MS3 in trouble. PLEASE HELP me land EM spot!!

[docLuis]

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I would like advice on how to maximize my chances on matching into EM.

Here is my situation: 1st and 2nd year grades are poor. 2 MP's, 4 HP's and 1 H. 1 MP occurred during the time I delivered my daughter, so I'm hoping that one will slide under the radar.

Good news? I still have Step 1 to take and I know I will rock 3rd year because I have the personality needed to impress attendings. I will have a publication, research, lots of leadership exp, volunteer, etc. My CV is packed.

-What score should I shoot for with Step 1 to "hide" pre-clerkship grades?
-How much would residency directors care about these grades if all else is above average?

PLEASE. Any advice will be much appreciated. THANK YOU.

 

[Rendar5]

I'm not sure how mcuh to be worried about pre-clinical grades. Those are very hard to compare between schools since a lot of schools don't even have pre-clinical grades.

 

[goosedander]

I would like advice on how to maximize my chances on matching into EM.

Here is my situation: 1st and 2nd year grades are poor. 2 MP's, 4 HP's and 1 H. 1 MP occurred during the time I delivered my daughter, so I'm hoping that one will slide under the radar.

Good news? I still have Step 1 to take and I know I will rock 3rd year because I have the personality needed to impress attendings. I will have a publication, research, lots of leadership exp, volunteer, etc. My CV is packed.

-What score should I shoot for with Step 1 to "hide" pre-clerkship grades?
-How much would residency directors care about these grades if all else is above average?

PLEASE. Any advice will be much appreciated. THANK YOU.

 

[Tiger26]

Concur with above

"I know I'm going to win the lottery because I'm just really great at picking sets of random numbers . . . "

 

[docLuis]

Point taken. I realize some attendings will be jerks. At least part of the grade is still the standardized exam. Plus, I am only really shooting for mostly HP's.

So what about the Step 1 and everything else? Advice please!! Thanks

 

[RxnMan]

...Good news? I still have Step 1 to take and I know I will rock 3rd year because I have the personality needed to impress attendings...

I have no idea how you can anticipate this. With one year of clinical experience under my belt, I will say that there was little to no consistentcy between rotations, grading, or attendings. There is almost no way for you to predict or ensure that your grades will be good in clinical rotations outside of crushing the shelf exams.

...-What score should I shoot for with Step 1 to "hide" pre-clerkship grades?...

As with anything, the higher/more gooder the better.

...-How much would residency directors care about these grades if all else is above average?...

There are several publications that address this point. Feel free to google them. Preclinical grades, IIRC, were far down the list of desirable attributes compared to clinical grades (elective + requireds), Step I, Step II, rank.

 

[Tiger26]

Point taken. I realize some attendings will be jerks. At least part of the grade is still the standardized exam. Plus, I am only really shooting for mostly HP's.

So what about the Step 1 and everything else? Advice please!! Thanks

Our EM advisor said preclinical grades and extracurriculars were the last thing that matters on an application.

The most important things are LORs, 3rd year grades, and board scores

It sounds like people are safe with anything in the 220-230 range, and still pretty successfull in the 210-220 range

 

[theCamel]

do just well enough on step 1+2 (205+ should do it) and in your clinical grades (above average+) to get invited to 5-8 EM residency interviews and then from the sounds of it you'll be set once they meet you.

 

[notdeadyet]

I have no idea how you can anticipate this. With one year of clinical experience under my belt, I will say that there was little to no consistentcy between rotations, grading, or attendings. There is almost no way for you to predict or ensure that your grades will be good in clinical rotations outside of crushing the shelf exams.

And for some rotations, the shelf can count for little of the final rotation grade. My current rotation is 30% shelf.

 

[SoCuteMD]

Point taken. I realize some attendings will be jerks. At least part of the grade is still the standardized exam. Plus, I am only really shooting for mostly HP's.

So what about the Step 1 and everything else? Advice please!! Thanks

It seems you've already made up your mind how much you are willing to do. HPs are nice, but really not all that impressive in the clinical years. No one can give you a "magic" Step 1 score. As much as people will tell you it doesn't matter, it does. And unfortunately for you it's very much a reflection of how hard you worked the first two years of medical school. There's little you can do in 4 weeks of study to make up for 2 years of not studying as hard.

 

[docLuis]

Thank you all for the helpful answers.

