Prerequisites for Highly Competitive Residencies

[dogotogod]

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I'm going to start MS1 in August and want to get an idea of what steps I'll need to take over the next four years to get into the some of the most competitive residencies (Neurosurgery/Orthopedics/etc.). I'm not sure which one I want to do, yet. However, if I aim high, I hope to make one of them.

From my understanding so far, a successful match requires:
-High USMLE step 1 score
-Good grades on the clinical rotations (as my school P/NPs all of the courses from MS1/MS2)
-Letters of Rec from professors in clinical rotations

Is there anything else I'll need to do to get into a good residency?
Are extracurriculars (Volunteering, Research, etc.) weighted as heavily as they are for medical school admissions? Also, in the curriculum, some of the fields I'm interested in don't have a dedicated block during the 3rd year clinical rotations schedule. Does this mean I will need to take Ortho/Neurosurgery rotations as "electives"?

Thanks

 

[HatWobble]

Depending on the field, research helps. Look into the program directors' survey on the NRMP website to see how important each specialty thinks research is.

Also, in the curriculum, some of the fields I'm interested in don't have a dedicated block during the 3rd year clinical rotations schedule. Does this mean I will need to take Ortho/Neurosurgery rotations as "electives"?

Yep, and you'll likely have to do away rotations at other schools, too, once you pick your specialty.

I'd recommend getting involved with interest groups on campus and meeting some residents and attendings in areas that you're interested it. They will help you zero in on exactly what is needed and expected for residency applications.

Don't stress too much about this before school starts! You've got time. Plenty of people match into competitive specialties who don't start considering that specialty until 3rd year.

 

[survivordo]

Besides for what you have listed above (all of which are very important) I would add that Step II scores must be extremely competitive as well, I would try to have them in during interview season. Also, for these fields I would say research is essentially mandatory.

Survivor DO

 

[FSU2013]

Just do your best. Med school is an adjustment. What you don't want to do is take on too much too early, then have your grades suffer.

Pre-clinical grades "technically" don't count for much, but class rank really does (and it determines if you're AOA). The first thing necessary to get a competitive residency is to get a lot of interviews. I know how dumb that sounds, but it's true. You need to get interviews. The first screens are usually being from the US, being an MD, high step 1 - that's kinda the same for everyone. After that, some fields care a ton about research (radonc), some are big on numbers, some are really big on rec letters, some are big on externships (ortho); and some individual programs within a field are different, some will decide based on your step 2, others don't care if you even take it before applying.

So, the four most important things you can do right now are: 1) get as close to a 4.0 as possible so you will be ranked highly in your class and have potential for AOA 2) learn the material. I know you would assume this is the same as number 1, but it's not - learn the material inside and out, and remember it - the more you remember, the easier step 1 studying will be (Most of the stuff on step 1 is from MS2, but you want every point you can get). 3) Network. Don't kill yourself for this one. Don't sacrifice grades or personal life, but go to the free lunches and meet the people you need to. 4) Don't worry about the rest yet.

Later, you can start thinking about research, volunteering, etc. If you do a ton of ortho research then go into derm, it probably won't help and it may make them look at you funny.

Tl;dnr - you have time. try to get a 4.0 and learn the material and worry about the rest later.

 

[rocketbooster]

You don't need AOA or a high GPA to get into those fields. You only need them if you want a shot at a top 10 program. To get into the field period you need a high step 1, research, and recs.

The only EC they care about is research. No one cares about volunteering anymore.

 

[Cali2]

I'm going to start MS1 in August and want to get an idea of what steps I'll need to take over the next four years to get into the some of the most competitive residencies (Neurosurgery/Orthopedics/etc.). I'm not sure which one I want to do, yet. However, if I aim high, I hope to make one of them.

Please remember that the goal is not to "aim high." Your goal is to figure out which field will be fulfilling to you personally and professional for the rest of your career.

It's just fine to make yourself competitive in case your field of choice ends up being, say, dermatology. But it's also perfectly fine to fall in love with family medicine, even if you would have been a competitive applicant for some of these other fields.

 

[Stellar Clouds]

You don't need AOA or a high GPA to get into those fields. You only need them if you want a shot at a top 10 program. To get into the field period you need a high step 1, research, and recs.

The only EC they care about is research. No one cares about volunteering anymore.

You'll probably still want AOA in any of the competitive fields, unless you don't mind dropping down your rank list.

 

[drotoman]

I'm going to start MS1 in August and want to get an idea of what steps I'll need to take over the next four years to get into the some of the most competitive residencies (Neurosurgery/Orthopedics/etc.). I'm not sure which one I want to do, yet. However, if I aim high, I hope to make one of them.

