M1 - Should I rule out any specialties yet based on grades?

[mamasgonnapass]

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There are many specialties that I will probably never even see. Knowing I would probably be a middle of the road student at a middle of the road medical school, should I not shadow/request rotations with specialties that are out of my reach? I've heard that if I really want something, I might possibly find a way into a low ranked program somewhere, but I don't want to put all my eggs in that basket.

If you are middle of the road--what do you do to stand out?

Shoud I rule out anything yet?

Sorry if this has been asked. I'm terrible with the search feature.

 

[Serous Demilune]

Generally speaking, a middle of the road med student (US MD) has a decent shot at matching a relatively competitive specialty if he or she applies very broadly. You won't match derm, plastics, or ENT without amazing scores and grades or research or great connections.

 

[mcloaf]

Everything is very much still ruled in for you.

 

[CherryRedDracul]

Wait till you take Step 1 before you start ruling stuff out. Right now, imagine every avenue is open for you and work hard.

 

[mamasgonnapass]

Woo hoo!! Also, that means I need to go back to studying. Thank you.

 

[MedWonk]

There are many specialties that I will probably never even see. Knowing I would probably be a middle of the road student at a middle of the road medical school, should I not shadow/request rotations with specialties that are out of my reach? I've heard that if I really want something, I might possibly find a way into a low ranked program somewhere, but I don't want to put all my eggs in that basket.

If you are middle of the road--what do you do to stand out?

Shoud I rule out anything yet?

Sorry if this has been asked. I'm terrible with the search feature.

Unless you're failing classes, then no. Just keep working hard.

 

[operaman]

What they've said. Work your tail off and be the best you can possibly be. Nothing is ruled out, but poorer performance will start closing some doors. No field is entirely cut out because you can distinguish yourself in other ways, but it's tougher. I've posted before about the types of people who are successful in competitive fields. Basically:

1) rock stars. They have everything below. Thankfully, no matter how awesome someone is, they can still only match at one spot.

2) research stars. Solid but more average apps but absolutely baller research. 10-20 good pubs, maybe half or so first author. I know an applicant with over 40 (not me!) good ones, but that's insane. These people Have often done an extra year of productive research or did a PhD.

3) geniuses. Flawless academics and 99th percentile boards. AOA. Conversationally brilliant. Innovative. Solid research but not as crazy as above. Maybe a pub or two and some presentations.

4) clinical/social/personable/hard workers. Solid but more average apps and maybe even slightly below in areas. These people are socially gifted, loved by patients and colleagues alike. These people outwork everyone around them. They never complain. They never cause any trouble. Their integrity is unimpeachable. These people shine on aways and are beloved by their home programs. People make calls for these folks. All of us hope we match with them.


Generally you need to fit somewhat into one of these to be succesful in tough fields. If your grades and boards are average, you'll have to distinguish yourself in another way. Nothing is closed off to you yet.

 

[Flamen04]

Please operaman. People don't have to be gods to match into tough fields.

 

[Awared]

And here I am wasting time on SDN... ****.

 

[Psai]

Please operaman. People don't have to be gods to match into tough fields.

I'm guessing that you haven't gone through the match yet

 

[operaman]

Please operaman. People don't have to be gods to match into tough fields.

Of course not, but they do tend to distinguish themselves in some way. I listed the most common I see but there can be others. But I do think pure numbers can be deceiving, especially in the charting outcomes in the match report. You'll see that X number matched with below average boards, but you can't see what else they had going for them. Most telling may be that for most tough fields, the stats for matched and unmatched applicants aren't that different once you put them all together. The differences come out on an individual basis. Trying to match into any tough specialty with average boards, average grades, average research, and a so-so personality is going to be an uphill battle. Doubly so if you're also below average in one area without any of the others to redeem you. There are simply too many people who distinguished themselves.

The good news is that with a modicum of self awareness and some solid mentorship, you can find the areas where you can really distinguish yourself. Maybe that means doing lots of aways, or maybe it means a research year, or maybe it means doing something else totally unique and extraordinary that sets you apart and makes your story compelling.
The danger is in assuming you only need average stats across the board, that you can quietly blend into the background and stumble into a spot.