SoCuteMD: I wrote incorrectly. I will shoot for all honors. However, I will have to be satisfied with mostly HPs IF I am unlucky enough to have a majority of horrible attendings. For the Step 1, I actually have a solid 2 months with no other coursework, I think I can make up for lost time 🙂

 

[kenshin1]

Thank you all for the helpful answers.

SoCuteMD: I wrote incorrectly. I will shoot for all honors. However, I will have to be satisfied with mostly HPs IF I am unlucky enough to have a majority of horrible attendings. For the Step 1, I actually have a solid 2 months with no other coursework, I think I can make up for lost time 🙂

Or perhaps if your work doesn't merit honors? Seriously, dude, I highly recommend you drop the "I'm so wonderful and charming" attitude before you start your clinical rotations. I don't think the 1st 2 years of med school necessarily predict success on the wards; however, someone who has not exactly set the world on fire so far in med school, should probably be a little humbler. Besides arrogance is appropriate exactly never in med school.

 

[docLuis]

I apologize if I have portrayed arrogance. I only intended to be positive.

I would appreciate taking the focus off of my misguided perception of clerkship success, and rather just answer these 2 questions:

If all else from this point forward is a significant improvement from my pre-clinical grades, do I have to worry about them?

Should I have to consider a less competitive specialty due to my pre-clinical grades?

Thank you!

 

[RxnMan]

I think more than anything, what we're collectively trying to convey is that you should work as hard as you can on all fronts - be it Step I, clinicals, etc. There's no garauntees on grades anywhere, and all facets are important. But what's in the past is past, so look to the future.

Thus, your only recourse, and this counts in pretty much all parts of life, is to work as hard as you can. That way, when you're in the interview chair and someone asks you about some low grade or other, you can reply that it was your best effort, you learned from it, and you have no regrets.

 

[BKN]

I realize some attendings will be jerks. Thanks

""The fault, dear Brutus, is not in our stars,
But in ourselves, that we are underlings."

Well, Cassius was taking the same attitude. He was suggesting that he and Brutus were Caesar's equals . . . but it ain't necessarily so. I would cut off the last four words, this is how it's usually quoted and it gives an entirely different meaning. I resented being at the bottom of the pile in my time, but I was wrong.

Sometimes, students or junior residents do need a kick. So don't assume that just because an attending is direct and impatient, that he's a jerk. He may be trying to tell you something about yourself that you need to hear.

OK, enough abuse. As to your overriding question, I've been selecting EM residents for 25 years now and can answer it. 2 marginal passes in preclinical courses will not doom your application, but they will raise a red flag. You need to do reasonably well on step 1 (above 82 on the 2 digit scale), shine on your 3rd year rotations and do 1 or 2 great EM rotations to get great SLORs. The SLORs are the most important single part of the application.

We are not generally looking for geniuses for EM. We are looking for Docs with at least average academic skills who also possess superior interpersonal and multitasking skills. Those who demonstrate the last two will get SLORs that are good enough to get in.

You can succeed at this, but given the 2 MPs you need to plan your campaign carefully.

 

[docLuis]

Thank you, BKN, for the very helpful information. You answered my question precisely. MS3's at my school frequently call the attendings "jerks", but I suppose they could be bitter, right? haha... Arrogant little medical students do have a considerable amount of lessons to learn. I agree.

Thank you very much for your time.

I love the brutal honesty from you all. It's quite refreshing. 🙂

 

[shortbread9]

I think you also need to consider doing a SubI sometime early in your 4th year of medical school at programs you would consider doing a residency, or a city you are interested in. To reiterate some other comments...and not to sound mean you do need to be a bit more humble. As a senior resident..nothing is more annoying or frustrating than a medical student that will tag around with you the whole day and act high and mighty....its really uncool! You really just need to be yourself. Most EM docs want a hardworking person that is calm and collected...we are not necessarily looking for the genius but someone who is well liked and can pull their own weight. Just do the best you can on your step 1, bring up your grades and try to be consistent and score lor's from a program director/residency director during your ED months. Going thru the interview process myself and helping to pick fellow interns i would much rather pick the genuine, nice, helpful and hardworking med student, than the brilliant, all honors /published/ and lazy student.
Just my 2cents. good luck

 

[Cerberus]

And for some rotations, the shelf can count for little of the final rotation grade. My current rotation is 30% shelf.

Not to mention how difficult the shelf exams are. My clinicals were almost always good (usually an H in clinicals) but the shelf exams sunk me over and over (it doesn't help that my school doesn't understand that a 70 is the average score on shelf exams, they treat it like it's a point above failing).

