Official 2013-2014 IM Residency WAMC (What Are My Chances) Thread

[Janders]

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I did a left main as a resident, using glide scope, apparently they are more common with the Glidescope stylet.

that likely explains it.

 

[Rendar5]

I once had the ICU try to blame me for a central line that came out 3 weeks after admission saying that there were no sutures in place. Fortunately I found a resident who actually did the first replacement in the ICU verify my story along with my chart. For intubations I have an xray to prove that it was not me who f***** up

 

[Apollyon]

(3) Left mainstem. Couldn't do it again if I tried.

Pssh...I did this as a paramedic! (Don't even know how it happened!)

 

[WilcoWorld]

Agree with the above - this is not the time to spare miliSeverts. Fight trauma on the C spine CT, use PERC to avoid d dimers (and the consequent CT), skip the CT in the straightforward kidney stone, etc. CXR is a low dose, things can go south very quickly if the tube's in the wrong place, and there are a lot of opportunities for people to screw it up after I'm done.

 

[dotcb]

Agree w/ everyone - do the CXR. This is not the place to cut corners in this high risk intervention. Anesthesiologists don't do it in the OR, but we should in the ED.

If by some chance you decide skip it, ultrasound both pleura to ensure bilateral ventilation. Breath sounds have little relationship with mainstems or pneumothoraces.

 

[Pietrantonio]

The patient just bought a tube and ventilator. The least of their expenses is a cxr. Do a cxr for tube placement. I've seen tubes secured at the hub with 3 cm to spare above the carina and I've seen the complete opposite. Not everyone has cookie cutter airway anatomy. It's good practice. Could always use waveform capnography during transports to ensure the tube remains in proper placement. Think about pedes and how critical tube placement is.

Sent from my SGH-T999 using Tapatalk

 

[Bostonredsox]

Agree with above. Ir You tube someone and send them up to me and they develop worsening hypoxemia and start to crash my first assumption is your tube isn't in the right place. If I can see a film showing it adequately placed and the rt tells me the depth is the same # now as when you intubated and I'm still getting good entidal I'm less likely to pull your tube and immediately reintubate but will rather do a bedside US for a PTX and then stick a bronchoscope in to make sure they haven't plugged. If there's no film and rt isn't sure on the initial post intubation depth, I'm yanking that tube out

 

[Hamhock]

Agree with above. Ir You tube someone and send them up to me and they develop worsening hypoxemia and start to crash my first assumption is your tube isn't in the right place. If I can see a film showing it adequately placed and the rt tells me the depth is the same # now as when you intubated and I'm still getting good entidal I'm less likely to pull your tube and immediately reintubate but will rather do a bedside US for a PTX and then stick a bronchoscope in to make sure they haven't plugged. If there's no film and rt isn't sure on the initial post intubation depth, I'm yanking that tube out

By yanking the tube out, I assume you mean: first briefly disconnecting the vent; then hooking up cwETCO2; then sedating +/- NMB; then conisdering DL to look for ETT correct placement vs. bronch vs. CXR vs. bedside ultrasound. I assume you wouldn't "yank" a tube because of worsening hypoxia without most of this first (especially looking to see if the tube is in place).

HH

 

[Rendar5]

Or just disconnecting and bagging with bvm. I assume the etco2 was noted before even touching the pt.

 

[Bostonredsox]

By yanking the tube out, I assume you mean: first briefly disconnecting the vent; then hooking up cwETCO2; then sedating +/- NMB; then conisdering DL to look for ETT correct placement vs. bronch vs. CXR vs. bedside ultrasound. I assume you wouldn't "yank" a tube because of worsening hypoxia without most of this first (especially looking to see if the tube is in place).

HH

Retread my most I mentioned etco2. And as the patient is usually sedated, if they come upstairs with worsening hypoxemia and I'm not sure they tube is in I stick the McGrath in and visualize the end of the tube. If it's through the cords I leave it, if it's not I deflate the cuff, pull it out and put in a new one. And if they are not deeply sedated enough that when I take a look with the McGrath then yes I do give a shot of amidate and roc/succ.

Edit I didn't mention etco2, sorry I Thought I had. I do assess if my etco2 is where it's supposed to be and factor that into my decision making

I don't have the ability to bronch. I don't have cwETco2, and although I use the us for lots of stuff, sticking a McGrath Mac in and seeing the tube on the screen passing through the cords seems to me to be the most efficient and fastest way of confirming the ERs tube if I'm unsure. Usually a little bump to already running propofol drip is all I need.