From my understanding so far, a successful match requires:
-High USMLE step 1 score
-Good grades on the clinical rotations (as my school P/NPs all of the courses from MS1/MS2)
-Letters of Rec from professors in clinical rotations

Is there anything else I'll need to do to get into a good residency?
Are extracurriculars (Volunteering, Research, etc.) weighted as heavily as they are for medical school admissions? Also, in the curriculum, some of the fields I'm interested in don't have a dedicated block during the 3rd year clinical rotations schedule. Does this mean I will need to take Ortho/Neurosurgery rotations as "electives"?

Thanks

You will be golden if you can do the following:


1. High step I score: anything over 250 will make your life so much easier
2. Step 2CK: not as crucial if you rock your step I but its importance has been growing over the past few years. Make sure you get at least a similar score to your step I
3. Pre-clinical grades: honors would be nice but the first two years don't count as much. But still there is no excuse to get a pass though. Try to get at least high pass.
4. Clinical grades: very important. As many honors as you can especially in core clerkships or ones related to your specialty of interest.
5. Research: mandatory. A case report or poster presentation shouldn't be too hard to accomplish.
6. Aways: mixed yield. But definitely do it if you're shooting for a well-respected program and have what it takes to shine, but not essential for a successful match.
7. Excellent LORs: Research/specialty rotations would be a good place to start getting to know your letter writers
8. Reasonably likeable personality/good interpersonal skills: this will help you get better evals on your rotations and ultimately do well on your residency interviews.

 

[rocketbooster]

You'll probably still want AOA in any of the competitive fields, unless you don't mind dropping down your rank list.

Not true. If you're only ranking top 10 programs first then yes. If you aren't, which is probably the case if you're not AOA, then you'll be fine and not drop.

SDN is full of too many gunner who exaggerate everything. Watch out for that op.

Theres a known 3rd or 4th year ENT resident at a top program who trolls ppl on the ENT forum for not having perfect applications. In reality they are plenty competitive. I think some ppl do it just for attention since in real life no one cares.

 

[Stellar Clouds]

Not true. If you're only ranking top 10 programs first then yes. If you aren't, which is probably the case if you're not AOA, then you'll be fine and not drop.

SDN is full of too many gunner who exaggerate everything. Watch out for that op.

Theres a known 3rd or 4th year ENT resident at a top program who trolls ppl on the ENT forum for not having perfect applications. In reality they are plenty competitive. I think some ppl do it just for attention since in real life no one cares.

Maybe it's not true, but maybe it is. It's far better to be overly qualified than under--this will significantly lower your anxiety level come March of your fourth year.

 

[evilbooyaa]

Man, posts like these remind me of how crazy SDN is.

I love the 'research: Mandatory' part lmao. True SDN fashion.

OP, take everything here with a huge grain of salt. Focus on doing as best as you can, sprinkle research if it won't hurt your grades, rock Step 1, and try to have some semblance of a life outside of medical school. Try not to make yourself crazy the first 3 years.

 

[drotoman]

Man, posts like these remind me of how crazy SDN is.

I love the 'research: Mandatory' part lmao. True SDN fashion.

OP, take everything here with a huge grain of salt. Focus on doing as best as you can, sprinkle research if it won't hurt your grades, rock Step 1, and try to have some semblance of a life outside of medical school. Try not to make yourself crazy the first 3 years.

I don't think you have a clear understanding of the OP's reason for this post: he/she wants to go into one of the "most competitive specialties" and keep the options open.

Have you actually gone through the application process? If so, for what specialty? Contrary to your belief, research IS mandatory for highly competitive specialties (derm, ENT, plastic..etc), period. Yes, there will be always a few who will match without any research experiences/publications, but no one should be naïve enough to look at it as the rule rather than the exception.

This is not about promoting perfectionism. But if the OP aims high in the pursuit of his dream specialty, he/she has to put in the necessary work to realize the goal. Btw doing so doesn't have to mean sacrificing social life entirely either. 😉

 

[evilbooyaa]

I don't think you have a clear understanding of the OP's reason for this post: he/she wants to go into one of the "most competitive specialties" and keep the options open.

Have you actually gone through the application process? If so, for what specialty? Contrary to your belief, research IS mandatory for highly competitive specialties (derm, ENT, plastic..etc), period. Yes, there will be always a few who will match without any research experiences/publications, but no one should be naïve enough to look at it as the rule rather than the exception.

This is not about promoting perfectionism. But if the OP aims high in the pursuit of his dream specialty, he/she has to put in the necessary work to realize the goal. Btw doing so doesn't have to mean sacrificing social life entirely either. 😉

Right but for his research to be worth anything, it really should be in the field of his interest, which he doesn't know as of yet. I'll give you derm, plastics, and rad onc as research required. Ortho doesn't require research AFAIK. Sure it helps, but not as much as other fields.

OP doesn't know what he wants to go into yet. He is planning to go for the most competitive specialties. Beyond that he doesn't know.

 

[drotoman]

Right but for his research to be worth anything, it really should be in the field of his interest, which he doesn't know as of yet. I'll give you derm, plastics, and rad onc as research required. Ortho doesn't require research AFAIK. Sure it helps, but not as much as other fields.

