Most important deciding factors

[Merlin0082]

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Hey all, I was wondering, for a student trying to match to ophthalmology, aside from the normal factors (boards, clinical grades, LOR), what other things are valued the most? Some that I've heard are listed below--which do you guys think would hold the most weight, and why? Thanks so much!

Medical Missions
Research
Doing well in electives in ophtho
Away rotations at the institution
Anything else I'm missing?

Thanks a lot for your help 🙂

 

[RestoreSight]

Hey all, I was wondering, for a student trying to match to ophthalmology, aside from the normal factors (boards, clinical grades, LOR), what other things are valued the most? Some that I've heard are listed below--which do you guys think would hold the most weight, and why? Thanks so much!

Medical Missions
Research
Doing well in electives in ophtho
Away rotations at the institution
Anything else I'm missing?

Thanks a lot for your help 🙂

In general order of importance:

STEP 1 > LOR >/= Research >> Clinical Grades >> STEP 2

Away rotations are institution dependent. Some care, others don't. Medical missions should be done for altruistic purposes, not to buff your resume.

Totally depends though. If you published in Nature and have an MD/PhD the order may change. STEP 1 is #1 just because its a screening tool for top programs, not because it comments in any way on how good an ophthalmologist you will become. 👍

 

[Tiburon]

In general order of importance:

STEP 1 > LOR >/= Research >> Clinical Grades >> STEP 2

Away rotations are institution dependent. Some care, others don't. Medical missions should be done for altruistic purposes, not to buff your resume.

Totally depends though. If you published in Nature and have an MD/PhD the order may change. STEP 1 is #1 just because its a screening tool for top programs, not because it comments in any way on how good an ophthalmologist you will become. 👍

Agree 100% with the above.

One more thing people don't often think about is who your mentors know. Some mentors may have close, personal contacts with people on admissions committees at other programs and may be willing to call and go to bat for you. I saw that help a number of people. Of course, they also had a solid app, but it never hurts to give a school another reason to interview you.

 

[Merlin0082]

In general order of importance:

STEP 1 > LOR >/= Research >> Clinical Grades >> STEP 2

Away rotations are institution dependent. Some care, others don't. Medical missions should be done for altruistic purposes, not to buff your resume.

Totally depends though. If you published in Nature and have an MD/PhD the order may change. STEP 1 is #1 just because its a screening tool for top programs, not because it comments in any way on how good an ophthalmologist you will become. 👍

Of course step 1 makes sense. In terms of LOR--is it useful to get them only in ophtho/related fields (things like surgery which has overlapping skills needed)? For example, if someone did really well in something like psychiatry, which is pretty removed from ophth, is it useful to try to get a letter here?

I had another question if you guys don't mind. I had initially thought of going into Internal Medicine, so over the past 2 years, I have formed a strong relationship with the Internal Medicine Program director at my school. I think she would write me a good one, but is this kind of letter helpful considering IM is also not really related to ophtho?

Thanks again for your help!

 

[Tiburon]

Of course step 1 makes sense. In terms of LOR--is it useful to get them only in ophtho/related fields (things like surgery which has overlapping skills needed)? For example, if someone did really well in something like psychiatry, which is pretty removed from ophth, is it useful to try to get a letter here?

I had another question if you guys don't mind. I had initially thought of going into Internal Medicine, so over the past 2 years, I have formed a strong relationship with the Internal Medicine Program director at my school. I think she would write me a good one, but is this kind of letter helpful considering IM is also not really related to ophtho?

Thanks again for your help!

You need 3 letters. Seems the consensus is that 2 ophtho letters and 1 non-ophtho is the best combination. Most get the non-ophtho letter in IM or surgery, although I've heard it doesn't matter and what's in the letter is more important. And, IM is related to ophtho so you're good there. I'd definitely use that letter from the sound of it, and then get 2 ophtho letters.

On a side note, if I had somebody from my psych rotation beating down the door to write me a letter, and I had no better options in IM or surgery, I'd consider letting him write it. An outstanding, awesome LOR from a pyschiatrist beats a lukewarm IM or surgery LOR. But, an outstanding, awesome IM or surgery LOR would trump the equally awesome psych LOR (I could be way off on this).

You can just have 1 ophtho letter and 2 non-ophtho letters, but I think that's less ideal.

