MD/PhD students compared to MD students.

[IceMan2008]

At Virginia Commonwealth University, where I'm applying in a little bit, you're mandated to stay within the top 1/3 of the class. Failure to stay in the top 2/3 gets you kicked out of the program, and then you have to retroactively pay back your tuition with interest.

I'm pretty sure the fear of God keeps those M.D/Ph.D students high in the class ranks, at least in Virginia.

I dont know where you got your facts. No program out there mandates you to pay back tuition even if you drop out after two years. They are under no obligation to keep a student in the MD or PhD portion. at my institution there have been a few people to drop out of the program. They usually had to simply pay for their remaining MD years. I've never heard of retroactive payment for tuition.

While I dont doubt some truth behind what you say about having to be in the top 1/3 there are MD/PhD programs that give their students the leg up when it comes to clinical years. This is key when deciding between MD/PhD programs. One "upper tier" program, for instance, mandates that MD/PhD students have a certain number of honors grades in order to graduate. While this is a mandate, MD/PhD students are essentially "given" one or two honors simply by being excluded from the class curve when tabulating grades. Other schools such as UIUC, you do you clinical rotations with nearly 90% MD/PhD students and are not compared to MD students. And at other schools, particularly some "prestigious" institutions 60-90% of the class gets the highest "honors" grades. I personally like the UIUC methodology. It makes more sense.

but the bottom line is...regardless of where you come from a Student A (MD) who has three honors (where 65% of the class gets honors) is most often ranked higher than Student B (MD/PhD) who has all high passes at a school where only the top 5% gets honors, regardless of whether student B is from a top tier school. I was just discussing this with one of the program directors today. This whole process of residency selection is wacky to say the least.

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[pseudoknot]

IceMan, what you say is only true of MSTP funded programs, which VCU isn't. They do indeed tell their students that if they leave the MD/PhD program they are on the hook for payback of tuition and stipends. It's legally questionable whether this can be enforced, but the students believe them, which may be all that matters. They are also required to stay on the top 2/3 and people have been dropped for not doing so during the preclinical years.

 

[Neuronix]

I dont know where you got your facts. No program out there mandates you to pay back tuition even if you drop out after two years. They are under no obligation to keep a student in the MD or PhD portion. at my institution there have been a few people to drop out of the program. They usually had to simply pay for their remaining MD years. I've never heard of retroactive payment for tuition.

Actually, there are programs out there that at least verbally or even on paper will have you agree to pay back tuition if you drop the PhD. This is forbidden by the NIGMS for MSTPs but non-MSTP MD/PhD programs are known to do this. Mayo was the prime example, though I don't know what they did since they got MSTP status 5 years or so ago. Before this, they would have you sign a contract stating you will pay back the tuition if you drop the PhD. I know the brother of a woman who was in the MD/PhD program there about 10 years and his sister was indeed required to pay back that extra money. She had to take a crapton of extra loans to pay for it.

I interviewed at a couple non-MSTP MD/PhD programs myself (which in retrospect was silly but I was just clueless when I applied) and ran into this as well. This sense from the program and the current students that you would have to pay back the money if you dropped. How many programs actually do this and enforce it I do not know.

This whole process of residency selection is wacky to say the least.

It's the same for med school admissions isn't it... Whoever has the highest GPA wins. It doesn't matter what your major was, what school you went to, or how grade inflated your school was. Some adcoms have some sense of this, but it makes little difference if at all.

I think the preclinical grade enforcement is particularly ridiculous. If you look at my preclinical grades my guess is I'd be in the bottom quartile of my class. I barely scraped by several exams. I almost wonder if they rounded my grade up because honestly how many times can you get a 70% final grade? I then scored a std dev above the mean on Step I and have been fairly successful in grad school. So wtf is the point of holding someone to getting good grades in something nobody cares about?! Other than of course, to stress the **** out of your own students and make them hate life.

 

[IceMan2008]

Actually, there are programs out there that at least verbally or even on paper will have you agree to pay back tuition if you drop the PhD. This is forbidden by the NIGMS for MSTPs but non-MSTP MD/PhD programs are known to do this. Mayo was the prime example, though I don't know what they did since they got MSTP status 5 years or so ago. Before this, they would have you sign a contract stating you will pay back the tuition if you drop the PhD. I know the brother of a woman who was in the MD/PhD program there about 10 years and his sister was indeed required to pay back that extra money. She had to take a crapton of extra loans to pay for it.