 

[docLuis]

I heard that the issue with shelf exams is that the practical and more "modern" lessons that you learn during rotations are not tested. Rather, they still test you on the more old fashioned textbook concepts.

If someone could further clarify/elaborate that would be great.

I am assuming the only way to ensure your best performance is to study review books daily?

 

[GeneralVeers]

I heard that the issue with shelf exams is that the practical and more "modern" lessons that you learn during rotations are not tested. Rather, they still test you on the more old fashioned textbook concepts.

If someone could further clarify/elaborate that would be great.

I am assuming the only way to ensure your best performance is to study review books daily?

It was all textbook concepts when I went through.

As a terrible test-taker I was at a supreme disadvantage. I aced most of my clinical parts (except for OB-GYN which was run by bitter female residents), but I did mediocre to sub-par on all the shelf exams. The result was that I ended up with a pass in almost all the rotations purely based on the shelf exam.

If you want to excel, focus on the shelf exams.

 

[The Buff]

If you want to excel, focus on the shelf exams.

...unless you are at a school like mine where the shelf scores are largely ignored and your grade is based wholly on what the attendings/clerkship director thinks about you. At least look at the breakdown of the grades in your school's clinicals before you throw all your efforts behind kissing ass or nosing books.

 

[Cerberus]

...unless you are at a school like mine where the shelf scores are largely ignored and your grade is based wholly on what the attendings/clerkship director thinks about you. At least look at the breakdown of the grades in your school's clinicals before you throw all your efforts behind kissing ass or nosing books.

My school is the exact opposite. Shelf exams usually make up 50% of the grade.

 

[mercaptovizadeh]

And for some rotations, the shelf can count for little of the final rotation grade. My current rotation is 30% shelf.

That's nothing. There are rotations at my school where the shelf is even less. In IM it's 25% and in peds it's 15%, which I think is ridiculous. At least in neuro it was 33% and in psych it was 30%.

 

[mercaptovizadeh]

I think more than anything, what we're collectively trying to convey is that you should work as hard as you can on all fronts - be it Step I, clinicals, etc. There's no garauntees on grades anywhere, and all facets are important. But what's in the past is past, so look to the future.

Thus, your only recourse, and this counts in pretty much all parts of life, is to work as hard as you can. That way, when you're in the interview chair and someone asks you about some low grade or other, you can reply that it was your best effort, you learned from it, and you have no regrets.

Exactly, everything counts, where "everything" = Step 1 (and to a less extent Step 2), 3rd year grades, and LORs. Everything else, aside from some high-powered EC like a PhD or founding (i.e. not just volunteering at) a free clinic, is mostly fluff. Shoot to get as many Hs as possible - it can't hurt. Similarly, for Step 1, study as hard and as long as you can and shoot for a perfect score - you won't get it, but that's the right attitude.

 

[DoctorPardi]

I am only a 2nd year but it would seem to me the classic MCAT advice would apply towards your "what score do I need to shoot for?" question.

Do the best you can and that's it.

People always want to know what they need to shoot for. If someone told you a 225 would cover up poor pre-clinical grades, wouldn't a 230 be even better or a 235 and so on?

I would study as hard as you could for as long as you could and just see what happens.

 

[Labslave]

That's nothing. There are rotations at my school where the shelf is even less. In IM it's 25% and in peds it's 15%, which I think is ridiculous. At least in neuro it was 33% and in psych it was 30%.

Shelf exams at my school never exceed 20% of our grade (for the vast majority, they accounted for only 15%), meaning that it was a subjective crapshoot time and time again. I've said it before on other threads and I will say it yet again: third year evaluations are more a reflection of the people that fill them out than they are of the student being evaluated. I did pretty well third year looking back on it now, but I did have a couple of rotations where I got very unlucky and it adversely affected multiple grades (and hence prevented me from getting AOA). Oh well. Life moves on.

To the OP: In all honesty, nobody cares about your preclinical grades as long as you passed. It might affect your class rank, in which case it may end up being important in the end to some programs (but likely only the most competitive). The best advice for succeeding from this point on has already been given: be humble, work hard, act like a normal human being, and don't complain. That will take care of the clinical portion of your grade. Then when you go home, study whenever you can for the shelf exams and make sure you read up on your patients.

Have fun and work hard. G'luck.

 

[docLuis]

I thank everyone for the awesome advice. I feel so much better 🙂 I am studying like mad for Step 1.

Does anyone have tips for LOR? I recruited one of the residency directors to be my mentor last year, so there's one. What can I do, if anything, during 3rd year to ensure more letters from EM directors?

