Radiology Faculty--Answering Questions/"AMA"

[ValleyRad2018]

This was for surgery, so I can't necessarily speak for the radiology match process.

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[SpartanWolverine]

I received the "ranked to match" emails mostly in January/February, but there was additional communication, even as early as a few hours after an interview, between October - February. I received letters in the mail as well.

I'm about halfway through my interviews at this point and have been surprised by a card and a letter from PDs so far. Can't say it has influenced my ranking at this point too much but it certainly impressed me.

 

[ValleyRad2018]

I'm about halfway through my interviews at this point and have been surprised by a card and a letter from PDs so far. Can't say it has influenced my ranking at this point too much but it certainly impressed me.

Yep. This was just my experience, but I remember being on the fence between two programs for the top spot. I received a "ranked to match" email from one of the programs about 1 week prior to the rank deadline, and that led me to rank that program first and ultimately match there.

Granted, many factors played into how I positioned the top 2, but I'd be lying if I said the email didn't influence my final decision. When you're splitting hairs, an email/letter can make the difference.

 

[rad2018]

No need to release the step 2 score unless required by any residency at which you interview. To be honest, once you make it to the interview stage, it’s doubtful that a slightly lower step 2 will even be looked at by the program. Of course, if you failed it or massively underperformed and the program is aware, it could hurt. At my program, we actually don’t go backward to get that data, but maybe that’s because we have penciled in and assumed a step 2 number if we didn’t have it when we made the selection for interview. It’s possible the programs that don’t make an assumption about your step 2 will actually go back and get it. However, I don’t think programs do it that way. I actually think that most programs have a mini ranking session immediately after the interview that roughly determines your general position and that any final meetings will only serve to tweak that slightly.

Thank you for the insight. I'm in a similar situation, wherein I scored 258 on Step1, but dropped a few points to 252 on Step 2 CK that I recently received last week. So far, I've been happy with the interview invites I've gotten. Although many of the schools I've applied to don't explicitly say they require Step2CK on their website, I was considering releasing the Step2CK score in January because some places I heard "prefer" having the score before their final rank list meetings.
Do you recommend I release the score right now (December) or wait until January? Would it make any difference?
In some of my interviews, I noticed that they had my Step1 score at the top of their profile sheets, so I was wondering if sending in a lower Step2 score would adversely me in anyway for my January interviews. Thank you.

 

[RadiologyPD]

252 Step 2 CK is a fine score--no worries that you dropped 6 points from Step 1. You could consider releasing the Step 2 CK score to show your Step 1 score was no fluke, but you don't have to unless a program requires it. If a program requires it, release whenever you want. I have no special advice to you. As I said, in our program, we don't have the time to go back and micromanage these board scores later--and it honestly wouldn't matter that your step 2 was 252 and not 258 or higher.

 

[2019medstudent]

Hi RadiologyPD,

I was wondering if you can offer insight in how you handle (adjust in your formula) clinical clerkship grades in schools that don't use the H/HP/P system. My school just uses numerical grades (0-100) without attaching H/HP/P to it, and in the Dean's letter, it comes with a histogram of how the entire class did. For example if someone got an 88 and it was in the top 25%, how did you adjust for this in your formula? My school is University of Miami if you have specific details for this school. Thanks!

 

[RadiologyPD]

University of Miami's system does require more work on my part.

I get the numerical grade from the transcript and try to figure out from the histogram whether the person's grade is in the top 20% (honors), next 30% (high pass), or bottom 50% (pass). I use the 20-30-50 rubric based on U of Miami's system of considering the top 22% as "superior", next 30% as "outstanding", next 23% "excellent" and bottom 25% "very good" (they give 1% of students the dreaded "good" descriptor).

 

[reslife56789]

Hello RadiologyPD. Question regarding the "letter of intent" (you are ranked #1 on my list, you are my top choice, etc,.). Three question regarding it.
1. When will be a good time to send this letter out?
2. Will the end of January be too late?
3. What is your take on sending a different letter to #2-5 programs to express interest? Thank you!

 

[Jfandango]

I received a post interview communication from a PD and I really loved the program, but I'm not finished interviewing yet and while I will rank them highly I'm not sure I'll rank them #1. Everyone cautions against saying you'll rank a program highly because it gets interpreted as saying you won't rank them #1. What should I say- just something ambiguous like "I loved your program?" Thank you.

 

[sudo]

What should I say- just something ambiguous like "I loved your program?" Thank you.

Emphasis on the question mark.

 

[RadiologyPD]

Keep in mind my personal feelings on this matter, namely
1. I really do not understand why any applicant would change their personal choice based on a communication from the program. Assuming you've made your choices based on reasons, if your "2nd choice" sends you a love letter and your "1st choice" doesn't, you really shouldn't change your order.
2. It doesn't matter to me (as the PD) whether our program is your first, 2nd, 3rd, 4th, or 5th good choice. I guess it would bother me if you really didn't like the program because then I suspect we aren't a great fit for you, and you won't be happy as a resident. The point is that us not being your first choice isn't going to kill me even if we really thought you'd do well in our program, so I'm not moving you down the rank list if you send me a "loved you (but not #1)" letter or don't send me a letter at all. Likewise, I'm not moving you up our rank list just because you've sent me a "#1 letter".

Having said that, it seems the current "standard of practice" is that many people send their #1 choices a "I've ranked you #1" letter. Also, I can't say that my principles apply to any other PD--maybe they do change their rank lists based on feedback--keep in mind, though, that I've not actually had any PD say that to me.