Well...if what you speak is the truth then I am surprised or even shocked. Not that this exists but that the students who were required to pay back money did not sue the the school. No matter if you have a "stipend" you are still considered legally an employee. If you receive reimbursement for services rendered and pay taxes on your compensation then you are an employee. This includes pay and tuition. It would be very easy to prove to a jury that you received compensation for services rendered and every paycheck or semester covered is final. This would be similar to someone working at a company for $100K a year for six years and decides to leave before his contract runs out. He is under no obligation to pay back $600K similar to the MD/PhD programs. If this is happening then it is simply wrong. Why would anyone want to go to a program like that? This is why full disclosure is necessary.

This speaks to a bigger issue. Students, residents, and physicians do not focus as they should on their rights as a body of labor. In my opinion, it is ludicrous that a system like the Match exists and that doctors do not form unions to demand better working conditions or rights. It would be really great if instead of accepting unfair contracts, we could compete and negotiate contracts as future residents. Some people claim that it would be hard to find residency positions if the match did not exist. Well...how do thousands of law students and business students do it? I realize i am getting off message...another time another long string of posts..

 

[pseudoknot]

Students, residents, and physicians do not focus as they should on their rights as a body of labor. In my opinion, it is ludicrous that a system like the Match exists and that doctors do not form unions to demand better working conditions or rights.

Well, there are three problems with this. Those groups are very different, first of all. Also, the match to some extent protects students from coercive tactics by residency programs.

Most importantly, in medicine and science there are a lot more applicants than positions, which fundamentally limits the ability of trainees to negotiate. I don't see this changing anytime soon.

 

[MiniFreud]

I think most VCU MD/PhD students believe they will have to pay it back, although I don't. (But I'm not in the program.) I do know one guy who got booted after M1 and didn't have to pay anything back.

I agree that payback policies are really outrageous and a big red flag.

A red flag for what? Bad ethics? Exploitative practices towards the students?

 

[StIGMA]

A red flag for what? Bad ethics? Exploitative practices towards the students?

Bingo.

Yes, we want you to come to our school. We will even fund you and give you a stipend. But if you dare change your mind once into the program or if your life goals change, you better be sure we will come after all you own and get our money back. We care for you like that. This behavior is typical of our whole MD/PhD staff, where you can expect loving support in a nurturing environment. This is best exemplified when we coerce you via matriculation into signing our asinine payback statements that sign your life to us, of course.

 

[gbwillner]

What's implied here is that forcing a student to get a publication during their PhD is going to somehow make them into academic scientists. I just don't see it? I think sluox's point is well taken. Some of these students aren't going to do academics anyway. So why force them to continue? Then there was my earlier point: if you do want to do academics I don't think not having that publication is going to hurt you very much in the long run.

My guess is that if you force lots of students to hang around a really long time when they don't want to you're going to get a lot of dropouts and the occasional suicide.

I'm not saying I agree with it... but like Chris Rock's take on OJ- I understand it. Why should a grad school reward you with a PhD if they don't think you've earned it or will go become a successful scientist? Why should the graduate school pay for your training so you can go into industry, or, better yet, never do anything science related as you just practice medicine?

Of course, the reasons why are that the high attrition rate (and suicides, LOL) will drive away future applicants. But that's the MSTP program's problem and not the graduate school's.

 

[bd4727]

This speaks to a bigger issue. Students, residents, and physicians do not focus as they should on their rights as a body of labor. In my opinion, it is ludicrous that a system like the Match exists and that doctors do not form unions to demand better working conditions or rights. It would be really great if instead of accepting unfair contracts, we could compete and negotiate contracts as future residents. Some people claim that it would be hard to find residency positions if the match did not exist. Well...how do thousands of law students and business students do it? I realize i am getting off message...another time another long string of posts..

I have found this idea interesting myself. I looked into it a while back. You can google it again or whatever, but in the 90s someone brought an antitrust lawsuit against the match. They lost. There are a number of really quality economics papers that look at the match. They are interesting reading (relative to who you ask).

I think bottom line from a lot of what I read is that because you cannot legally practice medicine without doing a residency, the residency programs have you by the proverbial balls and therefore unions, wage competition, etc go out the window.

Also, as someone else mentioned above, the match is relatively new. A major reason it was instituted was to benefits the students, because a lot were getting screwed bc of residencies competing for them (by giving you 1 day to accept their offer, etc).

Anyway, I think by this point inertia has made it such that the match will not change in any significant way anytime soon.

 

[bd4727]

It's the same for med school admissions isn't it... Whoever has the highest GPA wins. It doesn't matter what your major was, what school you went to, or how grade inflated your school was. Some adcoms have some sense of this, but it makes little difference if at all.

So just out of curiosity, what would people suggest is the hierarchy of things that boost your chances for admission to competitive residencies? What I am gleaning from this thread is:
1. Clinical Grades
2 or 3. Step 1
3 or 2. PhD
4. Preclinical grades
5. ??

or some other combination? Just curious to get a sense of everyone's opinion.

