Pediatrics competitiveness

[iscream4icecream]

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What sort of things/step scores make someone competitive for some of the top pediatric residency programs (ex. Boston children's, CHOP, Baylor, etc.)? We always hear that for pediatrics you don't really need crazy high step scores or tons of publications, but I'm assuming this isn't true for everywhere.

 

[eteshoe]

I'd imagine it's like any other top program - a self-selecting applicant pool so it's your prerogative to get a high enough score to be competitive.

 

[WheezyBaby]

Scores, grades, research

 

[BigRedBeta]

For the top tier programs, will be about as competitive as for any other competitive specialty.

While probably not intentional, these programs produce pediatricians that are going on to fellowship. I looked at the numbers a few years ago and CHOP/Boston/Cinci were putting >85% of their grads into fellowship. Baylor is a little different and produces more general pediatricians, which I imagine has to do with it being Texas.

Because getting into fellowships in pediatrics is not nearly as difficult as in IM, there's a greater debate on the utility of going to these programs. Because of their specialized care (they function more as quaternary and quintenary referral centers), IMO there are very real detriments to teaching bread and butter pediatric care to residents. I did fellowship at a different top 10 children's hospital and one of the quotes from the residents that I think summed up the education was "all I learned during intern year was how to dose tacrolimus" - obviously a bit of hyperbole, but also not exactly something that shows up on pediatrics boards. These program's board pass rates are excellent because they attract smart people. Harder to tell if they turn out good clinicians, or if they even want to...

 

[sliceofbread136]

For the top tier programs, will be about as competitive as for any other competitive specialty.

While probably not intentional, these programs produce pediatricians that are going on to fellowship. I looked at the numbers a few years ago and CHOP/Boston/Cinci were putting >85% of their grads into fellowship. Baylor is a little different and produces more general pediatricians, which I imagine has to do with it being Texas.

Because getting into fellowships in pediatrics is not nearly as difficult as in IM, there's a greater debate on the utility of going to these programs. Because of their specialized care (they function more as quaternary and quintenary referral centers), IMO there are very real detriments to teaching bread and butter pediatric care to residents. I did fellowship at a different top 10 children's hospital and one of the quotes from the residents that I think summed up the education was "all I learned during intern year was how to dose tacrolimus" - obviously a bit of hyperbole, but also not exactly something that shows up on pediatrics boards. These program's board pass rates are excellent because they attract smart people. Harder to tell if they turn out good clinicians, or if they even want to...

I'm going to disagree a little here with your analysis of cinci and Baylor, both of these places serve a wide catchment area in the community and see tons of bread and butter peds in addition tothe weird stuff. Even BCRP has their community hospital where they spend 25% of their time seeing bread and butter. There were some places like Stanford where I felt there was a sever lack of bread and butter but I definitely do not think that is the case with cinci and baylor

 

[mvenus929]

I'm going to disagree a little here with your analysis of cinci and Baylor, both of these places serve a wide catchment area in the community and see tons of bread and butter peds in addition tothe weird stuff. Even BCRP has their community hospital where they spend 25% of their time seeing bread and butter. There were some places like Stanford where I felt there was a sever lack of bread and butter but I definitely do not think that is the case with cinci and baylor

Is 25% bread and butter (and not just in gen peds, but the specialties too--diabetes, short gut, prematurity, CF, etc) enough to make a good, well rounded general pediatrician? If you're seeing 75% zebras, are you going to know the bread and butter well enough to take care of it?

Hospitalist has become a fellowship in part because people don't feel comfortable going into hospitalist medicine after graduating residency (we can get into the ridiculousness of the fellowship itself another time...). My friend is a first year hospitalist fellow this year, and he has less autonomy as a first year fellow than he did as a third year resident in our program, because we emphasize those bread and butter things so much. Do the grads of the large, hyper-specialized programs feel the same? I honestly don't know, and don't know if Cinci and Baylor can be excluded from the rest of the 'top' programs, but it's a valid point, none-the-less.

 

[sliceofbread136]

Is 25% bread and butter (and not just in gen peds, but the specialties too--diabetes, short gut, prematurity, CF, etc) enough to make a good, well rounded general pediatrician? If you're seeing 75% zebras, are you going to know the bread and butter well enough to take care of it?

Hospitalist has become a fellowship in part because people don't feel comfortable going into hospitalist medicine after graduating residency (we can get into the ridiculousness of the fellowship itself another time...). My friend is a first year hospitalist fellow this year, and he has less autonomy as a first year fellow than he did as a third year resident in our program, because we emphasize those bread and butter things so much. Do the grads of the large, hyper-specialized programs feel the same? I honestly don't know, and don't know if Cinci and Baylor can be excluded from the rest of the 'top' programs, but it's a valid point, none-the-less.

