Radiology Faculty--Answering Questions/"AMA"

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
I'm interested in IR, but still have a very strong interest in imaging and diagnostics. If I happen to match DR I do not intend to just coast through DR as a means to get to IR. I intend to be a highly productive resident. In terms of applications, I'm going to apply to both. Under these circumstances, if I applied to DR with strong letters from 2 IRs and a clinical letter, and was open about my interest in both IR and DR, how would it be perceived by the DR programs if I applied DR without a DR letter?

I think medical students see more of a "split" with IR and DR than truly exists. While I think it is unfortunate a sizable fraction of IR training spots have become "integrated" requiring that medical students fully commit to IR before doing any DR and that programs have to fully commit to selecting medical students to do IR before seeing their capabilities in the context of a DR program, the truth of the matter is that for the time being the world of radiology encompasses individuals who do a spectrum of procedures--the distinction between IR and DR is fuzzy for lots of individuals and in lots of practices. As a DR program director who does a lot of what might be considered IR procedures, I don't see the point of seeing these as "2 completely different fields". Bottom line--get the best letters you can. I consider radiologists who do exclusively IR to be radiologists. Not that it ever mattered to me if your letters were from radiologists to begin with.

I can see how an IR integrated program director might want an IR letter to be sure you have really had good exposure to IR and might want someone to vouch for your procedural potential, since you are essentially narrowing down your choices from the beginning. As a DR PD, if you are interested in IR but want to start with DR, it makes total sense to me. I know from years of training radiology residents that lots of people who thought they wanted to do IR when they started residency realized that they could satisfy their procedural desires with many DR subspecialties and ended up doing a DR subspecialty for fellowship. I personally feel it is a mistake that institutions are clamoring to create integrated IR residencies instead of independent IR residencies with ESIR.

I also think some of the concepts that people have are hiliarious--as if it is even possible to "coast through DR" on their way to a "more rigorous" IR curriculum. Look, it's not like you are doing a cushy transitional year before radiology just to get it out of the way--that's not the way it plays out, I'm afraid. There is a lot to know in order to be a competent diagnostic radiologist--most people find the residency challenging.

Members don't see this ad.
 
  • Like
Reactions: 2 users
I think medical students see more of a "split" with IR and DR than truly exists. While I think it is unfortunate a sizable fraction of IR training spots have become "integrated" requiring that medical students fully commit to IR before doing any DR and that programs have to fully commit to selecting medical students to do IR before seeing their capabilities in the context of a DR program, the truth of the matter is that for the time being the world of radiology encompasses individuals who do a spectrum of procedures--the distinction between IR and DR is fuzzy for lots of individuals and in lots of practices. As a DR program director who does a lot of what might be considered IR procedures, I don't see the point of seeing these as "2 completely different fields". Bottom line--get the best letters you can. I consider radiologists who do exclusively IR to be radiologists. Not that it ever mattered to me if your letters were from radiologists to begin with.

I can see how an IR integrated program director might want an IR letter to be sure you have really had good exposure to IR and might want someone to vouch for your procedural potential, since you are essentially narrowing down your choices from the beginning. As a DR PD, if you are interested in IR but want to start with DR, it makes total sense to me. I know from years of training radiology residents that lots of people who thought they wanted to do IR when they started residency realized that they could satisfy their procedural desires with many DR subspecialties and ended up doing a DR subspecialty for fellowship. I personally feel it is a mistake that institutions are clamoring to create integrated IR residencies instead of independent IR residencies with ESIR.

I also think some of the concepts that people have are hiliarious--as if it is even possible to "coast through DR" on their way to a "more rigorous" IR curriculum. Look, it's not like you are doing a cushy transitional year before radiology just to get it out of the way--that's not the way it plays out, I'm afraid. There is a lot to know in order to be a competent diagnostic radiologist--most people find the residency challenging.

Totally agree. To be a the best IR a student can be they should start with a surgical preliminary year that push them to the limit, spend MORE time to get good at DR due to the fact you will practice less of it than your DR colleague but held to the same standard and then we can talk IR.

Also, it's imperative that an IR physician must be ok with at least the idea of practicing some DR. As of right now there isn't enough 100% IR job for all the graduating IR trainees.
 
  • Like
Reactions: 1 user
I think medical students see more of a "split" with IR and DR than truly exists. While I think it is unfortunate a sizable fraction of IR training spots have become "integrated" requiring that medical students fully commit to IR before doing any DR and that programs have to fully commit to selecting medical students to do IR before seeing their capabilities in the context of a DR program, the truth of the matter is that for the time being the world of radiology encompasses individuals who do a spectrum of procedures--the distinction between IR and DR is fuzzy for lots of individuals and in lots of practices. As a DR program director who does a lot of what might be considered IR procedures, I don't see the point of seeing these as "2 completely different fields". Bottom line--get the best letters you can. I consider radiologists who do exclusively IR to be radiologists. Not that it ever mattered to me if your letters were from radiologists to begin with.

I can see how an IR integrated program director might want an IR letter to be sure you have really had good exposure to IR and might want someone to vouch for your procedural potential, since you are essentially narrowing down your choices from the beginning. As a DR PD, if you are interested in IR but want to start with DR, it makes total sense to me. I know from years of training radiology residents that lots of people who thought they wanted to do IR when they started residency realized that they could satisfy their procedural desires with many DR subspecialties and ended up doing a DR subspecialty for fellowship. I personally feel it is a mistake that institutions are clamoring to create integrated IR residencies instead of independent IR residencies with ESIR.

I also think some of the concepts that people have are hiliarious--as if it is even possible to "coast through DR" on their way to a "more rigorous" IR curriculum. Look, it's not like you are doing a cushy transitional year before radiology just to get it out of the way--that's not the way it plays out, I'm afraid. There is a lot to know in order to be a competent diagnostic radiologist--most people find the residency challenging.
Thank you for this.
 
Last edited:
Members don't see this ad :)
Totally agree. To be a the best IR a student can be they should start with a surgical preliminary year that push them to the limit, spend MORE time to get good at DR due to the fact you will practice less of it than your DR colleague but held to the same standard and then we can talk IR.

Also, it's imperative that an IR physician must be ok with at least the idea of practicing some DR. As of right now there isn't enough 100% IR job for all the graduating IR trainees.

I've never done it so obviously you know more than me, but does doing a surgical prelim year really help all that much? I mean we're talking about a 3-4 year gap between intern year and really getting your hands dirty with IR. It reminds me of the college premeds who said oh you better take genetics cuz you'll get your ass kicked in med school! But nobody cares about genetics in med school and it makes no difference between those who took it and those who didn't.

I realize I am probably totally off base so please correct me! Thanks.
 
Just a heads up, but let's leave this stickied thread for dedicated questions to RadiologyPD and put other questions in other threads. This is a good thread that will remain at the top for perpetuity; let's not clutter it up with unrelated discussion.
 
  • Like
Reactions: 1 user
I've never done it so obviously you know more than me, but does doing a surgical prelim year really help all that much? I mean we're talking about a 3-4 year gap between intern year and really getting your hands dirty with IR. It reminds me of the college premeds who said oh you better take genetics cuz you'll get your ass kicked in med school! But nobody cares about genetics in med school and it makes no difference between those who took it and those who didn't.

I realize I am probably totally off base so please correct me! Thanks.

I understand your point but you need to be a good physician to be a doctor:

I push my advisees away from doing a transitional year - as they would not gain as much confidence in being a provider - somewhat like doing a 5th year as a medical student.