 

[Porfirio]

I would say that it is all about your Step 1 score - just keep going.

 

[W19]

There are many specialties that I will probably never even see. Knowing I would probably be a middle of the road student at a middle of the road medical school, should I not shadow/request rotations with specialties that are out of my reach? I've heard that if I really want something, I might possibly find a way into a low ranked program somewhere, but I don't want to put all my eggs in that basket.

If you are middle of the road--what do you do to stand out?

Shoud I rule out anything yet?

Sorry if this has been asked. I'm terrible with the search feature.

I know how you feel!

 

[cbrons]

No your preclinical grades matter less than you think. A very good Step I and year 3 evals can cover a whole multitude of sins

 

[Jabbed]

It can be difficult, but you've gotten a lot of great advice in this thread alone so I'm hoping that you're starting along on the right path.

One thing that I would also recommend to boost self-confidence as well as reinforce curricular interests is to find a subject that greatly interests you from the preclinical curriculum and spend a couple of hours or so a week studying it independently (online lectures, textbooks, uptodate, research articles, etc). You would be surprised how easy it can be to study advanced subject matter once you've discovered your niche passion.

 

[seminoma]

OP, I understand how hard it is to accept statements like "preclinical grades matter very, very, very little". Really, I do. It's obviously not a reason to slack off, but if you mess up in a class you don't have to stress about it.

 

[Psai]

the caveat is that lower preclinical grades tend to indicate lesser mastery of the material. the people who did well pre-clinically generally work harder and are smarter than everyone else. they will get better step 1 scores and do better clinically because they know more and work harder. the letters themselves don't matter much, but the grades tend to be a relatively reliable surrogate marker

inb4 "i know someone who got 260 after getting all passes in preclinical years"

 

[seminoma]

the caveat is that lower preclinical grades tend to indicate lesser mastery of the material. the people who did well pre-clinically generally work harder and are smarter than everyone else. they will get better step 1 scores and do better clinically because they know more and work harder. the letters themselves don't matter much, but the grades tend to be a relatively reliable surrogate marker

inb4 "i know someone who got 260 after getting all passes in preclinical years"

I'm with you on the preclinical grades and step 1, but I disagree about those students necessarily being smarter. I also disagree about better step 1 scores leading to doing better clinically. Testing well doesn't translate to being able to apply all the knowledge into clinical situations.

 

[Serous Demilune]

I'm with you on the preclinical grades and step 1, but I disagree about those students necessarily being smarter. I also disagree about better step 1 scores leading to doing better clinically. Testing well doesn't translate to being able to apply all the knowledge into clinical situations.

Most questions on Step 1 and even more on Step 2 are literally about applying knowledge to clinical situations.

 

[seminoma]

Most questions on Step 1 and even more on Step 2 are literally about applying knowledge to clinical situations.

With the correct answer provided to you in a list to choose from.

Every MS2 can pick a correct diagnosis out of a list. Fewer MS2s can make the diagnosis without a list of possibilities. Still fewer can list the defining features of a given diagnosis. Still fewer can obtain a thorough enough history to rule in/out things on the differential. Still fewer can tell you the next clinical step. Still fewer can tell you why the other tests/procedures aren't indicated... And on and on.

I'm an MS2 and I happen to work really hard and do pretty well in school. That said, any MS2 who thinks he/she will automatically be a star next year because he/she did well in pre-clinicals and Step 1 is delusional. Most everyone who entered med school was a star in college, now half of them are below average and some of them are even failing. I doubt the transition to MS3 is easier than the transition to MS1.

 

[Serous Demilune]

With the correct answer provided to you in a list to choose from.

Every MS2 can pick a correct diagnosis out of a list. Fewer MS2s can make the diagnosis without a list of possibilities. Still fewer can list the defining features of a given diagnosis. Still fewer can obtain a thorough enough history to rule in/out things on the differential. Still fewer can tell you the next clinical step. Still fewer can tell you why the other tests/procedures aren't indicated... And on and on.

