If you were a PD who just found out Step 1 became P/F, what metric would you use to replace it?

[Angus Avagadro]

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How do you judge if a person is teachable before actually interacting with them over a long period of time? Can you tell from an applicant's ERAS application + interview?

The answer to each question is you cant. I can only judge that if I have worked with a student on auditions, or one of our students on service. You can get a general idea from someones app , clinical grades, class rank, letters and interviews. Nothing is foolproof, as I've mentioned.

 

[Dral]

Step 2ck.

I would want to know that my residents have the ability to prepare for and comfortably pass a standardized exam since if too many of my residents fail their specialty board exam when finishing residency, my program would come under fire.

Page 32:

https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019.pdf

 

[hallowmann]

They will never release the minimum board score filters because they don’t want transparency in the process. Transparency will show what every suspects - I.e. there are different qualification criteria depending on your educational and gender/race.

The student affairs dean at my school, or whatever his title is, told us they increase the rank order a bit for women and minorities to increase the diversity in the IM program. There’s no way they want the genhey eral public to get a hold of that data. Some people, I.e. conservative media, would interpret the data that some doctors are less qualified than others.

They wouldn't really need to post protective classes though (realistically this shouldn't be a component). We rank people higher because we liked them. That could be because they remind us of us, they have a sense of humor that's compatible, or we think they'll get along well with our other residents. Its not like our program needs to say "must be funny" to reduce

I suspect there is very little correlation between any of these exams and being a good clinician, though I'd be curious to see how step 1 tracks with borad pass rate. Good test takers are good test takers (tautology). Doing well on the exam just means you're organized or smart enough to get all the information in. This in itself is an important thing to know, because in residency you have to assimilate a lot of data.

No one is taking an applicant on the strength of the step 1 score. If you have a hardworking kid who doesn't have that much research from a smaller program that doesn't have much in your specialty. Good grades. Amazing step 1 score... that person still may have a shot at landing at a big program. Without that step 1 score to differentiate that student from the rest, it's tough.

It's like the MCAT or the SAT. The SAT has very little to do with success in college just as the MCAT has very little to do with success in medical school. They're essentially tests of how willing you are to commit yourself to jumping through hoops. But it's an important quality as the in-service, the board exam, fellowship application, buffing your CV for the big academic job... are all exercises in hoop jumping.

Oh I agree, I doubt the correlation is much, I just wouldn't be surprised if its greater than pre-clinical shelf exams.

 

[Mad Jack]

I think around 50% of our residents are either home students or great rotators. Our rank lists typically have the well known students listed very high. There’s just no substitute for the personal knowledge of how someone works.

Granted we all know they’re in audition mode for the month so they are probably showing something better than their average effort, but at least we know what’s possible. That said, we probably offer interviews to 10-20% of rotators because many people manage to slip out of audition mode pretty quickly.

Side note: I’ve looked back at rotators we didn’t like and most all of them have gone on to be successful residents in other programs.

We usually seem to rank one person a year to match that rotated with us because they were a great fit

 

[Mad Jack]

Step 2ck.

I would want to know that my residents have the ability to prepare for and comfortably pass a standardized exam since if too many of my residents fail their specialty board exam when finishing residency, my program would come under fire.

Page 32:

https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019.pdf

In psych, at least, board certification isn't very important so it doesn't tend to matter

 

[Phloston]

How do you judge if a person is teachable before actually interacting with them over a long period of time? Can you tell from an applicant's ERAS application + interview?

Speaks volumes (and reiterates the fact) that how someone comes off matters. Some students fixate on getting pimped on rotations. I did an 8-week endocrine term working 12 hours a day and was pimped maybe 2-3 times the whole term. It all just comes down to how much do you help the team, especially the intern. How willing are you to be a team player and not make it about yourself. People in medicine develop a strong sixth sense for detecting people who are about themselves. Sometimes doesn’t matter how knowledgeable or amazing you are. People want to see students who are competent enough but who are huge team players, actively engage, communicate well, and show interest in investing the time into learning.

 

[Goro]

I'm grateful that our wise resident and attending colleagues have chimed in.

