much needed advice from y'all

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baddreams55

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I got into only one med school this year and it is an allopathic primary care focused school. Of course I am not 100% sure that I don't want to do primary care, but at the end of my four years I want at least a decent chance to get a residency in a competitive specialty field. Since my school is primary care focused, clerkships in specialties like opthalmology, derm, nephrology, etc... are few and far between and no elective clerkships are even allowed until the middle of 4th year. What should I do? I did apply intially to many schools that have students that place in all sorts of competitive specialized residencies, but only the primary care school took me. Am I been screwed before I even begin my first year? Re-applying when I have an allopathic acceptance is out of the question, right? So what can I do about making myself competitive for specialty?

baddreams55
 
You can get any residency from any medical school. Just work hard, learn the material well, get good grades, high boards, good clinicals and strong aways. You'll be fine.
 
You should be fine. My school also emphasizes primary care. While the hours of clinic are pretty interminable (especially once I figured out I wanted to specialize) it's not the end of the world. There will still be specialists at your school - take advantage of them. For example if you are interested in Dx Rads, find a radiologist who will let you shadow or do research with him/her. Research is the key to many of the competitive specialty residencies so make sure you get your name on some kind of paper during your med school time. Start early (like the summer between 1st and 2nd years) so you'll be assured to get something published. Retrospective clinical studies are especially golden material for med students to work on. Finally, keep in mind that many specialties (GI, Cardiology, Nephrology, etc.) are fellowships which you apply for after a couple years of internal medicine residency (which is considered a primary care field). If you perform well enough to get an IM residency at an academic center, getting a fellowship is not that difficult if you are good clinically and have some research under your belt. As the above poster said, if you perform well (especially on step 1) then there is not reason you can't match into a specialty from any allopathic school. I would add only an emphasis on the importance of RESEARCH.
 
My school does not have a focus on primary care, but the opportunities for gaining experiences with specialists is still limited until 4th year. I think it is pretty much standard, third year is core clerkships with maybe a chance for one elective. Like was said above you have to make it happen, and that really goes for everything in med school. Pursue shadowing and if you know what you are interested in pursue research in that area, start talking to people by December to line up something for the summer. I wouldn't worry, I know a lot of people who are specialists who went to medical schools who focus on primary care.
 
Thank you for all the advice......

Pikachu, what are Retrospective clinical studies? I have never heard of them, but maybe that's because I haven't started first year yet.

About the research thing.......does the research have to be in your desired field (like derm or opthalmology?) cuz right now, I am doing a summer research fellowship at that primary care school on cancer-related helicases (good stuff, but not exactly derm or ophto). Not 100% sure, but it looks like I might get my name in the lab;s paper. But I won't be first author or anything, probably just 1 name out of 5 people. Do I have to be 1st author for it to be meaningful in residency matching? Wouldn't first authorship be unlikely for a pure MD (not md/phd) that only does 8 wk stretches of research?


baddreams55
 
baddreams55 said:
Pikachu, what are Retrospective clinical studies? I have never heard of them, but maybe that's because I haven't started first year yet.

It's a type of study where you look at patient outcomes that have already happened. For a really simple example, you could look at 50 patients who had appendectomies and see what kind of complications they had, whether the complications were related to age, sex, etc. As opposed to a prospective trial where you enroll people in the study, then follow what happens to them usually plus or minus a certain intervention or the presence of a certain variable. Prospective trials take a lot longer and as a med student are probably out of your reach for a variety of reasons. Finally you could do some actual lab work. It sounds like you're already planning this for the summer, which is good. It will be hard to keep up in a lab once you're actually taking med school classes, though.

About the research thing.......does the research have to be in your desired field (like derm or opthalmology?) cuz right now, I am doing a summer research fellowship at that primary care school on cancer-related helicases (good stuff, but not exactly derm or ophto). Not 100% sure, but it looks like I might get my name in the lab;s paper. But I won't be first author or anything, probably just 1 name out of 5 people. Do I have to be 1st author for it to be meaningful in residency matching?

Any name on any paper is good, although first author as a med student is certainly impressive to residency directors. I've heard that being in the first 3 authors is the best, since those are the ones who are mentioned in a standard citation. After 3rd, you get pushed into the "et al." department and your name doesn't show at all in a citation. However, your name would be on the actual paper and you can certainly cite this on your CV. Cancer-related helicases sounds good though, since basic cancer research can apply in almost every specialty.

Wouldn't first authorship be unlikely for a pure MD (not md/phd) that only does 8 wk stretches of research?
First authorship IS unlikely for lab work in med school unless you're an MD-PhD. I'm sure there are people out there who've done it, but it seems like it would be pretty hard. However, a first authorship is NOT out of your reach if you find a good mentor, most likely for a retrospective clinical study. It's easier to make time for chart review, etc. since you can just go and look through charts during your downtime then put it down, unlike most lab experiments. BEFORE you start any project, tell the person who is sponsoring the research that you want a first authorship for your work. A good research advisor should care enough about the student (and have enough publications themselves) that they won't insist on being first author on everything that comes out under their auspices. Stay away from any advisor who hedges on this. To get first author, you need to have put more work into the paper than anyone else. you would probably need to collect all or most of the data yourself, and be the main author of the draft. It's just a question of finding a manageable project (small-medium sample size) and a good advisor. If in the future you have a specific question about a project pm me. I've worked on several similar studies and so I have some idea about what kind of projects are realistic.
 
baddreams55 said:
Since my school is primary care focused, clerkships in specialties like opthalmology, derm, nephrology, etc... are few and far between and no elective clerkships are even allowed until the middle of 4th year.

Which school are you talking about? Are you sure you have the right information? I'm a little skeptical that you can't do any specialty rotations until the middle of fourth year since by then the match is already underway. As a person in the military, I'll find out where I matched on december 15th, which is before the middle of 4th year even occurs! Every school I know of allows electives at the beginning of fourth year. Also, most schools will work with you and let you push a required rotation back and do an elective early. For example, my school's big thing is also primary care and internal medicine. Yet I was still allowed to push back my ob/gyn rotation to fourth year in order to do an ophtho rotation early during third year.
 
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