I'm an MS2 and I happen to work really hard and do pretty well in school. That said, any MS2 who thinks he/she will automatically be a star next year because he/she did well in pre-clinicals and Step 1 is delusional. Most everyone who entered med school was a star in college, now half of them are below average and some of them are even failing. I doubt the transition to MS3 is easier than the transition to MS1.

Yea I'll concede that, you're right.

 

[Psai]

With the correct answer provided to you in a list to choose from.

Every MS2 can pick a correct diagnosis out of a list. Fewer MS2s can make the diagnosis without a list of possibilities. Still fewer can list the defining features of a given diagnosis. Still fewer can obtain a thorough enough history to rule in/out things on the differential. Still fewer can tell you the next clinical step. Still fewer can tell you why the other tests/procedures aren't indicated... And on and on.

I'm an MS2 and I happen to work really hard and do pretty well in school. That said, any MS2 who thinks he/she will automatically be a star next year because he/she did well in pre-clinicals and Step 1 is delusional. Most everyone who entered med school was a star in college, now half of them are below average and some of them are even failing. I doubt the transition to MS3 is easier than the transition to MS1.

whats your point
im an m3 and i still have trouble doing it
no one is saying that you'll be a star by getting all As and gold stars on your first year exams. but the people who know more tend to do better in preclinical and in clinical years. you're not going to be a star on the wards if you don't know as much as your peers although having a good attitude and a nice personality go a long way

 

[Zedor]

whats your point
im an m3 and i still have trouble doing it
no one is saying that you'll be a star by getting all As and gold stars on your first year exams. but the people who know more tend to do better in preclinical and in clinical years. you're not going to be a star on the wards if you don't know as much as your peers although having a good attitude and a nice personality go a long way

I agree with this. The transition to ms3 is easier than ms1 to 2, let alone to starting ms1.

 

[operaman]

With the correct answer provided to you in a list to choose from.

Every MS2 can pick a correct diagnosis out of a list. Fewer MS2s can make the diagnosis without a list of possibilities. Still fewer can list the defining features of a given diagnosis. Still fewer can obtain a thorough enough history to rule in/out things on the differential. Still fewer can tell you the next clinical step. Still fewer can tell you why the other tests/procedures aren't indicated... And on and on.

I'm an MS2 and I happen to work really hard and do pretty well in school. That said, any MS2 who thinks he/she will automatically be a star next year because he/she did well in pre-clinicals and Step 1 is delusional. Most everyone who entered med school was a star in college, now half of them are below average and some of them are even failing. I doubt the transition to MS3 is easier than the transition to MS1.

Having taken the first 2 steps and read a lot of the NBME's pubs on test construction, I would argue that the exams are becoming much better at testing relevant clinical thinking. It's not just picking the correct dx out of a list, but picking it out of a list of 5-10 things that would be your actual ddx in real life. Even on Step 1 I remember questions where all the answer diagnoses were highly plausible and I had to really tease through the history and the labs to figure out the right one (which is exactly what the questions were likely trying to test).

Learning to make a good ddx is definitely something you do more in third year and beyond, but my experience has been that the stronger students from preclinical years do this much better than the rest. While they may not automatically be a star, it's highly likely unless they have some sort of social interaction issues. My first 2 clerkships were surgery and IM and I definitely used my built up knowledge base every day and I think it helped me stand out. My anecdotal observations have been that the top students are much better clinically, perhaps because they don't have to worry as much about the shelf and can focus on developing their clinical skills.

The college --> med school transition definitely results in half of a group of former top students becoming below average. This same thing doesn't happen from M2 --> M3 because it's still the same group of people. Sure, maybe a tiny few are unable to pass Step 1 and leave the class but this would not significantly impact the others. The people I can think of who struggled with the transition to M3 were those who were very inefficient studiers and struggled with the drastic reduction in available study hours. Everyone feels like an idiot at least once every day, but that's just part of the experience.