If you do a rigorous preliminary year, whether it is medicine or surgery, you would be able to be someone's "senior" by the time you start radiology residency, and will not only be a better physician and radiologist - but also be better prepared to discuss studies and their indications with providers.

A medicine prelim year, which hopefully includes MICU rotations, will help you learn disease processes and care - and is also very helpful in radiology - IR and DR.

A surgery prelim year, which would likewise hopefully includes SICU rotations, will help you understand different surgery procedures and their complications - and help will prepare you to deal with pre-procedural prep and post-procedural care and complications for IR procedures. This also helps in DR, BTW.

It's true that it would be several years before you do predominantly IR rotations, but you will do image-guided procedures starting in your first year, maybe even in the first month.

Both medicine and surgery prelim years have their advantages in different, but generally surgery may be more helpful for procedures.
 
I understand your point but you need to be a good physician to be a doctor:

I push my advisees away from doing a transitional year - as they would not gain as much confidence in being a provider - somewhat like doing a 5th year as a medical student.

If you do a rigorous preliminary year, whether it is medicine or surgery, you would be able to be someone's "senior" by the time you start radiology residency, and will not only be a better physician and radiologist - but also be better prepared to discuss studies and their indications with providers.

A medicine prelim year, which hopefully includes MICU rotations, will help you learn disease processes and care - and is also very helpful in radiology - IR and DR.

A surgery prelim year, which would likewise hopefully includes SICU rotations, will help you understand different surgery procedures and their complications - and help will prepare you to deal with pre-procedural prep and post-procedural care and complications for IR procedures. This also helps in DR, BTW.

It's true that it would be several years before you do predominantly IR rotations, but you will do image-guided procedures starting in your first year, maybe even in the first month.

Both medicine and surgery prelim years have their advantages in different, but generally surgery may be more helpful for procedures.

Typo:
I understand your point but you need to be a good physician to be a radiologist:
 
I understand your point but you need to be a good physician to be a doctor:

I push my advisees away from doing a transitional year - as they would not gain as much confidence in being a provider - somewhat like doing a 5th year as a medical student.

If you do a rigorous preliminary year, whether it is medicine or surgery, you would be able to be someone's "senior" by the time you start radiology residency, and will not only be a better physician and radiologist - but also be better prepared to discuss studies and their indications with providers.

A medicine prelim year, which hopefully includes MICU rotations, will help you learn disease processes and care - and is also very helpful in radiology - IR and DR.

A surgery prelim year, which would likewise hopefully includes SICU rotations, will help you understand different surgery procedures and their complications - and help will prepare you to deal with pre-procedural prep and post-procedural care and complications for IR procedures. This also helps in DR, BTW.

It's true that it would be several years before you do predominantly IR rotations, but you will do image-guided procedures starting in your first year, maybe even in the first month.

Both medicine and surgery prelim years have their advantages in different, but generally surgery may be more helpful for procedures.

I see. So there wouldn't be a difference between a transitional year with surgery or medicine electives and a true medicine/surgery year correct?

When I look at my school's medicine prelim, it is something like this:
4 months medicine
1 month MICU
1 month ED
4 months subspecialty (cards, GI, etc)
1 month elective
1 month vacation

Compare that with a "typical" transitional year if there is such a thing:
4 months medicine
1 month MICU
1 month ED
1 month ambulatory
4 months electives
1 month vacation

If those 4 months of electives were in cards or GI or surgery or SICU or whatever, it would really be no different than a medicine prelim year. Am I missing something? I feel like a transitional year with 4 months of surgery/SICU would make me a better doctor and even a better IR candidate compared to "12" months of surgery or medicine. If I choose medicine, I will miss out on periprocedural care. If I choose surgery, I will miss out on all of the benefits of almost being a medicine senior?

I fully recognize I am a med student that has not yet gone through internship or residency so I am honestly curious.
 
  • Like
Reactions: 1 user
I don't think this has been asked yet, but apologies if it has been. How would you view an applicant to your program that did not pass step 2 CS on the first attempt?
 
I see. So there wouldn't be a difference between a transitional year with surgery or medicine electives and a true medicine/surgery year correct?

When I look at my school's medicine prelim, it is something like this:
4 months medicine
1 month MICU
1 month ED
4 months subspecialty (cards, GI, etc)
1 month elective
1 month vacation

Compare that with a "typical" transitional year if there is such a thing:
4 months medicine
1 month MICU
1 month ED
1 month ambulatory
4 months electives
1 month vacation

If those 4 months of electives were in cards or GI or surgery or SICU or whatever, it would really be no different than a medicine prelim year. Am I missing something? I feel like a transitional year with 4 months of surgery/SICU would make me a better doctor and even a better IR candidate compared to "12" months of surgery or medicine. If I choose medicine, I will miss out on periprocedural care. If I choose surgery, I will miss out on all of the benefits of almost being a medicine senior?

I fully recognize I am a med student that has not yet gone through internship or residency so I am honestly curious.

Radiology_Advisor has more experience than I do with advising medical students, so has more current knowledge of first year programs. In my case, I did a TY year that worked well for me--so in my opinion, it all depends on the program--but my experience was almost 30 years ago. I have generally had the opinion that you can get a good experience with a well constructed TY year, but the truth of the matter is that I haven't looked carefully at the offerings out there.

I don't think this has been asked yet, but apologies if it has been. How would you view an applicant to your program that did not pass step 2 CS on the first attempt?

To be honest, failing the step 2 CS hurts you. In the past, I have had a few applicants explain to me the particular circumstances for them in a way that seemed plausible (essentially, they said they just didn't get off on the right foot with the examiner) and so I gave them the benefit of the doubt, particularly since I am not personally familiar with how this examination is given or graded (not ever having taken it). Nevertheless, since failing step 2 CS is uncommon for US grads, they still dropped quite a bit in our rankings at the committee discussion phase. On top of that, these were 2 individuals who made it to our interview--for candidates that are otherwise "average", failing step 2 CS can be an insurmountable hurdle to actually getting the interview.
 
  • Like
Reactions: 1 user
Surprised that Step 2 CS is considered important in radiology. I am generally not a cynic, but I believe the "exam" is another monopolistic attempt by the NBME to line their coffers with more cash. That exam was a complete waste of my time and money.
 
  • Like
Reactions: 1 user
Radiology_Advisor has more experience than I do with advising medical students, so has more current knowledge of first year programs. In my case, I did a TY year that worked well for me--so in my opinion, it all depends on the program--but my experience was almost 30 years ago. I have generally had the opinion that you can get a good experience with a well constructed TY year, but the truth of the matter is that I haven't looked carefully at the offerings out there.

True, it would depend on the program and the options - and I suppose that if you work hard to learn, it wouldn't matter which program you do.
 
  • Like
Reactions: 1 user
Hello, firstly thank you for taking the time to do this!
I am not sure if I should take step 2 (have read about how you calculate board scores in the ranking process) and was wondering if you could weigh in.