What I am reading in this thread and others is that program directors will need a way to stratify applicants to their programs. It is not going to be based on school prestige. In fact none of them are saying that Prestige is going to be a major consideration, or at the minimum, the only Criterion.

So now the goalposts move from Step 1 to step 2. Regarding the latter, when will we see a Step2 Mania emerge? Who knows??!!

This is something that's going to be anywhere from two to five years into the future.

What we do know was that step 1 Mania was both real, and literally hurting medical students. So something had to change.

Notice that what many commentators who are in the know are also saying? They will be looking for the soft humanistic domains in order to determine who they want to spend the next three to seven years with as part of their team. In this regard what will be important are audition rotations, and letters from people in the field.

So all you new med students to-be, and pre-meds, remember what is on the cover of the Encyclopedia Galactica: "Don't panic!"

 

[Dral]

To drive my point home, in specialties with small programs, like 3 residents per year; if one resident fails one year, and someone also fails the next year, that’s a 33% fail rate two years in a row. Yikes.

I don’t know for sure, but I’m guessing my program could potentially rely more on our home students and rotators (even more than we did before).

School prestige has seemed to be low on our list, and I doubt that will change much.

Nothing is set in stone of course. We have to see how this plays out exactly.

 

[slowthai]

What I'm wondering is, how are programs going to accept rotators for aways in the most competitive fields if they can't even use a step score anymore? Step 2 results will be coming out way too late to even use.

 

[Phloston]

I'm grateful that our wise resident and attending colleagues have chimed in.

What I am reading in this thread and others is that program directors will need a way to stratify applicants to their programs. It is not going to be based on school prestige. In fact none of them are saying that Prestige is going to be a major consideration, or at the minimum, the only Criterion.

So now the goalposts move from Step 1 to step 2. Regarding the latter, when will we see a Step2 Mania emerge? Who knows??!!

This is something that's going to be anywhere from two to five years into the future.

What we do know was that step 1 Mania was both real, and literally hurting medical students. So something had to change.

Notice that what many commentators who are in the know are also saying? They will be looking for the soft humanistic domains in order to determine who they want to spend the next three to seven years with as part of their team. In this regard what will be important are audition rotations, and letters from people in the field.

So all you new med students to-be, and pre-meds, remember what is on the cover of the Encyclopedia Galactica: "Don't panic!"

We’re on the path to breeding the next generation of soft practitioners who can’t handle stress. USMLE mania is actually the best thing going for the US education system right now.

 

[Phloston]

To drive my point home, in specialties with small programs, like 3 residents per year; if one resident fails one year, and someone also fails the next year, that’s a 33% fail rate two years in a row. Yikes.

I don’t know for sure, but I’m guessing my program could potentially rely more on our home students and rotators (even more than we did before).

School prestige has seemed to be low on our list, and I doubt that will change much.

Nothing is set in stone of course. We have to see how this plays out exactly.

No one will overly admit he or she looks at school prestige. Of course they do. And they will.

 

[Phloston]

What I'm wondering is, how are programs going to accept rotators for aways in the most competitive fields if they can't even use a step score anymore? Step 2 results will be coming out way too late to even use.

Students will start listing off the AP exams they scored 5s on.

 

[wondervisions]

Other than platform fights with giant Q-tips. We would all choose that.

CASPer

 

[longhaul3]

What I'm wondering is, how are programs going to accept rotators for aways in the most competitive fields if they can't even use a step score anymore? Step 2 results will be coming out way too late to even use.

Not all programs currently require a Step 1 score for an away rotation. A lot of them are first-come, first-served. And many that require Step 1 are first-come, first-served beyond a trivial benchmark (like 230) that is well below the average matched score for the specialty.

On a side note, I think this does people a disservice at top programs because they will welcome you for a rotation with your 230, but from the beginning you have zero chance to match there. My home program in med school actually had a pretty high cutoff because they didn't want to waste anyone's time. With P/F Step 1 now, this will be moot, and I think most will just be pure first-come, first-served, except a few self-important programs.

Edit: Apologies about saying 230 is trivial, I know it's a fine score, just unrealistically low for these specialties.

 

[deleted947265]

The problem with the bolded is that it disproportionately harms the people at borders (borderline high to mid-tier person, borderline non-matching people). People who are on the edge for competitive programs would be forced to choose "trying for their dream program" or increasing the likelihood of matching with more safeties.