OP doesn't know what he wants to go into yet. He is planning to go for the most competitive specialties. Beyond that he doesn't know.

Not true about research having to be in the field of one's interest. The OP can take on projects he finds interesting in any specialty now and get 1 or 2 publications out of them during the first two years. No need to overdo it at this point though. Once he knows what specialty he wants to pursue, then he can redirect his focus. Having a publication or two early on during med school will only help in terms of residency candidacy. But, at the same time, it's not also too late to start research during the third year. Either way, some form of research is absolutely essential at least for the three most competitive specialties out there.

Without knowing which specialty he's eventually going into, the safest bet for the OP now is to have the stats that will get him into ANY specialty. It's always easy to switch from plastic to PM&R later on, but not necessarily the other way around.

 

[thefritz]

I will need to take Ortho/Neurosurgery rotations as "electives"?

Thanks

Some people come into med school already knowing they want to be a neurosurgeon (dad was a neurosurgeon). But please don't be one of those people that only wants to go into the most competitive residency because it is the most competitive. Virtually all fields in medicine pay well enough to make that a non-issue so try and think about what you want to do for a living.

To answer your question, I think the best thing you can do to get into a good residency is genuinely be interested in the field. If you are interested, then people will pick up on this and you'll do well because you like what you're doing. If you aren't interested, you'll show up with a 270 step 1 and not much else. That's the reason people with astronomical test scores go unmatched IMO. They have no genuine interest besides just wanting to beat everyone else, and I'm sure it comes across. Meanwhile the kid with the 220-230 who's been gung-ho neurosurgery and impressed people all across the country with away rotations and research projects zips right in.

Ortho is a little different than the other ultra-competitive fields IMO (even though it is the single hardest specialty to match into). The group of ortho applicants is so homogeneous, that everyone is into it. I think it is rare somebody gets their step 1 score back and says, oh wow, 270, well I was thinking about <something less-competitive>, but now lets do ortho simply because I can! That kind of stuff happens moreso with derm, ENT, optho, rads, etc. Again, IMO.

 

[thefritz]

1. High step I score: anything over 250 will make your life so much easier
2. Step 2CK: not as crucial if you rock your step I but its importance has been growing over the past few years. Make sure you get at least a similar score to your step I

Couple points: 250+ on the step1 is an astronomical score. I'd move that into a more reachable goal of 240. 240, and even 230s still leaves ultra competitive stuff well within your grasps. Also, I'd rather have a mediocre step 1 and an outstanding step 2 than the other way around. It totally varies by program of course, but applying with a lower step 2 than step 1 or no step 2 at all is gonna throw more flags than having a low step 1 and a great step 2 IMO. Blowing away step 1 leaves you in the uncomfortable position of having to choose between applying with no step 2 or risking applying with a lower score, both of which are bad.

Remember, you set the bar. Kill step 1, you better kill your clerkships and step 2 also.
On the flip side, score low on step 1, step 2 is essential. No one wants to risk ranking somebody who might fail step 2 and not graduate.

Bottom line is, it's about the USMLE as a package, not just step 1 as most premeds think. Hell, when I was starting med school, I didn't even know what the steps were.

 

[EtherBunny]

Couple points: 250+ on the step1 is an astronomical score. I'd move that into a more reachable goal of 240. 240, and even 230s still leaves ultra competitive stuff well within your grasps. Also, I'd rather have a mediocre step 1 and an outstanding step 2 than the other way around. It totally varies by program of course, but applying with a lower step 2 than step 1 or no step 2 at all is gonna throw more flags than having a low step 1 and a great step 2 IMO. Blowing away step 1 leaves you in the uncomfortable position of having to choose between applying with no step 2 or risking applying with a lower score, both of which are bad.

Remember, you set the bar. Kill step 1, you better kill your clerkships and step 2 also.
On the flip side, score low on step 1, step 2 is essential. No one wants to risk ranking somebody who might fail step 2 and not graduate.

Bottom line is, it's about the USMLE as a package, not just step 1 as most premeds think. Hell, when I was starting med school, I didn't even know what the steps were.

Dude, step 1 is SIGNIFICANTLY more important than step 2--not even in the same ballpark. I've been on the other side of the applications process for a highly competitive specialty (I.e, I reviewed the applications to help decide the rank lists.) No question about it, step 1 score is a huge factor in obtaining interviews. Many places screen on the basis of step 1.

 

[billybob746]

Couple points: 250+ on the step1 is an astronomical score. I'd move that into a more reachable goal of 240. 240, and even 230s still leaves ultra competitive stuff well within your grasps. Also, I'd rather have a mediocre step 1 and an outstanding step 2 than the other way around. It totally varies by program of course, but applying with a lower step 2 than step 1 or no step 2 at all is gonna throw more flags than having a low step 1 and a great step 2 IMO. Blowing away step 1 leaves you in the uncomfortable position of having to choose between applying with no step 2 or risking applying with a lower score, both of which are bad.