Current ms4 @ Top 3 medical school applying for rads (w/ plans to go into IR either straight from med school or DR residency). Taking a research year in rads starting next month.
Step 1: 230.
Clinical grades (school known to give very low % of honors): med/surgery/obgyn= pass. Peds=HP. Rads sub I/anesthia/medicine sub I= honors Planing to do surgery, peds, and gyn onc sub Is when I come back next year b/c have extra time in schedule and to make up for passes. School gives out more honors to sub I's apparently
Research- 5+ pubs (several 2nd author in pubmed, several first author poster and podium presentations, will increase during research year
Letters- Will have solid personable letters from big wigs in rads
ECs- several national professional society leadership positions

My question in terms of taking step 2 -Recently rethought if I should really take a risk to score 240+. I understand my strengths and weakness and standardized board exams are simply not one of them. Shelf exams have ranged from 70%-85% correct. I would have a solid 2 months time off to study however I studied to my max during step 1 and shelf exams, doing as many questions as humanly possible and utilizing as much time as possible. I am not one of those "do uworld 2x and get 240+". While it would be great to increase my score at least 10 points, there's a legit possibility I may not given my previous historical ratio of effort in:oops:utcome with these exams. My aim to improve my application would be honoring the gauntlet of 3 sub I's next year and doing the research year, but I am curious what you think! Thanks
 
Members don't see this ad :)
Hello, firstly thank you for taking the time to do this!
I am not sure if I should take step 2 (have read about how you calculate board scores in the ranking process) and was wondering if you could weigh in.

Current ms4 @ Top 3 medical school applying for rads (w/ plans to go into IR either straight from med school or DR residency). Taking a research year in rads starting next month.
Step 1: 230.
Clinical grades (school known to give very low % of honors): med/surgery/obgyn= pass. Peds=HP. Rads sub I/anesthia/medicine sub I= honors Planing to do surgery, peds, and gyn onc sub Is when I come back next year b/c have extra time in schedule and to make up for passes. School gives out more honors to sub I's apparently
Research- 5+ pubs (several 2nd author in pubmed, several first author poster and podium presentations, will increase during research year
Letters- Will have solid personable letters from big wigs in rads
ECs- several national professional society leadership positions

My question in terms of taking step 2 -Recently rethought if I should really take a risk to score 240+. I understand my strengths and weakness and standardized board exams are simply not one of them. Shelf exams have ranged from 70%-85% correct. I would have a solid 2 months time off to study however I studied to my max during step 1 and shelf exams, doing as many questions as humanly possible and utilizing as much time as possible. I am not one of those "do uworld 2x and get 240+". While it would be great to increase my score at least 10 points, there's a legit possibility I may not given my previous historical ratio of effort in:oops:utcome with these exams. My aim to improve my application would be honoring the gauntlet of 3 sub I's next year and doing the research year, but I am curious what you think! Thanks

With top 3 med school plus research year all doors will be open.
 
Hello, firstly thank you for taking the time to do this!
I am not sure if I should take step 2 (have read about how you calculate board scores in the ranking process) and was wondering if you could weigh in.

Current ms4 @ Top 3 medical school applying for rads (w/ plans to go into IR either straight from med school or DR residency). Taking a research year in rads starting next month.
Step 1: 230.
Clinical grades (school known to give very low % of honors): med/surgery/obgyn= pass. Peds=HP. Rads sub I/anesthia/medicine sub I= honors Planing to do surgery, peds, and gyn onc sub Is when I come back next year b/c have extra time in schedule and to make up for passes. School gives out more honors to sub I's apparently
Research- 5+ pubs (several 2nd author in pubmed, several first author poster and podium presentations, will increase during research year
Letters- Will have solid personable letters from big wigs in rads
ECs- several national professional society leadership positions

My question in terms of taking step 2 -Recently rethought if I should really take a risk to score 240+. I understand my strengths and weakness and standardized board exams are simply not one of them. Shelf exams have ranged from 70%-85% correct. I would have a solid 2 months time off to study however I studied to my max during step 1 and shelf exams, doing as many questions as humanly possible and utilizing as much time as possible. I am not one of those "do uworld 2x and get 240+". While it would be great to increase my score at least 10 points, there's a legit possibility I may not given my previous historical ratio of effort in:oops:utcome with these exams. My aim to improve my application would be honoring the gauntlet of 3 sub I's next year and doing the research year, but I am curious what you think! Thanks

I think many doors remain open, but probably not all doors.

I can't speak for how other programs do it, but I can only refer you back to how we filter out the plethora of applicants to an interview pool. See prior posts for details, but essentially it boils down to:
1. USMLE score(s)
2. Clinical grades IN CORE CLERKSHIPS compared to others at your institution
3. Intangibles: local connection, prior relationships (including rotation with us), strength of medical school, noteworthy attributes including research, Dean's letter assessment of relative performance (i.e., which "quartile"), letters, etc.

Again, I'm only talking about getting the interview. Once you get the interview, the more nuanced approach to your application has more weight than the board score.

More than 1/2 of the interview spots in my program are "given away" based #1 and #2 assuming AMG. This is often reflected in AOA status--we rarely do not extend an interview to a candidate who is AOA. No "intangibles" used to make those interview offers--they are "no brainers" for us. I don't take the time to review their research records, etc. If they are deficient in these intangibles, it will get exposed during the interview process, but they will get the interview. I suspect that other programs also select at least 1/2 of their applicants based on readily accessible metrics that include board scores.

You don't come across as a "no brainer" applicant due to relatively low USMLE and relatively low clinical grades in core clerkships. You know yourself best, but you currently sit as "below average" for board score. Most applicants do better on step 2 than on step 1, and there is a boost to your application if the PD sees a step 2 in the 240s or above. By not taking step 2, you stay in the "below average USMLE" pool. You are going to be most competitive for programs that don't care about you being below average in USMLE. If you take step 2 and stay in the "below average" pool, seems to me you didn't really change your competitiveness. If you take step 2 and get above 240, now some programs might elevate you to the "average USMLE pool", thus increasing your competitiveness for programs that for some reason do care more about USMLE performance.

In our system, you'd be below average for core clerkship performance. I understand that your school appears to be tough with clinical grades, and at least I spend a considerable effort trying to correct for that. I doubt most PDs spend that effort. On the score sheet, you're going to get marked as "no honors in core clerkships".

You are going to get plenty of interviews. The concern is that you may not get all the interviews you want. With 230, you might not make the cut off for the most reputable programs (not necessarily the "best" ones, but the ones with a reputation). Our USMLE cut-off is lower than 230 because I honestly don't think standardized test scores are good discriminators of who will be a good radiology resident--but in full disclosure, your 230 step 1 puts you below the 10th percentile for my residents in the last 5 years. So despite me not wanting to focus on USMLE scores, we end up ranking and getting applicants with higher board scores.

One note: I personally don't use the sub-I scores or other elective rotation grades as a differentiator in terms of performance because--as you said--schools give out more honors for these non-core rotations. I would not consider these non-core rotation grades as much of an advantage. Your strength for the "intangibles" to get the interview appears to be in strength of medical school and research accomplishments, along with some leadership history. If you are at a top medical school, are you competitive for that residency? (most top medical schools have pretty good rad residency programs). If your PD says he/she wants you in a letter of rec, that boosts you up a lot--especially if that person knows other people. It also means you have a good fallback (if it is true).

So, honest reflection is important here. If you really think you are a subpar test taker even for the non-basic science stuff supposedly tested in step 2, then don't stress out on it--don't take it early enough for it to be a factor. However, if you are the "average" applicant, you'll do better on step 2 than step 1 and that may lend some support for programs that use step 2 scores as a discriminator.
 
I think many doors remain open, but probably not all doors.

I can't speak for how other programs do it, but I can only refer you back to how we filter out the plethora of applicants to an interview pool. See prior posts for details, but essentially it boils down to:
1. USMLE score(s)
2. Clinical grades IN CORE CLERKSHIPS compared to others at your institution
3. Intangibles: local connection, prior relationships (including rotation with us), strength of medical school, noteworthy attributes including research, Dean's letter assessment of relative performance (i.e., which "quartile"), letters, etc.

Again, I'm only talking about getting the interview. Once you get the interview, the more nuanced approach to your application has more weight than the board score.