I actually think hard limits on applications could work, but you can't simply restrict applicants and leave the risk completely up to them. They are already more vulnerable than the programs to which they're applying. If you're going to place hard limits on applications, then you should also provide standardized (i.e. easily identifiable) and very transparent minimum interview requirements. If your program isn't going to interview IMGs or DOs, you should say so. If you're not going to consider anyone with a <215 (or 220, or 230, etc) or below, a fail in a board, less than X number of research experiences for interview, then it should be clear on the website or in the application (ERAS could even have a pop-up that asks if you want to continue with an app whose minimum requirements you don't meet). If those filters were made transparent, then I guarantee applications would drop to manageable levels, especially in combination with a limit on application numbers.

Enforcing application limits shouldn't hurt anyone. It's purely designed to force applicants to make sensible decisions. When you limit a resource, you force people to be more thoughtful in how they use that resource. If a person spends their 20 applications applying to programs that are way out of their league in a specialty that's highly competitive and they don't match; it's on them. With no limits they'll just spam applications hoping they get to eat a bowl of lucky charms.

Things like minimum number of research experiences and stuff like could stop some applications but not a lot. I imagine a lot of programs don't have them and probably aren't looking to add them.

 

[hallowmann]

Enforcing application limits shouldn't hurt anyone. It's purely designed to force applicants to make sensible decisions. When you limit a resource, you force people to be more thoughtful in how they use that resource. If a person spends their 20 applications applying to programs that are way out of their league in a specialty that's highly competitive and they don't match; it's on them. With no limits they'll just spam applications hoping they get to eat a bowl of lucky charms.

Things like minimum number of research experiences and stuff like could stop some applications but not a lot. I imagine a lot of programs don't have them and probably aren't looking to add them.

You act like everyone can easily determine whether programs are "out of their league". Have you seen FREIDA or residency program websites anytime recently? Things are outdated or simply lacking in information. You're talking about something that is difficult to navigate even if you know the system well. I thought a lot of programs were "out of my league" when I applied. I interviewed at most and matched at one. How can you easily determine this if programs don't provide truly minimum interview requirements?

I will add that advising on this topic from schools is wildly variable. I'm not really sure you can 100% fault someone for applying "out of their league" when they are slightly below the cutoffs that programs don't even advertise. Sure, could they have applied to weaker programs that never fill to make sure they match, yeah, but that also means less applications for reaches and less spots to weaker applicants at the weaker programs.

 

[longhaul3]

You act like everyone can easily determine whether programs are "out of their league". Have you seen FREIDA or residency program websites anytime recently? Things are outdated or simply lacking in information. You're talking about something that is difficult to navigate even if you know the system well. I thought a lot of programs were "out of my league" when I applied. I interviewed at most and matched at one. How can you easily determine this if programs don't provide truly minimum interview requirements?

I will add that advising on this topic from schools is wildly variable. I'm not really sure you can 100% fault someone for applying "out of their league" when they are slightly below the cutoffs that programs don't even advertise. Sure, could they have applied to weaker programs that never fill to make sure they match, yeah, but that also means less applications for reaches and less spots to weaker applicants at the weaker programs.

Yup. It's hard to know about programs until you're part of the field, which is obviously too late. In some small specialties there are a bunch of seemingly random programs that are great and super competitive because the chair is a world famous guy from India or Jordan or somewhere who happened to land there when he got to the US and ended up building the department into a powerhouse. Hard to know about things like that unless you are plugged in.

 

[Oedipa Maas]

You act like everyone can easily determine whether programs are "out of their league". Have you seen FREIDA or residency program websites anytime recently? Things are outdated or simply lacking in information. You're talking about something that is difficult to navigate even if you know the system well. I thought a lot of programs were "out of my league" when I applied. I interviewed at most and matched at one. How can you easily determine this if programs don't provide truly minimum interview requirements?

I will add that advising on this topic from schools is wildly variable. I'm not really sure you can 100% fault someone for applying "out of their league" when they are slightly below the cutoffs that programs don't even advertise. Sure, could they have applied to weaker programs that never fill to make sure they match, yeah, but that also means less applications for reaches and less spots to weaker applicants at the weaker programs.

