Musings on school choice from an MS4

[majestic red]

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I frequented these forums when I was applying to medical school and haven't really been back since then. I'm not sure what prompted me to come back, but as I'm preparing to apply for the residency match this year, I've been thinking back on my time as a med student and what I've learned since I was a pre-med. For the record, I'm at a "top-tier" MD school and will be applying for residency in a competitive surgical subspecialty, so my opinions are likely to be biased by these two facts.

I remember when I was applying to med school, people always told me that it didn't really matter where you go. I was told to just choose whichever school was cheapest or whichever school I felt I "fit in" at. This is somewhat true, and is probably more true for the majority of medical students than it was for me. It's true that you'll receive good training at any US MD school, and a motivated student will be able to match into any specialty from any school. In my case, however, I started med school without any real sense of what specialty I wanted to pursue. I had an inkling that I wanted something procedure-oriented, and I was relatively sure that I didn't want to end up in primary care. In my case, going to a "name-brand" school (and my specific school, at that) has made a huge difference in my career trajectory. It's a little early in the year for people to be making school choices, but I hope to give a bit of advice on how to pick the right school. Here's a list of things to consider, in order from more important to less important.

3rd year rotations
When I was interviewing, I remember placing a lot of emphasis and asking a lot of questions about the pre-clinical years, while basically ignoring the 3rd year curriculum. Part of this was because the pre-clinical years felt more familiar to me and I really had no basis for comparison for the clinical years. Part of this was because most of the med students we met during our interview days were 1st- and 2nd-years. I spent a lot of time trying to figure out if I wanted to go to a pass/fail school, or if I wanted to do PBL. The truth is, none of that stuff really matters. It's all about the 3rd year. The 3rd year is when most students decide on their future specialties, and the structure of your 3rd year curriculum can have a big impact on what you are or are not exposed to. For example, my school's Surgery clerkship consists of 3 month-long rotations with many options for month-long subspecialty surgery roations. Many other schools, including similarly-ranked schools that I was strongly considering as a pre-med, only have 2 months of Surgery with 1 week or less of subspecialty surgery. In my case, I just happened to schedule myself for a month-long rotation on what eventually be my specialty of choice and fell in love with it during my rotation. I doubt that I would have gotten enough exposure to decide on this specialty if I only had a week on service. This matters less for people interested in IM or Gen Surg or Ob/gyn or any number of other more standard "core" rotations, but it made a big difference for me.

Connections
My specialty of choice is highly competitive. My school has a residency program that I would be very happy to match at, but there are many schools that don't. We also have several well-known faculty members, which means that I've been able to get strong letters of recommendation and solid application advice. More than that, my school has a track record of matching students into good residency programs in this specialty, which means that I have access to a network of alumni who are now residents at many of the programs that I'd love to go to. These alumni have been invaluable in providing application/away rotation advice. I had no idea which faculty members or alumni would be important to me when I first entered medical school, but I do think that connections like these are more abundant at "brand-name" medical schools. Of course, connections aren't everything and you still need the grades and the board scores to match well, but I think I'm in a much better position here than I would have been elsewhere.

The 4th year
It's important to get an idea of your 4th year requirements. Some schools have an entirely elective 4th year, while others require certain rotations and sub-is. I'm personally inclined to think that the more control you have over your 4th year schedule, the better, but this is probably mostly because I don't want to be forced into doing a Medicine sub-i when I'm going into Surgery.

 

[aesculapian]

This is really helpful; thanks for sharing!

 

[Lya]

Thank you for your time and thoughtful post.

Many of these (flexible 4th year and solid alumni adviser network) are also similarly recommended by Survivor DO in his blog, so it is great to be reminded of their importances.

I have two quick questions:

1) About the 3rd year besides how rotation schedules are constructed, can you comment on the importance of having various hospital systems (VA, private, county etc.) available for students? Are they as important as the diverse patient populations?

2) Can you also comment on your advice on doing research from day 1 as a MS1? Although I am interested in oncology/IM, I want to look into research since I heard research is important for those looking into academic medicine.


Thank you again for your time.

