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Impact of multiple failed pre-clerkships

Discussion in 'Medical Students - MD' started by MusicalMed, Oct 14, 2016.

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  1. MusicalMed

    MusicalMed 5+ Year Member

    I've struggled greatly over the last year of medical school, and am now in my second year. Every other quarter, I have had a failing grade, and this first one of this year I had multiple. I have successfully remediated each time, however, and have not had to repeat a year. I know some schools, if successful remediation occurs, replace your grade, but that is not how I believe it works at my school. How may this impact me in the future? And better yet, can I come back from it? What are the best ways I can damage control? My primary interests right now (which I know are open to change) in order are:

    1. PM&R
    2. Psychiatry
    3. Internal Medicine - possibly to Cardio
    4. Anything eventually stemming to Sports Medicine, aside from Family Med

    Any and all constructive help would be appreciated.
     
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  3. Goro

    Goro Faculty 7+ Year Member

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    Where's @aProgDirector when you need him?

     
    Last edited: Oct 16, 2016
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  4. Jabbed

    Jabbed 2+ Year Member

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    The larger issue going forward is whether or not you will continue to fail in the clerkship years/step I. Something has obviously been going consistently wrong for you the past 2 years. Have you met with your academic counseling services/tutoring department? It sounds like you would benefit from an individualized learning plan.

    Second, find out how your failures will be reported on the MSPE. Ask your counselor.

    Assuming that you pass step I and with zero clerkship failures..
    1. Psych: will take you if you have a pulse
    2. PM&R: will take you even if you don't have a pulse
    3. IM: tougher depending on steps and clerkships; definitely in the ballpark for an okay program with fellowship potential if you pull your act together for step/clerkship
     
  5. ActinicKeratosis

    ActinicKeratosis

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    I'm sorry that you have been struggling. Have you been able to identify why you have been failing? Is it being overwhelmed? Not enough time to learn the material?
     
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  6. MusicalMed

    MusicalMed 5+ Year Member

    Yeah, I have continued to meet with them, but this time around I feel way more confident with my current tutor, as well as a better plan. As long as I can keep that up, I don't foresee any further difficulty, and any further review should only further my Step 1 score (I hope). I also have some pretty significant clinical experience, so I feel fairly at home in the hospital (and also have a slight idea of what's coming since I was with med students pretty often at work). Hopefully that translates well into clerkship grades.

    Haha, yes, thankfully my interests don't really lie in the super-competitive fields. Thank you for your input, @Jabbed , that at least gives me some hope if I can keep on the up and up.

    @ActinicKeratosis , I think I've just had resource overload as a main problem. Spreading myself too thin over various books/resources instead of just really nailing down a few. The second failure was due mostly to health problems, but does not explain the other 2 sub-par quarters, which were more from what I said a couple sentences ago. After talking with someone about it, I'm just focusing on really understanding a few resources instead of going over so many that I can't keep myself together. Hopefully that plan works.
     
  7. RangerBob

    RangerBob Not a real ranger... 5+ Year Member

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    Ouch :( Everyone always picks on psych and PM&R... Fortunately I love my field and yes, we do have a bit of a self-image/confidence problem, in large part because so many people still don't know what we do (or that we exist...), or that there's an "&" in our abbreviation (I see too many notes saying "will consult PMnR.")

    The joke I used to hear was if you spoke English and had a pulse we'd take you, but that was referring to the field back in the 80's and 90's. Back in those days our field was filled with IMG/FMGs, people that failed to match ortho (PM&R was the back-up plan for many of them), and a few people genuinely interested in rehab. It was truly a non-competitive field. We just weren't well known.

    I applied a few years ago when it was a bit less competitive, but it's a hard field to match into now just by virtue of the number of graduating US MD/DO's who want to go into the field and the lack of positions. Roughly 89-93% of US seniors applying to only PM&R get a spot (compared to 98% of US seniors applying to IM, 93-97% applying to EM, etc.). Fortunately (for applicants) our board scores remain low--I think we're the second to lowest scores, after psych, so it's easy to stick out of the crowd if you do well academically. In addition, that makes our field a little more forgiving of academic mistakes. The big key is applying to enough programs, which will be more important with red flags.

    Psych seems to be getting slightly more popular, but like PM&R, scores are still generally low and genuine interest in the field and a personable affect really go a long way. Now is a good time to find mentors in the fields you're interested in--the easiest program to get into is typically your home program, and mentors can also guide you when it comes to clerkship performance and residency applications.