Agree, I struggled with this a lot as an applicant. Looking at my scores and number of experiences “as compared to matched applicants” on Residency Explorer - some of my breakdowns for programs are the exact same yet I received invites to some and not others. I was also not invited to a single program where I had stats/experiences that were outliers in a positive direction. So how does someone like me choose their 20 programs if I am apparently hopelessly wrong about what a “safety” is and my target programs seemed to be looking at one or more intangible metrics? On one hand, an overall limit may help because programs may see “interest” as one of these metrics and knowing they are 1/20 could indicate that. On the other, I really do not think there is enough information out there for applicants to make truly informed decisions with a limit.

 

[longhaul3]

Agree, I struggled with this a lot as an applicant. Looking at my scores and number of experiences “as compared to matched applicants” on Residency Explorer - some of my breakdowns for programs are the exact same yet I received invites to some and not others. I was also not invited to a single program where I had stats/experiences that were outliers in a positive direction. So how does someone like me choose their 20 programs if I am apparently hopelessly wrong about what a “safety” is and my target programs seemed to be looking at one or more intangible metrics? On one hand, an overall limit may help because programs may see “interest” as one of these metrics and knowing they are 1/20 could indicate that. On the other, I really do not think there is enough information out there for applicants to make truly informed decisions with a limit.

You hit on part of what I see as the ultimate result here. The reason weaker applicants have to apply to so many programs is that the interview yield per application is low, but that's because the better applicants are still also applying to the same programs. If the top people are limited, they won't want to apply to as many mid- or low-tier programs, and those programs will have fewer applications, mostly from the same kind of applicants who they typically match every year anyway. The yield per app will increase, and every program will interview a more homogeneous group. Everyone will go on fewer interviews with a similar overall match outcome. Some people will get shut out because they applied to the wrong programs.

 

[Dantrolene FC]

Enforcing application limits shouldn't hurt anyone. It's purely designed to force applicants to make sensible decisions. When you limit a resource, you force people to be more thoughtful in how they use that resource. If a person spends their 20 applications applying to programs that are way out of their league in a specialty that's highly competitive and they don't match; it's on them. With no limits they'll just spam applications hoping they get to eat a bowl of lucky charms.

Things like minimum number of research experiences and stuff like could stop some applications but not a lot. I imagine a lot of programs don't have them and probably aren't looking to add them.

I disagree with the application limits.

In terms of board scores, I’m like 2-3 points below average for my field of choice. Nothing really sets me apart on my application - no real research, honors in one rotation, no awards in med school, etc.

I applied to programs I thought I’d be competitive for and a couple regional programs that I would consider safety programs. Then I applied to about 15 top programs that I never dreamed I would have gotten interviews offers from, but I ended up getting 4 of those interviews which are my top 4 programs on my rank list.

If we had application limits, I would not have had the privilege to interview at these programs nor the opportunities to try and match there because I would have never applied.

Where else in life do we limit applications? Nobody limits the amount of undergrads or med schools you apply to. What if they limited the amount of attending positions you can apply to as a soon to be graduating resident/fellow? What if someone said you could only apply to 3 attending jobs? That would suck big time.

 

[Dral]

No one will overly admit he or she looks at school prestige. Of course they do. And they will.

Not exactly. If you look at our program, we do not get the MD/PhD, top 25, big name high power research med school types as residents. Thusly, we don't typically look at that as a metric for inviting for interviews since we find that those types of applicants do not typically rank us nor do they end up here (predominantly by their choice).

Thus, we tend to invite from a different applicant pool. We get perfectly good, smart excellent residents from mid to lower tier schools. Do we get some top 25 applicants through here? Sure, but maybe 1 or so out of 15 or 20 students who interview.

If you are saying in general people use it as a metric, then sure...all else equal in a vacuum I would choose the UPenn over a mid tier school. In practice...not always.

The program I'm at is a solid program, but not a big name program. It goes both ways...med students choose us based on the same principles ('big name'/prestige), whether correctly or incorrectly. If a Yale med student has us and NYU to choose between, they'll often likely rank NYU higher based on prestige. Those students often end up at NYU instead of here.