 

[pseudoknot]

So just out of curiosity, what would people suggest is the hierarchy of things that boost your chances for admission to competitive residencies? What I am gleaning from this thread is:
1. Clinical Grades
2 or 3. Step 1
3 or 2. PhD
4. Preclinical grades
5. ??

or some other combination? Just curious to get a sense of everyone's opinion.

It depends on the field, but for most it's going to be clinical grades & Step I >> everything else.

There are a few published papers on this topic. You can try searching pubmed or my posts cause I've put up citations on them before, but I need to go to bed so I can't dig them out right now.

 

[Neuronix]

(and suicides, LOL)

You're going into Psychiatry right? Just kidding, your point is well taken.

In the 90s someone brought an antitrust lawsuit against the match. They lost.

The most recent case never went to trial. Congress granted the match immunity.

See: http://content.nejm.org/cgi/content/full/351/12/1165

Match Point?
Alexi A. Wright, M.D., and Ingrid T. Katz, M.D., M.H.S.
New Eng J Med Volume 351:1165-1167 September 16, 2004 Number 12

what would people suggest is the hierarchy of things that boost your chances for admission to competitive residencies?

I'm going into Radiology, so I cite this article:

Key Criteria for Selection of Radiology Residents: Results of a National Survey
Hansel J. Otero, MD, Sukru M. Erturk, MD, Silvia Ondategui-Parra, MD, MPH, Pablo R. Ros, MD, MPH
Academic Radiology Vol 13:1155-1164

When surveyed, residency directors cited these factors as most important when selecting those to interview.
Determinants for Considering Whether to Interview (1-10 scale)
1. USMLE Scores (Step I basically cause most Rad applicants don't take Step II until later) -- 8.65
2. Dean's Letter -- 7.52
3. Class Rank -- 7.5
4. Recommendations -- 7.36
5. Honor Society -- 7.24
6. Leadership -- 6.76
7. Research Experience -- 6.35
8. Specific Rotation Grade -- 5.45
9. Employment Experience -- 5.07
10. Volunteer Experience -- 5.02

It is unfortunate that the survey results did not lead to publishing the final selection criteria, though 15 directors responded that subjective things like "fit" and "gut feel" were most important for who got the highest rankings.

Note for the pre-meds that election to honor society (read: AOA) and class rank are typically determined mostly, if not entirely, by clinical grades.

 

[gstrub]

I'm not saying I agree with it... but like Chris Rock's take on OJ- I understand it. Why should a grad school reward you with a PhD if they don't think you've earned it or will go become a successful scientist? Why should the graduate school pay for your training so you can go into industry, or, better yet, never do anything science related as you just practice medicine?

Of course, the reasons why are that the high attrition rate (and suicides, LOL) will drive away future applicants. But that's the MSTP program's problem and not the graduate school's.

I don't see the problem of tuition payback. What's to stop students from going to school for free for 2 years and dropping the PhD after 1 year, because they don't like it? I think a lot more students would do this if the payback weren't looming over their heads. The program is spending hundreds of thousands of dollars on you, they expect you to fulfill your end of the bargain.

 

[Neuronix]

I think a lot more students would do this if the payback weren't looming over their heads.

Payback is never allowed in MSTP programs due to restrictions set by the NIGMS. Does this mean more students drop out (2 and screw!) of MSTPs than non-MSTP MD/PhD programs? I don't have data on this, but I really doubt it.

 

[gstrub]

Yeah, but remember, the MSTP money is backed by the government. Perhaps it is because the non-MSTP programs are putting up their own money...they want some insurance? I'm not sure. Also, I think attrition rates are considered when applying for MSTP status, so I would think they want 100% to finish the program is a non-MSTP program were applying for funding. Just guessing here...

 

[pseudoknot]

Yeah, but remember, the MSTP money is backed by the government. Perhaps it is because the non-MSTP programs are putting up their own money...they want some insurance? I'm not sure. Also, I think attrition rates are considered when applying for MSTP status, so I would think they want 100% to finish the program is a non-MSTP program were applying for funding. Just guessing here...

It's not like the program is getting the money back either way. As Neuronix notes, attrition is pretty rare and most students who apply to these programs do so sincerely at the time.

 

[IceMan2008]

So just out of curiosity, what would people suggest is the hierarchy of things that boost your chances for admission to competitive residencies? What I am gleaning from this thread is:
1. Clinical Grades
2 or 3. Step 1
3 or 2. PhD
4. Preclinical grades
5. ??

or some other combination? Just curious to get a sense of everyone's opinion.