 

[Spinach Dip]

IIRC, anesthesiologists dont confirm tube placement with an xray because they stay with the patient and extubate them at the end of the procedure. There is no "changing of hands" unless one anesthesiologist relieves another for a break or something. (Also, the patient is anesthetized, meaning a lower likelihood of moving and dislodging the tube...)

However, patients that earn tubes while in the ED will frequently take them to the ICU/OR/whatever. This patient leaves the ED physicians' control, which is the key difference between scenarios.

I would take the xray, even if I was 100% sure of its placement and its only purpose was to cover my own ass.

 

[Hamhock]

IIRC, anesthesiologists dont confirm tube placement with an xray because they stay with the patient and extubate them at the end of the procedure.

...but this is why I almost always CXR post-op patients brought to the ICU (rare cases such as bronch in OR and good cwETCO2, maybe no but probably still do)

HH

 

[Pietrantonio]

The reality of some of our suggestions (including mine) is that we often don't have waveform capnography or bronchoscopes at our disposal. The CXR is the definitive test for tube placement. We have our secondary ways to confirm like ezcap, condensation in the tube, equal and bilateral chest rise / breath sounds, etc. I noticed some were talking about yanking the tube with o2 desaturations. That should be last option to consider when all else fails. How reliable is the SpO2 sensor? Waveform? Shake one and I guarantee you'll get a reading of ~80's %. If it's a good waveform, listen to breath sounds. Are they equal? Suction the tube. This clears secretions as well as confirms tube patency. If you can't pass the catheter down the tube you definitely have an occlusion. Check the tube placement that it remains at the same level as previously reported. What about vent settings? You can always increase PEEP to improve oxygenation. Increase tidal volume if pplat pressures allow. What about your inspiratory time. A longer I-time will promote increased oxygenation. How long have they been on a high FiO2? Oxygen is toxic and over time causes problems. I see so many patients sitting on >60% Fio2 and we scratch our heads wondering why their PO2 is getting worse and their SpO2 is tanking overtime. So while I agree to check tube placement by looking visually again or even getting another cxr, there are other ways to possibly solve a problem without pulling it. That would suck to extubate a patient simply because the SpO2 probe was bad. 😉

The DOPE pneumonic is a great "flow" habit in terms of checking things.
D - Displacement of the tube
O - Obstruction or Occlusion
P - Pnemo
E - Equipment

 

[beckham66]

hi all,

Grateful for any general advice to increase my chances for an IM residency in 2015

My scores are 255/264/235
All UK experience since graduation with MRCP
6 months USCE with good LORs
7 publications in pubmed (mixture of research and case reports)

am on old grad 08 I realise that is a red flag

What else can I do to improve my chances apart from getting more USCE? I'm not sure how valuable my UK exp and UK medical education is in the US?

Grateful for any advice

thanks 🙂

 

[IM2GI]

hi all,

Grateful for any general advice to increase my chances for an IM residency in 2015

My scores are 255/264/235
All UK experience since graduation with MRCP
6 months USCE with good LORs
7 publications in pubmed (mixture of research and case reports)

am on old grad 08 I realise that is a red flag

What else can I do to improve my chances apart from getting more USCE? I'm not sure how valuable my UK exp and UK medical education is in the US?

Grateful for any advice

thanks 🙂

Great scores and productive research. If you were a fresh candidate from a US medical school you would be getting interviews from a lot of top ~20 programs.

Not much you can change at this point. You have already identified your issues, non-US training and a 7-year gap which will need a very good explanation. The core of your application is what it is. Some programs will screen you out but I suspect you will still get a lot of interviews and a chance to explain your situation. I would also address it in your personal statement. You need a credible story for why you are coming back to be a resident after this long. I suspect some PDs will worry about your ability to be a grunt resident now that you have been in independent practice for so long.

My only advice would be, if you have one particular program or geographic area you are interested in, to do several away rotations to let the department get to know you over a prolonged period. It will be connections that (potentially) help people get over the red-flags in your app.

 

[oraiby]

need some help from IM residents
im an IMG 2011 grad
doing currently IM residency at my home country
did step 2 only : score 260
planing to do step 1 and CS
our residency program provides the inservice training exam , luckily this year i took it and my result turned out to be fine (PGY 1 ) level
got 80 %
does it have an impact on my CV or it will not count (as stated in their report that these results are not to be attached in personal statements ...etc )
anyhow planing to do rest of steps but its very difficult to study for the steps while doing residency ( wish me luck )
best of luck for all applicants with the match

 

[beckham66]

Great scores and productive research. If you were a fresh candidate from a US medical school you would be getting interviews from a lot of top ~20 programs.

