromise some clinical exposure. I know of some programs where you don't run code strokes as a neuro resident until end of PGY-3 or even PGY-4, whereas I was running them by myself from early PGY-2.

All in all, it's a good idea to try to match at the best place you can.

 

[Ijustwannabeadoctor]

To answer a lot of posts about what I mean by “top Residency” I guess I mean more that I want to be as competitive an applicant as possible to have as much say as I can in where I match and to not have any doors closed to me

 

[ForHumors]

As an MD student who just matched into neurology last week, I'm happy to add my 2¢

In general, big-name programs want to see applicants who are well-rounded with a successful track record through medical school, but also with the ability to "sell" themselves for why they will be a good hire for a program.

Given that the better-known programs tend to be academic, that means having a track record of doing research, publishing, and having an interest in pursuing an academic career tends to go over favorably, particularly if you can develop a skill or a niche that you can use to your advantage during the application process. That doesn't mean you have to be fully committed to one niche area as a medical student, but it gives programs more of a sense of who you might become one day and suggests that you're a go-getter carving out an area for yourself. The added benefit of finding a *good* research mentor is having someone in your corner helping guide you to residency.

That said, top programs expect a high level of competency clinically, as evidenced by your clinical grades, your letters of recommendation, and the board exams. You do have to perform well above average on your step exams for the well-regarded programs, particularly if you're not an MD/PhD. Just be aware that SDN tends to be overly exam obsessed. Scores get your foot in the door, they don't get you the job. Furthermore, for neurology (and for all residency programs actually) they do have a point where program directors don't really care if you scored higher. I got >260 on Step 1 and >270 on Step 2CK and I am very skeptical that my scores actually translated into me getting more interview invites than if I had scores in the 250s.

Clinical grades and LORs probably actually matter more than exam scores. If your school has them, AOA and Gold Humanism help. Having a good reputation in your school's neurology department (and internal medicine department, where you will also get a LOR) matters a lot, much more than people on SDN often discuss. It really helps to have your reputation as a good student precede you when you go on your IM and Neurology Sub-internships and before you ask for LORs. Especially since cross-institution phone calls occur to see if an applicant that looks good on paper is actually the real deal.

When it comes to applying, it's worth applying broadly without restricting yourself to a particular part of the country. Programs tend to be ~10 per class; not as small as some surgical specialties, but small classes mean that a particular place is less likely to be a shoe-in. Oftentimes big-name programs are predisposed to rank particular students coming from particular medical schools. Case in point, WashU nearly always sends 1-2 MSTPs to MGH/Partners. It's not that these spots are allocated per se, but it means there are probably fewer truly "open" spots going around than you might hope. Lastly, there is always a degree of randomness to the process. Best of luck! Feel free to reply or message me if you have more questions.