Remember, you set the bar. Kill step 1, you better kill your clerkships and step 2 also.
On the flip side, score low on step 1, step 2 is essential. No one wants to risk ranking somebody who might fail step 2 and not graduate.

Bottom line is, it's about the USMLE as a package, not just step 1 as most premeds think. Hell, when I was starting med school, I didn't even know what the steps were.

PLEASE DO NOT listen to this guy. Step 1 is by far and away the MOST important of any of the steps. Anyone with half a brain would much rather have a killer step 1 and mediocre step 2 than the other way around. If you kill step 1, you can always take step 2 after you submit applications and not worry about it. Of course it is always best to have high scores across the board, but if there's anything you want to focus on, it's step1. That test will keep your doors open, but a mediocre score will rapidly close them. Not sure what this guy is talking about, but he is 100% completely, horribly dead wrong.

 

[rocketbooster]

Couple points: 250+ on the step1 is an astronomical score. I'd move that into a more reachable goal of 240. 240, and even 230s still leaves ultra competitive stuff well within your grasps. Also, I'd rather have a mediocre step 1 and an outstanding step 2 than the other way around. It totally varies by program of course, but applying with a lower step 2 than step 1 or no step 2 at all is gonna throw more flags than having a low step 1 and a great step 2 IMO. Blowing away step 1 leaves you in the uncomfortable position of having to choose between applying with no step 2 or risking applying with a lower score, both of which are bad.

Remember, you set the bar. Kill step 1, you better kill your clerkships and step 2 also.
On the flip side, score low on step 1, step 2 is essential. No one wants to risk ranking somebody who might fail step 2 and not graduate.

Bottom line is, it's about the USMLE as a package, not just step 1 as most premeds think. Hell, when I was starting med school, I didn't even know what the steps were.

Um no. Definitely no. Completely wrong.

Even though Step 2 is starting to become worth more than in the past, Step 1 is still 100x more important than Step 2. If you are applying to an early match field (ophtho, urology), then Step 2 is completely worthless. It will never gain ground in those fields because most applicants have barely started 4th year before apps are due.

 

[Dral]

PLEASE DO NOT listen to this guy. Step 1 is by far and away the MOST important of any of the steps. Not sure what this guy is talking about, but he is 100% completely, horribly dead wrong.

Agree. Step 1 is most important.

That Fritz person is talking about Ortho being the single most difficult specialty to match into as well. Don't know what that's about either.

 

[drotoman]

Couple points: 250+ on the step1 is an astronomical score. I'd move that into a more reachable goal of 240. 240, and even 230s still leaves ultra competitive stuff well within your grasps. Also, I'd rather have a mediocre step 1 and an outstanding step 2 than the other way around. It totally varies by program of course, but applying with a lower step 2 than step 1 or no step 2 at all is gonna throw more flags than having a low step 1 and a great step 2 IMO. Blowing away step 1 leaves you in the uncomfortable position of having to choose between applying with no step 2 or risking applying with a lower score, both of which are bad.

Remember, you set the bar. Kill step 1, you better kill your clerkships and step 2 also.
On the flip side, score low on step 1, step 2 is essential. No one wants to risk ranking somebody who might fail step 2 and not graduate.

Bottom line is, it's about the USMLE as a package, not just step 1 as most premeds think. Hell, when I was starting med school, I didn't even know what the steps were.

So many unfounded statements here.

Step I matters so much more than Step 2CK, especially at the interview granting stage. A high Step 2 score can potentially help you get ranked higher than otherwise but in no way will make up for a mediocre Step I score. And a low Step I score = 0 interview in competitive specialties. Also 250+ on Step I is not considered "astronomical" in highly competitive specialties. I've seen many people with 250+ or even 260+ applying for plastic, derm and ENT.

 

[thefritz]

None of anything else that has been posted is 'founded' either.

In regards to ortho being the most competitive, it is. Last year 18.1% of US seniors went unmatched. Next highest was Rad-onc at 15.3. In terms of spots available per US senior, also the most competitive. Most people base competitiveness on average step 1 score, which is total BS IMO. Competitiveness is a multifactorial characteristic that is based around the number of spots available and the number of people applying for those spots.

A 250+ puts you in somewhere in the top 5 to 8% of test-takers. Call that what you will. I call it presumptuous to go around saying you're gonna score 250+. I know plenty of people who studied for months and were sure they were going to be getting 260s. Most were in the 230-240 range. Very few people actually get numbers that high, but plenty of people think they are going to. There aren't enough 250s to go around to fill every ortho, derm, rad-onc, ent, uro, ns, rads, optho, plastics, c/t/v surg, and top-tier IM and surg programs.

With regards to the importance of step 2, choose to believe what you want. Yes, some programs screen by step 1 score. But some screen by step 2. I was told directly by the PD of a very competitive program that they view step 2 as more important and that they don't consider applicants with high step 1 scores who purposely put off step 2 out of fear of scoring lower. This is an N=1 of course, but the point here is don't blow of step 2. I seriously question the step 1 be-all end-all.