Therefore, my take:
1. If you are inclined to send a letter of interest, best timing would be not too long after the program stopped interviewing. Once a program stops interviewing, they are already finishing up their rank list. There is actually a disadvantage for the program to let a lot of time elapse after the last interviews are done, because selection committee members will start to forget how they felt about candidates.
2. If timing for #1 occurs well before your last interview, you probably want to send an LOI that doesn't specify #1 status..."I've not yet completed my interviews, but wanted to reach out to tell you I was incredibly impressed by...blah, blah, blah." Then follow that one up by an actual "You're my #1" to the ONE program that you want after you've completed your interviews..."I've now finished all interviews and want to follow up my last communication with a reaffirmation of my interest, and also to let you know that you're #1....".
3. Otherwise, if you are inclined ONLY to send a letter to your "#1 program", wait until all your interviews are over.
4. Be careful about sending a #1 letter and then changing your mind. And don't send one if you don't mean it. I still remember the names of individuals that sent me a "you're my #1 letter" who actually would have matched with us who went elsewhere. While we always keep lists of where our applicants ended up, I can't help but make special mental note of those people--and so do my selection committee members, because we have a debrief meeting after Match Day...not because we are vindictive, but just because you tend to remember those things. I suspect I will remember these people for many many years, and basically consider them untrustworthy and dishonest.
5. If you send a LOI and it doesn't say "you're my #1", then we know we aren't. You might as well have not sent one, because then I can't be SURE we aren't your #1 (i.e., you might be someone who doesn't send LOI). In my case, given the way I feel about these things, that doesn't matter. Can't say this is true or not for anyone else.

 

[rad2018]

What's your take on mentors/chairs/advisors at your home institution "making a call" on your behalf after interviews? Do you view these favorably, and if so, is the ideal timing around when rank lists are being finalized? Most of my mentors already wrote LORs for me, so I'm not sure what's the etiquette or if having them try to make a call to my #1 would be redundant or unnecessary. Do you view these calls similar to applicants' "you're my #1" love letters? Thank you.

 

[RadiologyPD]

Actually getting a call from a mentor/letter writer to vouch for a candidate is rare and not the same as a "#1 letter".

I've received a few of these in my past for resident applicants (way less than 1% of candidates, perhaps 0.1%). There are 2 flavors:
1. Person reaches out to me and we know each other (even in a limited way, even if it is a mutual friend/colleague). In every instance that this occurred, the candidate had some "flaw" (usually low board scores, sometimes something else that would cause us to question the candidate's fit to our program). The caller wants to tell me how fantastic the person is despite the flaw--they are advising me to "look beyond the flaw". Yes, it definitely helps that person's chances. It has to be done BEFORE the ranking session, preferably even before the interview session, because I don't get to make these rank lists on my own. I have to take that information and "sell it" to my colleagues since we collectively rank candidates. The best time to sell this is immediately after the interview day, when we sit down and collectively score the candidates we just interviewed.

Keep in mind that the few times this has happened, I always wonder why the person who is calling isn't just grabbing the candidate for their own program. Why tell me about an undervalued asset that will make your program shine? Unless, of course, there is an obvious reason the person wants/needs to be at my program.

2. Person reaches out to me and is a total unknown--sometimes not even a radiologist--and is also a letter writer. Marginal impact, to be honest. I'm impressed that someone took the time to go the extra mile for the candidate but since I have no relationship whatsoever, it doesn't add much to the letter. Here, the prestige of the caller can make a difference. If you have a junior faculty member in Internal Medicine calling me, probably not much help. If you have the president of some national radiology society calling me, it helps. Again, this communication generally has to occur before or very soon after the interview itself.

If you don't have a fantastic relationship with your mentor/letter writer, I wouldn't ask them to call--if they offer it's one thing, but I can't imagine you actually asking someone to go that extra mile for you.

Fellowship applicants are a totally different ballgame--yes, have them call. It can be the biggest factor in selection.

 

[Ronego]

You are implying that your program( and probably every other program) keep records of people that lied to them on their love letters is nothing short of a sad comedy.
I assume you keep these records in a safe place and share it with other PDs during RSNA LOL! to get back at those untrustworthy applicants.
If somebody sends you a letter of interest saying I am going to rank you first means if they match at your program they will be extremely happy, nobody is trying to deceive you or take advantage of your trust.
I know you want applicants to be truthful, but they have invested a lot and stakes are high so it is only reasonable to send these sort of letters if they will be happy at your program if they match.

 

[qxrt]

You are implying that your program( and probably every other program) keep records of people that lied to them on their love letters is nothing short of a sad comedy.
I assume you keep these records in a safe place and share it with other PDs during RSNA LOL! to get back at those untrustworthy applicants.
I know you want applicants to be truthful, but they have invested a lot and stakes are high so it is only reasonable to send these sort of letters if they will be happy at your program if they match.

Come on, now. That is not what he said. He keeps records on where all of his applicants ended up (not that unusual for residencies). All he said is that he tends to remember those that lied, not that he keeps a specific list of them. And it would be natural for any of us to remember those who outright lied to us like that, nothing that says anything about his group other than that they are subject to human whims just like any of us.

I know you want applicants to be truthful, but they have invested a lot and stakes are high so it is only reasonable to send these sort of letters if they will be happy at your program if they match.

You, on the other hand, seem to be implying that it's okay for an applicant to send a "you are my #1" to a program that he/she doesn't intend to rank #1, because it's okay "if they will be happy at your program if they match." I don't think many people would agree with you there.

 

[RadiologyPD]

You are implying that your program( and probably every other program) keep records of people that lied to them on their love letters is nothing short of a sad comedy.

To put it into perspective, it really doesn't happen very often that a candidate tells me "I'm ranking you #1" and then we go past their position in the Match and they didn't match with us...maybe 3 times in the past 5 years. I'm able to remember these people BECAUSE it's infrequent.

