In the pre-Allopathic forum, there is a thread on "Does your School Matter for residency". I was going to post this information there, but it appears that the thread is quickly becoming polluted by children. (Psst. Let's hope they don't discover this thread.) The best way to answer the question, "what matters for residency?", is to appeal to data. Norma Wagoner and Robert Suriano published a paper in Academic Medicine (Jan 1999) titled, "Program Directors' Responses to a Survey on Variables Used to Select Residents in a Time of Change." The purpose of the study was to identify information for academic deans to help them counsel medical students about the relative importance of various academic criteria in determing competitiveness for residency slots. To achieve this aim, they mailed questionnaires in 1996 to a nationally stratified group of 1,200 program directors across 14 specialties. The response rate was 66% -- decent, but not fabulous, about on a par with many other national data sets. They asked these residency directors to rank 16 different academic criteria on a scale from 1 to 5, with 1 being "unimportant" and 5 being "critical". Specialties were grouped into three categories according to their match rates. "Group A" (most competitive, >85% fill rate): ortho, general surg, ob-gyn, ophtho; "Group B" (60-80% fill rate): peds, family, internal, emergency; "Group C" (25-52% fill rate): psych, PM&R, path, rads, rad/onc, anesthesia. Keep in mind that the data are from 1996, so this classification system probably wouldn't hold water today -- rads and anesthesia are much more competitive, and general surgery is much less competitive, than 6 years ago. In any case, here are the criteria in order of importance, for the "Group A" (most competitive) specialties. 4.17 grades in required clerkships 4.03 total number of honors grades 3.96 class rank 3.92 AOA status 3.92 USMLE Step 1 score 3.80 USMLE Step 2 score 3.72 medical school academic awards 3.70 grades in senior specialty-specific elective 3.49 medical school reputation 3.47 published medical school research 3.22 grades in pre-clinical courses 3.21 grades in senior specialty-nonspecific electives Hrm. So much for first- and second-year grades. So much for publications. So much for USMLE Step 1. (However, keep in mind that these rankings are not necessarily incompatible with an applicant evaluation system that relies on Step 1 scores as a screening tool. They might matter less than (say) clerkship grades, but some programs may require that you achieve a minimum cutoff in order to be considered for an interview.) I'm not going to bother posting the rankings for the other categories, but you can either look up the article or extrapolate your own conclusions -- the article also publishes the rankings for each specialty. Basically, the less competitive residencies tend to employ a broader set of criteria. And given the previously noted caveat about this being based on 1996 data, if you are wondering (say) what the list would look like for rad/onc specifically, it's an extremely competitive field right now so you would probably want to look at the "Group A" rankings (not the "Group C" list). Cheers -a.