Not much you can change at this point. You have already identified your issues, non-US training and a 7-year gap which will need a very good explanation. The core of your application is what it is. Some programs will screen you out but I suspect you will still get a lot of interviews and a chance to explain your situation. I would also address it in your personal statement. You need a credible story for why you are coming back to be a resident after this long. I suspect some PDs will worry about your ability to be a grunt resident now that you have been in independent practice for so long.

My only advice would be, if you have one particular program or geographic area you are interested in, to do several away rotations to let the department get to know you over a prolonged period. It will be connections that (potentially) help people get over the red-flags in your app.

Thanks for your reply will certainly do that. Yes I know will get filtered by some places but cant avoid that. Will definitely address it in my personal statement. I have always been in clinical practice in the UK so no gaps in that respect. I guess its a case of unfulfilled ambition of wanting to work in the US and that can only happen via a residency. In the UK we do med school straight out of high score so am not particularly old and can easily handle the strains of being a 'grunt resident'. I realise UK experience is not US experience but hoping that it counts for something from an english speaking Western country etc

 

[IM2GI]

Thanks for your reply will certainly do that. Yes I know will get filtered by some places but cant avoid that. Will definitely address it in my personal statement. I have always been in clinical practice in the UK so no gaps in that respect. I guess its a case of unfulfilled ambition of wanting to work in the US and that can only happen via a residency. In the UK we do med school straight out of high score so am not particularly old and can easily handle the strains of being a 'grunt resident'. I realise UK experience is not US experience but hoping that it counts for something from an english speaking Western country etc

I dont mean just the workload, but 7 years of being able to practice the way you want, are you going to be able to be an intern and have to staff patients? Do things someone else's way? You are used to making your own decisions, it will be an adjustment to be the low man on the totem pole again. I think that will spook some PDs, could be wrong.

 

[IM2GI]

need some help from IM residents
im an IMG 2011 grad
doing currently IM residency at my home country
did step 2 only : score 260
planing to do step 1 and CS
our residency program provides the inservice training exam , luckily this year i took it and my result turned out to be fine (PGY 1 ) level
got 80 %
does it have an impact on my CV or it will not count (as stated in their report that these results are not to be attached in personal statements ...etc )
anyhow planing to do rest of steps but its very difficult to study for the steps while doing residency ( wish me luck )
best of luck for all applicants with the match

I can't imagine anyone will care about your inservice exam score.

Take step 1. You will not even be considered without that score.

 

[beckham66]

I dont mean just the workload, but 7 years of being able to practice the way you want, are you going to be able to be an intern and have to staff patients? Do things someone else's way? You are used to making your own decisions, it will be an adjustment to be the low man on the totem pole again. I think that will spook some PDs, could be wrong.

Thanks for your response well finished residency only 3 years ago and even now I wouldnt say I am a solus operandi far from it. Essentially still work and will continue to do so as part of an MDT and I wouldnt say any decision I make is autonomous far from it.

 

[oraiby]

I can't imagine anyone will care about your inservice exam score.

Take step 1. You will not even be considered without that score.

Thanks for the reply
Sure will do that

 

[beckham66]

I dont mean just the workload, but 7 years of being able to practice the way you want, are you going to be able to be an intern and have to staff patients? Do things someone else's way? You are used to making your own decisions, it will be an adjustment to be the low man on the totem pole again. I think that will spook some PDs, could be wrong.

Just read that recent nrmp document regarding IMG stats in match 13 and if you score 250/260 you have around an 80% chance matching that too for old grads so hopeful can get something even a community program is fine

 

[MichaelG17]

Will be applying next cycle but I was hoping I could get some feedback for matching IM. I hope it could help me focus where I should do away rotations
Michigan State Student
Step 1 score = 230's
No publications but planning on presenting a quality improvement study at a couple conferences.
Did not honor IM rotation (just missed it)
Planning on applying to mainly programs in Michigan (Beaumont, Henry Ford, DMC, GRMEP, WSU, UofM, etc.) and the Chicago (UIC, Loyola, Rush, Cook County, NW, UChicago, Mt. Sinai) and Boston areas (BU, Tufts, Cambridge, Beth Israel Deaconess, etc.)

Any thoughts on how I stack up/how far out of reach I am from the top programs?

 

[gutonc]

Will be applying next cycle but I was hoping I could get some feedback for matching IM. I hope it could help me focus where I should do away rotations
Michigan State Student
Step 1 score = 230's
No publications but planning on presenting a quality improvement study at a couple conferences.
Did not honor IM rotation (just missed it)
Planning on applying to mainly programs in Michigan (Beaumont, Henry Ford, DMC, GRMEP, WSU, UofM, etc.) and the Chicago (UIC, Loyola, Rush, Cook County, NW, UChicago, Mt. Sinai) and Boston areas (BU, Tufts, Cambridge, Beth Israel Deaconess, etc.)