If somebody sends you a letter of interest saying I am going to rank you first means if they match at your program they will be extremely happy, nobody is trying to deceive you or take advantage of your trust.

I really enjoy meeting most of the candidates I interview and I do recognize them occasionally years later at national meetings, especially the ones that impressed me. I'll go up and say hi and ask them how it's going, if it seems appropriate to do so. I just don't think it serves you well to outright lie in a love letter--it just spoils your reputation. If you mean to say "if I match at your program, I'd be delighted", then say that--it conveys your enthusiasm adequately. If you mean to say "I'm ranking you #1", fine to say that. If you think that saying "I'm ranking you #1" only means "I'd be delighted to match at your program", you have a problem communicating effectively.

 

[Ronego]

I just don't think it serves you well to outright lie in a love letter--it just spoils your reputation. If you mean to say "if I match at your program, I'd be delighted", then say that--it conveys your enthusiasm adequately. If you mean to say "I'm ranking you #1", fine to say that. If you think that saying "I'm ranking you #1" only means "I'd be delighted to match at your program", you have a problem communicating effectively.

Let me put that into a better context. Most of the time there is no clear cut difference between the top 3 programs that are being ranked and in some cases people change their mind after they send you that "I will rank you 1st email", I guess you don't expect them to send you an email explaining you are no longer their favorite program. On the other hand some PDs of low tier program hate not to be considered as the top choice for an applicant (and I can't blame an applicant who wants to be ranked by the low tier programs just to be safe) and indirectly ask for love letters during the interview(for an instance the PD asked me to send an email before NRMP ROL deadline after the interview if I was still interested in their program . All in all I would rather believe in shades of grey than absolute black and white.

 

[Rads4lyfe]

Let me put that into a better context. Most of the time there is no clear cut difference between the top 3 programs that are being ranked and in some cases people change their mind after they send you that "I will rank you 1st email", I guess you don't expect them to send you an email explaining you are no longer their favorite program. On the other hand some PDs of low tier program hate not to be considered as the top choice for an applicant (and I can't blame an applicant who wants to be ranked by the low tier programs just to be safe) and indirectly ask for love letters during the interview(for an instance the PD asked me to send an email before NRMP ROL deadline after the interview if I was still interested in their program . All in all I would rather believe in shades of grey than absolute black and white.

Arguing that it's okay to lie to programs for your own benefit("to be safe")...seems like a slippery slope.

Sure, you may change your mind about your top program in the last minute, and I'm not really sure what the best approach is at that point; I'd argue it's better to be honest. But blatantly telling a backup program they are your number 1...seems unethical no matter how you argue it. No one wants to work with a liar.

You also said this earlier "If somebody sends you a letter of interest saying I am going to rank you first means if they match at your program they will be extremely happy, nobody is trying to deceive you or take advantage of your trust". I'm pretty sure most people would interpret ranking a program number 1 means you are in fact ranking it number 1. No it does not mean you will be happy matching there...it means you are ranking it number 1. You may be "extremely happy" at that program, but that isn't what you are saying.

Imagine if it was the other way around. How would you feel if your dream program told you they were ranking you to match, and you don't match there. I would feel cheated and lied to.

 

[RadiologyPD]

I briefly looked at that document but quite honestly I'm having a hard time looking through it all, with archived chats and comments everywhere. How would you know if you've seen all the comments on the program you are looking for (I guess you could do a search in the document, I didn't)?

There seems to be some interesting impressions in that document and a lot of junk, including a fair bit of misogynistic stuff which is unfortunate.

Speaking of which, I'm not sure why you think I'm a guy?

 

[nickelbackfan]

RadiologyPD, thank you again for taking the time to answer these questions. As someone who is applying next year, I am curious what "Ranked to Match" emails technically mean. Is it fair to assume that if a program release them and you DONT get one that you will most likely NOT match, however if you DO receive one you still MAY NOT match even if you rank them 1? Also does there have to be particular language in order for it to qualify as a RTM letter? Thanks!

 

[RadiologyPD]

If you don't get an RTM communication, that doesn't mean you aren't going to match at that program.

Remember, neither my current program nor the program I previously was involved with (at least when I was there) sent these RTM letters. So I don't actually know how it works (everywhere, or anywhere for that matter). What follows is what I had thought some programs did, and what I suppose some programs could do.

If programs send a "Rank to Match", my presumption has been that the program is saying you are in the top x number of slots and we have x slots, with x being the same number. In this scenario, probably most of the people who end up matching at the program didn't get an RTM communication (unless the program is just absolutely in demand, which begs the question as to why they even needed to send an RTM communication in the first place).

I suppose (but do not know) that a program could take the approach that we will send RTM communications to as many candidates that we are absolutely certain would match at our program if they ranked us #1, based on a conservative view of historical patterns. So if a program has 5 spots and had never filled their quota of 5 spots before the 25th rank (5 ranks/spot), I suppose a program might decide to send RTM communications to the top 10-12 candidates, thinking that this was being pretty conservative--or maybe even 15-18 candidates. I guess you could get pretty quantitative about it and determine your mean and standard deviation for how many ranks it historically took you to fill all your spots, and then send RTM communications to that number of candidates that are below the "mean- 3 SD" rank, and you'd be 99.7% sure of getting it right (assuming a normal distribution)--but I doubt anyone is being that analytical. Even so, there's always the 1 in a million event (that seems to happen every decade) which would make me leery of doing this if I were inclined to send RTM communications.

I think PDs would be pretty leery of having a written document out there that says "we are ranking you to match" and then the person who got the document didn't match. Digitize that letter and with social media, that could easily make trouble for the PD and program (if not litigation, then at least reputation damage).

