HP in psych rotation… Are midwest academic programs out of the question?

[PuffBlueCat]

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Just found out today I am getting a HP in my psych rotation. Pretty disappointed to say the least, as I intend on applying psych this fall. I was sure I performed well enough to secure the H, but apparently not (H/HP/P/F scale).

Our clinical grades are ~50/50 eval/shelf, and I scored in the 86th percentile for the shelf. Not the best, but that has been more than enough to honor other rotations. I know this of course impacts my competitiveness, but I am curious as to where I might sit overall. For context:

DO student (original 5, if that matters)

3rd quartile (just barely - a gpa drop of .03 put me from 2nd to 3rd) preclinical grades.

Minimal research: 1 psychopharm related poster on ketamine, 1 poster/manuscript on a GI topic, 1 manuscript/presentation on medical education.

Passed step/comlex 1 each on first attempts

Lots of varied work experience prior to starting med school including 2.5yrs full time as an outpatient psych tech (lots of service industry, tutoring)

Rotations so far:
Peds: HP
OBGYN: H
FM: H
Surgery: H
Psych: HP
IM: TBD - H is still possible, but HP is probably more likely.

All of my eval comments have been positive (some overwhelmingly positive). The “worst” comment I received was essentially a generic “performed well for a 3rd year, keep reading/studying” on peds, which was my first rotation.

No step/comlex 2 until June, which I know may have a big impact.

I am from Wisconsin, and ideally would match at one of the 4 psych programs there, but I will be applying broadly (i.e. to all programs with DOs) throughout the “east north central” and “west north central” regions. So the academic programs I am most interested in are midwest academic (MCW, U Wisconsin, Mayo, U Michigan, U Iowa, etc.), not east/west coast academic.

To be clear - I’m not just gunning for academics. I plan on applying to mostly community programs. I am mainly just curious to see what y’all think about my chances for the academic programs I do apply to.

Thank you all in advance for your thoughts/comments!

 

[comp1]

Your grades in rotations are just about the least important thing you mentioned, so no, if you don't match, that won't be why.

 

[PuffBlueCat]

Your grades in rotations are just about the least important thing you mentioned, so no, if you don't match, that won't be why.

I know clinical grades aren’t necessarily the most heavily weighted aspect of the application, but my understanding is that they are fairly important. Especially if one’s specialty is one of the core 3rd year rotations.

Do you have any thoughts on my application overall? As I put it all down, I’m realizing it doesn’t look that impressive…

 

[splik]

Many places don't put much stock in grades from DO schools (though it depends on the school). The most important thing you can do is get several psych away rotations (ideally sub-is) at the programs you would like to match at. Get honors in them (usually much easier to honor 4th yr rotations) and ideally get them early enough to get 2 LoRs. Do as well as you can on Level 2, and consider taking Step 2 if you can do well.

 

[TexasPhysician]

I know clinical grades aren’t necessarily the most heavily weighted aspect of the application, but my understanding is that they are fairly important. Especially if one’s specialty is one of the core 3rd year rotations.

Do you have any thoughts on my application overall? As I put it all down, I’m realizing it doesn’t look that impressive…

Grades are fairly important in that you don’t want to fail any. Your grades are fine. H vs HP in 1 course is unlikely to play any role in your application. Application looks fine. Do away rotations where you want to go.

 

[comp1]

I supervise DO and MD students from different schools so I'm somewhat familiar in the process. Because of the way many DO schools are setup in terms of rotations all over a state or the country, there is a massive amount of variability even WITHIN a school. This is much less common at MD schools that tend to have a central hospital where most rotations are completed. When you have a central hospital, grading typically becomes more reflective of work done and less subject to individual bias because the programs tend to do more training for faculty on that. I don't know what the case is for your school, but I can tell you that residency programs are not going to be intimately familiar with what happened during your training and are thus going to weight your grades even less than they might an MD with similar grades in general. This is not to mention that grades matter less to psychiatry in general over other specialties, including in the psychiatry clerkship AND that many (if not most by now) schools have done away with the whole concept of high pass and honors. In terms of your overall application, I think you already know it's fine. It's probably average and you have a fair to good chance of matching somewhere in psychiatry assuming you are pleasant and enjoyable at the interview, which is much important than your clerkship grade.

 

[Stagg737]

Good comments above, some specific points as someone who works with sub-i's all the and is involved in the process at a midwest academic center:

Our clinical grades are ~50/50 eval/shelf, and I scored in the 86th percentile for the shelf. Not the best, but that has been more than enough to honor other rotations. I know this of course impacts my competitiveness, but I am curious as to where I might sit overall. For context:

DO student (original 5, if that matters)

3rd quartile (just barely - a gpa drop of .03 put me from 2nd to 3rd) preclinical grades.

86th percentile on the shelf is fantastic, moreso if the the NBME shelves and not NBOME. The HP grade itself isn't going to matter, the question I'd have is if your shelf score was that great, what happened with the eval to bring you down. Probably nothing major since you still got a high pass, but we prioritize applicants with less stellar grades/test scores who are fantastic to work with and TEACHABLE.