More than 1/2 of the interview spots in my program are "given away" based #1 and #2 assuming AMG. This is often reflected in AOA status--we rarely do not extend an interview to a candidate who is AOA. No "intangibles" used to make those interview offers--they are "no brainers" for us. I don't take the time to review their research records, etc. If they are deficient in these intangibles, it will get exposed during the interview process, but they will get the interview. I suspect that other programs also select at least 1/2 of their applicants based on readily accessible metrics that include board scores.

You don't come across as a "no brainer" applicant due to relatively low USMLE and relatively low clinical grades in core clerkships. You know yourself best, but you currently sit as "below average" for board score. Most applicants do better on step 2 than on step 1, and there is a boost to your application if the PD sees a step 2 in the 240s or above. By not taking step 2, you stay in the "below average USMLE" pool. You are going to be most competitive for programs that don't care about you being below average in USMLE. If you take step 2 and stay in the "below average" pool, seems to me you didn't really change your competitiveness. If you take step 2 and get above 240, now some programs might elevate you to the "average USMLE pool", thus increasing your competitiveness for programs that for some reason do care more about USMLE performance.

In our system, you'd be below average for core clerkship performance. I understand that your school appears to be tough with clinical grades, and at least I spend a considerable effort trying to correct for that. I doubt most PDs spend that effort. On the score sheet, you're going to get marked as "no honors in core clerkships".

You are going to get plenty of interviews. The concern is that you may not get all the interviews you want. With 230, you might not make the cut off for the most reputable programs (not necessarily the "best" ones, but the ones with a reputation). Our USMLE cut-off is lower than 230 because I honestly don't think standardized test scores are good discriminators of who will be a good radiology resident--but in full disclosure, your 230 step 1 puts you below the 10th percentile for my residents in the last 5 years. So despite me not wanting to focus on USMLE scores, we end up ranking and getting applicants with higher board scores.

One note: I personally don't use the sub-I scores or other elective rotation grades as a differentiator in terms of performance because--as you said--schools give out more honors for these non-core rotations. I would not consider these non-core rotation grades as much of an advantage. Your strength for the "intangibles" to get the interview appears to be in strength of medical school and research accomplishments, along with some leadership history. If you are at a top medical school, are you competitive for that residency? (most top medical schools have pretty good rad residency programs). If your PD says he/she wants you in a letter of rec, that boosts you up a lot--especially if that person knows other people. It also means you have a good fallback (if it is true).

So, honest reflection is important here. If you really think you are a subpar test taker even for the non-basic science stuff supposedly tested in step 2, then don't stress out on it--don't take it early enough for it to be a factor. However, if you are the "average" applicant, you'll do better on step 2 than step 1 and that may lend some support for programs that use step 2 scores as a discriminator.

My question here: I am under the impression that extremely good med schools, like the top 3 law schools (HYS) produce different match outcomes. The match outcome of HMS, Hopkins and UCSF are so far above the rest that I understand their name alone is equivalent to a higher step score. Just like as you mentioned, while it maybe harder to justify ranking a DO candidate with very good stats to your committee, it maybe easier to justify ranking a below average USMD from top 3 schools to your committee and the easiest way to show a good match for some is to recruit from big names.

For some institutions that are top places regionally or top 50 within the nation, recruiting any student from the top 3 is seen as a win because there maybe between a total 10-15 of those applicant going around the country each year, more rare than AOA applicants.

What do you think of this sentiment I stated above? How much do you think extremely good names help? Can you quantify it down to a score? (In my experience, a HMS grad will get a boost almost equivalent to 40 points of step 1).

And lastly, do you think that some PDs (obviously not yourself as I gathered from the post I quoted) uses reputation of med school as a no brainer interview tool?
 
My question here: I am under the impression that extremely good med schools, like the top 3 law schools (HYS) produce different match outcomes. The match outcome of HMS, Hopkins and UCSF are so far above the rest that I understand their name alone is equivalent to a higher step score. Just like as you mentioned, while it maybe harder to justify ranking a DO candidate with very good stats to your committee, it maybe easier to justify ranking a below average USMD from top 3 schools to your committee and the easiest way to show a good match for some is to recruit from big names.

For some institutions that are top places regionally or top 50 within the nation, recruiting any student from the top 3 is seen as a win because there maybe between a total 10-15 of those applicant going around the country each year, more rare than AOA applicants.

What do you think of this sentiment I stated above? How much do you think extremely good names help? Can you quantify it down to a score? (In my experience, a HMS grad will get a boost almost equivalent to 40 points of step 1).

And lastly, do you think that some PDs (obviously not yourself as I gathered from the post I quoted) uses reputation of med school as a no brainer interview tool?

I can only speak from my perspective and share what we do, so in the following comments, when I say "we", you should know that n=1 on that. I honestly don't know exactly what other PDs do. It may be that some PDs do use medical school pedigree more than I do--BUT, I will say that there is a sense from some selection committee members I know that they like "scrappy" candidates, and that some students from some "elite" schools are viewed as possibly entitled and thus less scrappy. I know of one selection committee member at another program that feels that Harvard medical school students have "attitude" and don't work as hard. Just saying...

We do like to get students from the best medical schools, but I don't think the boost is as great as you think for the mythical "top 3" schools. In other words, there's a big difference in how we might view an applicant from a top brand medical school compared to an unknown medical school, but not much of a difference in how we might see a "top 3" medical student compared to a "top 20" medical student. To be honest, I don't even know what the true "top 3" schools are.

In our scheme, we have varied the amount of intangible influence we have given an application at the "select to interview" stage based on medical school pedigree from year to year. In order to do this, we have used an arbitrary ranklist we found on the internet that was easy to use--
medical-schools.startclass.com/-- not because I believe the methodology has any value or accuracy, but because it was easy for me to download the list into my spreadsheet :) Schools are then lumped into groups (i.e., top 20, next 20, etc), and we calculate a "subtraction number" based on their group. In our algorithm, this gets factored into the "clinical clerkship" score. Without going into the details, essentially the applicants core clinical clerkship scores are "converted" to a number using a formula (complicated--takes into account the % of honors, % of high pass, etc.). We then subtract the number that represents the pedigree assessment. The final result is the "modified clinical clerkship score".

In some years, we have tweaked the algorithm to give more importance to the pedigree than in other years. In the years we've given it more importance, the schools were organized into groups of 20 (i.e., top 20, next 20, etc) up to 100, so that schools 1-20 have a "subtraction" number of 0, schools 21-40 have a "subtraction" number of 20, etc---after 100, everything gets a subtraction number of 100. DO schools get a subtraction number of 120. IMGs get a subtraction number of 150. For any state's most highly ranked state school (or 2 top schools for the big states like Texas), we cut the subtraction number in half--so, for example, the University of Iowa is #39 in the arbitrary meaningless ranking we use. Because it is the major state school for Iowa, instead of giving students from that school a "subtraction" score of 20 (since it is in the 21-40 pile), we give it a subtraction score of 10 (half of 20). The reason for this? Because some students choose to go to the best in-state school for financial reasons--it is often cheaper than the private schools that they may have gotten into. We wanted to somehow reflect that.

In other years, we tweaked the algorithm to have pedigree have less importance. In those years, we only had a 10 point difference between the tiers (top 20 had subtraction score of 0, next 20 had subtraction score of 10, etc). In those years, the students from schools that were ranked 100 or higher had subtraction scores of 50, not 100. DO schools had a subtraction score of 75, IMGs also 75.