To all those people getting RTM communications, be sure they actually say "RTM" and not some slicked up version of "we'd be delighted to have you".

 

[questionsmaster]

Hi Radiology PD,

A week ago, I sent an update e-mail to programs informing them that I had an abstract/poster accepted. This week, I had another publication accepted. Would updating them again so soon be too excessive/annoying? At this point, does it even matter to programs or affect rank list? I already have a research-heavy application (15 publications), so I am leaning toward not updating them. Thanks for your help!

 

[speedyxx626]

Hi Radiology PD,

A week ago, I sent an update e-mail to programs informing them that I had an abstract/poster accepted. This week, I had another publication accepted. Would updating them again so soon be too excessive/annoying? At this point, does it even matter to programs or affect rank list? I already have a research-heavy application (15 publications), so I am leaning toward not updating them. Thanks for your help!

Just an applicant here...but I HIGHLY doubt that extra pub is going to make any difference. I think that sending another email could just make you come across as annoying and it might hurt you more than help you

 

[RadiologyPD]

Agree with speedyxx626 on this one. If you've already got enough evidence of academic work, yet another one isn't going to make any difference and if you already sent "an update", another update might make you seem annoying.

 

[sired]

Hi @RadiologyPD ,

I can't express how helpful your answers have been, thank you so much.
Here are some of my questions:

1. What would you think of a candidate who is reapplying this year after not having matched last year? Would this be a red flag for you?
2. Some programs state clearly on their website that they don't accept IMGs. Since your program has almost never hired IMGs, why don't you do the same?

 

[RadiologyPD]

1. What would you think of a candidate who is reapplying this year after not having matched last year? Would this be a red flag for you?
2. Some programs state clearly on their website that they don't accept IMGs. Since your program has almost never hired IMGs, why don't you do the same?

It is not a red flag for me if someone didn't match last year--we have interviewed a number of candidates who didn't match into Orthopedics or Neurosurgery in the cycle before. As for not matching into Radiology, again, no red flag but unlikely to match into our program, because we have a plethora of candidates (academic program in the Western US is probably the most competitive category).

Regarding #2, we have interviewed some IMGs and ranked some highly. See post #28 and #29--one year, we ranked an IMG #1,

 

[yankees26]

out of curiousity, how far down a rank list do programs generally go to fill say 6 spots?? I know this would be very highly dependent on program but say how far would a top 20 program generally go down?

 

[RadiologyPD]

It's definitely changed over the years as the number of applicants have gone up due to over-interviewing by candidates (even the top candidates). It used to be that the most competitive candidates would apply to maybe 10 programs at most, but now even those competitive applicants are applying to many more, so that they end up interviewing at programs which don't have a chance of getting the student because the student is geographically/emotionally/personally committed to going somewhere else and has the stats to get there.

My understanding is that the median radiology program fills at about 7-8 ranks/position. The elite programs (top 5) probably can hit 3-4 ranks/position, especially if geographically desirable. For the "top 20" programs outside those elite 5, the average fill rate is probably about 5-6 ranks/position--so for your "top 20 but not manifestly top 5" program of 6 spots, the program probably fills in the 30-35 range.

Of course, it naturally depends on how the program ranks. If they rank known students higher (based on rotations) or "uprank" candidates based on receiving a "you're #1" letter, then they may have phenomenally lower rank/position stats.

 

[Muncus]

Trying to be as honest as possible. Here are the problems for our program with respect to most DO applicants and certainly all IMG applicants:
1. The perception (again, perception) that we struggled to fill the program if a number of our residents are DO/IMG. Without trying to give away too much, I'm not at Mallinckrodt--my program isn't one of those 15+ residents/year beasts that can have an IMG or DO and everyone decides "dang, that person must be awesome"--instead, for us, because we have a smaller program, the impression will be, "why couldn't they fill with AMGs". Realize that this is not just a perception among applicants--I'd have explain to all my faculty (none of whom are DOs) that we really wanted this DO--they are going to think we had a bad Match.

Hi @RadiologyPD !

I'd love to hear your general thoughts on the Schulze Ranklist (on the spreadsheet) that has been compiled by an applicant where the most desirable/competitive programs are ranked in order. More specifically, I am also interested in hearing if you believe the "perception" you were referring to earlier (quoted), actually exists for programs based on this list, or if it is just presumed? An extension to that question is, even if the perception exists, do you think it significantly impacts the competitiveness of a program?

As an IMG applicant in this cycle, the spreadsheet contained a lot of information, some of it useful and some of it less so. There were some toxic rumors that were spread about a number of different programs with unclear underlying motives. I've seen programs being called undesirable even if it's a well-known program, just because it has 1-2 IMGs. I do not want to get a discussion started on what IMGs deserve and what they don't. The fact is, as I think you pointed out at some point, it's an uphill battle for IMGs and I'm not saying this is right or wrong. My only point is that I know far too many programs on similar "tiers", whether it be on a competitiveness or prestige level, that have way too different standards for admission of IMGs. I know that it is an unpredictable process even for American graduates, but I have met extremely talented IMG applicants who interview at a top place like MIR (which the ranklist shows is highly competitive among AMGs), but are straight out rejected at other places of almost as high tier (will not say names). I think in the latter, the role of perception plays a huge role, so do you think PDs will look at this Schulze ranklist and feel reassured that the IMG perception is presumed more than factual? And again, even if it is factual, I think most applicants who are contending at that level can distinguish competitiveness from prestige/strength of a program as you can clearly see on many of the individual ranklists on the spreadsheet.

I am mostly referring to top- and midtier programs as even I think that a low-tier program in an undesirable location that has a lot IMGs most likely had a problem filling with AMGs.