Any thoughts on how I stack up/how far out of reach I am from the top programs?

UM, NW, UofC and probably BI aren't happening (but no reason not to apply...I might be wrong). Otherwise you'll get IVs most of those places. Not sure why you wouldn't also include UWisc, MCW and UMinn from a geographic (and good program) perspective.

 

[MichaelG17]

UM, NW, UofC and probably BI aren't happening (but no reason not to apply...I might be wrong). Otherwise you'll get IVs most of those places. Not sure why you wouldn't also include UWisc, MCW and UMinn from a geographic (and good program) perspective.

Thank you.

 

[IM2GI]

Will be applying next cycle but I was hoping I could get some feedback for matching IM. I hope it could help me focus where I should do away rotations
Michigan State Student
Step 1 score = 230's
No publications but planning on presenting a quality improvement study at a couple conferences.
Did not honor IM rotation (just missed it)
Planning on applying to mainly programs in Michigan (Beaumont, Henry Ford, DMC, GRMEP, WSU, UofM, etc.) and the Chicago (UIC, Loyola, Rush, Cook County, NW, UChicago, Mt. Sinai) and Boston areas (BU, Tufts, Cambridge, Beth Israel Deaconess, etc.)

Any thoughts on how I stack up/how far out of reach I am from the top programs?

Michigan State MD or DO program? (they have both, right?)

 

[MichaelG17]

Michigan State MD or DO program? (they have both, right?)

We do. I'm in the MD program.

 

[pandoraone]

Question regarding Step1 scores: For a US medical grad, what kind of score would make it 'a good chance' to get interview invites from the Big4 IM residencies? I am looking to set a goal for Step1 (I know we should shoot for as high as possible but I wanted to know a ballpark) so that I can match at one of the big4 places.

In terms of research, 4 pubs (review papers) and 2 more on the way (clinical papers).

Thanks

 

[WaryWildcat]

Question regarding Step1 scores: For a US medical grad, what kind of score would make it 'a good chance' to get interview invites from the Big4 IM residencies? I am looking to set a goal for Step1 (I know we should shoot for as high as possible but I wanted to know a ballpark) so that I can match at one of the big4 places.

In terms of research, 4 pubs (review papers) and 2 more on the way (clinical papers).

Thanks

Depends completely on where you go to medical school... I know people at my own average medical school with stacked apps including board scores that go up higher than I knew was possible, and they've been categorically rejected from all the "Big 4" like the rest of us, but I've also heard tell on the interwubs of people from top medical schools with 220s who get the interviews. Your scholarly activities will help wherever you're coming from.

What's your best bet at a WAMC? Probably not these forums, but looking at where your school has actually matched people. If you do really well at your school, then it's likely you'll be able to match at the "best" programs that your school has sent people to (although keep in mind this variable of "best program" is by and large determined by hearsay and the reputation of any program you attend is far and away trumped by the variable of how well you would perform there)

 

[pandoraone]

Depends completely on where you go to medical school... I know people at my own average medical school with stacked apps including board scores that go up higher than I knew was possible, and they've been categorically rejected from all the "Big 4" like the rest of us, but I've also heard tell on the interwubs of people from top medical schools with 220s who get the interviews. Your scholarly activities will help wherever you're coming from.

What's your best bet at a WAMC? Probably not these forums, but looking at where your school has actually matched people. If you do really well at your school, then it's likely you'll be able to match at the "best" programs that your school has sent people to (although keep in mind this variable of "best program" is by and large determined by hearsay and the reputation of any program you attend is far and away trumped by the variable of how well you would perform there)

Thanks for the response,

I go to Mayo, and a lot of people like to stay here because they are from the midwest. As a west-coaster, not really a big fan of the weather here and want to go to the east coast.

 

[IM2GI]

We do. I'm in the MD program.

I disagree with Guton, you might have a shot at getting an interview at the more prestigious MidWest programs with a score >230. These programs have to interview ~400 people each year, so there are a lot of interviews to go around. You will probably get by the built in-filters, but the lack of research might put you in the reject pile. Make sure you have something to put in the research area of ERAS.

You are going to be borderline so make the rest of your app as strong as you can. I agree with adding the programs he mentioned, as they are strong and will give you more options in the midwest.