If one kept inviting Harvard applicants and they would come interview but never end up at your program, you would probably stop inviting as many Harvard applicants eventually. Why use up all our interview spaces for applicants who probably won't end up wanting to come to our program when we can invite and choose from a larger interview pool of great students from mid or lower tier schools who are more likely to end up here.

 

[Espressso]

I disagree with the application limits.

In terms of board scores, I’m like 2-3 points below average for my field of choice. Nothing really sets me apart on my application - no real research, honors in one rotation, no awards in med school, etc.

I applied to programs I thought I’d be competitive for and a couple regional programs that I would consider safety programs. Then I applied to about 15 top programs that I never dreamed I would have gotten interviews offers from, but I ended up getting 4 of those interviews which are my top 4 programs on my rank list.

If we had application limits, I would not have had the privilege to interview at these programs nor the opportunities to try and match there because I would have never applied.

Where else in life do we limit applications? Nobody limits the amount of undergrads or med schools you apply to. What if they limited the amount of attending positions you can apply to as a soon to be graduating resident/fellow? What if someone said you could only apply to 3 attending jobs? That would suck big time.

You're missing the point of why programs have turned to Step 1 as such a filter for reviewing apps... it's because they're getting so many applications. And that sheer volume can and would be reduced if there were application limits. And Step 1 becoming a filter for programs is what drove the step 1 mania. There really isn't an adequate long-term solution when it comes to Med Ed and Residency applications without the addition of limits on applications.

 

[Dantrolene FC]

You're missing the point of why programs have turned to Step 1 as such a filter for reviewing apps... it's because they're getting so many applications. And that sheer volume can and would be reduced if there were application limits. And Step 1 becoming a filter for programs is what drove the step 1 mania. There really isn't an adequate long-term solution when it comes to Med Ed and Residency applications without the addition of limits on applications.

They could just make it harder to apply to programs. There’s no way I would have applied to as many programs if I had to write secondary applications and mail them through snail mail.

 

[AnatomyGrey12]

I disagree with the application limits.

In terms of board scores, I’m like 2-3 points below average for my field of choice. Nothing really sets me apart on my application - no real research, honors in one rotation, no awards in med school, etc.

I applied to programs I thought I’d be competitive for and a couple regional programs that I would consider safety programs. Then I applied to about 15 top programs that I never dreamed I would have gotten interviews offers from, but I ended up getting 4 of those interviews which are my top 4 programs on my rank list.

If we had application limits, I would not have had the privilege to interview at these programs nor the opportunities to try and match there because I would have never applied.

Where else in life do we limit applications? Nobody limits the amount of undergrads or med schools you apply to. What if they limited the amount of attending positions you can apply to as a soon to be graduating resident/fellow? What if someone said you could only apply to 3 attending jobs? That would suck big time.

I think any application limit would have to be a healthy number, like 50-60. So people can still throw out apps at reach places like you mention.

 

[NotAProgDirector]

So all you new med students to-be, and pre-meds, remember what is on the cover of the Encyclopedia Galactica: "Don't panic!"

I am disappointed. This is completely incorrect.

In many of the more relaxed civilizations on the Outer Eastern Rim of the Galaxy, the Hitchhiker’s Guide has already supplanted the great Encyclopaedia Galactica as the standard repository of all knowledge and wisdom, for though it has many omissions and contains much that is apocryphal, or at least wildly inaccurate, it scores over the older, more pedestrian work in two important respects.

First, it is slightly cheaper; and second, it has the words "DON'T PANIC" inscribed in large friendly letters on its cover.

— Adams, The Hitchhiker's Guide to the Galaxy (1979)

 

[Goro]

I am disappointed. This is completely incorrect.

Failing memory!
For those of you who never read the Douglas Adams books, you are indeed missing something!!!

 

[Espressso]

They could just make it harder to apply to programs. There’s no way I would have applied to as many programs if I had to write secondary applications and mail them through snail mail.

Like @AnatomyGrey12 said, 50-60 programs would be reasonable. That's a lot of programs for most people, but you could apply to less if you want. It still gives you room to apply to a bunch of reaches as well as programs that are more of a "lock". And it forces applicants to do more homework prior to applying.