    If the OP gets their act together and does not fail any future classes, passes Step 1 and 2 on the first try, they should be able to find a position (assuming they apply to enough programs) in any of the fields they mention--it's definitely doable. While most programs could probably care less about pre-clinical grades, multiple failed pre-clinical courses is still going to be a red flag. That's why it's so critical to not fail anything else going forward and avoid any future red flags. At least for PM&R and psych, strong clinical scores and strong USMLE scores (aim for above average) should more than make up for the failed pre-clinical courses.
     
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  8. Jabbed

    Jabbed 2+ Year Member

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    Perhaps I was a little glib, but I didn't mean any offense to the field itself or its practitioners.

    (Unfortunately, I also fall into the ignorant crowd, although I do remember the & at least..)
     
  9. RangerBob

    RangerBob Not a real ranger... 5+ Year Member

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    That puts you ahead of senior neurosurgery residents!

    I realize you meant no offense--your earlier post was kind of funny.
     
  10. quickfeet

    quickfeet Smooth Operator 5+ Year Member

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    This is an OCD behavior that I myself have.

    Along with your mention about health problems, have you been evaluated for mental illness?
     
  11. quickfeet

    quickfeet Smooth Operator 5+ Year Member

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    I still don't know what PM&R does.

    I get pain medicine. But that I thought that was more anesthesiology. I also get addiction medicine/psych, but that seems to be subspecialty of psychiatry, and then a more purely medicine-based one that is a subspecialty of internal medicine...
     
  12. RangerBob

    RangerBob Not a real ranger... 5+ Year Member

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    pmr2.jpg

    The one-liner is PM&R is the subspecialty dedicated to the treatment and diagnosis of people with disabling conditions, with an emphasis on restoring/maximizing function. We do MSK, pain, sports medicine, ortho/stroke/amputee/SCI/TBI rehab (inpatient and outpatient), among other things.

    Pain is a board-certified sub-specialty of PM&R (and anesthesia, among others. Even psych can apply for pain medicine fellowships). Most fellowships tend to be anesthesia-run, some are more PM&R dominant. PM&R-trained pain physicians tend to treat more holistically, better understand the place of PT/OT (and thus how to write a therapy prescription--you don't write to your pharmacist for "antihypertensive medications--eval and treat" after-all.) Anesthesia-trained pain physicians tend to be better when it comes to the more complex procedures. The fellowship helps even things out a bit, but you're still going to have the foundation of whatever residency you did.

    Addiction medicine/psych as specialties don't have any relation to PM&R (aside from us still dealing a lot with psych and addition issues), except that pretty much any specialty, including PM&R, can apply for most addiction medicine fellowships. Addiction psych fellowships are open only to psych grads as far as I know.
     
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  13. MusicalMed

    MusicalMed 5+ Year Member

    Yes - I'm currently receiving help, but being newly diagnosed (this past winter) with something has definitely impacted me overall. I've been on the up and up, but it's been a huge battle. I've got an exceedingly good support system, as well.
     
  14. MusicalMed

    MusicalMed 5+ Year Member

    Thank you for your response @RangerBob . With my new study plan, I'm more than confident that I can stay on the straight and narrow throughout the rest of my second year. Traditionally, my school does very well on STEP 1. Hopefully if I keep up the pace and get back with the pack, I can hopefully keep moving forward.

    I also submitted some summer research I did with PM&R for a convention in May, so I hope that all things work out with that. At the bare minimum I will have the opportunity to at least present a poster.
     
  15. twospadz

    twospadz 2+ Year Member

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    Throughout your medical school career, people will give you bad advice or a false sense of security when it comes to matching, steps, rotations, or classes. This is one of those instances. If you look at the Charting outcomes for Us grades, a decent amount did not match into psych. Psych has gotten much more competitive. Honestly, if you look at step score between 221-230, 15 people did not match for psych. If you compare this to Anesthesiology, everyone matched with that step score. Or Diagnostic radiology, only 1 person didn't match. Like I said, people will give you bad advice and it will be really mess you up in the long run.
     

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  16. Jabbed

    Jabbed 2+ Year Member

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    Step score sub-200: >75% chance of matching
    200-210: ~90% chance of matching

    I mistook a passing score as 200 (apparently it's 192). Even then, I don't see how "fix your study habits and you will be okay" is necessarily bad advice.