I just had a conversation with the PDs of the anesthesiology and IM program at my institution this week. They mentioned to me that the way PDs at other schools, particularly the most competitive ones look at PhDs is that it adds sprinkles to the icing on the cake. He said that at the most competitive programs for IM, peds, Neuro, and ROADs they will only interview applicants with a Step 1 cut off score. Most applicants have about 4-6/6 honors. They can be lenient with the USMLE score. It is very possible to match at an outstanding program even if you have only one publication (doesnt have to be a first author) but 5/6 honors. However, it is extremely difficult if you only have 0-2/6 honors and simply high passed the rest. Some programs can be flexible if you have 50% honors grades while programs at the top tier do not. I was told that applicants who have only 0-1 honors and HP'd the rest are a big red flag, way bigger than those who dont publish or dropped out of the MD/PhD program. According to one of them it indicates that they were "slackers" (not my words) in their clinical rotations and would likely be poor residents in the most competitive programs. He said that they usually compare students with the similar grades and board scores. If one student has a PhD given the same board score and number of honors then it may tilt the balance in their favor. In the same respect, a high board score cannot make up for poor grades. I know of three medical students who had 250+ step1 scores (one of whom had three publications) and all high passes and failed to match in ortho, rads, and ophtho in ANY program.

 

[echod]

I know of three medical students who had 250+ step1 scores (one of whom had three publications) and all high passes and failed to match in ortho, rads, and ophtho in ANY program.

For the 3 med students, did they have a PhD? How can one be a "slacker" if he/she scores above 250 on step I. For most people, scores like that require a lot of hard work and dedication. About honors, there's some schools that only give the magic H to 20% of the students, which means that a hard worker can easily end up with a high pass, especially considering how good some med students are at sweet talking.

 

[Doctor&Geek]

For the 3 med students, did they have a PhD? How can one be a "slacker" if he/she scores above 250 on step I. For most people, scores like that require a lot of hard work and dedication. About honors, there's some schools that only give the magic H to 20% of the students, which means that a hard worker can easily end up with a high pass, especially considering how good some med students are at sweet talking.

They did not apply widely enough or rank enough schools, or they have "personality issues".

 

[gbwillner]

So just out of curiosity, what would people suggest is the hierarchy of things that boost your chances for admission to competitive residencies? What I am gleaning from this thread is:
1. Clinical Grades
2 or 3. Step 1
3 or 2. PhD
4. Preclinical grades
5. ??

or some other combination? Just curious to get a sense of everyone's opinion.

This question will get you 1000 different answers.

I have been through the process, and so have all my classmates. Of course, there are regional and institutional biases- such as the fact that I come from a "top" school. Anyway, I have found that this is heavily dependent on the field and type of institution (academic vs. not).

IMHO, there are specific programs, like path, medicine, neuro, and peds, where having an MD/PhD gets you in to one of your top three programs regardless of other factors. Of course there are outliers- people who are total slackers, have personality issues, come from low-ranking programs, or no publications; for whom this may not apply. Of course I am assuming you want to go to a top academic center. Otherwise I'm not sure it helps you at all.

Then there are other programs that are much more competitive but an MD/PhD gets you in SOMEWHERE (assuming you apply broadly), and puts you on the top of the heap IF you're already a competitive applicant. I would include optho and rad onc in this group. There are others but they escape me at the moment. Rad Onc is probably the most competitive specialty today... and 1/3 of all residents are MD/PhDs, despite being less than 10% of applicants.

Then there are the specialties where I don't think the PhD makes much of a difference at all. I would put most of the surgical specialties here, especially plastics and orthopedics. I would also ad rads to this category.

Of course, this is also not true for all institutions. There is tremendous variability and there is no "real answer".

Good luck

 

[IceMan2008]

For the 3 med students, did they have a PhD? How can one be a "slacker" if he/she scores above 250 on step I. For most people, scores like that require a lot of hard work and dedication. About honors, there's some schools that only give the magic H to 20% of the students, which means that a hard worker can easily end up with a high pass, especially considering how good some med students are at sweet talking.

One of them did have a PhD. She scrambled into a preliminary position and now is a third year IM resident in a "2nd tier" program in the midwest. She had two publications, a 250+ step 1, and all high passes. I all knew these guys during medical school and they didnt have any personality issues. One of them limited themselves to programs that have strong research emphasis. The common denominator...they just didnt have the grades. It is true that getting a 250 on step 1 takes A LOT of hard work, but you have to be consistent. A high step 1 and a PhD does not make up for being a slacker (not my words) cruising by with high passes. At least at my school, when I go to applicant dinners, many of the MD/PhD students talk up how a PhD is a ticket into a competitive residency. I am going through the process like the previous poster once did and most of my former classmates are upper level residents, fellows, and attendings. Even in rad onc, I dont know a single person from my school or several schools in the immediate vicinity who matched successfully that was not in the top 10-20% of their class clinically or AOA regardless of PhD status.