Pre-clinical grades are meh. As long as we're confident someone will pass Step/Level 3 and eventually get board certified this is nbd. Depends on the DO school. I'll be honest that we've had several residents from KCOM (the OG) and they seem to struggle significantly more than most other DO students and residents I work with, so I've slowly developed somewhat of a bias/concern there.

Minimal research: 1 psychopharm related poster on ketamine, 1 poster/manuscript on a GI topic, 1 manuscript/presentation on medical education.

This is fine. The fact that you're doing it and it shows some interest in psych is a plus. Nothing stellar, but won't hurt you where I'm at. Only really lacking if you're shooting for a research track or a major research program.

All of my eval comments have been positive (some overwhelmingly positive). The “worst” comment I received was essentially a generic “performed well for a 3rd year, keep reading/studying” on peds, which was my first rotation.

This is great and will go a lot farther than almost anything else. I had 9 ii's when I was applying as a terrible applicant by the numbers, but my LORs and MSPE were glowing to the point that most PDs commented on it. One commented that one of my LORs was one of the best they'd ever seen and a couple said my MSPE comments and LORs were basically the whole reason they interviewed me. As long as your stats are good enough to keep you from getting screened out (which they seem fine), imo this is most important to land interviews and addresses my concern about the HP mentioned above.

No step/comlex 2 until June, which I know may have a big impact.

This doesn't matter. As long as scores are in when you submit your application no one cares.

I am from Wisconsin, and ideally would match at one of the 4 psych programs there, but I will be applying broadly (i.e. to all programs with DOs) throughout the “east north central” and “west north central” regions. So the academic programs I am most interested in are midwest academic (MCW, U Wisconsin, Mayo, U Michigan, U Iowa, etc.), not east/west coast academic.

To be clear - I’m not just gunning for academics. I plan on applying to mostly community programs. I am mainly just curious to see what y’all think about my chances for the academic programs I do apply to.

Others with more connections/experience can chime in here, but I think it's worth applying to all of those. U Mich might be a bit of a reach and Mayo may want more research/activities, but UW, MCW, and Iowa should be within reach. I'd also look into some of the Chicago programs (UIC, Rush, Loyola) if you're willing to live there. Could apply to NW and UChicago too, but those may be a bit of a reach as well.

 

[Merovinge]

Others with more connections/experience can chime in here, but I think it's worth applying to all of those. U Mich might be a bit of a reach and Mayo may want more research/activities, but UW, MCW, and Iowa should be within reach. I'd also look into some of the Chicago programs (UIC, Rush, Loyola) if you're willing to live there. Could apply to NW and UChicago too, but those may be a bit of a reach as well.

There are a lot of really solid programs in the midwest. In addition to all the ones above, I would make sure to consider IU, Ohio programs, UofMinnesota, and at least take a flier on UPMC and WashU, you never know when lightning will strike. Midwestern programs are definitely more interested in people from the Midwest in my experience and we are relatively used to some really solid DO schools in the area.

 

[Stagg737]

There are a lot of really solid programs in the midwest. In addition to all the ones above, I would make sure to consider IU, Ohio programs, UofMinnesota, and at least take a flier on UPMC and WashU, you never know when lightning will strike. Midwestern programs are definitely more interested in people from the Midwest in my experience and we are relatively used to some really solid DO schools in the area.

There are! I forgot Minnesota, definitely worth adding to the list along with some Ohio programs. Didn't include IU, Wash U or a few others because they seem farther south than what OP is looking for and UPMC is great but I don't really consider that midwest, more eastern, definitely not "east north central" like what OP is describing. I'd say that geography is describing WI, MN, western MI and northern Iowa and Chicago area. Plenty of other very solid midwest programs outside that zone like you mention.

 

[PuffBlueCat]

I supervise DO and MD students from different schools so I'm somewhat familiar in the process. Because of the way many DO schools are setup in terms of rotations all over a state or the country, there is a massive amount of variability even WITHIN a school. This is much less common at MD schools that tend to have a central hospital where most rotations are completed. When you have a central hospital, grading typically becomes more reflective of work done and less subject to individual bias because the programs tend to do more training for faculty on that. I don't know what the case is for your school, but I can tell you that residency programs are not going to be intimately familiar with what happened during your training and are thus going to weight your grades even less than they might an MD with similar grades in general. This is not to mention that grades matter less to psychiatry in general over other specialties, including in the psychiatry clerkship AND that many (if not most by now) schools have done away with the whole concept of high pass and honors. In terms of your overall application, I think you already know it's fine. It's probably average and you have a fair to good chance of matching somewhere in psychiatry assuming you are pleasant and enjoyable at the interview, which is much important than your clerkship grade.

This hit close to home - I'm pretty certain there is a ton of variability in my schools rotation sites.... I'd like to think I'm at one of the better ones, but who knows.