Others may disagree, but I'd rather have a 225 step 1 and a 265 step 2 than the other way around. Under performing (and it's a stretch to call a 225, an average score, underperforming, but then again this is SDN where everyone has monster scores) on the clinical science exam is a major red flag IMO.

I never said step 1 wasn't important. Of course do the best you can. My point is that step 2 is also important, that applying without a step 2 score (to regular match programs obviously) is a major red flag (people don't like hearing this), and that a mediocre step 1 isn't the end. Even more to the point, don't kill yourself on step 1, get a great score, then think it's in the bag and that step 2 is a formality.

I don't think anything I've said here is unreasonable.

 

[GoSpursGo]

Are extracurriculars (Volunteering, Research, etc.) weighted as heavily as they are for medical school admissions? Also, in the curriculum, some of the fields I'm interested in don't have a dedicated block during the 3rd year clinical rotations schedule. Does this mean I will need to take Ortho/Neurosurgery rotations as "electives"?

Thanks

A lot of what I have to say will be redundant, but as others have said research is by far the only EC which they care about, though if you do something cool or meaningful on the side it might give you something interesting to talk about in an interview which can make you more memorable (still much less important than research though). Remember, EVERYONE in the fields you're talking about is going to have great grades and high step scores; to stand out you have to have the whole package, and if you just "sprinkle in a little research" you run the risk of being completely forgettable... and when you're shooting for the stars, some qualified people DO go unmatched.

Beyond that, I would say that it is extremely important that you find yourself a mentor within the fields that you're interested in. Making connections with the faculty is important so that once you're ready to start research you can have some people to talk to who can point you in the right direction of someone who needs help on a project. Get involved in the appropriate interest groups and talk to the 3rd and 4th years who are going/just have gone through the application process. Each specialty is a little different, and blanket statements you receive here beyond "you need research" should be taken with a grain of salt. The higher up students can give you an idea of what you really need to do to make yourself a good applicant within the specific field (including their thoughts on the whole Step 2 argument above, which I think is also specialty-dependent).

 

[Ahmed Maher]

what about IMGS prerequsities for competitive specialities?

 

[thefritz]

what about IMGS prerequsities for competitive specialities?

I have no idea. ValueMD might be a better source. Looking at charting outcomes, it seems that it is totally variable. IMGs match into competitive specialties with sub-200 step scores. Some with 250+ don't match. Very few apply and it seems like the match rates are dismal, in the 10% or less range. I would guess that those who do match are doing so based on things totally unrelated to usmle scores. People on this website are obsessed with the usmle step 1. While I don't fully agree with the groupthink here on the step 1, I especially think it is not relevant for imgs. You can start here: http://www.nrmp.org/data/resultsanddata2012.pdf
Radiology and surgery appear to be the only competitive fields with more than a handful of non-US imgs who matched. Dermatology had 1 and rad-onc had 0 for comparison.

I have friends from Europe (2 from western countries) who did research projects here in the US in very competitive fields. They haven't applied yet, but from what I gathered from them, you would need an excellent command of english and would need to spend a lot of time in the US doing research and getting publications. According to them, it is difficult and extraordinary competitive to train in the US (because of our highly unusual physician income in this country, everyone wants to) and consequently competitive to line up the things you need to do (research, exchange rotations, etc), to be able to do that.

 

[Dral]

None of anything else that has been posted is 'founded' either.

In regards to ortho being the most competitive, it is. Last year 18.1% of US seniors went unmatched. Next highest was Rad-onc at 15.3. In terms of spots available per US senior, also the most competitive. Most people base competitiveness on average step 1 score, which is total BS IMO. Competitiveness is a multifactorial characteristic that is based around the number of spots available and the number of people applying for those spots.

I see where you are getting your data:

http://www.nrmp.org/data/resultsanddata2012.pdf

Page 32.

That is not accurate.

The title is:
Match Results for U.S. Seniors and Independent Applicants
Who Ranked Each Specialty as Their Only Choice, 2012

There are tons of ppl that rank more than one specialty.

Besides, on that table, Thoracic surgery has a 50% unmatched rate.

If you have a different source I'm not seeing, I'd appreciate a link.

Look at total numbers...total numbers of Derm applicants is less than 200 according to the way you read that chart...there are WAY more than 200 total derm applicants. That chart indicates instead that there are fewer than 200 derm applicants who ONLY ranked derm.

Table data not accurate to reflect competitiveness. Sorry.

 

[imer]

...Later, you can start .

 

[John Lannister]

Competitiveness is multifactorial and these arguments are dumb.

They are different groups of people applying to different fields. The only real way to compare would be to use the SAME applicants and have them apply to different fields and see who fared better.