One of the strategies that med schools use to limit the number of people who have to scramble is that they advise students not to limit themselves to the most competitive programs. If you are one of the unfortunate few that has only 1 or 2 honors and is seeking a radiology residency your advisor may say "Jimmy, I think you should have a back up. You should apply to as many programs as possible. While you're at it try an elective in family medicine." Some deans are very good at persuading you not to limit yourself.

Their reasoning behind this clinical focus is that you can be a bad scientist and the worst that could happen is that you wont get funded. But if you just pass clinically then people get hurt. This is why medical errors are so prevalent. Residency directors are right to look for clinically outstanding residents. This is also why there are a lot of FMG that are starting to fill the ranks of mid tier programs in competitive residencies. At many places across the country they are no longer limited to programs that dont fill. Many FMGs tend to be the most outstanding clinicians from their home countries and are the cream of the crop. I personally dont think I'm talented enough to train in the USA and go to a foreign country and compete against the locals in their language. Several PDs I've met have said this very same thing to me. The radiology PD at my school said that he would rather take an outstanding (with good spoken English) FMG over a US trained med student who got pass grades during third year. There are a growing number of FMGs in our radiology and anesthesiology programs each year for this reason and because some programs dont fill. It is still extremely difficult or impossible for them to match into certain specialties at at certain programs but they are gaining ground. More power to them!

 

[Neuronix]

Their reasoning behind this clinical focus is that you can be a bad scientist and the worst that could happen is that you wont get funded. But if you just pass clinically then people get hurt.

I don't believe this logic for one minute. If you just "pass" clinically you go into Internal Medicine or Family Practice or Pediatrics. Where do the mistakes that hurt patients the most happen? What, the Dermatologist needs to be the smartest guy in the hospital? The Rad Onc? Yeah right. It's all about competition for money and lifestyle.

Residency directors are right to look for clinically outstanding residents. This is also why there are a lot of FMG that are starting to fill the ranks of mid tier programs in competitive residencies. At many places across the country they are no longer limited to programs that dont fill. Many FMGs tend to be the most outstanding clinicians from their home countries and are the cream of the crop.

This is called residents as cheap labor. Let's call a spade a spade. Residency is supposed to be about TRAINING to be a physician. If you come in already trained, what was the point of residency? But I can see the appeal for the FMG--they come from their home countries and get a massive salary upgrade when they finish. Meanwhile, the program gets a physician out of it they can pay 1/4 or less one of their regular physicians, and then they make them work harder and take more **** than anyone else in the hospital.

So if this is true, was residency about education at all?! Fortunately, it's not that common.

But if you just pass clinically then people get hurt. This is why medical errors are so prevalent. Residency directors are right to look for clinically outstanding residents.

Yeah, because every resident should be "outstanding". Because we can all be "outstanding". Definition of outstanding:

"distinguished from others in excellence; "did outstanding
work in human relations"; "an outstanding war record""

So how can everyone be distinguished by their peers in excellence? Though of course according to your post, MD/PhDs need to be outstanding in everything. I feel like this thread has turned into the pre-allo of residency selection.

There are a growing number of FMGs in our radiology and anesthesiology programs each year for this reason and because some programs dont fill.

Radiology and gas could fill with all AMGs if they wanted to. But they might have to take more 210-220 Step I scores. You know--50th percentile. Oh noes, we might have to take students in the 50th percentile of their med school classes that got HPs instead of Honors. Let's forget all about the battle to get into med school and these students are competing with the best and brightest of the people their age--medical students. We need to pick the best of the best of the best.

If you're right, than some programs are so spoiled on numbers, so narrow-minded, that an exam really does seem to mean anything. But I think (and hope) you're exaggerating. I mean seriously, what percentage of med students are 250 Step I AND 25th percentile in their med school classes or higher? Well considering 224 was the mean in my exam and 16 was the SD, that's about 10% of medical students that score 250+ on Step I. Add that to how many are honors students (let's say AOA). So are you saying that the top 5% of med students fill every single competitive specialty? 5% of med students go into Radiology alone, and that's not even considering all the other "competitive" specialties.

It is still extremely difficult or impossible for them to match into certain specialties at at certain programs but they are gaining ground. More power to them!

Disagreed. Your typical medical student has to take a lifetime worth of debt just to attend medical school. The MD/PhD has to spend their entire 20s getting education. This means we should give up our healthcare system to FMGs who cram very hard for Step I and Step II and finish med school in their home countries before we are even done undergrad? This is a tangent to the point of this thread, but you're not going to get much sympathy saying "Well you MD/PhDs are lazy with your HPs. Don't expect to match. But if there's a FMG who's already a doc in their home country, they should totally match! More power to them!"

I'm pulling out the BS meter on this one.