 

[majestic red]

1) About the 3rd year besides how rotation schedules are constructed, can you comment on the importance of having various hospital systems (VA, private, county etc.) available for students? Are they as important as the diverse patient populations?

I personally chose to do most of my 3rd year rotations at my school's main hospital because of transportation issues (my husband and I share a car, which he needs in order to commute to work every day, so my options for driving out to other sites were limited). I have friends that rotated at the VA and at various private hospitals, and I do think that it's probably worth doing. The VA associated with my school has notoriously bad nursing staff, which was actually great for the rotating medical students because they got a lot of opportunities to draw blood, put in Foleys, take vitals, etc. Rotations at the private hospitals tended to be relatively cushy, and the only thing my friends ever commented on was how good the cafeteria food was

2) Can you also comment on your advice on doing research from day 1 as a MS1? Although I am interested in oncology/IM, I want to look into research since I heard research is important for those looking into academic medicine.

I didn't do research as an MS1 and, looking back, I kind of wish that I had. Besides the second half of 4th year, 1st year is probably the most free time that you'll have in medical school, so it's a good time where you can potentially get a reasonable amount of work done. It is, of course, hard to know what specialty you'll end up choosing and so you may not end up doing research that's relevant to your ultimate field, but I do think that most residency programs will look favorably on research in any field. I actually ended up taking a research year as part of my school's MA/MD program, which I really enjoyed. Definitely only do research if you have a genuine interest in doing research, though. Otherwise, you won't get anything out of it, and you probably won't be productive. Plenty of people match into big academic IM programs without having done extensive amounts of research, so don't feel like you have to do it just to check a box.

 

[mvenus929]

1) About the 3rd year besides how rotation schedules are constructed, can you comment on the importance of having various hospital systems (VA, private, county etc.) available for students? Are they as important as the diverse patient populations?

Personally, I think it's important to be able to do rotations at other health systems, because it's good to see how other people do things. I rotated at two different hospital systems, besides my home school, and two private practice offices, and I think it was good to see how each managed things, especially since the hospital systems had residents. I can tell you that I'm specifically not applying to the residency programs at the hospitals I did away rotations at because I did a rotation there and didn't like the way the system was set up.

 

[Lya]

Personally, I think it's important to be able to do rotations at other health systems, because it's good to see how other people do things. I rotated at two different hospital systems, besides my home school, and two private practice offices, and I think it was good to see how each managed things, especially since the hospital systems had residents. I can tell you that I'm specifically not applying to the residency programs at the hospitals I did away rotations at because I did a rotation there and didn't like the way the system was set up.

That's what I was suspecting as well. Thank you for your clarifications. Now I have a clearer idea on what I should include in my upcoming interview.

I personally chose to do most of my 3rd year rotations at my school's main hospital because of transportation issues (my husband and I share a car, which he needs in order to commute to work every day, so my options for driving out to other sites were limited). I have friends that rotated at the VA and at various private hospitals, and I do think that it's probably worth doing. The VA associated with my school has notoriously bad nursing staff, which was actually great for the rotating medical students because they got a lot of opportunities to draw blood, put in Foleys, take vitals, etc. Rotations at the private hospitals tended to be relatively cushy, and the only thing my friends ever commented on was how good the cafeteria food was


I didn't do research as an MS1 and, looking back, I kind of wish that I had. Besides the second half of 4th year, 1st year is probably the most free time that you'll have in medical school, so it's a good time where you can potentially get a reasonable amount of work done. It is, of course, hard to know what specialty you'll end up choosing and so you may not end up doing research that's relevant to your ultimate field, but I do think that most residency programs will look favorably on research in any field. I actually ended up taking a research year as part of my school's MA/MD program, which I really enjoyed. Definitely only do research if you have a genuine interest in doing research, though. Otherwise, you won't get anything out of it, and you probably won't be productive. Plenty of people match into big academic IM programs without having done extensive amounts of research, so don't feel like you have to do it just to check a box.

For those relatively less competitive programs like IM, you said you can match without having done exhaustive amounts of research and usually programs perceive favorably on research in any field. Thank you for confirming my presumptions.