 

[qxrt]

I just looked up the Schulze method. It apparently assumes that all "unranked" programs are by default lower than "ranked" programs in any given list. That seems like a fundamental flaw when applied to the spreadsheet, where someone may rank BID top and not BWH/MGH because they didn't interview there, but the algorithm automatically assumes that the rank list placed BID over BWH/MGH. It sounds like a flaw that would break any meaning that such a composed list would have, as it assumes that all candidates have access to the same pool of programs (when in reality, each candidate only has access to whatever programs sent him/her an interview).

 

[Rads4lyfe]

I just looked up the Schulze method. It apparently assumes that all "unranked" programs are by default lower than "ranked" programs in any given list. That seems like a fundamental flaw when applied to the spreadsheet, where someone may rank BID top and not BWH/MGH because they didn't interview there, but the algorithm automatically assumes that the rank list placed BID over BWH/MGH. It sounds like a flaw that would break any meaning that such a composed list would have, as it assumes that all candidates have access to the same pool of programs (when in reality, each candidate only has access to whatever programs sent him/her an interview).

I'm sure there is some way this is factored in, though I haven't really read into the statistics of the Schulze method. Somehow it looks like on the Schulze method ranklist on the spreadsheet, programs at the top are kind of what I would have expected for the most part.

 

[RadiologyPD]

I'd love to hear your general thoughts on the Schulze Ranklist (on the spreadsheet) that has been compiled by an applicant where the most desirable/competitive programs are ranked in order. More specifically, I am also interested in hearing if you believe the "perception" you were referring to earlier (quoted), actually exists for programs based on this list, or if it is just presumed? An extension to that question is, even if the perception exists, do you think it significantly impacts the competitiveness of a program?

I found the spreadsheet you reference and looked at it. I don't really understand your question and its relationship to the spreadsheet listing of rank choices and the subsequent "ranking" of programs using the Schulze method.

In my quick review, I only found 2 of the people posting their rank lists who indicate that they are IMGs. The places those 2 people interviewed at are fine but not universally considered "top":
CT - Hartford - Hartford Hospital Program - DR (both applicants)
IA - Iowa City - University of Iowa Hospitals and Clinics Program - DR
MA - Boston - Tufts Medical Center Program - DR (both applicants)
MA - Burlington - Lahey Clinic Program - DR
MA - Springfield - UMMS-Baystate Program - DR (both applicants)
MA - Worcester - St Vincent Hospital Program - DR
MA - Worcester - University of Massachusetts Program - DR
NJ - Newark - Rutgers New Jersey Medical School Program - DR
NY - Syracuse - SUNY Upstate Medical University Program - DR (both applicants)
OH - Cleveland - Case Western/University Hospitals Cleveland Medical Center Program - DR
OH - Cleveland - Cleveland Clinic Foundation Program - DR
PA - Philadelphia - Albert Einstein Medical Center Program - IR/DR
PA - Philadelphia - Drexel University College of Medicine/Hahnemann University Hospital Program - DR
TX - Houston - Baylor College of Medicine Program - DR
VT - Burlington - University of Vermont Medical Center Program - DR

I really don't feel like rehashing this issue, see my prior posts. Briefly, as I mentioned earlier, there are 2 main issues when it comes to inviting IMGs to interview:
1. It's hard to evaluate the candidates on paper if you are a program that relatively underweights board scores as a selection criterion (like we've decided to do at my program). Remember, I rely on % honors in core clerkships and relative difficulty of getting honors at that medical school as a metric, and that is practically impossible to determine for IMGs. When you have an abundance of other competitive candidates who are easier to "score", it's easy just to select those candidates for interviews.
2. There is a perception that your program had difficulty recruiting great AMG candidates if you consistently have IMG candidates. This is not a problem for the "big dogs" (like Mallinckrodt or MGH), because the assumption when you see an IMG in one of those residency programs is that the IMG worked there as a research person and was extremely well liked and vetted by the time the person joined the residency. So the fact that Mallinckrodt or MGH have an occasional IMG speaks only to the likelihood that the person spent a year or two doing research there and is incredibly good.

Like I said, one year we ranked an IMG top of our list. The person ended up at MGH, where the person had done research.

As for thoughts on this ranking of programs using the Schulze method, it seems to me the methodology is sound for establishing the relative ranking of programs for the cohort of people who entered data. Keep in mind that since the cohort who entered data have a variety of different personal considerations (geography, IR vs. DR interests, significant other preferences, etc.), the ranking does not really speak to "quality of program". If you as a candidate generally share the same personal considerations as the cohort, then I guess the rankings are legit for you, but they are skewed toward the interests of the cohort that entered data. For example, if there were more people entering data in this spreadsheet from California, and those people wanted to stay in California, then an average program in California is going to rank higher than the most outstanding program in the midwest. Not taking anything away from UC Irvine, I would say this is in play for how UC Irvine is #20 and Mayo Rochester is #35. I'm not buying that UC Irvine is a better program than Mayo Rochester.

What would be far more interesting and useful for future candidates (and not really possible with the small data set) is to have "cohort pools" so that candidates (and even programs themselves) might see how programs stack up for certain pools. Are you a candidate primarily interested in California schools? Ok, look at the list generated by the Schulze method on rank lists for the cohort of candidates (preferably over a few years) who were primarily interested in California schools, and see how the programs got ranked, to determine the "market valuation". Are you a candidate primarily interested in small-to-medium sized programs with ESIR potential? Ok, look at the Schulze-generated list for the cohort with similar interests.