 

[dl2dp2]

after talking to the neuro PD at my school (considered one of the top 3), i got more of a similar picture as gbwilliner and less so as iceman.

the guy told me since i'm a "MD/PhD from school 'x', i'll get my choice of top neuro programs in the country," and that "i should probably get Honor in neuro, but two years ago two kids from this MD/PhD program only got HP in neuro but still both matched at harvard." He seems to imply that stressing over this is counterproductive. Try you best and do well, but it boils down more to what career YOU want rather than being cheery picked by PDs.

honoring all 6 rotations when you are many years away from the wards is VERY VERY hard! Our program director's motto is "to strive for a mixture of H and HP".

Maybe my PD's full of **** but I'd say iceman's making a blanket statements regarding residencies. IM/peds/neuro/path is VERY different in its criteria compared to ROAD specialties. Supposedly radiology cares a lot about PhDs as well, though I could be wrong. Thirdly, according to NMRP's data, people with PhDs have very very low non-match rates, even for derm/rad onc. Chances are, if you are a MD/PhD from a "top" school, you'll match into the residency of your choice--but for competitive specialties, it might not be the first place on your list, but most likely you can still pick a geographical preference.

lower tier MD/PhDs there might be more unknown variables, but overall I'd say the chances are still pretty good.

No need to spread the web of fear.

 

[dl2dp2]

Their reasoning behind this clinical focus is that you can be a bad scientist and the worst that could happen is that you wont get funded. But if you just pass clinically then people get hurt. This is why medical errors are so prevalent. Residency directors are right to look for clinically outstanding residents.

This is a specific point I want to counter. Most high-power academic IM/peds/etc. programs are not self-sustainable purely on clinical revenue, and extramural funding is at least 50% of the budget. Usually future faculty is drawn from residents, and hence a bent on being a very successful future researcher is HUGE in selection. At the end of the day the department wants someone who can pull in multiple R01s and support staff and hook up on multicenter trials, etc. etc. Who do you think is more likely to make this happen? AMG MD/PhD w/ a few P here and there, or a IMG with 270 board score?

In academic departments, not getting funded is often WAY worse than being clinically mediocre. It's a very publish or perish kind of atmosphere. You can be the greatest doctor in the world, but if you can't bring in the money, you get subjugated to a little dirty cramped office and see MEDICARE patients 24/7. I've seen this happen and don't want to be there. In private practice, however, efficiency matters more, and I would imagine being clinically superior and have a better fund of knowledge would actually make you more valuable.

 

[Doodledog]

Their reasoning behind this clinical focus is that you can be a bad scientist and the worst that could happen is that you wont get funded. But if you just pass clinically then people get hurt.

Bad scientists conduct research that either does not answer the question that they wish to answer or leads to misleading answers, some of which may cause people to "get hurt." Bad scientists misinterpret their data or hide data that may not be consistent with their biases or what they think will help their career. Bad scientists do not collaborate properly and do not work together to answer important questions. I am certain, from spending several decades as a scientist and in the scientific community, that I have seen bad scientists hurt a lot of people.

Being a bad scientist is not benign, IMHO.

 

[CCLCMer]

I was told that applicants who have only 0-1 honors and HP'd the rest are a big red flag, way bigger than those who dont publish or dropped out of the MD/PhD program. According to one of them it indicates that they were "slackers" (not my words) in their clinical rotations and would likely be poor residents in the most competitive programs.

If we wait six months, we may get something of a more objective answer to this question. At CCLCM, we don't have any possibility of Honors. We don't even have HP. On my unofficial transcript, all of my clinical grades are recorded as Pass because we only have P/F for our rotations. Also, we are MD/MS students, not MD/PhD, so we can't count on a PhD to "bail us out". For anyone who is interested, I'll try to remember to bump this thread and post what happens in March when the first class matches.

 

[Neuronix]

At CCLCM, we don't have any possibility of Honors. We don't even have HP.

Ohhh, good point, but there's no need to wait 6 months. Stanford has not had grades or class rankings for years now. Their match list looks pretty good to me...

 

[CCLCMer]

Ohhh, good point, but there's no need to wait 6 months. Stanford has not had grades or class rankings for years now. Their match list looks pretty good to me...

Stanford is P/F for their clinical years too? Wow, I didn't know that. Cool.

So for those people who think Honors grades in third year matter so much, do you have any thoughts about how PDs rank people from Stanford against people from other schools? I find it hard to believe that every Stanford grad stays at Stanford for residency, so there must be some method of considering people who don't have any Honors or HP whatsoever. Is there anyone posting from Stanford in this forum who can clue the rest of us in?

 

[pseudoknot]

Stanford is P/F for their clinical years too? Wow, I didn't know that. Cool.