There is no data like this available. The best available data is the charting the outcomes that comes out every 2 years. Unless you're using that data, there's no reason to even have a discussion. Just using US senior % unmatched rates ALONE is a terrible way to measure competitiveness. Maybe if it was one of 5 or 6 categories, you could include it in a discussion.

GOOD DAY!

 

[username456789]

Competitiveness is multifactorial and these arguments are dumb.

They are different groups of people applying to different fields. The only real way to compare would be to use the SAME applicants and have them apply to different fields and see who fared better.

There is no data like this available. The best available data is the charting the outcomes that comes out every 2 years. Unless you're using that data, there's no reason to even have a discussion. Just using US senior % unmatched rates ALONE is a terrible way to measure competitiveness. Maybe if it was one of 5 or 6 categories, you could include it in a discussion.

GOOD DAY!

Spot on.

 

[thefritz]

Competitiveness is multifactorial and these arguments are dumb.GOOD DAY!

Yes, they are. But the derm crowd has on step 1 and AOA blinders.
Everybody and his brother wants to be an orthopedic surgeon. Derm, eh we have 1 or 2 a year at this school vs. 15 or so ortho. More competition for research, rotations, letters, away rotations, etc. A lot more room for an MS-3 to make a name for him/herself in derm. More applicants per spot and higher percentage unmatched in ortho. Common to do a research year if unmatched or sit out in derm. 42% success rate for indys. 28% in ortho. If you don't get it the first time, you're pretty much done -- common to through in gen surg programs as backups. 49% of people with a 200-220 step 1 matched derm in 2011. 53% for ortho. Take that for what you will.

Of course, plastics has them both beat, but it's not really fair to count it because it only looks at integrated programs when so many choose to go the traditional route (same for integrated cardiac/vascular/thoracic).

Both fields are highly competitive. Does it matter which is moreso? Only if you view it as a trophy. And it varies year to year. Again the point is it's not all about step 1. Given that the first two years (or really only 15 months at most schools these days) are pretty much a total waste of time and universally disregarded in residency applications, it would make sense to use that time to prepare for step 1. If I could go back, I would have done that.

On second though, perhaps the best piece of advice I could give to a new med student, is that any school administrator who tells you that their curriculum will prepare you well enough for step 1 and that you only need a month to study for it is a LIAR and is deliberately deceiving you in order to keep attendance up. If you have a systems based curriculum without traditional final exams, you will need significantly more preparation for step 1 than somebody who is fresh off cumulating path and pharm finals.

 

[FunnyCurrent]

what about IMGS prerequsities for competitive specialities?

I know one woman from Russia who was sleeping with the head of plastics department (changed for anonymity but it was a competitive residency). Technically I don't know that they are sleeping together but they have been dating openly for the last 2 years. She brags about only applying to one or two places. effin annoying...

Is Ahmed a girls name or a boys name?

 

[kedrin]

I don't know if I have seen a thread with so much Bull**** information in it concerning this topic.

 

[tantacles]

I don't know if I have seen a thread with so much Bull**** information in it concerning this topic.

Agreed. In fact, preallo has the perfect thread that answers this question:

http://forums.studentdoctor.net/showthread.php?t=1007

In many ways, getting into residency is just like getting into medical school, see?

 

[billybob746]

None of anything else that has been posted is 'founded' either.

In regards to ortho being the most competitive, it is. Last year 18.1% of US seniors went unmatched. Next highest was Rad-onc at 15.3. In terms of spots available per US senior, also the most competitive. Most people base competitiveness on average step 1 score, which is total BS IMO. Competitiveness is a multifactorial characteristic that is based around the number of spots available and the number of people applying for those spots.

A 250+ puts you in somewhere in the top 5 to 8% of test-takers. Call that what you will. I call it presumptuous to go around saying you're gonna score 250+. I know plenty of people who studied for months and were sure they were going to be getting 260s. Most were in the 230-240 range. Very few people actually get numbers that high, but plenty of people think they are going to. There aren't enough 250s to go around to fill every ortho, derm, rad-onc, ent, uro, ns, rads, optho, plastics, c/t/v surg, and top-tier IM and surg programs.

With regards to the importance of step 2, choose to believe what you want. Yes, some programs screen by step 1 score. But some screen by step 2. I was told directly by the PD of a very competitive program that they view step 2 as more important and that they don't consider applicants with high step 1 scores who purposely put off step 2 out of fear of scoring lower. This is an N=1 of course, but the point here is don't blow of step 2. I seriously question the step 1 be-all end-all.

Others may disagree, but I'd rather have a 225 step 1 and a 265 step 2 than the other way around. Under performing (and it's a stretch to call a 225, an average score, underperforming, but then again this is SDN where everyone has monster scores) on the clinical science exam is a major red flag IMO.

I never said step 1 wasn't important. Of course do the best you can. My point is that step 2 is also important, that applying without a step 2 score (to regular match programs obviously) is a major red flag (people don't like hearing this), and that a mediocre step 1 isn't the end. Even more to the point, don't kill yourself on step 1, get a great score, then think it's in the bag and that step 2 is a formality.