The "modified" core clinical clerkship score (which is the formula-driven core clerkship score minus the pedigree subtraction number) is adjusted with a fudge factor so that the average score and the median score for our applicants is targeted around 500 points (it turns out our average and median scores are not that different on this number the way we have calculated it, which pleases me). The "modified" USMLE combo score (which is the combined step 1 and step 2 scores, with dampening of the scores for high outlier performance on step 1--see previous post, but essentially it minimizes the boost you get from a super high step 1 score) happens to average around 500 points for our applicants (yes--that means you add step 1 and step 2 and the average applicant at our program approaches 500--usually at 498 or so).

So you see the impact. In the years we let pedigree most highly influence the score, there was about a 10% impact (100 points subtracted from a score that averaged 1000) to your score if you were from a relatively unknown medical school--but only a 2% impact for those students from the schools ranked 20-40 compared to those students ranked 0-20. Yes, in those years, the student from medical school #100 would have had a 100 point lower score compared to the student from medical school #1 if everything else was the same--meaning the equivalent of 50 step 1 points and 50 step 2 points. Huge--when comparing applicant from the #1 med school to the applicant from the #100 medical school. But the applicant from the #40 medical school would have had only a 20 point lower score compared to the applicant from the #1 medical school (equivalent of 10 step 1 points and 10 step 2 points), and there would be no difference between applicant from #1 medical school and applicant from #20 medical school.

In the years we had pedigree least influence the score, there was really only a 5% impact to your score if you were from a relatively unknown medical school compared to a top 20 medical school (50 points out of 1000 average). If everything was the same between two students except pedigree, applicant from #1 medical school would have a 50 point advantage over applicant from #100 medical school (equivalent of 25 step 1 points and 25 step 2 points)--again, pretty significant. However, comparing applicant from #1 med school to applicant from #40 medical school, only a 10 point difference (equivalent of 5 step 1 points and 5 step 2 points)--and again, no difference between applicant from #1 medical school and applicant from #20 medical school.

Putting it all in perspective, however, remember that I only give out about 50-60% of the slots based on this formulaic approach. After that, for my last 40-50% of the slots, I look at the intangibles I discussed earlier. This is where leadership, research, rock-star recommendation letters, etc factor in. Remember also that this is just to get you the interview. Once we interview you, the combined USMLE and clinical clerkship score only accounts for 50% of your evaluation, with the other 50% based on your interview assessment--and even then, we eyeball the results and aren't beholden to the "numbers".

This is why I said to nickelbackfan that "many doors will open, but not all doors may be open". Selection committees like to see relative outperformance--high USMLE scores, good core clerkship performance--when they select for interview, and reserve only a subset of the interview spots for candidates with "intangibles". Doing a research year is looked upon more favorably for candidate A who didn't need to do that to get a top-tier residency as compared to candidate B who had sub-average USMLE and core clerkship performance. We know that the research year for candidate B was almost certainly taken in order to boost chances of getting a better residency--for candidate A, it may have been a true expression of interest in an academic career that could boost the residency's "legacy" if the candidate goes to that residency and then becomes an academic leader.
 
Last edited:
  • Like
Reactions: 1 user
@RadiologyPD

Thank you for the incredibly insightful reply. I apologize for not making my initial question clearer. I am aware of professional association for academic radiology Pds (our PDs seem to allude to them) so I thought you have some knowledge on the prevailing thoughts about prestige.
 
I can only speak from my perspective and share what we do, so in the following comments, when I say "we", you should know that n=1 on that. I honestly don't know exactly what other PDs do. It may be that some PDs do use medical school pedigree more than I do--BUT, I will say that there is a sense from some selection committee members I know that they like "scrappy" candidates, and that some students from some "elite" schools are viewed as possibly entitled and thus less scrappy. I know of one selection committee member at another program that feels that Harvard medical school students have "attitude" and don't work as hard. Just saying...

We do like to get students from the best medical schools, but I don't think the boost is as great as you think for the mythical "top 3" schools. In other words, there's a big difference in how we might view an applicant from a top brand medical school compared to an unknown medical school, but not much of a difference in how we might see a "top 3" medical student compared to a "top 20" medical student. To be honest, I don't even know what the true "top 3" schools are.

In our scheme, we have varied the amount of intangible influence we have given an application at the "select to interview" stage based on medical school pedigree from year to year. In order to do this, we have used an arbitrary ranklist we found on the internet that was easy to use--
medical-schools.startclass.com/-- not because I believe the methodology has any value or accuracy, but because it was easy for me to download the list into my spreadsheet :) Schools are then lumped into groups (i.e., top 20, next 20, etc), and we calculate a "subtraction number" based on their group. In our algorithm, this gets factored into the "clinical clerkship" score. Without going into the details, essentially the applicants core clinical clerkship scores are "converted" to a number using a formula (complicated--takes into account the % of honors, % of high pass, etc.). We then subtract the number that represents the pedigree assessment. The final result is the "modified clinical clerkship score".

In some years, we have tweaked the algorithm to give more importance to the pedigree than in other years. In the years we've given it more importance, the schools were organized into groups of 20 (i.e., top 20, next 20, etc) up to 100, so that schools 1-20 have a "subtraction" number of 0, schools 21-40 have a "subtraction" number of 20, etc---after 100, everything gets a subtraction number of 100. DO schools get a subtraction number of 120. IMGs get a subtraction number of 150. For any state's most highly ranked state school (or 2 top schools for the big states like Texas), we cut the subtraction number in half--so, for example, the University of Iowa is #39 in the arbitrary meaningless ranking we use. Because it is the major state school for Iowa, instead of giving students from that school a "subtraction" score of 20 (since it is in the 21-40 pile), we give it a subtraction score of 10 (half of 20). The reason for this? Because some students choose to go to the best in-state school for financial reasons--it is often cheaper than the private schools that they may have gotten into. We wanted to somehow reflect that.

In other years, we tweaked the algorithm to have pedigree have less importance. In those years, we only had a 10 point difference between the tiers (top 20 had subtraction score of 0, next 20 had subtraction score of 10, etc). In those years, the students from schools that were ranked 100 or higher had subtraction scores of 50, not 100. DO schools had a subtraction score of 75, IMGs also 75.

The "modified" core clinical clerkship score (which is the formula-driven core clerkship score minus the pedigree subtraction number) is adjusted with a fudge factor so that the average score and the median score for our applicants is targeted around 500 points (it turns out our average and median scores are not that different on this number the way we have calculated it, which pleases me). The "modified" USMLE combo score (which is the combined step 1 and step 2 scores, with dampening of the scores for high outlier performance on step 1--see previous post, but essentially it minimizes the boost you get from a super high step 1 score) happens to average around 500 points for our applicants (yes--that means you add step 1 and step 2 and the average applicant at our program approaches 500--usually at 498 or so).

So you see the impact. In the years we let pedigree most highly influence the score, there was about a 10% impact (100 points subtracted from a score that averaged 1000) to your score if you were from a relatively unknown medical school--but only a 2% impact for those students from the schools ranked 20-40 compared to those students ranked 0-20. Yes, in those years, the student from medical school #100 would have had a 100 point lower score compared to the student from medical school #1 if everything else was the same--meaning the equivalent of 50 step 1 points and 50 step 2 points. Huge--when comparing applicant from the #1 med school to the applicant from the #100 medical school. But the applicant from the #40 medical school would have had only a 20 point lower score compared to the applicant from the #1 medical school (equivalent of 10 step 1 points and 10 step 2 points), and there would be no difference between applicant from #1 medical school and applicant from #20 medical school.