So for those people who think Honors grades in third year matter so much, do you have any thoughts about how PDs rank people from Stanford against people from other schools? I find it hard to believe that every Stanford grad stays at Stanford for residency, so there must be some method of considering people who don't have any Honors or HP whatsoever. Is there anyone posting from Stanford in this forum who can clue the rest of us in?

Yale is also truly P/F all four years, if I remember correctly. I'm sure Step I/II and LORs play a larger role with those students, and yes, probably name recognition from the school itself.

 

[pseudoknot]

Radiology and gas could fill with all AMGs if they wanted to. But they might have to take more 210-220 Step I scores. You know--50th percentile.

It's slightly off topic, but radiology and anesthesiology are not in the same league of competitiveness at all. The average step I score for anesthesiology is close to the average for all matched applicants to all specialties, per Charting Outcomes.

 

[MiniFreud]

I dont know where you got your facts.

http://www.medschool.vcu.edu/mdphd/procedures/index.html

Look under "Promissory Note."

 

[IceMan2008]

Bad scientists conduct research that either does not answer the question that they wish to answer or leads to misleading answers, some of which may cause people to "get hurt." Bad scientists misinterpret their data or hide data that may not be consistent with their biases or what they think will help their career. Bad scientists do not collaborate properly and do not work together to answer important questions. I am certain, from spending several decades as a scientist and in the scientific community, that I have seen bad scientists hurt a lot of people.

Being a bad scientist is not benign, IMHO.

I understand that there are unethical scientist out there and that they do hurt people. What I am simply suggesting is that mistakes on the wards due to clinical incompetence have consequences that are immediate. For instance, I once saw (after the fact) a resident give a patient a bolus of insulin based on a blood glucose measurement that was three days old. The patient became very hypoglycemic and symptomatic. On the other hand, I have accidentally contaminated cells during cell culture experiments due to carelessness. Generally I would simply start over again. The great part of working in a lab and being a scientist is that you can make mistakes, and failures sometimes yield greater discoveries than successes. In clinical medicine, you dont always get a second chance.

On the other hand, a threshold of competence is necessary to practice medicine safely. If mistakes are made, people do get hurt. I've seen it before. Tildy makes an excellent point that scientists can hurt people through unethical behavior. But the immediate consequences of one's incompetence are not as quickly apparent as they are in clinical medicine. Personally, I think the bar is set too low in medical schools. You can get through med school by skimming the bottom and eventually become an unsafe physician if those habits are carried over into clinical practice. Part of what it means to get honors is being diligent and conscientious, reading about cases, knowing everything possible about your patients, and being able to communicate effectively. There are loads of studies that suggest that the single greatest predictor of resident performance is "number of honors" grades during the third year of medical school.

Diligence and conscientiousness are attributes that are developed through time and hard work. People who pass through med school simply do not put in the time, effort, and dedication (with the exception of people who have other issues involved such as personal problems, learning difficulties, a family crisis. There are exceptions). While this may seem like a blanket statement, I urge you to think back to a clerkship or class where you did not do as well as you could have. Ask yourself, "was there something more I could have done to do better?" The answer is nearly always, "yes."

 

[IceMan2008]

If we wait six months, we may get something of a more objective answer to this question. At CCLCM, we don't have any possibility of Honors. We don't even have HP. On my unofficial transcript, all of my clinical grades are recorded as Pass because we only have P/F for our rotations. Also, we are MD/MS students, not MD/PhD, so we can't count on a PhD to "bail us out". For anyone who is interested, I'll try to remember to bump this thread and post what happens in March when the first class matches.

Ofcourse schools that dont have a H/HP/P/F or A/B/C/D other internal measurement of the distribution of medical student performance are the exception and my claim does not apply in these instances. P/F does not differentiate to outstanding students from those that skim the bottom. Also students that go to the CC, stanford, yale are the cream of the crop. I am assuming that the faculty believe that everyone is exceptional. More power to you!

 

[pseudoknot]

For instance, I once saw (after the fact) a resident give a patient a bolus of insulin based on a blood glucose measurement that was three days old.

That seems like really gross incompetence that we wouldn't expect from even someone at the bottom of his class in med school.

Personally, I think the bar is set too low in medical schools.

OK, well, that's a pretty extreme perspective in my opinion. Maybe you're right though, maybe our healthcare outcomes would be better if we had a lot fewer doctors. Who knows.

There are loads of studies that suggest that the single greatest predictor of resident performance is "number of honors" grades during the third year of medical school.

"Loads?" Really? That may be the greatest predictor, but I don't remember it explaining most of the variation in resident performance. There are studies showing that Step I is a pretty crappy predictor of clinical performance, but that's still everyone's gold standard. Science hasn't met resident selection yet.