    Perhaps I should incorporate confidence intervals into any future advice posts.
     
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  17. RangerBob

    RangerBob Not a real ranger... 5+ Year Member

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    I don't think Jabbed is giving the OP a false sense of security (aside from joking about being able to match PM&R if you're a zombie--but zombies are all the fad these days). The bottom line is the OP should do as well as they can from here on out--if they get average grades and don't fail anything else they can absolutely match into psych, PM&R, or IM. I know plenty of people who matched psych or PM&R with failed board scores--the key is applying/interviewing broadly enough when you have those red flags. (And the OP's red flags are still fairly small--they're nothing compared to failed clerkships or USMLEs)

    If a med student with a Step 1 score of 221-230 (avg score for a matched applicant to psych is 224) does not match psych, there's a very good reason for it, and it's likely interpersonal-related (or that the applicant had other red flags, didn't rank enough programs, etc.). Psych programs generally are looking for applicants who are genuinely interested in the field, a good fit, and can work with others and will be more forgiving of scores and weigh the interview more heavily compared to other specialties (not unlike PM&R)

    According to the Charting Outcomes in the Match, if the OP applied to and ranked 12 psych programs he/she has a near 98% chance of matching. It would not be difficult at all to arrange for 12 psych interviews if the OP applied broadly enough. The same goes for PM&R, but requires more programs for that same 98% chance of matching. I didn't look up the stats for IM but I'm guessing it's less than 12.

    OP--do your best from here on out. Try to get at least average scores, including on Step 1 and 2 (higher is always better--learn as much as you can now because it only makes you a better physician and will open more doors). If you can do that, and you're a easy person to talk and and personable, you won't have any problem getting into PM&R, psych, or IM. Good work on the PM&R research by the way--that will definitely help if you apply to PM&R.
     
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  18. Seroquel

    Seroquel

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    Yes, to reiterate: psych does NOT just take anyone with a pulse, by and large. It absolutely has gotten much more competitive and my school had at least 1 or 2 people not match last year despite having solid applications. Do as well as you can going forward and hopefully you can match into the specialty that you really want.
     
  19. Psai

    Psai Account on Hold Physician 2+ Year Member

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    Everyone thinks that their field has gotten much more competitive. I really don't think so.
     
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  20. FiveOClock

    FiveOClock 2+ Year Member

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    Screen Shot 2016-10-22 at 10.03.56 AM.png
     
  21. Seroquel

    Seroquel

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    Not saying psych is the new plastics but it's misleading to tell someone not to worry about failing and that psych is so easy to match into. It's not true anymore.
     
  22. Psai

    Psai Account on Hold Physician 2+ Year Member

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    You should probably have someone look at that for you then.
     
  23. firstaidforever

    firstaidforever

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    You also have to account for self selection as well. I doubt most students with a 221-230 and red flags would consider applying to gas/rads.
     
  24. twospadz

    twospadz 2+ Year Member

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    I know one guy who matched into radiology last year who failed step 1. Also, know a few in people who applied and applying this year to anesthesiology with low steps scores. So maybe not most, but more than you would expect.
     
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  25. Seroquel

    Seroquel

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    I know of 2 such individuals who matched last year into anesthesiology, both into solid programs. Actually the first person has a step 1 of 205.
     
  26. zyxab

    zyxab 2+ Year Member

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    And there are probably hundreds of students like that who matched into psych. All specialties are more competitive than they used to be, but psych is still among the least competitive.
     
  27. W19

    W19 SDN Gold Donor Gold Donor Classifieds Approved 2+ Year Member

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    There should be uniformity in how schools report successful remediation... If you successfully remediate at my school, you just got a 'C' grade and your transcript does not even indicate that you remediate the class... Is it fair to the students who passed the class with a C without remediation?

    As far as your chances to match, I think you should put your effort in matching into IM; PM&R and Psych are getting competitive because of the fewer spot that these specialties have...
     
  28. Taddy Mason

    Taddy Mason 30 Helens agree Bronze Donor Classifieds Approved

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    Just quit with this crap, please.
     
  29. W19

    W19 SDN Gold Donor Gold Donor Classifieds Approved 2+ Year Member

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    What did I say here that is wrong?
     
  30. Taddy Mason

    Taddy Mason 30 Helens agree Bronze Donor Classifieds Approved

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    You know perfectly well.
     