Maybe I was especially uninformed, but this variability within a schools rotation sites is a nuance I did not account for when I applied to med school. I'm not sure how a premed student could have any idea how important this could be down the line.

 

[PuffBlueCat]

Good comments above, some specific points as someone who works with sub-i's all the and is involved in the process at a midwest academic center:


86th percentile on the shelf is fantastic, moreso if the the NBME shelves and not NBOME. The HP grade itself isn't going to matter, the question I'd have is if your shelf score was that great, what happened with the eval to bring you down. Probably nothing major since you still got a high pass, but we prioritize applicants with less stellar grades/test scores who are fantastic to work with and TEACHABLE.

Pre-clinical grades are meh. As long as we're confident someone will pass Step/Level 3 and eventually get board certified this is nbd. Depends on the DO school. I'll be honest that we've had several residents from KCOM (the OG) and they seem to struggle significantly more than most other DO students and residents I work with, so I've slowly developed somewhat of a bias/concern there.


This is fine. The fact that you're doing it and it shows some interest in psych is a plus. Nothing stellar, but won't hurt you where I'm at. Only really lacking if you're shooting for a research track or a major research program.


This is great and will go a lot farther than almost anything else. I had 9 ii's when I was applying as a terrible applicant by the numbers, but my LORs and MSPE were glowing to the point that most PDs commented on it. One commented that one of my LORs was one of the best they'd ever seen and a couple said my MSPE comments and LORs were basically the whole reason they interviewed me. As long as your stats are good enough to keep you from getting screened out (which they seem fine), imo this is most important to land interviews and addresses my concern about the HP mentioned above.


This doesn't matter. As long as scores are in when you submit your application no one cares.


Others with more connections/experience can chime in here, but I think it's worth applying to all of those. U Mich might be a bit of a reach and Mayo may want more research/activities, but UW, MCW, and Iowa should be within reach. I'd also look into some of the Chicago programs (UIC, Rush, Loyola) if you're willing to live there. Could apply to NW and UChicago too, but those may be a bit of a reach as well.

NBOME shelf unfortunately 🙄

My preceptor for the rotation was pretty "hands off", and I didn't get much valuable feedback despite being up front with my interest in the specialty and desire to learn. I feel like it was kind of a weird rotation, honestly.

That's good to hear about the MSPE/LORs. I am pretty confident these will be strengths of mine.

Thank you for the input on the programs - that was my feeling with Michigan and Mayo. I neglected to mention the Chicago programs, but I'll be including those as well for sure!

 

[PuffBlueCat]

There are a lot of really solid programs in the midwest. In addition to all the ones above, I would make sure to consider IU, Ohio programs, UofMinnesota, and at least take a flier on UPMC and WashU, you never know when lightning will strike. Midwestern programs are definitely more interested in people from the Midwest in my experience and we are relatively used to some really solid DO schools in the area.

I'll be including most all of those as well when it comes time to apply!

 

[PuffBlueCat]

There are! I forgot Minnesota, definitely worth adding to the list along with some Ohio programs. Didn't include IU, Wash U or a few others because they seem farther south than what OP is looking for and UPMC is great but I don't really consider that midwest, more eastern, definitely not "east north central" like what OP is describing. I'd say that geography is describing WI, MN, western MI and northern Iowa and Chicago area. Plenty of other very solid midwest programs outside that zone like you mention.

I was just basing my geographical preferences on the ERAs regions. I figured I would just apply to all the programs stretching from North Dakota to Kansas to Ohio lol

 

[Merovinge]

I was just basing my geographical preferences on the ERAs regions. I figured I would just apply to all the programs stretching from North Dakota to Kansas to Ohio lol

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Sure every academic program in those regions is a good starting point, you can narrow it down once you actually get interviews. Just throw on UPMC, it's one of the best, if not the best psychiatric training programs in the country. Pittsburg as a city is more Midwestern than East Coast, although certainly a bit of a blend of both.

 

[Stagg737]

I was just basing my geographical preferences on the ERAs regions. I figured I would just apply to all the programs stretching from North Dakota to Kansas to Ohio lol

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There are a lot of solid academic programs in those two areas and a few decent community programs as well. Apply broadly and I would think you will be fine.

 

[SPsych6]

You will be fine. My school didn't even do H/HP etc. I reviewed residency applications as the chief for multiple years and really looked more at the comments/reviews than the grades. I just was making sure you weren't failing rotations. Your personal statement will matter 100x more than your grades. Everything you are doing looks good. You will match unless you interview poorly. You should really just focus on your personal statement and practicing interviews.

 

[FlowRate]

I think it's mainly coming from a DO school (and having a currently unknown step 2 scores) that screens you out of the high end mega-academic places that generally don't take DO's. I feel like you should be a competitive applicant for pretty much everywhere else, as long as you crush step 2 and your LOR's/MSPE are as good as you indicate they should be. The HP grade is not a deal breaker.