 

[3characterslong]

Step 2 is the obvious answer. You need an objective, numerical stratification tool to deal with thousands of applications. Its that simple.

When CK goes P/F, it will come down to school prestige. No one uses the word "prestige" in a good context anymore, but its true. Key phrases: "LoRs from people I know" - AKA famous AKA from JH,. Use your brain people. Pub quantity and quality will be bonus points, which people at top tier academic sites will have better access to. Harvard already scoops up all the fascinating geniuses who got out of Uruguay before the Massacre of 1995, so the PSs are going to be one sided too. At the end of the day, Joey from Podunksville who trained at South Dakto School of Osteopathic Medicine just isn't going to be able to match into Ortho Surgery, even with an IQ of 190; thats the future.

You're a ***** if you think anyone is pouring through 3000 LoRs to hunt down something as ambiguous as "soft praise". You're an even bigger ***** if you think that information is meaningful for 90%+ of applicants.

 

[slowthai]

Like @AnatomyGrey12 said, 50-60 programs would be reasonable. That's a lot of programs for most people, but you could apply to less if you want. It still gives you room to apply to a bunch of reaches as well as programs that are more of a "lock". And it forces applicants to do more homework prior to applying.

I totally agree, but man. In 2018, the average number of apps sent out was 90. That's ridiculous. I wonder if most people would think 50-60 would be reasonable given that statistic.

 

[watermelon master]

Not exactly. If you look at our program, we do not get the MD/PhD, top 25, big name high power research med school types as residents. Thusly, we don't typically look at that as a metric for inviting for interviews since we find that those types of applicants do not typically rank us nor do they end up here (predominantly by their choice).

Thus, we tend to invite from a different applicant pool. We get perfectly good, smart excellent residents from mid to lower tier schools. Do we get some top 25 applicants through here? Sure, but maybe 1 or so out of 15 or 20 students who interview.

If you are saying in general people use it as a metric, then sure...all else equal in a vacuum I would choose the UPenn over a mid tier school. In practice...not always.

The program I'm at is a solid program, but not a big name program. It goes both ways...med students choose us based on the same principles ('big name'/prestige), whether correctly or incorrectly. If a Yale med student has us and NYU to choose between, they'll often likely rank NYU higher based on prestige. Those students often end up at NYU instead of here.

If one kept inviting Harvard applicants and they would come interview but never end up at your program, you would probably stop inviting as many Harvard applicants eventually. Why use up all our interview spaces for applicants who probably won't end up wanting to come to our program when we can invite and choose from a larger interview pool of great students from mid or lower tier schools who are more likely to end up here.

Just curious if a top 25 applicant interviews at your program and you don't think they are going to rank your program highly just on your perceived prejudices about them - does this change the way you rank them? Or do you rank applicants in order of your preference? Do you care where you "fall down" in your rank list?

 

[slowthai]

Very very interesting data. No surprise that ortho's been at or near the top for 5 straight years. Also heard that uro was particularly tough this last match; it was at the top according to this table, so it makes sense. Amazing that any surgical field made it into the top 5 for IMGs, especially nsx, uro, and ortho. These people must have just been hail-marying it up, lol.

On the fellowship side, it's interesting how you see almost a doubling in the numbers for IMGs vs AMGs. Not surprising, for obvious reasons. Also found the GI and cards switching places from the AMG cohort to the IMG cohort to be funny.

Taken from here: ERAS Statistics

 

[Espressso]

I totally agree, but man. In 2018, the average number of apps sent out was 90. That's ridiculous. I wonder if most people would think 50-60 would be reasonable given that statistic.

That's even more reason to do it. Especially if step 2 goes to p/f which it probably will.

 

[slowthai]

Relevant 2018 paper: Drivers of Application Inflation: A National Survey of Internal Medicine Residents

"When asked to assess the influence of various factors on deciding the total number of residency applications to submit, respondents most frequently cited talking with peers (39%), talking with recent graduates of the same medical school (35%), and fear of not matching (34%) as “very influential” (Table 1). Factors most often rated “not at all influential” included advice from a local internal medicine program director (24%), advice from the dean's office (24%), and advice from the medicine clerkship director (23%)."