 

[IM2GI]

Thanks for the response,

I go to Mayo, and a lot of people like to stay here because they are from the midwest. As a west-coaster, not really a big fan of the weather here and want to go to the east coast.

"Big four" is a crapshoot, regardless of scores, unless you go to an elite med school. You will want >250, lots of research, a semester in Africa saving the world, and have an internal connection.

 

[IMbound2015?]

Hi all, I'm an MD/PhD student looking to apply to ABIM research track residencies next year (currently taking a year off). Would ideally stay on the two coasts. Any input is greatly appreciated!

Step 1: 229
Step 2 CK/ CS: 259/P
School: Top 10
Class Rank: top 25%
Grades in Clekship: All honors except for Surgery (HP)
AOA: No
Research/ Publications/ Extracurriculars: 7 papers (3 first author, 2 second,2 third).
Overview of where you want to end up: Harvard programs, Yale, Hopkins, Columbia, Cornell, Stanford, UCLA, UCSF, UCSD, WashU, Penn, U of Washington.

My main concern is my mediocre step 1 score, I wonder if it will keep me out of the top places... I know I need some more safeties, any suggestions? Thanks.

 

[amine2086]

Hi all, I'm an MD/PhD student looking to apply to ABIM research track residencies next year (currently taking a year off). Would ideally stay on the two coasts. Any input is greatly appreciated!

Step 1: 229
Step 2 CK/ CS: 259/P
School: Top 10
Class Rank: top 25%
Grades in Clekship: All honors except for Surgery (HP)
AOA: No
Research/ Publications/ Extracurriculars: 7 papers (3 first author, 2 second,2 third).
Overview of where you want to end up: Harvard programs, Yale, Hopkins, Columbia, Cornell, Stanford, UCLA, UCSF, UCSD, WashU, Penn, U of Washington.

My main concern is my mediocre step 1 score, I wonder if it will keep me out of the top places... I know I need some more safeties, any suggestions? Thanks.

I would definitely add few more safeties. All the programs on your list are very competitive and you are not shoe-in for any of them given your average step 1 score. My thought is you will get IVs from some of them but probably not all (especially if any if these programs filter based on step 1 score).

 

[IM2GI]

Hi all, I'm an MD/PhD student looking to apply to ABIM research track residencies next year (currently taking a year off). Would ideally stay on the two coasts. Any input is greatly appreciated!

Step 1: 229
Step 2 CK/ CS: 259/P
School: Top 10
Class Rank: top 25%
Grades in Clekship: All honors except for Surgery (HP)
AOA: No
Research/ Publications/ Extracurriculars: 7 papers (3 first author, 2 second,2 third).
Overview of where you want to end up: Harvard programs, Yale, Hopkins, Columbia, Cornell, Stanford, UCLA, UCSF, UCSD, WashU, Penn, U of Washington.

My main concern is my mediocre step 1 score, I wonder if it will keep me out of the top places... I know I need some more safeties, any suggestions? Thanks.

You will likely end up at one of those programs. The bitch of it is that some programs set a filter of >230 to download ERAS apps, so you likely will get filtered out of atleast the "big 4". I dont think you will have a problem matching at a "top 20" program.

The rest of your application looks strong. Why is everyone including UCSD these days? The power of the weather must be strong.

You should add a few programs in the Pitt/Madison range just so you know you will have options.

 

[randomperson2]

OK first time posting here, I would really appreciate any feedback you guys can give me, I am just finishing up third year and I have decided on IM and the region I just dont know anything about the programs or my competitiveness.
Step 1:229
Step 2 CK/ CS: taking this summer
School: top MD 30 southeast
Class Rank:~65 %tile
Grades in Clerkship: All HP except pass in medicine and psych (took medicine first block of third year, good comments but not good enough shelf score)
AOA: nope
Research/ Publications/ Extracurriculars: research with the surgery dept one summer, won 1st place student research fair, have some publications prior to medical school
Overview of where you want to end up: I am matching with my significant other who is very very competitive and going into peds, so we are looking at programs basically in any big city in the north east (not much desire to stay down south)
Very Basic List (honestly dont know many programs thats why im asking where to look) - DC - GWU, Gtown Chicago - anywhere? dont know the good programs i would be competetive for NYC - same thing, i assume Cornell etc are out. Philly - clearly not penn but once again dont know the places. Boston - probably my top choice area wise, tufts, BU? Ohio (im from the midwest) - OSU, Cincinnati.
PLEASE HELP.
My biggest questions are in making a list of where I have a realistic shot at getting into. For example is OSU a good program, is tufts a good program, could a do better/worse. THANKS for any advice.
-Person

 

[yoyopa]

Hi all, I'm an MD/PhD student looking to apply to ABIM research track residencies next year (currently taking a year off). Would ideally stay on the two coasts. Any input is greatly appreciated!