I would guess 25% is enough personally, but I'm just an intern so I cant say for sure to be honest. I'm fairly confident that a graduate of BCRP would do just fine as a primary care provider, especially coming from their leadership track where it is closer to 40% of time spent at a community hospital. As far as Baylor and cinci I would say it is pretty much 50/50 which in my opinion is the absolute ideal ratio in training. Uwash serves an incrediably large catchment area and has an absolute insane volume so I'm guessing they get plenty of bread and butter as well. Hopkins has to serve all the Medicaid patients of Baltimore of which I am sure there are a billion so they probably see plenty of bread and butter. Columbia had quite a bit of low socioeconomic bread and butter patients as well. I'm not sure on standford and ucsf but I thought it was an issue with both of those programs. I don't specifically recall any of the other top programs, so can't comment on those

As far as autonomy goes, I don't really take as much issues as a lot of other people do with that. I come up with my own opinion and plan no matter who is going to be listening to it and I find as attendings grow more comfortable and confident in my abilities they give me more freedom. I will say that at my own program (a top 10) that I have more autonomy than I actually want at this stage of my training

 

[BigRedBeta]

I said that Baylor was different. And I'll give you that Cinci produces more general pediatricians than CHOP or Boston (I haven't ever looked at the numbers for the Combined program).

What becomes the issue is how do the programs focus on standard pediatric care. It's one thing to see bronchiolitis 50 times, it's another thing to have it be an understood focus of education with the approach being "what do you need to know if you're a general pediatrician in Pig's Knuckle, Missouri or Donkey Hoof, Ohio". Autonomy in taking care of bread and butter pediatric patients is crucial. And hospital based care of bronchiolitis isn't sufficient either, there needs to be exposure through the continuum of care from clinic, to the ED, to the floor, to the PICU.

In my experience in fellowship at a top 10 children's hospital, the residents didn't realize how little autonomy they had. They felt they had taken ownership but only because they hadn't seen what true autonomy looked like - and that's with the usual caveat that no pediatric trainee ever gets the same level of autonomy of their IM cohort. The residents at my hospital were all incredibly smart, but struggled to make decisions because no one ever let them...great place to be a fellow though.

Just to give a few simple examples - in my residency (large freestanding children's hospital that took 26 interns/yr, had some fellowships but not fully loaded - NICU/PICU/Cards/Pulm/PEM/Neuro), we did high flow on the floors and only transferred bronchiolitics when they needed NIPPV or an ETT (and in my intern year, it was the year of H1N1 so the PICU didn't want to hear about our any non-ETT needing kids even if they were on 16-20LPM). In fellowship, if a kid reached 4LPM of HFNC, it had to go to the PICU. So there were a whole subsection of patients that interns never got to see, even though they weren't that sick and only maxed out on 6 or 8 LPM. In the NICU at my residency program, interns were expected to attempt UAC/UVC's on all the babies that needed them. They were taught by the upper level resident who was there to help and only in extreme emergencies or if the line was particularly difficult did the fellow take over...and when one of my best friends interview for Neo fellowships at the big names she was shocked to hear time and time again that only fellows put in lines. Nevermind the fact that being able to put in lines is a hugely beneficial skill for anyone who routinely goes to deliveries and is well within in general pediatrics scope of practice.

That's the sort of difference I speak of when I say that bread and butter pediatrics is not a priority and why it's up for debate on whether not going to a big name program and not wanting to do fellowship is a good idea.

 

[sliceofbread136]

I said that Baylor was different. And I'll give you that Cinci produces more general pediatricians than CHOP or Boston (I haven't ever looked at the numbers for the Combined program).

What becomes the issue is how do the programs focus on standard pediatric care. It's one thing to see bronchiolitis 50 times, it's another thing to have it be an understood focus of education with the approach being "what do you need to know if you're a general pediatrician in Pig's Knuckle, Missouri or Donkey Hoof, Ohio". Autonomy in taking care of bread and butter pediatric patients is crucial. And hospital based care of bronchiolitis isn't sufficient either, there needs to be exposure through the continuum of care from clinic, to the ED, to the floor, to the PICU.

In my experience in fellowship at a top 10 children's hospital, the residents didn't realize how little autonomy they had. They felt they had taken ownership but only because they hadn't seen what true autonomy looked like - and that's with the usual caveat that no pediatric trainee ever gets the same level of autonomy of their IM cohort. The residents at my hospital were all incredibly smart, but struggled to make decisions because no one ever let them...great place to be a fellow though.

