Hi all, I wanted to introduce myself. I am the associate program director for an osteopathic internal medicine program. Though I'm a DO, I trained at an allopathic IM program, thus have some perspective about the differences etc. Currently, I am sifting through applications and remembered back to my days as a medical student. I utilized the student doctor forums and thought I might make myself available to anyone that has questions or would like insight from someone in my position. I'd like to think that I will be very responsive but please forgive me if it takes some time to answer specific questions. Either way, I am selfishly interested in engaging with you all, to at least better determine how to best train and recruit future internists. Cheers!
Osteopathic Internal Medicine Insight
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What are some of the biggest difference between allo and osteo residents that you've worked with? Pros and cons of each side?
Thank you for taking your time!
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Hi IM APD,
How would you say that AOA and ACGME internal medicine is different? Is it likely to be able to do fellowships after AOA IM?
Thank you for your time
How would you say that AOA and ACGME internal medicine is different? Is it likely to be able to do fellowships after AOA IM?
Thank you for your time
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I'm assuming you'll be converting to ACGME?
What % of your graduates place into fellowships?
I've taken Step 1, but for IM, do you also recommend Step 2 CK?
What other, non-score related, things do you look for most in applicants?
Yes, our program started the process a couple years ago and we are in initial accreditation.
In the time I've been at this program, we haven't had a resident who wanted a fellowship get turned down... as for the breakdown, probably 75% go into hospital medicine, 20% fellowships and 5% outpatient medicine.
Depends... we have a relative COMLEX cutoff for screening purposes; thus, if you marginally passed step 1, I would whole heartedly recommend taking step 2 so that a large jump can potentially open more doors for you. If you killed step 1 (>600 for example), there is little upside in taking step 2 for application purposes. I do absolutely recommend taking USMLE step 1 if you are interested in allopathic residency. Most MD PD's still don't completely understand how to compare the two tests and the apple to apple comparison is helpful for a strong applicant.
On the margins, the scores are largely the gatekeeper for interviews. A COMLEX of 650 is getting an interview unless a huge red flag exists. Likewise, a failure of step 1 will almost assuredly not get an interview with us unless there is a big extenuating circumstance. For everyone else in the middle, I largely glaze over gpa. A lot of schools inflate their gpa's and I don't know how much credibility to give them (trends matter however and I do look to see if you marginally passed or received high honors in your IM rotation). I look at your letters... A single incredibly strong letter has swayed me to give an interview to someone I otherwise would not have. Be selective in who you ask to write a letter for you. You can't control what they say, but if some writes a 2 sentence letter, telling me that you dressed appropriately and were mostly on time, I'm going to think either they didn't like you, or you don't have insight into who to ask for a letter. Both options are bad. Lastly, I do read everyone's personal statement who meets our scoring cutoff. These rarely make or break the application but they can explain a deficiency and give me insight into what motivates you. I want candidates who have an innate curiosity about medicine and shows me that you can work through hardships. Our program is academically strenuous and its nice to see applicants who state that they are looking for a program that challenges them. I personally dislike statements that start with quotes or that try and get too cutesy, but that's me. Never write a personal statement to someone else standards bc for everyone like me, they'll be 5 other PD's that love quotes in the PS. Hope that helps.
Tough to totally answer this as I can be too general by comparing all AOA program to ACGME or too narrow by comparing my residency program to the one I'm currently at.
That said: in very general terms, most AOA programs have historically been community based whereas most ACGME programs have an academic affiliation. Because of this and b/c DO programs haven't been under the ACGME umbrella for long, the stereotype is that AOA trained residents learn more by 'doing' and allopathic grads have a wider breadth of learning opportunities. I'll scatter shot some thoughts below
-Comparing my personal experience, ACGME rules for patient caps etc allowed us more time for non-patient centered learning. That might manifest by having an evidence based learning month, or a clinical skills month. We had morning report AND noon conference. Grand rounds were a bigger deal and we had more opportunities to hear from people outside the region or outside medicine to add to our clinical education. Research is highlighted much more in allopathic programs, not only to meet ACGME requirements but also to prepare for allopathic fellowships which wanted to see a dedicated research interest in the field. Being at a large academic center had its drawbacks though. Everyone worked in their own silo. So if there was an interesting case, it likely had 4 different services on board, all very protective of taking independent care of their specific organ. Because there were more fellows, some of the more exotic procedures and vent management etc went through them first. I'd say that up until DO programs started streamlining toward ACGME rules, they were very much of the opinion that 'our primary focus is learning by taking care of the patient's in front of us' and 'if there is time to enrich outside of that, then great'; whereas allopathic training had a bit more depth of exposure but the depth of experience within that exposure might be more shallow. I would put my current residents clinical acumen up against any of the docs I graduated residency with (and that's saying something), so its really how do you prefer to learn. I would absolutely train at the most rigorous program you can find though. 3 years of pain is worth a careers worth of confidence in what you're doing.
This somewhat overlaps with my comments above and again, my exposure does not allow for apple to apple comparison. I think you can take certain stenotypes and draw your own conclusions. The data shows that osteopathic students are more likely to choose primary care pathways compared to their allopathic counterparts. Compare the personality traits of a family medicine resident vs. that of a radiology or Ortho resident. In very large strokes, I see some of those differences just b/c certain personality types are drawn to DO rather than MD and vice versa. Work ethic is a push. There might be slightly more variation from top to bottom in a DO residency class but these differences seem to go away after the PGY1 year.
Both sides will train you to be a competent physician. Becoming outstanding is largely up to the amount of work any one individual wants to put into it. When choosing which way to go, you really just need to determine whats important to you. Location typically is the first driver. Community vs. Academic seems to be a close 1b. After that, take into consideration, do you want a fellowship? It is still hard to get a competitive allopathic fellowship as a DO. So, is it to your advantage to choose a DO program that has a cards fellowship that typically picks from its own residents, for example? Maybe. But are there more allopathic fellowships out there and is there more opportunity to do research so that your application is stronger? Also, maybe. I didn't get to intubate as a resident. Anesthesia owned that. My residents can all intubate with their eyes closed. They do bone marrows. They are looked at as the smartest, most competent docs in the hospital. A lot of allopathic academic centers are fellow driven and the IM residents are just kind of in the way. Soooo, all that to say, figure out what you want from a program. There are going to be both DO and MD programs that fit the bill.
Hello, I failed my COMLEX Level 1 and 2 because of medical conditions that went undiagnosed for a while. Passed both of them the second time around with a jump of 100 points. I did explain in my personal statement as to why I failed. I think I have excellent letters and a great research background. Should I even consider applying to IM programs or all the doors are closed ?