I don't think anything I've said here is unreasonable.

unfortunately, thefritz' brain is just that...on the fritz. please, nobody listen to anything this guy posts in this thread. everything you have said is plain wrong and you are spreading garbage to those who do not know any differently. if you notice, throughout the thread everyone is disagreeing with you, and there's a reason...because you are wrong.

 

[billybob746]

None of anything else that has been posted is 'founded' either.

In regards to ortho being the most competitive, it is. Last year 18.1% of US seniors went unmatched. Next highest was Rad-onc at 15.3. In terms of spots available per US senior, also the most competitive. Most people base competitiveness on average step 1 score, which is total BS IMO. Competitiveness is a multifactorial characteristic that is based around the number of spots available and the number of people applying for those spots.

A 250+ puts you in somewhere in the top 5 to 8% of test-takers. Call that what you will. I call it presumptuous to go around saying you're gonna score 250+. I know plenty of people who studied for months and were sure they were going to be getting 260s. Most were in the 230-240 range. Very few people actually get numbers that high, but plenty of people think they are going to. There aren't enough 250s to go around to fill every ortho, derm, rad-onc, ent, uro, ns, rads, optho, plastics, c/t/v surg, and top-tier IM and surg programs.

With regards to the importance of step 2, choose to believe what you want. Yes, some programs screen by step 1 score. But some screen by step 2. I was told directly by the PD of a very competitive program that they view step 2 as more important and that they don't consider applicants with high step 1 scores who purposely put off step 2 out of fear of scoring lower. This is an N=1 of course, but the point here is don't blow of step 2. I seriously question the step 1 be-all end-all.

Others may disagree, but I'd rather have a 225 step 1 and a 265 step 2 than the other way around. Under performing (and it's a stretch to call a 225, an average score, underperforming, but then again this is SDN where everyone has monster scores) on the clinical science exam is a major red flag IMO.

I never said step 1 wasn't important. Of course do the best you can. My point is that step 2 is also important, that applying without a step 2 score (to regular match programs obviously) is a major red flag (people don't like hearing this), and that a mediocre step 1 isn't the end. Even more to the point, don't kill yourself on step 1, get a great score, then think it's in the bag and that step 2 is a formality.

I don't think anything I've said here is unreasonable.

and i didnt even finish reading your post because i couldnt take it any more but now i just did...a 225 is JUST THAT...AN AVERAGE SCORE!!!! that is, in fact, the average, nationwide, of all test takers!! do you know a single correct fact about anything?

 

[kedrin]

Sounds like delusional disorder to me

 

[drotoman]

unfortunately, thefritz' brain is just that...on the fritz. please, nobody listen to anything this guy posts in this thread. everything you have said is plain wrong and you are spreading garbage to those who do not know any differently. if you notice, throughout the thread everyone is disagreeing with you, and there's a reason...because you are wrong.

👍👍👍

 

[ijn]

Many competitive fields don't give a crap about your Step 2 CK score. Especially fields like neurosurgery which were historically early match and therefore never used Step 2 CK as a measuring stick.

 

[disorder]

TL;DR

but

Step 2 has been increasing in importance for other specialties like IM.
i obviously don't classify this as a "highly competitive residency" but the top tier places can be almost as hard to get into as derm/ortho/whatever . every little bit can help, and the 2012 match data shows that on AVERAGE over all the programs that responded to the NRMP, IIRC step 2 was like 3/4 on importance when issuing an interview invitation.

again, no one knows what the top tier programs are looking at, though. this was an average.

AND

nobody likes seeing a drop in your step scores. period. unless you're producing something like a 260/250 split or whatever.

 

[ijn]

Yeah, IM likes it. Looking at that same survey you can see for rads, radonc, derm, ENT, ortho, neurosurg, and plastics it's near the bottom of importance in terms of extending interview invitations.

 

[rocketbooster]

Don't worry guys. I reported the fritz's post. Hopefully it gets removed.

 

[Dral]

Yes, they are. But the derm crowd has on step 1 and AOA blinders.
Everybody and his brother wants to be an orthopedic surgeon. Derm, eh we have 1 or 2 a year at this school vs. 15 or so ortho. More competition for research, rotations, letters, away rotations, etc..

Lol. Uh no.

There are more ortho spots to go around also. Your 'soft' arguments are not convincing.

 

[tantacles]

Don't worry guys. I reported the fritz's post. Hopefully it gets removed.

Why? Does it violate the terms of service?

 

[John Lannister]

Yes, they are. But the derm crowd has on step 1 and AOA blinders.
Everybody and his brother wants to be an orthopedic surgeon. Derm, eh we have 1 or 2 a year at this school vs. 15 or so ortho. More competition for research, rotations, letters, away rotations, etc. A lot more room for an MS-3 to make a name for him/herself in derm. More applicants per spot and higher percentage unmatched in ortho. Common to do a research year if unmatched or sit out in derm. 42% success rate for indys. 28% in ortho. If you don't get it the first time, you're pretty much done -- common to through in gen surg programs as backups. 49% of people with a 200-220 step 1 matched derm in 2011. 53% for ortho. Take that for what you will.