 

[deleted480308]

Having taken the first 2 steps and read a lot of the NBME's pubs on test construction, I would argue that the exams are becoming much better at testing relevant clinical thinking. It's not just picking the correct dx out of a list, but picking it out of a list of 5-10 things that would be your actual ddx in real life. Even on Step 1 I remember questions where all the answer diagnoses were highly plausible and I had to really tease through the history and the labs to figure out the right one (which is exactly what the questions were likely trying to test).

Learning to make a good ddx is definitely something you do more in third year and beyond, but my experience has been that the stronger students from preclinical years do this much better than the rest. While they may not automatically be a star, it's highly likely unless they have some sort of social interaction issues. My first 2 clerkships were surgery and IM and I definitely used my built up knowledge base every day and I think it helped me stand out. My anecdotal observations have been that the top students are much better clinically, perhaps because they don't have to worry as much about the shelf and can focus on developing their clinical skills.

The college --> med school transition definitely results in half of a group of former top students becoming below average. This same thing doesn't happen from M2 --> M3 because it's still the same group of people. Sure, maybe a tiny few are unable to pass Step 1 and leave the class but this would not significantly impact the others. The people I can think of who struggled with the transition to M3 were those who were very inefficient studiers and struggled with the drastic reduction in available study hours. Everyone feels like an idiot at least once every day, but that's just part of the experience.

I'd have to predict this is true....if I only know 3/7 characteristics of a bacteria i'm much less likely to diagnose it than than a classmate that knows all 7 like the back of their hand

 

[seminoma]

Yea I'll concede that, you're right.

Nope, seems I'm wrong haha.

whats your point
im an m3 and i still have trouble doing it
no one is saying that you'll be a star by getting all As and gold stars on your first year exams. but the people who know more tend to do better in preclinical and in clinical years. you're not going to be a star on the wards if you don't know as much as your peers although having a good attitude and a nice personality go a long way

I was just pointing out that being able to apply knowledge on multiple choice tests doesn't always translate to being able to apply the same knowledge in other settings. Of course your knowledge base is whatever it is, but the ability to use it meaningfully is a different thing.. or at least I thought it was.

Having taken the first 2 steps and read a lot of the NBME's pubs on test construction, I would argue that the exams are becoming much better at testing relevant clinical thinking. It's not just picking the correct dx out of a list, but picking it out of a list of 5-10 things that would be your actual ddx in real life. Even on Step 1 I remember questions where all the answer diagnoses were highly plausible and I had to really tease through the history and the labs to figure out the right one (which is exactly what the questions were likely trying to test).

Learning to make a good ddx is definitely something you do more in third year and beyond, but my experience has been that the stronger students from preclinical years do this much better than the rest. While they may not automatically be a star, it's highly likely unless they have some sort of social interaction issues. My first 2 clerkships were surgery and IM and I definitely used my built up knowledge base every day and I think it helped me stand out. My anecdotal observations have been that the top students are much better clinically, perhaps because they don't have to worry as much about the shelf and can focus on developing their clinical skills.

The college --> med school transition definitely results in half of a group of former top students becoming below average. This same thing doesn't happen from M2 --> M3 because it's still the same group of people. Sure, maybe a tiny few are unable to pass Step 1 and leave the class but this would not significantly impact the others. The people I can think of who struggled with the transition to M3 were those who were very inefficient studiers and struggled with the drastic reduction in available study hours. Everyone feels like an idiot at least once every day, but that's just part of the experience.

I hope I have as good of a transition as you have had!

 

[Mad Jack]

No.

 

[mamasgonnapass]

Thank you!

 

[tiedyeddog]

Research is a great way to standout. Getting a first author anything is a pretty big star on your record.

It is flat out almost always required in some fields, with the rarity being those who have none.

 

[giantswing]

I agree with this. The transition to ms3 is easier than ms1 to 2, let alone to starting ms1.

I disagree partially - m3 isn't bad if you're not worried about doing well. If you're worried about honoring, third year can be brutal. So much is out of control with so much less time to study.

 

[Psai]

I disagree partially - m3 isn't bad if you're not worried about doing well. If you're worried about honoring, third year can be brutal. So much is out of control with so much less time to study.

This is so true