In the years we had pedigree least influence the score, there was really only a 5% impact to your score if you were from a relatively unknown medical school compared to a top 20 medical school (50 points out of 1000 average). If everything was the same between two students except pedigree, applicant from #1 medical school would have a 50 point advantage over applicant from #100 medical school (equivalent of 25 step 1 points and 25 step 2 points)--again, pretty significant. However, comparing applicant from #1 med school to applicant from #40 medical school, only a 10 point difference (equivalent of 5 step 1 points and 5 step 2 points)--and again, no difference between applicant from #1 medical school and applicant from #20 medical school.

Putting it all in perspective, however, remember that I only give out about 50-60% of the slots based on this formulaic approach. After that, for my last 40-50% of the slots, I look at the intangibles I discussed earlier. This is where leadership, research, rock-star recommendation letters, etc factor in. Remember also that this is just to get you the interview. Once we interview you, the combined USMLE and clinical clerkship score only accounts for 50% of your evaluation, with the other 50% based on your interview assessment--and even then, we eyeball the results and aren't beholden to the "numbers".

This is why I said to nickelbackfan that "many doors will open, but not all doors may be open". Selection committees like to see relative outperformance--high USMLE scores, good core clerkship performance--when they select for interview, and reserve only a subset of the interview spots for candidates with "intangibles". Doing a research year is looked upon more favorably for candidate A who didn't need to do that to get a top-tier residency as compared to candidate B who had sub-average USMLE and core clerkship performance. We know that the research year for candidate B was almost certainly taken in order to boost chances of getting a better residency--for candidate A, it may have been a true expression of interest in an academic career that could boost the residency's "legacy" if the candidate goes to that residency and then becomes an academic leader.

Also, another question.

In your experience, is it true that residents from top schools often rest on their laurels or are entitled?

How do DOs and IMGs differ from other residents you match, usually? (if you have worked with them) or alternatively, what about students from lower ranked med school if you don't work with DOs or IMG much?
 
Do you find that gender or race play into a role in determining who to interview and/or rank?
 
Thank you for the incredibly insightful reply. I apologize for not making my initial question clearer. I am aware of professional association for academic radiology Pds (our PDs seem to allude to them) so I thought you have some knowledge on the prevailing thoughts about prestige.

I have been a member of the Association of Program Directors in Radiology (APDR) for many years. We don't get very granular in discussing selection criteria. Don't misunderstand my reply--prestige matters, but it's not "top 3" or bust. To what extent each PD/selection committee factors in prestige will differ--I gave you a very detailed look as to what we do. If I had only 1 spot left for interview, 2 potential candidates, and can only consider USMLE and core clerkship performance--candidate A from a reputable school ranked #50 who has average USMLE (for us, 500 combined step 1 and step 2 score) and average core clerkship performance (which for us usually means at least one or two core clerkship grades in the top 35% of the class), and candidate B from the so-called #1 school who has well below average USMLE and below average core clerkship grades--I will interview candidate A. I don't like to see consistent below average metrics. The real takeaway is that we don't put ourselves in that position, because I hand out about 50-60% of my spots based on the USMLE/core clerkship combo that factors in prestige, with my "last" 40-50% spots for interview selected based on a series of intangibles which I have alluded to in prior posts, of which prestige of school is relatively low (since it was already factored into the USMLE/core clerkship combo score).

In your experience, is it true that residents from top schools often rest on their laurels or are entitled?

As a rule, not in my experience.

How do DOs and IMGs differ from other residents you match, usually? (if you have worked with them) or alternatively, what about students from lower ranked med school if you don't work with DOs or IMG much?

More likely to go into private practice (I'm not talking about truly international IMGs--i.e., those raised abroad--who probably are more likely to pursue academic careers). Less likely to contribute to the residency "legacy".

Do you find that gender or race play into a role in determining who to interview and/or rank?

Yes at our shop. As I said before, we "overinterview" (interview far more candidates than we should need to), in part to find the diamonds in the rough and in part to ensure a diverse pool of applicants. When we don't have compelling reasons to rank one candidate over another, diversity is something we consider.
 
Last edited:
  • Like
Reactions: 1 users
Some LORs are indeed helpful--most are not. The really good ones do help applicants in the "33%" in our system who aren't no-brainers for interview based on their "non-interview" score (again, this is just our system).

What makes a LOR helpful? I always figured that everyone's "strong" letters (including mine) just said the same generic positive things, because most (all?) attendings want you to match. I assume everyone's letters say stuff like better than any other medical student, on the level of an intern, etc. Is the helpfulness of the letter based on if you personally know the person or if they have a title (pd, section chief, research chair etc)?
 
Helpful LORs:
1. Give me a brief understanding of how the letter writer knows the candidate.
2. Describe attributes with specific behaviors and actions. Examples: "Candidate stood out from the start by doing x, y, and z". I may ask about these in the interview.
3. Attributes described are the ones I'm most interested in (see prior posts)
4. Highlight facets of the candidate's application that I may have glossed over.
5. Express a sincere desire on the part of the letter writer to "go to bat" for the applicant.
6. Definitely helps if I know the person or know of the person writing the letter, but least important. In general, get the best letter, not the most famous letter writer.

Some letters are generic. "Applicant is x, y, and z" with no examples from the relationship.

We don't use "critical behavior" interviews--we haven't found that successful, probably because my interviewers are not particularly trained in how to conduct these. What we try to do is identify "critical behaviors" from application materials. So understanding a candidate's ACTIONS and descriptions of BEHAVIORS ("Candidate showed up 30 minutes before everyone and left 30 minutes after everyone) are better than labels ("Candidate is outstanding").

Hope that makes sense.
 
Last edited:
  • Like
Reactions: 2 users
It does make sense, thank you. It sounds like the more personal, the better, which I'm glad to hear. Though I do wonder if the writing skill of the author plays a bigger role than the quality of the student.... my father (not in medicine) once asked me to edit a letter for someone he genuinely thought highly of, but the letter was terrible and generic even though he wrote it from scratch!

Out of curiosity, do you ever read a letter where you realize/ suspect the student wrote it themselves? It hasn't happened to me, but it seems to happen fairly frequently at my school that students write their own.
 
Yes, the impact of an LOR can depend on the skill of the writer.

So, the truth is that for most candidates, LORs don't help or hurt. Truth be told, we rarely if ever separate candidates based on strength of LORs.

A fantastic letter can really help distinguish a candidate. 3 really generic short letters saying nothing (or even worse, coded with dubious descriptors, like "candidate diligently improved in areas of weakness") can raise doubts. Most LORs just "round out" our mental construct of the individual (if everyone says the candidate is reserved but very personable over time, we might discount a perceived lack of "zing" during the interview).

I've never read a letter which made me think the student wrote it.
 
  • Like
Reactions: 1 user
Got another question for you rad PD. It's inspired by a conversation I was having with a DO candidate in the student forums.

Say you have a DO candidate who have not taken the USMLE but has a near perfect (like 795/800) Comlex level 1 score. Other things being the same, would you consider his application? How do you "translate" his/her comlex score into USMLE step 1? Do you use COMLEX score at all when you rank DO candidates?
 
Got another question for you rad PD. It's inspired by a conversation I was having with a DO candidate in the student forums.

Say you have a DO candidate who have not taken the USMLE but has a near perfect (like 795/800) Comlex level 1 score. Other things being the same, would you consider his application? How do you "translate" his/her comlex score into USMLE step 1? Do you use COMLEX score at all when you rank DO candidates?

We don't use COMLEX scores. The first filter we use to identify applicants within ERAS is the USMLE Step 1 score. Until an applicant has that in their application, the application isn't reviewed (not considered complete).
 