  31. W19

    W19 SDN Gold Donor Gold Donor Classifieds Approved 2+ Year Member

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    You guys/gals think I am trying to strike fear into members here when I am simply reporting what I see in the last charting the outcomes of the match...

    It's easier to match into IM than psych or PM&R based on the last charting the outcome
     
  32. Taddy Mason

    Taddy Mason 30 Helens agree Bronze Donor Classifieds Approved

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    Then work on your analysis/interpretation skills if that is truly the case.
     
  33. Syncrohnize

    Syncrohnize Probationary Status Gold Donor Classifieds Approved 5+ Year Member

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    Psychiatry...or maybe possiblly Cardiology


    Sent from my iPhone using SDN mobile
     
  34. MusicalMed

    MusicalMed 5+ Year Member

    Thank you all for your posts. I wanted to keep you all up to date with what has happened since my original post. I unfortunately ended up failing one more pre-clerkship exam, but successfully remediated it.

    Ever since then, however, I have been a better student (what is now over a year later). I passed the last 2 quarters of my second year just fine, and I ended up in the 220s for Step 1 (first and thankfully only time taking that test). Third year has been treating me well, with an honors in a pathology elective as my first class, passing Family Medicine and Ob/Gyn so far (with multiple exemplary/honors evals from each clerkship). Unfortunately, not CRUSHING shelf exams, but at least passing comfortably :).

    I have also expanded my extra-curriculars, having gone to a conference in Colorado for a PM&R related poster presentation and presenting at school-wide research day with it, as well as assisting residents at the student-run clinic on MSK nights, high school football games, and even cage fights (which was alongside a PM&R doc). My interests have now pretty much narrowed down to PM&R and Psych.

    Any and all constructive help appreciated!
     
  35. intubesteak

    intubesteak

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    SOLID WORK
     
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  36. JP2740

    JP2740 7+ Year Member

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    Agreed. Unbelievable the **** you hear nowadays. There was an endocrinologist the other day telling me it's become more competitive. No it hasn't lol.
     
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  37. DBV

    DBV

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    As for your potential interest in medicine to cards, your biggest problem will be step 1. Doing poorly in preclinicals correlates with a low step which will limit where you can go and impact your chances at fellowship
     
  38. Newyawk

    Newyawk

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    [​IMG]
     
  39. Stagg737

    Stagg737 2+ Year Member

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    Congratulations. Glad to hear you're doing better, just keep up it up and I'm sure things will work out just fine.

    I mean, statistically speaking many fields are getting more competitive. Average Step scores of matched individuals are increasing, number of positions to SOAP into are decreasing, IMGs and FMGs are getting pushed out, and it's getting harder for "weak" applicants to match anywhere let alone solid programs.

    If you look at psych (the initial field in question in this thread), two years ago there were 12 positions available for the SOAP. The following year they added 120 residency positions and there ended up being only 4 positions nationally to SOAP into. At the same time average Steps 1 scores of matched applicants went from 212 in 2012 to 223 in 2016. Meanwhile the national average only increased 4 points. If you don't believe it go look in the psychiatry attending/residency forums. PDs and residents are saying that people who were accepted into programs 5 years ago wouldn't even get interviews this year.

    So yes, psych is becoming significantly more competitive. Is it the same as ortho or derm? Of course not, and it likely never will be. That doesn't mean it isn't moving in that direction though, and I'd be willing to bet that psych is the new EM in terms of moving from a non-competitive field into a moderately competitive field.
     
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  40. darklabel

    darklabel MS4 5+ Year Member

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    I heart this but based on last year's match data had a match rate of 94.3%, which is up from the year before that had 93.8%. So more people are matching overall and not everyone is a super star. If what you said was true of things getting more competitive and weaker applicants not matching then the % matched would decrease.
     
  41. JP2740

    JP2740 7+ Year Member

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    Moderately competitive field or average step score 223, pick one
     
  42. Stagg737

    Stagg737 2+ Year Member

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    Not sure where you're getting those numbers, but according to the Charting the Outcomes data:

    2011: 1,597 applicants for 1,097 positions, meaning 1.54 applicants/position. 1,032 total matches. So 565 people went unmatched, for a total of 64.6% of applicants matching.