Of course, plastics has them both beat, but it's not really fair to count it because it only looks at integrated programs when so many choose to go the traditional route (same for integrated cardiac/vascular/thoracic).

Both fields are highly competitive. Does it matter which is moreso? Only if you view it as a trophy. And it varies year to year. Again the point is it's not all about step 1. Given that the first two years (or really only 15 months at most schools these days) are pretty much a total waste of time and universally disregarded in residency applications, it would make sense to use that time to prepare for step 1. If I could go back, I would have done that.

On second though, perhaps the best piece of advice I could give to a new med student, is that any school administrator who tells you that their curriculum will prepare you well enough for step 1 and that you only need a month to study for it is a LIAR and is deliberately deceiving you in order to keep attendance up. If you have a systems based curriculum without traditional final exams, you will need significantly more preparation for step 1 than somebody who is fresh off cumulating path and pharm finals.

You can't make meaningful conclusions with the data you have (% successful applicants, your small school population, your perceptions about student's motivations).

These arguments are dumb because they have no purpose. It's arguing for the sake of arguing. If someone here is applying to derm or ortho and wants advice, then that's something that can be discussed by successful applicants.

The most useful discussion I've ever seen about specialties and competitiveness was ranking them as: Highly, moderately or less competitive. Fortunately, a large consensus is out there that derm and surgical specialties are "highly competitive". To begin to compare two highly competitive specialties is an exercise in futility and qualifies as pathetic SDN time wasting.

And yes, Step 1 is important. I've never heard anyone say that it isn't if you are considering moderate or highly competitive specialties.

 

[thefritz]

Oh, ok, well I guess I'm wrong then...

By all means, blow off step 2 until after you've submitted your apps. It doesn't matter and nobody will question why you have a solid step 1 score yet have not even taken step 2 even though you've already been a fourth year student for anywhere between 3-7 months before applications are due. You've been way to busy with the hell that is fourth year, and people will get that.

Step 1, a test of basic science memorization abilities that you will never use again, is really the only thing that matters in predicting the quality of future residents. Step 2, a test of clinical science reasoning, is the last thing anybody cares about. Also, step 2 is easy compared to step 1 and you don't have to study as much.

Ortho is a breeze to get into compared to derm. If you have less than a 250 step 1, no one will interview you in derm. There are so many ortho spots though that low step 1 scorers can still get a spot somewhere.

The importance of a solid step 2 isn't just inconvenient for high step 1 scorers, it's false, along with the unnerving idea that a strong step 2 can help make up for a weak step 1, which would make it harder to patronize your classmates and pigeonhole them into primary care.

Better?

 

[thefritz]

and i didnt even finish reading your post because i couldnt take it any more but now i just did...a 225 is JUST THAT...AN AVERAGE SCORE!!!! that is, in fact, the average, nationwide, of all test takers!! do you know a single correct fact about anything?

If I'm understanding you correctly, which is rather difficult, you are ridiculing me for stating that 225 is an average score, then you point out that a 225 is, in fact, the nationwide average, and then asking me if I know a single correct fact about anything.

Ummmm...ok

 

[Stellar Clouds]

Ortho is a breeze to get into compared to derm. If you have less than a 250 step 1, no one will interview you in derm.

Derm isn't as impossible as you are saying here. From the charting outcomes - average step 1 for the matched US senior was 244. There were plenty of people getting interviews with step scores far lower than 250.

 

[jerseytrash]

Derm isn't as impossible as you are saying here. From the charting outcomes - average step 1 for the matched US senior was 244. There were plenty of people getting interviews with step scores far lower than 250.

Yup, there's a lot more that goes into applying for derm than just the step 1 score (as is the case for ANY specialty). They value being AOA quite a lot (I think 50% of the people who match every year are AOA), and they value research a ton.

Pedigree (unfortunately) also plays something of a role, as does who you know... I've heard of programs blackballing all the students applying from certain schools because they didn't like the head of that school's program or because something happened in the past with an applicant from that school who matched there or something. It isn't fair, but it happens.

 

[Kaputt]

Yeah, IM likes it. Looking at that same survey you can see for rads, radonc, derm, ENT, ortho, neurosurg, and plastics it's near the bottom of importance in terms of extending interview invitations.

Places that require/value Step 2 before interview invites are in the extreme minority in any specialty. I think what matters most is whether they care about Step 2 when it comes time to rank. But yeah, the specialties you listed still put Step 2 pretty low on the rank decision making process.

 

[WilliamsEph]

Why is research so important to getting a competitive residency? I don't know a single practicing physician that conducts research. Of course, if one is planning on going into academic medicine its a different story.