 

[QofQuimica]

Personally, I think the bar is set too low in medical schools. You can get through med school by skimming the bottom and eventually become an unsafe physician if those habits are carried over into clinical practice. Part of what it means to get honors is being diligent and conscientious, reading about cases, knowing everything possible about your patients, and being able to communicate effectively. There are loads of studies that suggest that the single greatest predictor of resident performance is "number of honors" grades during the third year of medical school.

Dude, even if you read for ten hours a day after spending 14 hours on the wards, you're still going to make mistakes. One of my preceptors pointed out that *all* of us are eventually going to make a mistake that kills or seriously hurts someone, not because we're bad people or we're not trying our best, but because in medicine, you're frequently making decisions without having all of the information. Or maybe our understanding (as a field) of the disease just isn't good enough for any individual doctor to "know" what the right way to handle the situation is. Or maybe we're just exhausted or distracted and overlook something that ordinarily we would have seen. Or maybe there's a systemic error that makes it easy for people to miss something important on labs (I've seen one example of this at my hospital already). Of course we should all try to learn as much as we can and do the best job we're capable of for our patients. But I think the lack of insight that you seem to have about the mistakes that *you* will make (and I say WILL, not MIGHT, because you *will* make mistakes just as the rest of us will) is far scarier than some med students skating by on a rotation or two that they don't find interesting.

Diligence and conscientiousness are attributes that are developed through time and hard work.

No one would argue with this point.

People who pass through med school simply do not put in the time, effort, and dedication (with the exception of people who have other issues involved such as personal problems, learning difficulties, a family crisis. There are exceptions).

You'd be surprised how many people have these "personal problems" in med school. I would say *most* med students have at least one major crisis, not just a select few. Life doesn't stop just because you're a *medical student* (cue the sunbeams and awe-inspiring music here.) If you have been fortunate enough to get through 7-8 years of grad/med school without a family member dying or becoming seriously ill, not ever being seriously ill yourself, having no major issues with your spouse or significant other, and never being too burned out/depressed to give your very best effort at all times, you are indeed a hugely fortunate person. I sincerely hope that your luck continues throughout residency and the next 30-40 years of your career.

While this may seem like a blanket statement, I urge you to think back to a clerkship or class where you did not do as well as you could have. Ask yourself, "was there something more I could have done to do better?" The answer is nearly always, "yes."

Actually, I would honestly answer no to this question. True, I have given a better effort at some times than I have at others. But in the context of what was going on in my life at those times when I wasn't performing at my very top capacity, I would say that I actually did pretty darn well, considering. See my previous point about *most* med students having some major crisis come up at some point during school.

 

[CCLCMer]

Ofcourse schools that dont have a H/HP/P/F or A/B/C/D other internal measurement of the distribution of medical student performance are the exception and my claim does not apply in these instances. P/F does not differentiate to outstanding students from those that skim the bottom. Also students that go to the CC, stanford, yale are the cream of the crop. I am assuming that the faculty believe that everyone is exceptional. More power to you!

I still would like to know what the residency application experience is like for grads of schools like Stanford or Yale. It's too bad that we don't have anyone posting here from those schools. CCF seems to like to keep its own people. I know several staff who did fellowships or residencies here, and a lot of fellowships go to CCF residents. Even at the med school level, there seems to be some of this. For example, we were highly encouraged to rotate here instead of at one of the other Cleveland hospitals. Also, when I mentioned maybe staying at CCF for my internship or residency, the dean was really enthusiastic about the idea. I definitely got the impression that the only reason I wouldn't be doing my residency here is if I decided that I'd rather go somewhere else!

On a somewhat related tangent, how many of you did aways or plan to do them? How did that affect your preference for where to do a residency? I'm thinking that I would like to do at least one away so that I can at least see how things are done at another institution. Also, I will be doing some rotations at UH (the main Case hospital), Rainbow Babies (Case's children's hospital) and the VA, which I have heard are all very different educational experiences than rotations at CCF.

 

[gbwillner]

On the other hand, a threshold of competence is necessary to practice medicine safely. If mistakes are made, people do get hurt. I've seen it before. Tildy makes an excellent point that scientists can hurt people through unethical behavior. But the immediate consequences of one's incompetence are not as quickly apparent as they are in clinical medicine. Personally, I think the bar is set too low in medical schools. You can get through med school by skimming the bottom and eventually become an unsafe physician if those habits are carried over into clinical practice. Part of what it means to get honors is being diligent and conscientious, reading about cases, knowing everything possible about your patients, and being able to communicate effectively. There are loads of studies that suggest that the single greatest predictor of resident performance is "number of honors" grades during the third year of medical school.

Not my experience.... 'Honors' means you did exceptionally well on the shelf board, which has nothing to do with any of the things you mention. Heck, it has more to do with being a fast reader than it does any of those things.