    2016: 2,134 applicants for 1,386 positions, meaning 1.50 applicants/position. 1,373 total matches. So 761 people went unmatched, for a total of 64.3% of applicants matching.

    So not much difference in terms of number of people matching (thanks to expansion of positions). However, when you also look at the average stats of those matching, those matching now have better statistics than those in previous years, which I feel can't be ignored. Additionally, if you look at the NRMP Main Match Results and data, they say there were actually 2,588 total psych applicants (not sure how there's such a huge discrepancy) which would change that data significantly (would mean 1,215 went unmatched for a total match rate of 53.1%, a major change).

    Edit: The difference comes from changes in data measurement. In 2016 CtO showed 2,134 people ranked psych as their first choice, while 2,588 people applied to psych total.

    I meant psych is moving in that direction, as in 10 years from now that average Step 1 score will be significantly higher just like what has happened with EM (went from average 223 in 2011 to 233 in 2016, a jump significantly higher than the average overall improvement in the same time period). Not that it's "moderately" competitive now. Also, I was wrong. Psych jumped to 224 (minor difference but worth noting for correctness).
     
  43. JP2740

    JP2740 7+ Year Member

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    It’s all good man. I’m not really in the business of putting down fields (except for jokes and stuff). Listen, I went into IM. It’s not competitive. I could easily say the step score is increasing because all average step scores are going up. People are performing better. Just because less applicants from an unknown foreign territory are matching it doesn’t mean the field is getting more competitive and it shouldn’t make anyone feel better either. The hierarchy of competitiveness (the 1-10 slots) are still intact. Competitiveness is relative. It’s all good.
     
  44. AlbinoHawk DO

    AlbinoHawk DO Student Osteopath 2+ Year Member

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    If you are a US MD, you will match any of those 3 specialties if you get a board score > 200 and do okay in clerkships. The problem is matching somewhere good or a location that you really desire.
     
  45. masaraksh

    masaraksh 5+ Year Member

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    You gotta look at data that filters out the FMG and IMG info IMO, otherwise it’s just not applicable to a US MD. That’s a massive confounding variable. Foreign grads have a large amount of bias and hurdles to overcome that you can’t really lump their experience with that of US MDs.

    I doubt the match rate into psych for US MDs is 53%
     
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  46. darklabel

    darklabel MS4 5+ Year Member

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    Sorry I was linking to data for USMDs. Overall even with the increase in enrollment and higher step averages, there is a higher percentage of applicants matching in all specialties.
     
  47. Stagg737

    Stagg737 2+ Year Member

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    Definitely not trying to come across as defensive, as I'd like it to be as non-competitive as possible this year since I'm applying. I agree with most of what you're saying, but facts are average Step score for psych is increasing at 2.5x the rate of the average for all fields for USMDs. That combined with the fact that many PDs in the field are saying it's becoming more competitive than they imagined it would makes me think it is legitimately becoming more competitive. That may be true for most fields, but hearing 3rd and 4th year residents talk about the match process compared to people this year and last year there seems to be a stark contrast.

    That's fair. I just look at all data because I am not a USMD and since USMDs aren't the only physicians practicing in the US, I look at everyone participating in the match.
     
  48. MusicalMed

    MusicalMed 5+ Year Member

    Yup! I'm in the US MD demographic.
     
  49. Taddy Mason

    Taddy Mason 30 Helens agree Bronze Donor Classifieds Approved

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    Nope. US MD with Step scores at, or slightly above the average for psych, no red flags other than a late-ish CK score (I’ve read all my LORs and MSPE), strong interest in psych demonstrated prior to, and during med school, applied to 42-44 programs with no major geographic limitations, and am sitting at 3 IIs and several waitlist in the middle of Dec...
     
    Last edited: Dec 11, 2017 at 8:41 PM
  50. MusicalMed

    MusicalMed 5+ Year Member

    Ah darn - wishing you the best.
     
  51. Taddy Mason

    Taddy Mason 30 Helens agree Bronze Donor Classifieds Approved

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    Thanks. Not looking for sympathy, but I went into the process basically assuming that hyperbole, especially falling right in the middle number-wise. But, @Stagg737 is right about psych’s growing competitiveness. Will look for the link later, but I’m 99% positive psych has been the fastest growing specialty in terms of number of applicants over the past 4 years.

    In short - needing just passing Step scores for psych is far from the truth.
     
    Last edited: Dec 11, 2017 at 6:14 PM
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