When you mish-mash everyone's personal interests into a big pile, then I guess you can argue these idiosyncratic preferences cancel out--but you need a lot more data than the 100 rank lists that seem to have been used to create this spreadsheet. And all you are really getting is the perception of medical students about the relative desirability of programs. What you really want is the relative ranking of programs based on actual quality of training, not medical student perception of quality of training.

It would be great if NRMP ran the Schulze method on the ranklists and gave the information out to candidates and to PDs. Then it would be each program's job to make their program better or market their program better--it would be a race to the top.

 

[Rads4lyfe]

I found the spreadsheet you reference and looked at it. I don't really understand your question and its relationship to the spreadsheet listing of rank choices and the subsequent "ranking" of programs using the Schulze method.

In my quick review, I only found 2 of the people posting their rank lists who indicate that they are IMGs. The places those 2 people interviewed at are fine but not universally considered "top":
CT - Hartford - Hartford Hospital Program - DR (both applicants)
IA - Iowa City - University of Iowa Hospitals and Clinics Program - DR
MA - Boston - Tufts Medical Center Program - DR (both applicants)
MA - Burlington - Lahey Clinic Program - DR
MA - Springfield - UMMS-Baystate Program - DR (both applicants)
MA - Worcester - St Vincent Hospital Program - DR
MA - Worcester - University of Massachusetts Program - DR
NJ - Newark - Rutgers New Jersey Medical School Program - DR
NY - Syracuse - SUNY Upstate Medical University Program - DR (both applicants)
OH - Cleveland - Case Western/University Hospitals Cleveland Medical Center Program - DR
OH - Cleveland - Cleveland Clinic Foundation Program - DR
PA - Philadelphia - Albert Einstein Medical Center Program - IR/DR
PA - Philadelphia - Drexel University College of Medicine/Hahnemann University Hospital Program - DR
TX - Houston - Baylor College of Medicine Program - DR
VT - Burlington - University of Vermont Medical Center Program - DR

I really don't feel like rehashing this issue, see my prior posts. Briefly, as I mentioned earlier, there are 2 main issues when it comes to inviting IMGs to interview:
1. It's hard to evaluate the candidates on paper if you are a program that relatively underweights board scores as a selection criterion (like we've decided to do at my program). Remember, I rely on % honors in core clerkships and relative difficulty of getting honors at that medical school as a metric, and that is practically impossible to determine for IMGs. When you have an abundance of other competitive candidates who are easier to "score", it's easy just to select those candidates for interviews.
2. There is a perception that your program had difficulty recruiting great AMG candidates if you consistently have IMG candidates. This is not a problem for the "big dogs" (like Mallinckrodt or MGH), because the assumption when you see an IMG in one of those residency programs is that the IMG worked there as a research person and was extremely well liked and vetted by the time the person joined the residency. So the fact that Mallinckrodt or MGH have an occasional IMG speaks only to the likelihood that the person spent a year or two doing research there and is incredibly good.

Like I said, one year we ranked an IMG top of our list. The person ended up at MGH, where the person had done research.

As for thoughts on this ranking of programs using the Schulze method, it seems to me the methodology is sound for establishing the relative ranking of programs for the cohort of people who entered data. Keep in mind that since the cohort who entered data have a variety of different personal considerations (geography, IR vs. DR interests, significant other preferences, etc.), the ranking does not really speak to "quality of program". If you as a candidate generally share the same personal considerations as the cohort, then I guess the rankings are legit for you, but they are skewed toward the interests of the cohort that entered data. For example, if there were more people entering data in this spreadsheet from California, and those people wanted to stay in California, then an average program in California is going to rank higher than the most outstanding program in the midwest. Not taking anything away from UC Irvine, I would say this is in play for how UC Irvine is #20 and Mayo Rochester is #35. I'm not buying that UC Irvine is a better program than Mayo Rochester.

What would be far more interesting and useful for future candidates (and not really possible with the small data set) is to have "cohort pools" so that candidates (and even programs themselves) might see how programs stack up for certain pools. Are you a candidate primarily interested in California schools? Ok, look at the list generated by the Schulze method on rank lists for the cohort of candidates (preferably over a few years) who were primarily interested in California schools, and see how the programs got ranked, to determine the "market valuation". Are you a candidate primarily interested in small-to-medium sized programs with ESIR potential? Ok, look at the Schulze-generated list for the cohort with similar interests.

When you mish-mash everyone's personal interests into a big pile, then I guess you can argue these idiosyncratic preferences cancel out--but you need a lot more data than the 100 rank lists that seem to have been used to create this spreadsheet. And all you are really getting is the perception of medical students about the relative desirability of programs. What you really want is the relative ranking of programs based on actual quality of training, not medical student perception of quality of training.

It would be great if NRMP ran the Schulze method on the ranklists and gave the information out to candidates and to PDs. Then it would be each program's job to make their program better or market their program better--it would be a race to the top.

It would be pretty difficult to rank programs based on actual quality of training. I'm not sure what metrics could be used. The closest we have to that so far is doximity I suppose, which ranks based on faculty perception of program quality.

I do think the schulze rank list is a new and interesting way to look at programs, even though the sample size is small. It's basically ranking based on desirability/difficulty to match which is very useful for medical students. I also agree that it would be cool to see a schulze list that is more standardized through NRMP also.

 

[RadiologyPD]

I agree that that there probably aren't a lot of differences between program quality within "tiers" (see post #139). Which is why I think these program "rankings" are suspect in the first place. Look, what's the biggest difference between the so called "#1" program and the so called "#50" program?...the recruiting class, that's what. Your "radiology ability" at the end of 4 years of residency is mostly influenced by YOU, your work ethic, your study habits, your emotional IQ, YOU (again, see post #139). At the end of 4 years, if you took the residents who went to #1 program and instead made them train at the #50 program, they would be better than the residents who were supposed to go to the #50 program who ended up training at the #1 program. If you took the recruiting class at the University of Kentucky basketball team and had them play together at Wichita State--well, all of a sudden, you've got a national championship at Wichita State.