Step 1: 229
Step 2 CK/ CS: 259/P
School: Top 10
Class Rank: top 25%
Grades in Clekship: All honors except for Surgery (HP)
AOA: No
Research/ Publications/ Extracurriculars: 7 papers (3 first author, 2 second,2 third).
Overview of where you want to end up: Harvard programs, Yale, Hopkins, Columbia, Cornell, Stanford, UCLA, UCSF, UCSD, WashU, Penn, U of Washington.

My main concern is my mediocre step 1 score, I wonder if it will keep me out of the top places... I know I need some more safeties, any suggestions? Thanks.

I'd consider adding Northwestern, U of Chicago, Pitt, Mount Sinai, BUMC, and NYU for sure (all have ABIM research tracks that guarantee most fellowships). Pick out 2-3 solid categorical programs in you geographic area (e.g. Brown, Dartmouth, OHSU, etc.) you would cancel if all goes as planned and you should be set. With a productive PhD, decent clinical app, and continued interest in research many of the programs in the top 10-25 range will take serious looks, breaking the top 5-10 might be a bit tougher as a result of step 1 screens and many of those programs not having distinct physician-scientist review committees since you apply for ABIM as a PGY-1 at most of these institutions.

 

[pandoraone]

Is a chairman letter required? How do we really get to know them?

 

[randomperson2]

OK first time posting here, I would really appreciate any feedback you guys can give me, I am just finishing up third year and I have decided on IM and the region I just dont know anything about the programs or my competitiveness.
Step 1:229
Step 2 CK/ CS: taking this summer
School: top MD 30 southeast
Class Rank:~65 %tile
Grades in Clerkship: All HP except pass in medicine and psych (took medicine first block of third year, good comments but not good enough shelf score)
AOA: nope
Research/ Publications/ Extracurriculars: research with the surgery dept one summer, won 1st place student research fair, have some publications prior to medical school
Overview of where you want to end up: I am matching with my significant other who is very very competitive and going into peds, so we are looking at programs basically in any big city in the north east (not much desire to stay down south)
Very Basic List (honestly dont know many programs thats why im asking where to look) - DC - GWU, Gtown Chicago - anywhere? dont know the good programs i would be competetive for NYC - same thing, i assume Cornell etc are out. Philly - clearly not penn but once again dont know the places. Boston - probably my top choice area wise, tufts, BU? Ohio (im from the midwest) - OSU, Cincinnati.
PLEASE HELP.
My biggest questions are in making a list of where I have a realistic shot at getting into. For example is OSU a good program, is tufts a good program, could a do better/worse. THANKS for any advice.
-Person

bump

 

[irishmedgrad2016]

Hi, I am new to this forum so I apologize in advance if I am posting in the wrong place. I am a second year medical student in Ireland at the moment and hope to go to the US in for residency when I graduate in 2016. I was wondering what people think my chance of getting into a top medical program like Hopkins or Harvard are. I have read a number of post explaining how difficult it is but would be interested in peoples views on my own personal situation. I will have too clinical electives done by the time I apply to the match, one at Johns Hopkins and the other at UPMC. I plan on sitting the step 1 this summer and the both the step 2 exams next year (I aim to score >240). I hope to graduate within the top 10% at least within my class. I will not have completed any major research. Based on my current credential do you think my application would be competitive if applying to the top programs and if not what could I do in the mean time to improve my chances.

 

[gutonc]

Hi, I am new to this forum so I apologize in advance if I am posting in the wrong place. I am a second year medical student in Ireland at the moment and hope to go to the US in for residency when I graduate in 2016. I was wondering what people think my chance of getting into a top medical program like Hopkins or Harvard are. I have read a number of post explaining how difficult it is but would be interested in peoples views on my own personal situation. I will have too clinical electives done by the time I apply to the match, one at Johns Hopkins and the other at UPMC. I plan on sitting the step 1 this summer and the both the step 2 exams next year (I aim to score >240). I hope to graduate within the top 10% at least within my class. I will not have completed any major research. Based on my current credential do you think my application would be competitive if applying to the top programs and if not what could I do in the mean time to improve my chances.

Come back when all those things are hard numbers, not hopes and dreams.