Love this, lol

 

[Dral]

Just curious if a top 25 applicant interviews at your program and you don't think they are going to rank your program highly just on your perceived prejudices about them - does this change the way you rank them? Or do you rank applicants in order of your preference? Do you care where you "fall down" in your rank list?

If someone interviews at our program we really focus on fit. A top 25 person who meshes with a lot of the faculty has just as much of a chance as being ranked number one as anyone else. Once someone interviews I feel we’re pretty good at ranking on preference without bias of how we feel an applicant will rank us.

 

[DubbiDoctor]

Students should report their shelf percentiles and their Step 2 CK score. This would provide an, albeit imperfect, standardized evaluation of clinical knowledge that doesn't depend on one performance. So if you have a bad day on CK and score 40th percentile, but your average shelf is 75th percentile, residencies can take that into consideration. Obviously, this would just serve as a screening tool. For selecting whom residencies rank among those they interviewed, research, fit, etc will matter more.

Edit: I don't agree with the suggestion to report preclinical NBME exams, because the preclinical component of medical school should be de-emphasized. If we're going to be evaluated on our test taking skills, it should at least be a clinically oriented test - not how well do you know the details of glycolysis or what percentage of K+ is reabsorbed in the proximal tubule? Hopefully, step 1 going pass/fail will encourage more schools to switch to a one year preclinical curriculum. 2 years in the classroom is not necessary and won't make us better physicians.

 

[Phloston]

Not exactly. If you look at our program, we do not get the MD/PhD, top 25, big name high power research med school types as residents. Thusly, we don't typically look at that as a metric for inviting for interviews since we find that those types of applicants do not typically rank us nor do they end up here (predominantly by their choice).

Thus, we tend to invite from a different applicant pool. We get perfectly good, smart excellent residents from mid to lower tier schools. Do we get some top 25 applicants through here? Sure, but maybe 1 or so out of 15 or 20 students who interview.

If you are saying in general people use it as a metric, then sure...all else equal in a vacuum I would choose the UPenn over a mid tier school. In practice...not always.

The program I'm at is a solid program, but not a big name program. It goes both ways...med students choose us based on the same principles ('big name'/prestige), whether correctly or incorrectly. If a Yale med student has us and NYU to choose between, they'll often likely rank NYU higher based on prestige. Those students often end up at NYU instead of here.

If one kept inviting Harvard applicants and they would come interview but never end up at your program, you would probably stop inviting as many Harvard applicants eventually. Why use up all our interview spaces for applicants who probably won't end up wanting to come to our program when we can invite and choose from a larger interview pool of great students from mid or lower tier schools who are more likely to end up here.

Good insights here.

 

[Phloston]

Not all programs currently require a Step 1 score for an away rotation. A lot of them are first-come, first-served. And many that require Step 1 are first-come, first-served beyond a trivial benchmark (like 230) that is well below the average matched score for the specialty.

On a side note, I think this does people a disservice at top programs because they will welcome you for a rotation with your 230, but from the beginning you have zero chance to match there. My home program in med school actually had a pretty high cutoff because they didn't want to waste anyone's time. With P/F Step 1 now, this will be moot, and I think most will just be pure first-come, first-served, except a few self-important programs.

Edit: Apologies about saying 230 is trivial, I know it's a fine score, just unrealistically low for these specialties.

Also good insights. If someone wants to match at your program they’ll be enthusiastic enough to rotate there and be first to get their feet in the door.

 

[deleted947265]

I disagree with the application limits.

In terms of board scores, I’m like 2-3 points below average for my field of choice. Nothing really sets me apart on my application - no real research, honors in one rotation, no awards in med school, etc.

I applied to programs I thought I’d be competitive for and a couple regional programs that I would consider safety programs. Then I applied to about 15 top programs that I never dreamed I would have gotten interviews offers from, but I ended up getting 4 of those interviews which are my top 4 programs on my rank list.

If we had application limits, I would not have had the privilege to interview at these programs nor the opportunities to try and match there because I would have never applied.

2-3 points below average isn't anything to be worried about lmao. If you were a ten points below average then maybe I guess. Even with application limits you could've applied to some of those programs just not 15. There wouldn't be any harm in applying to 3-4 and then sending the rest to other programs.