 

[rocketbooster]

In general order of importance:

STEP 1 > LOR >/= Research >> Clinical Grades >> STEP 2

Away rotations are institution dependent. Some care, others don't. Medical missions should be done for altruistic purposes, not to buff your resume.

Totally depends though. If you published in Nature and have an MD/PhD the order may change. STEP 1 is #1 just because its a screening tool for top programs, not because it comments in any way on how good an ophthalmologist you will become. 👍

What's the approximate Step 1 cutoff for screening you mentioned?

 

[Tiburon]

What's the approximate Step 1 cutoff for screening you mentioned?

It varies from school to school I'd bet.

My guess is that most schools have a score below which it is nearly impossible to get an interview (be it 200, 210, 220, etc... depending on how competitive the school), and scores above which makes it much, much easier to get an interview granted you had research and good LOR (240, 250, 260 depending on how competitive the school is).

In between (220-240) you have the majority of people and you look more closely at other stuff before offering them/denying them an interview. That said, obviously a 239 is better than a 221, so the 239 person would have a better shot.

Those are just my thoughts and what I'd do if I were a program director.

 

[RestoreSight]

What's the approximate Step 1 cutoff for screening you mentioned?

Depends on the instiution. A practical approach is to think about a program with limited time and a huge potential pool. Most programs will not interview more than 10-12 applicants per available position. Larger programs may interview more, smaller less. Some have only a few interview dates at all to begin with. To that end, the STEP score is used to parry down the number of applicants to a manageable number. Think 220s-230s typically with considerable variation depending on the prestige of the program

Still, I know of two applicants who matched at a top 20 program with a 205 and 207 STEP 1. Nothing substitutes for confidence and determination

 

[Melenema]

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[cubsrule4e]

ha, looks like a lot of us newbie MS3s are starting to crawl to this forum, but since you mentioned it... when you say "ophtho letter," could that be from your ophtho PI, or would it have to be someone you worked with on your clerkships? I just remember that when applying to med school your research LORs couldn't substitute for LORs written by profs who taught you in class. Just wondering if the situation is similar for residency apps.

Typically theyll want a letter from your ophtho chairman, assuming you have a department, another ophtho letter (mine was from the PD) and then a 3rd letter that can be from anyone who you feel knows you well/worked closely with, in this case it could be the person you did all your research with.

 

[Tiburon]

ha, looks like a lot of us newbie MS3s are starting to crawl to this forum, but since you mentioned it... when you say "ophtho letter," could that be from your ophtho PI, or would it have to be someone you worked with on your clerkships? I just remember that when applying to med school your research LORs couldn't substitute for LORs written by profs who taught you in class. Just wondering if the situation is similar for residency apps.

It could be anything. Somebody you worked with in clinic on clerkships or somebody you did Ophtho research with. If you are doing research with a clinician, maybe follow him in clinic for a few days so when he writes the letter he can comment on research and clinical stuff.

It's ideal to have a letter from your chairman, but plenty of people don't have the opportunity to get those and use a different one. The majority of people over the last few years from my school who went into Ophtho did not have a letter from our chairman.

 

[kwel]

Does the title of your non-ophtho letter writer (endowed chair vs. full prof vs. asst prof vs. clinical instructor) matter at all? I'm sure higher = better, but does it matter as much as it does for the ophtho letters?

 

[jsh1986]

I was shocked at the weight that one of my letters (from a well known ophthalmologist) played. the other 2 letters I had, one who is actually very famous in the internal medicine world, and the other a junior academic ophthalmologist were almost ignored...as was most of the rest of my application. It seems like all that mattered was that this one ophthalmologist had given me his endorsement and that was "all they needed to know" about me.

Ophtho is a small, small world. Create as well rounded an application as you can, obviously, but never miss the opportunity to get to know/be mentored by a well known (and well liked!) ophthalmologist. The dividends it can yield are unreal. This is common to most surgical subspecialities I have found...