  • Like
Reactions: 1 users
I don't think it's been asked yet, but what kind of things do you like to read about in a personal statement? Are there things you wish people talked more about other than the usual reasons for choosing radiology?
 
See post #77, reposted below. For most people, the personal statement won't factor into your ranking chances. Some are really good, most are ok, a few are really bad.

The personal statement (PS) probably won't be a factor in whether or not an individual gets an interview--since programs receive so many applications for the number of spots, it's just too hard to review all the PS in the filter process and most do not stand out. I don't read the PS during the "select to interview" process for candidates that hit all the right metrics (see earlier post on what I look for during the select to interview process). For candidates with metrics that don't make them no-brainers for interview (good metrics that a lot of people have), I will review the PS. A really good or great personal statement helps at that point, and is an advantage during the interview process--if memorable in a positive way, it helps the candidate stand out. It can be useful to "steer" the interviewer to ask about interesting or unique aspects of a candidate's application, which then make the interview "effortless" and serves to increase the likability of the candidate. But don't be weird just to be unique--an off color or weird PS is offputting to the interviewer.

The PS is a tough one--if you just "mail in" a generic one, it becomes obvious to the interviewer. If you try to be too cute, it can come off wrong. But if you nail it, it really helps to make you memorable. I would definitely have others that you trust review what you write to see if it rubs anyone the wrong way. If you try and it ends up being generic, that's ok. Most of them fall into this category. If you don't try at all and it is obvious that you just wrote down a bunch of cliches, that isn't a great impression. It won't hurt you if your metrics are great, but won't help you if you are in the mix with a bunch of other candidates with the same metrics.

My personal bias is that I want to know a bit more about the applicant in the PS, not why they think radiology is a great field. I find it somewhat irritating if you spend the PS telling me why radiology is a great field--I know it is, I'm a radiologist. I'd rather you highlight experiences in your CV or in your life that give you some "color" or that you think set you apart or that give me an indication of what you find important in your career. If you are passionate about caving, tell me about that in the context of what that says about you, the challenges you've faced, and the direction you are headed. Tie that into your interest in radiology or medicine in general, and you have the makings of a PS that gives me some insight into you--or at least is something I can talk to you about during your interview.
 
May be buried somewhere in this thread but what is the consensus on how many letters to send? Most program websites say they require 3. Not a minimum of three etc. What is the etiquette on sending 4 letters if we have them? Will one get thrown out/not looked at?
 
Hey @RadiologyPD, first off I wanted to thank you for all your informative posts on SDN- I really appreciate all of your insight. I had a question regarding how you handle 'minor misdemeanors'? I've received two: the first for a speeding ticket 5+ years ago where I was going <5MPH over the speed limit and the other for having an expired license (<2 weeks expired). Will these adversely affect my application in any way or have me screened out of any programs because of it? Also, would you consider this a 'red flag'?
 
Last edited:
No issue with these minor misdemeanors, will not affect your application (imo) and not a red flag. See post #96 and reply in #97 for further comments more serious types of infractions.
 
May be buried somewhere in this thread but what is the consensus on how many letters to send? Most program websites say they require 3. Not a minimum of three etc. What is the etiquette on sending 4 letters if we have them? Will one get thrown out/not looked at?

Are these all LORs from radiologists?
 
This thread is gold--thank you.

1. Will you ultimately rank a student without knowing their Step 2 score? I am a DO student. I have not taken Step 2 but intend to. I read at some point you make a faux Step 2 by doing Step 1 + 5. But I'd like to avoid releasing the score if it is bad.

2. Where can I find out what residency programs are competitive/train well? Several times you mention that applicants should find what they want in a residency program and go there, but you also mention tracking applicants to your program to see if they have made it to another "competitive" academic residency. I am an MS4 very late blooming into wanting to go into radiology, and have no idea what's "good" and "bad". I am not from the continental states, so my plan was to just wing it on the interview trail and try and get the best feel I can from that short amount of time at each interview
 
This thread is gold--thank you.

1. Will you ultimately rank a student without knowing their Step 2 score? I am a DO student. I have not taken Step 2 but intend to. I read at some point you make a faux Step 2 by doing Step 1 + 5. But I'd like to avoid releasing the score if it is bad.

2. Where can I find out what residency programs are competitive/train well? Several times you mention that applicants should find what they want in a residency program and go there, but you also mention tracking applicants to your program to see if they have made it to another "competitive" academic residency. I am an MS4 very late blooming into wanting to go into radiology, and have no idea what's "good" and "bad". I am not from the continental states, so my plan was to just wing it on the interview trail and try and get the best feel I can from that short amount of time at each interview

In general, the most competitive residency programs in any field (including radiology) are the ones that nearly recruit exclusively from top 40 USMD schools (the very top ones have a hefty concentration of those from top 20) while increasing number of DOs and FMG/IMGs corelates with decrease in competitiveness.

Competitiveness does not always equal strength of training however.
 
1. Will you ultimately rank a student without knowing their Step 2 score? I am a DO student. I have not taken Step 2 but intend to. I read at some point you make a faux Step 2 by doing Step 1 + 5. But I'd like to avoid releasing the score if it is bad

Yes. I need to put in something for my spreadsheet to work, so I put in step 1, which underestimates the real step 2 for most people. I may tweak that a bit for this coming year. Remember, though, that step scores don't define you for my program.

2. Where can I find out what residency programs are competitive/train well? Several times you mention that applicants should find what they want in a residency program and go there, but you also mention tracking applicants to your program to see if they have made it to another "competitive" academic residency. I am an MS4 very late blooming into wanting to go into radiology, and have no idea what's "good" and "bad". I am not from the continental states, so my plan was to just wing it on the interview trail and try and get the best feel I can from that short amount of time at each interview

Great question, and not one I can easily answer.

Over the years, I've decided that so much of what makes a person a good radiologist is innate, not something that a program magically gives you. Ultimately it's a combination of (1) desire; (2) work ethic; (3) intrinsic aptitude; (4) interpersonal skills; (5) experiential learning (i.e., learning from your experiences and mistakes), and (6) training/mentorship. Not necessarily in that order, but maybe. Training/mentorship is someone showing you the "tricks of the trade", forcing you to develop good habits, showing you how it's done correctly, inspiring you to be the best you can be.

The only things the residency program brings to the table are #5 and #6.

The problem with using the "quality of past residents" or "where residents went for fellowship" as an assessor is that the quality of those past residents had a lot to do with items #1-4, for which the residency program really cannot take credit. Why are _____ residents great (insert top residency program into the blank)? Because they get great people to rank them highly and matriculate into those residencies! As one of my old mentors used to say, "you can't polish a turd"....meaning if a person not well suited to be very good at radiology (see items #1-4) matriculates into "the #1 radiology residency", that person isn't going to be very good coming out.

You control #1-4 for yourself (maybe--intrinsic aptitude may not be something you can control). So when you look at residency programs, try to understand from a variety of their current residents whether it's a cultural fit for you (is it a high expectation place and that's where you thrive, or is it a "bust your ass" kind of place and that's where you thrive, or is it a nurturing place and that's where you thrive, or is it a trial by fire place and that's where you thrive, etc), do any of the residents actually have mentor(s), can they actually explain why they do what they do and why you rotate the way you do or is it just a matter of getting the work done (i.e, does every rotation have to have a resident?), are the residents actually getting instructed and is that instruction by subspecialists in their subspecialty (that is, do you get feedback on your overnight chest CT interps from Chest attendings, your overnight US interps from US attendings, your overnight MSK interps from MSK attendings), are the faculty known for good teaching, etc.