Where else in life do we limit applications? Nobody limits the amount of undergrads or med schools you apply to. What if they limited the amount of attending positions you can apply to as a soon to be graduating resident/fellow? What if someone said you could only apply to 3 attending jobs? That would suck big time.

Nowhere, but there's a time and place for everything. There is no limit on the number of undergrad schools you can apply to because its just not an issue. Who is out there applying to 20 colleges? My college has a 71% acceptance rate. My application essay was literally "My checks clear".

I think there should be a limit on the number of med schools you can apply to per cycle. But my reason ties back to the exact same issue. Medical school admissions, like residency is far too competitive, there are too few slots, and too many applicants. It has created an arms race that's hurting adcoms and applicants alike. It doesn't have to be brain surgery to figure out of how many people you have acceptances to, how many are actually going to go to your school, but that's what med school admissions deans have to do because AAMC. Adcoms and residency directors shouldn't have to look at someone's application and wonder if the applicant is seriously considering their program.

Here's the problem with application fever:

Let's assume for the sake of argument we have a 100 spots available at different programs and 150 applicants. The applicants have a rating on average of 25 with a standard deviation of 25/3. Let's assume a gap of one half the SD between applicants predicts that a program will rank the higher rated applicant over the lower rated one 65% of the time. We could probably apply the same rating to the programs as well, the higher rating the program, the higher an applicant will generally rank them.

Realistically, the more competitive applicant you are, the less you have to worry about matching. However for people in the middle or lower end of the spectrum, it is highly advantageous to send as many applications as you can because you could always have the case where you get ranked higher than the lower ranked person. Now this is all fine, to a point. The issue that you get in this scenario is people at all ends of the spectrum applying everywhere. That's where we're at with residency applications have been. Since everyone else is applying to a bunch of programs, you have to as well because you could get very unlucky and just lose out on a bunch of positions. So you throw out a bunch of applications to lower tiered programs so if you get shut out at a program you should be competitive for at least you'll match there.

It wouldn't be a problem if it didn't cost time, money, or resources for the applications to be reviewed, but it does. This just floods the system with nonsense. Sure even with limits they're going to get applications where they say "Why did this person apply here?". The match rate for orthopedic surgery has only decreased 4% since 2005, but the number of applications on average has increased by 32. The average program receives 600 applications for what... 8 slots? It's not beneficial to applicants, any more money you spend on applying to programs you don't need is a waste of your money and a PD's time. You can only go to one place.

All it does is make the AAMC a ton of money.

 

[popopopop]

Students should report their shelf percentiles and their Step 2 CK score. This would provide an, albeit imperfect, standardized evaluation of clinical knowledge that doesn't depend on one performance. So if you have a bad day on CK and score 40th percentile, but your average shelf is 75th percentile, residencies can take that into consideration. Obviously, this would just serve as a screening tool. For selecting whom residencies rank among those they interviewed, research, fit, etc will matter more.

Edit: I don't agree with the suggestion to report preclinical NBME exams, because the preclinical component of medical school should be de-emphasized. If we're going to be evaluated on our test taking skills, it should at least be a clinically oriented test - not how well do you know the details of glycolysis or what percentage of K+ is reabsorbed in the proximal tubule? Hopefully, step 1 going pass/fail will encourage more schools to switch to a one year preclinical curriculum. 2 years in the classroom is not necessary and won't make us better physicians.

My school reports our shelf percentiles on our MSPE and honors is determined by how we do on our shelf and evals. It's a bit unfair since hours vary wildly on rotations between students. You might get an attending or team that just lets you off hours before other students on the same service, thus allowing you to study much more.

 

[Mr.Smile12]

Scores from the standardized video interview for all residency applicants.. at least to add to the mix. (At least interested in getting feedback about how that pilot was received.)

Some element of AI or applicant tracking system to analyze essays and LORs.

 

[AnatomyGrey12]

Scores from the standardized video interview for all residency applicants.. at least to add to the mix. (At least interested in getting feedback about how that pilot was received.)

Some element of AI or applicant tracking system to analyze essays and LORs.

My understanding is the video interview pilot was an absolute disaster.