(Someone asked about this in a prior post: Endowed professors receive a significant portion of their salary from a mini endowment (i.e. a significant portion of their salary will be straight from a passive investment vehicle, usually like $1-3m that was donated to create the "John Doe Professor of Ophthalmology). Think about how unusual this-- much of their income comes from an investment someone made--not from RVUs). These are extremely honorific and coveted. People are given these because they are perceived to be badasses. I would get to know anyone who holds an endowed professorship. Any other professor gets his salary from the university's bottom line and is expected to provide certain services in return to the university (committee, teaching, etc). The idea with endowed professors is that they are sort of protected from these obligations. Obviously professorship rank will give you an idea of how important the guy is, but endowed professorships are really the icing on the cake. You don't get an endowed professorship for just having been in the dept for 30 yrs. You get it because you are a rockstar.

 

[ophthope]

It is a small world, and I think that the relative recognition of the name matters more than an endowed professorship. However, endowed professorships probably correlate highly with name recognition. For instance I'm sure if you get a letter from the AAO president and compare it with a letter from a random endowed chair, the AAO president letter will hold more weight. There are plenty of other well known program directors or chairs that are known publishers, or AAO award winners (Straatsma, Outstanding Humanitarian, etc), or AAO current/former leadership position holders that will be recognized far and wide in Ophthalmology but won't be endowed. The letters will still hold weight.

However, even though I had a letter from a recognized name which may have been the 'foot in the door,' I got more comments about my other two letters which came from doctors with whom I had really developed friendships. They could speak about my personality, my motivations, and had more knowledge about me outside of just medicine. This isn't possible for everyone and I understand that, but if you have an Ophtho attending or core rotation attending with whom you have become close that letter may really stand out to interviewees.

It's amazing how different my interview experience was compared to jsh1986 anecdotes though, so I would take all of this with a grain of salt. I had a fairly 'big wig' letter which was mentioned briefly in all interviews and then the rest of the things on my application were discussed thoroughly.

 

[Melenema]

..

 

[kwel]

I was shocked at the weight that one of my letters (from a well known ophthalmologist) played. It seems like all that mattered was that this one ophthalmologist had given me his endorsement and that was "all they needed to know" about me.

I had a fairly 'big wig' letter which was mentioned briefly in all interviews and then the rest of the things on my application were discussed thoroughly.

When you say they made a big deal of these letters what does that mean? What kinds of things will they ask/mention about your letters?

 

[ophthope]

When you say they made a big deal of these letters what does that mean? What kinds of things will they ask/mention about your letters?

Mine generally went like this:

"I see that you have a letter from Dr. John, he is a great Ophthalmologist. He's done X,Y, and Z and is a great asset to that program." And then that would be followed up by some conversation about the letter writer and in what way you worked with them.

Another common one for letters was, "In your letter he/she wrote '[insert quote from letter]' about you, why do you think he said that?" That one was generally from my other writers who knew me more personally and could say more meaningful things about me. It basically gives you a chance to explain why someone would have said that you were responsible / hard-working / a great asset / etc.

I would like to mention that for the most part, interviews aren't horribly stressful experiences. When you are grilled about something it is gentle, and it isn't about Ophthalmology. Nobody ever asks you to differentiate between phacomorphic and phacolytic glaucoma, but they may try to figure out your study habits and how you organize your work life.

 

[jsh1986]

Ophthope summarized it well. My interviews primarily focused on the work I did w that PI, what he said about me, why he said certain things, etc. Again, for this reason, I was shocked at the "weight" that this letter had in my overall application portfolio. There were entire aspects of my application that I had spent considerable amount of time preparing that were never even discussed. This was frustrating and surprising to me.


As with all things on SDN, take everything you read here with a grain of salt. People have very different experiences and although interview habits may cluster, you will in all likelihood find yours to not fall into a clean bin that someone else has previously described. Treat the content of threads like this as an opportunity to consider brushing up on parts of your application that you had not previously given much thought to (i.e. like the weight of "big wig" letters).

When you say they made a big deal of these letters what does that mean? What kinds of things will they ask/mention about your letters?

 

[scubaman85]

Step 1 is the most important followed closely by your letters of rec. Try and get to know the most well known ophtho professor/researcher at your institution and spend a lot of time with them so that they can say specific things about you in a letter so it doesn't look generic to the people who read your application (good things include: you are a hard worker, good with patients, strong critical thinking skills, excellent housestaff potential, etc). Also the people who you get letters from had to have trained somewhere back in the day so their institution may give you an interview/look more favorably on your application since you worked with an alumnus. Who you know does matter in this process, just like in the rest of the real world