 

[WaryWildcat]

Hi, I am new to this forum so I apologize in advance if I am posting in the wrong place. I am a second year medical student in Ireland at the moment and hope to go to the US in for residency when I graduate in 2016. I was wondering what people think my chance of getting into a top medical program like Hopkins or Harvard are. I have read a number of post explaining how difficult it is but would be interested in peoples views on my own personal situation. I will have too clinical electives done by the time I apply to the match, one at Johns Hopkins and the other at UPMC. I plan on sitting the step 1 this summer and the both the step 2 exams next year (I aim to score >240). I hope to graduate within the top 10% at least within my class. I will not have completed any major research. Based on my current credential do you think my application would be competitive if applying to the top programs and if not what could I do in the mean time to improve my chances.

I hate to be a Debbie Downer, but as an FMG with no major research completed and with no other compelling extracurriculars, Hopkins, the Harvards, and UCSF very likely ain't gonna happen, even if the step >240 does (or probably even if a step >260 does - step averages have risen 10 points or so in the last 10 years, so 250 is probably the new 240, and it seems like step scores more or less act as a screen to get your application looked at more seriously). I'm by no means saying that AMGs are superior to FMGs, I'm just saying that the admission process for US residencies (especially major academic ones) is heavily skewed in favor of graduates of American allopathic medical schools. Even so, the programs you mention reject AMGs with baller scores and productive research routinely, and AMGs with baller scores and no research almost categorically (unless you went to a top US MD school, or you've liberated a medium-sized African nation or something). Apply if you want because it costs next to nothing, but don't expect to get any love from them. No offense intended, just trying to keep it real. There are many awesome places to train in the US though, and your training won't necessarily be better at a place with a big name (despite what the general feeling is on these boards), so if you score well and get good clinical experience/letters during your US rotations you may well get into a very good place here in the states. I know that UPMC for one takes close looks at FMGs; on my interview day there was someone there from a Caribbean school.

Since you asked what you could do to help, it's not too late to start, and be productive in, significant research if you're midway through M2, so if you feel that you really need to go to a Harvard or Hopkins and will accept nothing less, you should find a productive mentor in something you're interested in and get on the ball with that. I know it sounds crazy to do research during M3 clinical experiences (or to take time off to do it) but that's the kind of thing people do to match at "elite" IM residencies if they feel they really need to. If research isn't your cup of tea, do something else to make yourself stand out; volunteering, global medical work, etc. But, sadly, if all you do is rock your clinical experiences and board exams, it's probably not enough to get a serious look from the programs you mention.

 

[irishmedgrad2016]

I hate to be a Debbie Downer, but as an FMG with no major research completed and with no other compelling extracurriculars, Hopkins, the Harvards, and UCSF very likely ain't gonna happen, even if the step >240 does (or probably even if a step >260 does - step averages have risen 10 points or so in the last 10 years, so 250 is probably the new 240, and it seems like step scores more or less act as a screen to get your application looked at more seriously). I'm by no means saying that AMGs are superior to FMGs, I'm just saying that the admission process for US residencies (especially major academic ones) is heavily skewed in favor of graduates of American allopathic medical schools. Even so, the programs you mention reject AMGs with baller scores and productive research routinely, and AMGs with baller scores and no research almost categorically (unless you went to a top US MD school, or you've liberated a medium-sized African nation or something). Apply if you want because it costs next to nothing, but don't expect to get any love from them. No offense intended, just trying to keep it real. There are many awesome places to train in the US though, and your training won't necessarily be better at a place with a big name (despite what the general feeling is on these boards), so if you score well and get good clinical experience/letters during your US rotations you may well get into a very good place here in the states. I know that UPMC for one takes close looks at FMGs; on my interview day there was someone there from a Caribbean school.

Since you asked what you could do to help, it's not too late to start, and be productive in, significant research if you're midway through M2, so if you feel that you really need to go to a Harvard or Hopkins and will accept nothing less, you should find a productive mentor in something you're interested in and get on the ball with that. I know it sounds crazy to do research during M3 clinical experiences (or to take time off to do it) but that's the kind of thing people do to match at "elite" IM residencies if they feel they really need to. If research isn't your cup of tea, do something else to make yourself stand out; volunteering, global medical work, etc. But, sadly, if all you do is rock your clinical experiences and board exams, it's probably not enough to get a serious look from the programs you mention.

Hi, thank you very much for your detailed response. I really appreciate the advice. I realize that the aims I have for the for the step examinations are only hopes and dreams at the moment but I was just interested in getting some opinions on how competitive I will be as an applicant to the US if I do reach those milestones. Also it's definitely not the case for me that no program outside of the top 3 would be acceptable, I know that there are many other programs that are awesome to train at while being a little more open to FMG. I think the suggestion you made of looking in to doing some volunteering or global medical work could be a more achievable way for me to improve my application, I will definitely look in to that. Thank you.