Just to give a few simple examples - in my residency (large freestanding children's hospital that took 26 interns/yr, had some fellowships but not fully loaded - NICU/PICU/Cards/Pulm/PEM/Neuro), we did high flow on the floors and only transferred bronchiolitics when they needed NIPPV or an ETT (and in my intern year, it was the year of H1N1 so the PICU didn't want to hear about our any non-ETT needing kids even if they were on 16-20LPM). In fellowship, if a kid reached 4LPM of HFNC, it had to go to the PICU. So there were a whole subsection of patients that interns never got to see, even though they weren't that sick and only maxed out on 6 or 8 LPM. In the NICU at my residency program, interns were expected to attempt UAC/UVC's on all the babies that needed them. They were taught by the upper level resident who was there to help and only in extreme emergencies or if the line was particularly difficult did the fellow take over...and when one of my best friends interview for Neo fellowships at the big names she was shocked to hear time and time again that only fellows put in lines. Nevermind the fact that being able to put in lines is a hugely beneficial skill for anyone who routinely goes to deliveries and is well within in general pediatrics scope of practice.

That's the sort of difference I speak of when I say that bread and butter pediatrics is not a priority and why it's up for debate on whether not going to a big name program and not wanting to do fellowship is a good idea.

I'm just gonna agree to disagree here. I've had plenty of experience with attendings and fellows who have been trained at top 10 places and they have all been absolutely amazing in both hyper specialized and routine care. Ive yet to see any evidence that these programs are churning out anything but incredible physicians.

 

[sliceofbread136]

Another random point, Hopkins has the best autonomy of any pediatric program in the country. They literally round without an attending present

 

[sliceofbread136]

And to actually answer OPs post, for chop and bcrp you kind of need a 250+ with an additional extra "wow" factor and good grade. Everything below that you will have some more lee-way

 

[Mehd School]

I rotated with a younger attending that trained in Boston and he said he had low 260's and that was on par with most of his residency class. Top programs in any field are competitive as hell.

 

[fireball99]

I have been following SDN for >10 years now but this is my first post. I have been a resident at a top ten program in pediatrics. Baylor College of Medicine pediatrics. I think you hit the nail on the head.

I would consider carefully before choosing a large program but I do not have experience at another top 10 program. There was no autonomy, I repeat, no autonomy. Even if you do see rare patients,or high volume of patients, you would not manage them, you would write their note and answer nursing phone calls. There is an unspoken understanding of this and the several hundred nurses, ancillary staff, and attendings/fellows treat residents in similar manner and that is as note writers and phone answering persons. A small example among many, many others should suffice: when level I trauma comes in, or a generally sicker patient (most level 1 &2 go to Memorial Hermann) the attending will immediately grab a visiting adult ER resident and a fellow. It speaks volumes that the attendings do not strive to, enjoy, or feel compelled to involve their own pediatric residents in learning situations. This example was repeated many times on every rotation throughout the hospital every day. I was warned when I interviewed by residents and attributed that to their being tired, which is true, but I believe there was a general grumbling among a large portion of residents who agreed with me. There was no supervisory learning opportunities, no autonomy, with a well known demanding schedule including 8-9 months of q4 28 hour call. This program did not care about the residents, this was demonstrated on repeated attempts to provide face to face constructive feedback and or tailor my learning experience which was followed by rebuffs from program leadership and direct reprimands by attendings / department and overall overtly negative reactions from staff /attendings .The program had become a training program on fellowship support. I am certain, as I have been a part of a smaller to medium sized program, that you can get as good and better training at a residency program with less hours worked. I am not sure what the program once was but I believe it has changed.

 

[prettylittlebird]

Re: anecdotal reports of needing Step 1 of 250+ to get into top peds residencies - does anyone know if there are posted Step 1 averages? I've searched and haven't really been able to find anything so I'm curious. Obviously the NRMP releases score data and averages for the specialty overall but doesn't break it down by school as far as I know...

 

[sliceofbread136]

Re: anecdotal reports of needing Step 1 of 250+ to get into top peds residencies - does anyone know if there are posted Step 1 averages? I've searched and haven't really been able to find anything so I'm curious. Obviously the NRMP releases score data and averages for the specialty overall but doesn't break it down by school as far as I know...

There are not. I had ~260 and got about 8 of the top 10. Between bcrp and chop only got one.

 

[prettylittlebird]

There are not. I had ~260 and got about 8 of the top 10. Between bcrp and chop only got one.

Bummer. It would be nice if they could release something like the MSAR for residency programs. Congrats on your Step 1 score and interviews!