Of course, I understand that ideally the research topics have to match with your ultimate speciality, but for less competitive programs, can I do research in things like health policy at a policy institute across the street, even though it has nothing to do with the clinical side of medicine? Or when you say research in any field, do you mean any field so long as it is clinically pertinent? This is an important question for me, because my ultimate interests are highly similar to those of Drs. Harvey Fineberg and Ezekiel Emanuel. Thank you again for your responses despite your busy schedule.

 

[majestic red]

Personally, I think it's important to be able to do rotations at other health systems, because it's good to see how other people do things. I rotated at two different hospital systems, besides my home school, and two private practice offices, and I think it was good to see how each managed things, especially since the hospital systems had residents. I can tell you that I'm specifically not applying to the residency programs at the hospitals I did away rotations at because I did a rotation there and didn't like the way the system was set up.

We should clarify that away rotations are a separate entity from rotating at a private hospital, VA, country hospital, etc. during 3rd year. Away rotations are done during 4th year, usually at outside institutions that you're interested in doing residency at. These are also known as visiting student rotations or audition rotations. You can do an away rotation at any institution, regardless of which medical school you go to, and there is an application process for scheduling these away rotations. While I would highly recommend doing these rotations in order to see the different hospital systems and get a better idea about whether you really want to apply to these programs, the opportunity to do these rotations has nothing to do with which med school you attend.

For those relatively less competitive programs like IM, you said you can match without having done exhaustive amounts of research and usually programs perceive favorably on research in any field. Thank you for confirming my presumptions.

Of course, I understand that ideally the research topics have to match with your ultimate speciality, but for less competitive programs, can I do research in things like health policy at a policy institute across the street, even though it has nothing to do with the clinical side of medicine? Or when you say research in any field, do you mean any field so long as it is clinically pertinent? This is an important question for me, because my ultimate interests are highly similar to those of Drs. Harvey Fineberg and Ezekiel Emanuel. Thank you again for your responses despite your busy schedule.

I think that the thing that's most helpful about doing research in a field related to your specialty of choice is that it allows you to work closely with a faculty member in that field, who would then be able to write a strong letter of recommendation for you and open doors for you through networking, etc. However, when people are looking at your residency application, all they're really looking for is that you've demonstrated a strong interest in academics. In that respect, I think it's perfectly fine to do research in health policy. As I mentioned before, you should do research that interests you-- otherwise, you're less likely to be productive.

 

[SunsFun]

Thanks for sharing your thoughts. Would you be able to give us an idea of specialties that may be more accessible in some schools over others?

 

[majestic red]

Thanks for sharing your thoughts. Would you be able to give us an idea of specialties that may be more accessible in some schools over others?

This is kind of hard question, and I have to admit that I don't have intimate knowledge of the curricula at schools other than my own. However, I think that some schools definitely allow greater access to the ROAD specialties, sugical subspecialties (ortho, ENT, plastics, uro, neurosurg, etc.). PM&R is another specialty where I've heard of other schools not offering rotations for. On the flip side, FM is a specialty that some "top-tier" research institutions will not give students much exposure to. As I mentioned before, everyone will get good exposure to IM, Gen Surg, Peds, Ob/gyn, Psych, and Neuro. However, even if your interest is in one of these areas, it might be worth it to figure out exactly how much time you spend in each of these rotations as a 3rd year. The difference between getting 2 months or 3 months of surgery could mean that you're just that much more comfortable in the OR, that much more practiced with your technical skills, and that much more ready to impress on your 4th year away rotations.

 

[mvenus929]

We should clarify that away rotations are a separate entity from rotating at a private hospital, VA, country hospital, etc. during 3rd year. Away rotations are done during 4th year, usually at outside institutions that you're interested in doing residency at.

No, to clarify, I was talking about away rotations during third year, as a part of core clerkships. My school requires that students do an average of 8-12 weeks away from our home institution, at specific sites depending on the rotation (including another teaching hospital, a private hospital, the VA hospital, and private clinics). I haven't done any away rotations during fourth year.