 

[Rih4387]

Help!!! Has anyone heard about temples residency program for internal medicine? I know the pathology and diversity of the patient population is phenomenal, but how are the didactics and most importantly how do the residents like the program? It is one of my top choices for internal medicine, but I have heard many different things as far as resident satisfaction (which I am sure will exist everywhere). Just wondering if anyone did a rotation there and/or had any firsthand insight. Thanks!!

 

[step213]

Hi, thank you very much for your detailed response. I really appreciate the advice. I realize that the aims I have for the for the step examinations are only hopes and dreams at the moment but I was just interested in getting some opinions on how competitive I will be as an applicant to the US if I do reach those milestones. Also it's definitely not the case for me that no program outside of the top 3 would be acceptable, I know that there are many other programs that are awesome to train at while being a little more open to FMG. I think the suggestion you made of looking in to doing some volunteering or global medical work could be a more achievable way for me to improve my application, I will definitely look in to that. Thank you.

I'd say research is your best bang for the buck, publish and be prolific and you can probably land yourself a nice spot. Again probably not in the big 3 but somewhere good.

 

[Handsome88]

I'd say research is your best bang for the buck, publish and be prolific and you can probably land yourself a nice spot. Again probably not in the big 3 but somewhere good.

You do realize he is an IMG. I don't think it's that easy. I know lots with 240+ and research and have had a hard time getting interviews at mediocre places. I myself have mid 230s and 4 pubs in great journals and people have been telling me that my chances are slim these days for mid-tier even.

 

[dubloo]

Hello,

I have a question regarding the type of IM program I am likely to match into. I am an MS4. Here are my credentials:

top 25 medical school
third quartile grades
Step 1 in 220s
Step 2 in 260s
Got B+ (near honors) in medicine clerkship
Some minor research (book chapters, poster presentations, abstracts)

What are my chances of getting into an almost top (not MGH, B+W, UCSF, JHU) IM program? Examples are Columbia, Yale, Stanford, Northwestern, NYU, Mt. Sinai, UCSD, UCLA.

Thanks!

 

[nmfms]

this seems like a question for the 2014-2015 WAMC thread lololol

top 25 school and 260 S2 will open some of those doors, 3rd quartile grades, B+ in medicine will close some of those doors. Apply (in 6.5 mos) and find out.

 

[gutonc]

I'm just going to merge it into this year's WAMC thread and hope it dies its mercifully deserved death.

But I won't hold my breath.

Also, LOL at Columbia, Stanford, Yale, NW, etc not being considered good enough but at least tolerable.

 

[RunKid11]

M3, would be applying next year for 14-15 cycle. Trying to figure out if I'd need to do aways, research, who to schmooze, etc. Thanks for any input

Top 40, state school in Midwest

Step 1: >250
Step 2: haven't taken yet
First two years: Top 25% M1, Top 10% M2
Clerkship grades: Pass in OB and surgery, high pass in pediatrics*
Research: worked full-time for one year on internal medicine research after undergrad in IM department at top 20 med school (no pubs); M1-M2 summer research in anesthesia (1 poster), undergrad research in psych (1 pub and 1 poster)
Other/random: run competitively, placed well in a few good-sized races, edited lit journal at med school and won some awards for fiction writing
Programs: I'm from the midwest and have no connections, but would really like to go to California, so I'd be concentrating my applications there, but also looking at a few Chicago, NY, DC, and Seattle programs; mostly concerned about combination of location and strength of program, but not interested in certain places (e.g., Hopkins in Baltimore, MGH in Boston - not that I'd probably have a shot anyway):
Stanford, UCSF, UCLA, UCSD, UCI, USC, kaiser - LA, kaiser - SF, Cedars-Sinai, UCLA - Harbor, Scripps, UWashington, Northwestern, UChicago, Rush, UIC, Georgetown, GW, NYP, Mount Sinai, NYU

I know that I'd have to add a few safety programs in, as most of the ones I listed are obviously reaches for anybody, but I'm interested in my chances. I know my Step 1 is solid, but I don't feel like I have a sense of the odds given my school's location and the so-so clinical grades

*My school has pretty stringent clerkship grading, with at most 10% getting honors, the next 15% getting high pass and only if you meet cut-off criteria for both shelf and clinical evals; for example, my peds shelf score was 96, but still only got high pass because didn't quite meet clinical eval score cut-off; similar story with surgery; not a single person in the first cohort from my year going through IM qualified for honors at all (my school kind of sucks in this regard)