 

[WheezyBaby]

Re: anecdotal reports of needing Step 1 of 250+ to get into top peds residencies - does anyone know if there are posted Step 1 averages? I've searched and haven't really been able to find anything so I'm curious. Obviously the NRMP releases score data and averages for the specialty overall but doesn't break it down by school as far as I know...

That thing I can't remember the name of for residency programs has ballpark averages (like, ranges from 240+, 220-240, etc). I don't remember if they're self reported by the program or actually calculated based on actual resident values. There's definitely no exact number though. Regardless, if I had to guess I don't think there's anywhere that has 250 as a strict cut off for peds.

 

[sliceofbread136]

That thing I can't remember the name of for residency programs has ballpark averages (like, ranges from 240+, 220-240, etc). I don't remember if they're self reported by the program or actually calculated based on actual resident values. There's definitely no exact number though. Regardless, if I had to guess I don't think there's anywhere that has 250 as a strict cut off for peds.

Agreed, felt like the non test score stuff mattered much more significantly. Research and advocacy are huge

 

[sliceofbread136]

Bummer. It would be nice if they could release something like the MSAR for residency programs. Congrats on your Step 1 score and interviews!

Just to clarify, I didn’t have anything super impressive on my app otherwise. Just one pending pub and some other interesting volunteer work here and there. No real WOW factor, which I think adds significantly in peds. A 230 with a big wow factor would likely snag most of the top ten places (except maybe chop or bcrp)

 

[prettylittlebird]

Thanks everyone! All helpful things. Any thoughts on if research is required to be in peds? Also @sliceofbread136 what would you consider to be a "wow" factor? Heavy research/clerkship honors/a really cool story for PS?

 

[jhamaican]

It is not complicated.

Top tier for any specialty is going to be competitive.

Research, grades, LOR, awards, falcon training in the Himalayas etc... you know the drill.

 

[sliceofbread136]

Thanks everyone! All helpful things. Any thoughts on if research is required to be in peds? Also @sliceofbread136 what would you consider to be a "wow" factor? Heavy research/clerkship honors/a really cool story for PS?

Heavy research or significant achievements in advocacy mainly. Clerkship honors are important but don’t really count as a wow factor.

 

[Naruhodo]

Reviving a dead thread with a slightly different question. An info session at my med school on peds shared that the average applicant from our school applies to 24 pediatrics residencies! That's more residencies than number of colleges and med schools I applied to combined (not that that was a smart approach, but I'm just being honest). Does this sound right to others?

 

[Oh_Gee]

we all need to get more bread. and butter, i guess

 

[aprilfools]

Reviving a dead thread with a slightly different question. An info session at my med school on peds shared that the average applicant from our school applies to 24 pediatrics residencies! That's more residencies than number of colleges and med schools I applied to combined (not that that was a smart approach, but I'm just being honest). Does this sound right to others?

Lol yeah, to put things in perspective the average Ortho applicant is up around 70-80 programs.

 

[EmergDO]

Reviving a dead thread with a slightly different question. An info session at my med school on peds shared that the average applicant from our school applies to 24 pediatrics residencies! That's more residencies than number of colleges and med schools I applied to combined (not that that was a smart approach, but I'm just being honest). Does this sound right to others?

The average EM applicant applies to like 40-50 programs so that seems kinda low, but I guess peds is also less competitive.

 

[mvenus929]

The problem with that stat is that people don't actually need to apply that many places, but do, so programs either have to interview more, or try to select which ones they are going to interview. So the people with good stats and applications and who interview well don't have any issues, and the big programs with name recognition don't have any issue filling, but the less competitive applicants and programs end up unmatched/unfilled because the 'best' candidates are applying to wayyy more places than they need to.

 

[Naruhodo]

OK, gearing up for this to be my new reality then. Like mvenus929 says it all seems a bit ridiculous, but I definitely don't want to undershoot and end up with an unintended gap year.
I'm also thinking about some combined peds programs, and it seems that since these are sometimes smaller applicant pools you might get away with fewer applications. But then again there's not that many spots. So best to be on the safe side I guess.

 

[W19]

Another random point, Hopkins has the best autonomy of any pediatric program in the country. They literally round without an attending present

Really! How competitive is Hopkins? A former classmate of mine matched Hopkins with low 230s on step1.

 

[Redpancreas]

What sort of things/step scores make someone competitive for some of the top pediatric residency programs (ex. Boston children's, CHOP, Baylor, etc.)? We always hear that for pediatrics you don't really need crazy high step scores or tons of publications, but I'm assuming this isn't true for everywhere.

Similar to IM, 240+, pubs+, good schools+, you can have deficits as long as they're strengths in other areas.