Forget about Schulze rankings and conventional wisdom--kick the tires, consider the factors that are important to you, and make your decision on where you want to be, rankings be damned.

 

[Subsegmental]

EDIT:I figured being an AMA this would be okay to post, since I figure as a PD you probably don't take the time to look at other threads.

Hi RadiologyPD, I've always appreciated your posts and I was wondering if I could get some feedback on what to do at this point.

Recently found out my step 1 score and obviously very disappointed. Not where I hoped or thought I'd be. Still set on DR (I feel IR is now out the window) and wondering what I should do.

My interests have wavered between IR & DR for years, with Pediatric Radiology being something that has become more interesting, and thus tilting me towards DR.

3rd year med student
US MD
Step 1 204
Step 2 Pending
Clerkships 4P, two pending, but with clinical honors and good evaluations in most, honored the shelf on the only one I didn't get clinical honors.
ECs:
Worked throughout med school. I've held lots of leadership positions in med school committees and volunteering. Involvement in SIR (RFS/MSC with leadership positions).
Research: several experiences and publications in IR-adjacent fields and a few case reports.

Overall I plan to apply SUPER broadly and hopefully stand out on aways, but I'm also unsure about the 'IR applicant bias' at DR interviews that I've seen people on here post about, and I wonder if I should even apply IR at this point any way, but also if my application being so IR focused is going to be detrimental to my chances in DR.

Thanks again for this valuable resource.

 

[Cognovi]

I just looked up the Schulze method. It apparently assumes that all "unranked" programs are by default lower than "ranked" programs in any given list. That seems like a fundamental flaw when applied to the spreadsheet, where someone may rank BID top and not BWH/MGH because they didn't interview there, but the algorithm automatically assumes that the rank list placed BID over BWH/MGH. It sounds like a flaw that would break any meaning that such a composed list would have, as it assumes that all candidates have access to the same pool of programs (when in reality, each candidate only has access to whatever programs sent him/her an interview).

Sounds like any legit voting method using rank list data needs to meet the so-called non-compulsory support criterion, wherein a voter who does not vote for (rank) a certain program will neither help nor hurt that program in the ultimate rankings.

 

[RadiologyPD]

3rd year med student
US MD
Step 1 204
Step 2 Pending
Clerkships 4P, two pending, but with clinical honors and good evaluations in most, honored the shelf on the only one I didn't get clinical honors.
ECs:
Worked throughout med school. I've held lots of leadership positions in med school committees and volunteering. Involvement in SIR (RFS/MSC with leadership positions).
Research: several experiences and publications in IR-adjacent fields and a few case reports.

I don't want this to turn into a "chance me" thread, so I'll try to be as broad as possible in my response.

Each program emphasizes board scores to different degrees, but all programs are concerned about students who "test poorly" because radiology boards is now a computerized test and radiology is a field in which broad knowledge is important. My guess is that a combined step 1 + step 2 score for most IR applicants is going to be over 480, and if below 450, you are likely knocked out of consideration for IR programs right now unless you have some other fantastic hook -- if IR is your interest, you're looking at doing an independent IR residency after DR (either with or without ESIR). For DR programs, much will depend on your step 2 score and any other hooks you can develop.

You are going to have to get beyond the USMLE score filter. Your best bet is usually securing a spot in the DR program at your medical school by getting a hook with the department. Aways are another method to get past the filter, but you are going to need the personality to shine in an away--probably has no bearing on how good you will be as a radiologist, but it's best if you have that magnetic personality that is the perfect combination of respectful, jovial, gets along with other residents/students, fun to be around, etc., etc. Sometimes you can come off as a bull****ter if you try to fake this perfect personality.

Unfortunately, most PDs don't have the bandwidth to look into your clinical clerkship performance to see that you got "clinical honors"--in fact, when you tell me you got "clinical honors" but only passed your clerkships, what it tells me as a PD is that you aren't great at taking tests. Again, don't take this the wrong way, but PDs don't want their residents to be ones that have a problem taking tests, since if you fail the radiology boards, its a problem for the program.

So, you need a hook to get into the better mid-level programs now that your step 1 is well below the knock-out filter of most mid-level DR programs. The most important thing you can do is spend every last bit of effort you can muster to blow away Step 2, and then concoct some reasonable reason why you didn't do well in Step 1 which you will relate in a personable, real way during interviews. Then, create a really brief email that you'll send to targeted programs that ask them to consider your "overall" step performance in light of the fact that you did so well on Step 2 before they make a decision about your application. Another possible hook is to latch onto a radiology mentor who has some clout, impress the s**t out of them doing research or even a research year, or in some other way impress that person, and then the radiology mentor can help open some doors for you. In general, ECs aren't much of a hook--leadership in medical student organizations checks a box but don't think this gives you a great hook, UNLESS in the process of doing the EC, you can score a hell of a letter of recommendation from a faculty mentor.

If you don't get 225 or higher on Step 2, it's going to be hard to get into a DR program I think. Maybe impossible. You'll have to consider programs with some blemishes, and then work your butt off to become the best radiologist you can be. Good luck.

 

[alchemist123]

I don't want this to turn into a "chance me" thread, so I'll try to be as broad as possible in my response.

