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Importance of Various Academic Criteria for Residency

Discussion in 'Medical Students - MD' started by atsai3, Jul 22, 2002.

  1. atsai3

    atsai3 10+ Year Member

    May 15, 2002
    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).

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  3. MacGyver

    MacGyver Banned Banned

    Aug 8, 2001
    I think this study was missing one very important criteria. They did not factor in personal knowledge at all, which I think is a big help in the match.

    You are much more likely to get a residency at a program at which you have rotated thru.

    At nearly every medical center, more people match at that institution from the local med school than from other parts of the country. This is just as true for Harvard as it is for Loma Linda
  4. Fermi

    Fermi Senior Member 15+ Year Member

    Jun 6, 2000
    While I agree that this survey is one of the best resources we have for quantifying or ranking residency selection factors, it does seem to have some misleading/contradictory information. While preclinical grades don't seem to matter (they are at the bottom), the #2-4 most important criteria--total number of honors grades, class rank, and AOA status--are all heavily dependent on your preclinical grades. In addition, why do so many med students invest precious time into research if it's near the bottom of selection criteria? It looks like I should just quit my research job and go after those honors grades; I would get a much better return on my time investment.
  5. atsai3

    atsai3 10+ Year Member

    May 15, 2002

    It seems as though some of the top-ranked academic critieria very from school to school. Some schools do not rank for the first two years but do give grades for clinical clerkships. Total number of honors grades was defined as total number of honors grades in clerkships. So as to minimize competitiveness among students, some schools do not award AOA status until well after the residency applications are in. And the result that residency directors don't really value published medical research -- this I found extremely puzzling in light of some conversations I've had with residency program directors.

    In any case, quitting everything to work on grades may not be a terribly great strategy to pursue. There was a Table 3 with program directors' rankings of "non-academic issues", and residency directors ranked with 2.91 the item "did not participate in extracurricular activities in medical school" -- meaning that if you discard everything to work on grades, it raises a bit of a red flag. Of ourse, this varied by specialty -- pathology directors rated its importance well below the mean, while family medicine directors thought it extremely important. (But this factor certainly wasn't the most important non academic issue. For example, they rated "received disciplinary action in medical school" with 4.90.)

    And about doing visiting clerkships: Directors ranked highest "compatibility with program", which may be a proxy for doing a visiting clerkship and doing well.

  6. SocialistMD

    SocialistMD Resident Objectivist 15+ Year Member

    Jan 29, 2001
    Actually, preclinical grades factor in very little in AOA status. The president of our school's AOA chapter told us that your IM and surgery rotations in third year outweigh first and second year combined. AOA status is highly weighted towards clinical years. Many of them said they didn't honor but one course in first year, yet still made junior AOA due to their stellar clinical rotations. Also, I think the total number of honors grades is in reference to honors in clinical courses.

    Preclinical courses are really only there to build a foundation from which one can springboard to successful clinical rotations and, eventually, into becoming a great clinician. That is why preclinical education varies throughout the country. Each school is doing what it thinks is best to prepare its students for the clinical years, those years that really do matter in educating a future physician.
  7. Fermi

    Fermi Senior Member 15+ Year Member

    Jun 6, 2000
    atsai & Socialist,

    Thanks for the additional info. I'm happy to hear that the "number of honors" criterion only includes clinical grades. As for AOA, I think the selection formula varies from chapter to chapter, and preclinical grades may still be heavily weighted, especially for Junior AOA selection.

    I'll have to look up that article to get the whole picture on this. Thanks again--


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