 

[Jwax]

I thank everyone for the awesome advice. I feel so much better 🙂 I am studying like mad for Step 1.

Does anyone have tips for LOR? I recruited one of the residency directors to be my mentor last year, so there's one. What can I do, if anything, during 3rd year to ensure more letters from EM directors?

I've got a question about EM LORs as well. Feel free to ignore me if this has been answered elsewhere (I feel like I've seen it on the FAQ sec or somewhere else randomly). My city has every residency except EM. There is an EM residency in the state, but it is in a city 1.5 hours away that I couldn't get it worked out with my schedule to be able to do a 2 week selective in EM there during 3rd year. I've already got at least two EM physicians, one at our school's hospital, one at a community hospital that I shadowed for ~2 years before and a little bit here and there during med school. They'd both write me some very nice letters. Since there is no residency here, obviously neither are considered "academic" physicians. I plan on doing two aways at the beginning of 4th year and maybe try and get a sub-I as well at our state residency hospital, but that means that I'll only be able to obtain academic LORs from people who have only seen me for a month and it will be pretty last minute for my app.

To get the point (sorry, I ramble), is it really a bad deal if I have two non-academic EM docs and 1 academic from wherever my first away is? Or do I need to wait until I can get all academic docs? Kind of considered using the one who's known me for years, getting a doc from IM or surg, and then one from an away EM doc. Would that be a good thing? Thanks.

 

[Cerberus]

I've got a question about EM LORs as well. Feel free to ignore me if this has been answered elsewhere (I feel like I've seen it on the FAQ sec or somewhere else randomly). My city has every residency except EM. There is an EM residency in the state, but it is in a city 1.5 hours away that I couldn't get it worked out with my schedule to be able to do a 2 week selective in EM there during 3rd year. I've already got at least two EM physicians, one at our school's hospital, one at a community hospital that I shadowed for ~2 years before and a little bit here and there during med school. They'd both write me some very nice letters. Since there is no residency here, obviously neither are considered "academic" physicians. I plan on doing two aways at the beginning of 4th year and maybe try and get a sub-I as well at our state residency hospital, but that means that I'll only be able to obtain academic LORs from people who have only seen me for a month and it will be pretty last minute for my app.

To get the point (sorry, I ramble), is it really a bad deal if I have two non-academic EM docs and 1 academic from wherever my first away is? Or do I need to wait until I can get all academic docs? Kind of considered using the one who's known me for years, getting a doc from IM or surg, and then one from an away EM doc. Would that be a good thing? Thanks.

You need 2 SLORs from academic EM physicians. Since your school doesn't have an EM department, you will need to do aways. The residency director at my program told me he just tosses out SLORs from non-Academic EM docs...

 

[DCDAWG]

Our EM advisor said preclinical grades and extracurriculars were the last thing that matters on an application.

The most important things are LORs, 3rd year grades, and board scores

It sounds like people are safe with anything in the 220-230 range, and still pretty successfull in the 210-220 range

That seems to be consensus. But, Id like to know what would be considered a reach for someone with middle of the class grades and a 220-230. Would someone in that range find themselves getting interviews at a wide variety of programs?

 

[Cerberus]

I am only a 2nd year but it would seem to me the classic MCAT advice would apply towards your "what score do I need to shoot for?" question.

Do the best you can and that's it.

People always want to know what they need to shoot for. If someone told you a 225 would cover up poor pre-clinical grades, wouldn't a 230 be even better or a 235 and so on?

I would study as hard as you could for as long as you could and just see what happens.

I think the best answer is to just shoot for the highest score you can possibly get. Aim high on STEP I. I haven't gone through the match yet, but I've gone over my app with several people and they all comment on one thing in my cv above anything else, my STEP I score.

 

[Tiger26]

I think the best answer is to just shoot for the highest score you can possibly get. Aim high on STEP I. I haven't gone through the match yet, but I've gone over my app with several people and they all comment on one thing in my cv above anything else, my STEP I score.

As in good or bad?

 

[BKN]

That seems to be consensus. But, Id like to know what would be considered a reach for someone with middle of the class grades and a 220-230. Would someone in that range find themselves getting interviews at a wide variety of programs?

Yes. A few programs would not interview, but if you sent out 30 apps, you would probably easily exceed the minimum of 10 interview invites.

 

[Cerberus]

As in good or bad?

Good. A solid STEP I will open a lot of doors, whereas a poor one will slam them shut.