Of course, look at the rankings, but take them with a huge grain of salt. For the most part, I'd lump residencies into big categories--I don't really think there is a valid "rank" list.
 
Last edited:
  • Like
Reactions: 7 users
Very informative threat. I had a few questions. Please and thanks in advance. Question 1 and 2 can be considered together.

1) How many Diagnostic Radiology programs do you recommend applying to?

2) I have heard of applying to a certain number of different tiers of programs (ie Safety programs, reach programs, dream programs, etc.), but am not really sure how to gauge that without knowing very much about the "prestige" of radiology programs. Any input on trying to organize programs into "tiers" would be helpful. Any thoughts on the ranking of programs by Doximity, Auntminnie, and others?

3) What are some of the best questions you have been asked in an interview? Worst questions? Which questions are good to repeat to different interviewers?

4) At what point is an applicant pushing the limits in regards to trying to express ties to the state. ie my uncle lives in this state, my cousin lives here, my dad was born and grew up in this state, etc. Also, is the best place to express these ties in the personal statement?

Thanks!
 
  • Like
Reactions: 1 user
1) How many Diagnostic Radiology programs do you recommend applying to?

I don’t have a good answer for you, since I don’t have any experience advising medical students. For example, I don’t have a clue as to how many applications that applicants to my program have submitted. Seems that the answer would depend on the strength of your application, your geographic restrictions, the competitiveness of the programs to which you are applying, and the extent to which you are trying to get the absolute best fit for you (so you want to check out more programs than you perhaps “need” to, or you don’t just settle for the program that is a “safety” choice). Perhaps Radiology_Advisor can provide more concrete numbers based on experience.

2) I have heard of applying to a certain number of different tiers of programs (ie Safety programs, reach programs, dream programs, etc.), but am not really sure how to gauge that without knowing very much about the "prestige" of radiology programs. Any input on trying to organize programs into "tiers" would be helpful. Any thoughts on the ranking of programs by Doximity, Auntminnie, and others?

Great question, no real answers. I think the rankings I’ve seen on Doximity are probably the best we have as flawed as they are, but only on a regional basis. I don’t think it makes any sense to argue about whether UCSF or Stanford is better or worse than MGH or Hopkins is better or worse than Mallinckrodt or Michigan or Mayo. I also think there are some major caveats to the regional rankings. First, I don’t think that the actual “rank” is necessarily in the right order or even meaningful—a program ranked #1 may not actually be #1 but is probably up there--but you individually could thrive more at the #5 program or #10 program as compared to the #1 program. Furthermore, there is going to be the occasional program that is way off the mark in its rank.

3) What are some of the best questions you have been asked in an interview? Worst questions? Which questions are good to repeat to different interviewers?

I don’t see the interview as a “quality of the question” thing. The worst questions are those that are pandering or seem disingenuous to the applicant—like the applicant whose record seems more geared toward a community-based career but who is asking me about research grant funding. These interviews are expensive for you!—you need to figure out whether you want to spend 4 years at this place, and will this experience help you get to where you want to be professionally. Ask me anything you need to ask me to help you figure that out. I’m not ranking you on your ability to ask me a good question. Definitely don’t ask your interviewer what is the best question he/she has heard about his/her program :) By god, don’t repeat questions for the sake of repeating them, if you know the answer. The boredom on your face as I try to answer your fake question that you’ve already asked to others may come through.

4) At what point is an applicant pushing the limits in regards to trying to express ties to the state. ie my uncle lives in this state, my cousin lives here, my dad was born and grew up in this state, etc. Also, is the best place to express these ties in the personal statement?

If you honestly have a reason you want to be in the area, express that in the personal statement. For my program, it can help you get the interview if you are borderline (see prior post #9 and #60). But, in my program, keep in mind that this can work a little against you in the ranking process. Why is that? Well, if you absolutely must be in my geographical area, I know that your ability to help us recruit others in the future based on your career trajectory may be limited. I love it when my residents pursue fellowships at the best places in the country—it adds to my academic “street cred” when someone I trained goes to “finishing school” with one of my academic colleagues at another fine institution. If they then grab a job at the best private practice at that location or back in my geographical area or in some other region, great! If they alternatively go into academics at that place or another great institution, even better! This person’s career just became another “case example” for our residency to brag about to potential applicants. They also become an alumnus in a geographical area which we may not have as many alum as compared to our own area, which helps when I’m trying to place future residents into jobs. When applicants ask me “where do your residents go for fellowship and where do they end up”, I get to brag about these residents. On the other hand, when my residents “have to” stay in my geographic area, their options can be limited. Maybe they end up taking a job “beneath them” because they “have to” stay in my area and the best job isn’t in my area that year. Or they choose a fellowship they aren’t thrilled with because they “have to” stay in my area. I understand those choices and I help them get the best position they can, but it’s not going to help us recruit. Go back and look at post #41 . Our ultimate litmus test for ranking candidates is “How proud will we be of this trainee?” and one of the things to consider is whether we are proud of where they end up and whether their career trajectory will help us recruit future great applicants. It’s certainly not the main thing to consider, but it is one of the things.
 
Last edited:
  • Like
Reactions: 3 users
@CharlieBillings--I'll let others more fully answer your question, it's not really one in which I have any special insight, and probably not germane to this particular thread. In general, you aren't as "fast" coming out of training as after having experience. Your compensation model will vary based on the type of practice and the particular arrangement you have. There's a fair number of practices in which your compensation isn't explicity tied to your actual RVU output, since the duties of the practice partners is often more than just reading films, though there can be bonus arrangements that are often RVU based. There are also other employment arrangements (like teleradiology) in which you get paid based on what you read.
 
  • Like
Reactions: 1 user
Is there a preference for a type of reference letter (radiologist, IM, general surgery)? Bad to have all three be radiologists? Most programs I have asked seem to say no problem with three radiologists, but whether this is the truth...I don't know...
 
RadiologyPD: any specific words on how you or other IR or DR PDs view an applicant's membership in Gold Humanism Honor Society? I know you have mentioned all (or most) AOA students getting interviews, so with GHHS being the other uniquely-identified honor society on ERAS, I was curious as to your thoughts here. Thank you!!
 
Remember, AOA was just a way to get an interview at my place. It basically says your combined "book smarts" and "clinical rotation smarts" put you at the top of your class. We then use our interview process to establish whether your priorities/behaviors/goals/skills fit with what we want (I've gone over that exhaustively). So AOA just gets you in the door, but doesn't help after that.

Frankly, Gold Humanism hasn't been a differentiator for us in terms of getting you in the door. Since I'm less involved with our institution's medical school than our institution's graduate medical programs, it's really not on my radar. I looked into it based on your post. Looks like this may be different for internal medicine program directors and perhaps other primary care fields (J Surg Educ. 2009 Nov-Dec;66(6):308-13. doi: 10.1016/j.jsurg.2009.08.002.) The way we do the selection process, it probably won't factor in.

I think Sigma Sigma Phi could help me differentiate DO candidates, and perhaps I'll start using it more to distinguish between DO candidates--we haven't really in the past. Having said that, I've posted previously why DO candidates are at a relative disadvantage in our selection process, and we end up interviewing relatively few. I think the most competitive programs that are deluged by applicants are in the same boat.
 
  • Like
Reactions: 1 user
I know you mentioned in one of your earlier posts that you do look at the distribution of clinical grades and correct for it - especially with regards to Honors and High Pass. However, what about grades of "Pass"? Does grades of "pass" significantly hurt a candidate from a name brand/ top 10 school where 40% of grades are P?
 
Top