Each program emphasizes board scores to different degrees, but all programs are concerned about students who "test poorly" because radiology boards is now a computerized test and radiology is a field in which broad knowledge is important. My guess is that a combined step 1 + step 2 score for most IR applicants is going to be over 480, and if below 450, you are likely knocked out of consideration for IR programs right now unless you have some other fantastic hook -- if IR is your interest, you're looking at doing an independent IR residency after DR (either with or without ESIR). For DR programs, much will depend on your step 2 score and any other hooks you can develop.

You are going to have to get beyond the USMLE score filter. Your best bet is usually securing a spot in the DR program at your medical school by getting a hook with the department. Aways are another method to get past the filter, but you are going to need the personality to shine in an away--probably has no bearing on how good you will be as a radiologist, but it's best if you have that magnetic personality that is the perfect combination of respectful, jovial, gets along with other residents/students, fun to be around, etc., etc. Sometimes you can come off as a bull****ter if you try to fake this perfect personality.

Unfortunately, most PDs don't have the bandwidth to look into your clinical clerkship performance to see that you got "clinical honors"--in fact, when you tell me you got "clinical honors" but only passed your clerkships, what it tells me as a PD is that you aren't great at taking tests. Again, don't take this the wrong way, but PDs don't want their residents to be ones that have a problem taking tests, since if you fail the radiology boards, its a problem for the program.

So, you need a hook to get into the better mid-level programs now that your step 1 is well beyond the knock-out filter of most mid-level DR programs. The most important thing you can do is spend every last bit of effort you can muster to blow away Step 2, and then concoct some reasonable reason why you didn't do well in Step 1 which you will relate in a personable, real way during interviews. Then, create a really brief email that you'll send to targeted programs that ask them to consider your "overall" step performance in light of the fact that you did so well on Step 2 before they make a decision about your application. Another possible hook is to latch onto a radiology mentor who has some clout, impress the s**t out of them doing research or even a research year, or in some other way impress that person, and then the radiology mentor can help open some doors for you. In general, ECs aren't much of a hook--leadership in medical student organizations checks a box but don't think this gives you a great hook, UNLESS in the process of doing the EC, you can score a hell of a letter of recommendation from a faculty mentor.

If you don't get 225 or higher on Step 2, it's going to be hard to get into a DR program I think. Not impossible, but hard. You'll have to consider programs with some blemishes, and then work your butt off to become the best radiologist you can be. Good luck.

Thanks for the general response! In general, what is the "cutoff" step 1 score for most DR programs?

 

[Subsegmental]

I don't want this to turn into a "chance me" thread, so I'll try to be as broad as possible in my response.

Each program emphasizes board scores to different degrees, but all programs are concerned about students who "test poorly" because radiology boards is now a computerized test and radiology is a field in which broad knowledge is important. My guess is that a combined step 1 + step 2 score for most IR applicants is going to be over 480, and if below 450, you are likely knocked out of consideration for IR programs right now unless you have some other fantastic hook -- if IR is your interest, you're looking at doing an independent IR residency after DR (either with or without ESIR). For DR programs, much will depend on your step 2 score and any other hooks you can develop.

You are going to have to get beyond the USMLE score filter. Your best bet is usually securing a spot in the DR program at your medical school by getting a hook with the department. Aways are another method to get past the filter, but you are going to need the personality to shine in an away--probably has no bearing on how good you will be as a radiologist, but it's best if you have that magnetic personality that is the perfect combination of respectful, jovial, gets along with other residents/students, fun to be around, etc., etc. Sometimes you can come off as a bull****ter if you try to fake this perfect personality.

Unfortunately, most PDs don't have the bandwidth to look into your clinical clerkship performance to see that you got "clinical honors"--in fact, when you tell me you got "clinical honors" but only passed your clerkships, what it tells me as a PD is that you aren't great at taking tests. Again, don't take this the wrong way, but PDs don't want their residents to be ones that have a problem taking tests, since if you fail the radiology boards, its a problem for the program.

So, you need a hook to get into the better mid-level programs now that your step 1 is well beyond the knock-out filter of most mid-level DR programs. The most important thing you can do is spend every last bit of effort you can muster to blow away Step 2, and then concoct some reasonable reason why you didn't do well in Step 1 which you will relate in a personable, real way during interviews. Then, create a really brief email that you'll send to targeted programs that ask them to consider your "overall" step performance in light of the fact that you did so well on Step 2 before they make a decision about your application. Another possible hook is to latch onto a radiology mentor who has some clout, impress the s**t out of them doing research or even a research year, or in some other way impress that person, and then the radiology mentor can help open some doors for you. In general, ECs aren't much of a hook--leadership in medical student organizations checks a box but don't think this gives you a great hook, UNLESS in the process of doing the EC, you can score a hell of a letter of recommendation from a faculty mentor.

If you don't get 225 or higher on Step 2, it's going to be hard to get into a DR program I think. Maybe impossible. You'll have to consider programs with some blemishes, and then work your butt off to become the best radiologist you can be. Good luck.

Thanks for the response.
If I didn't score what I did I wouldn't have posted.
Definitely gives me some direction and a great deal of insight into what I need to do.

 

[RadiologyPD]

Thanks for the general response! In general, what is the "cutoff" step 1 score for most DR programs?

I'm sorry, I really don't know. At our program, 220 is a soft cut off. I'll look at candidates below that based on someone I know calling me, my faculty requests (either they know the person or someone they know asked us to consider), local candidate or otherwise connected to us, special circumstances (military funding), and outstanding step 2 score (i.e., got less than 220 on step 1 but got more than 250 on step 2).

 

[Docbel]

Hi RadiologyPD

Thank you for taking the time to answer my question. I was wondering how radiology PDs across the country value clerkship grades as a critical factor in interview/ranking selection given their known highly subjective manner and poor interrater reliability (Faculty Evaluations Correlate Poorly with Medical Student Examination Performance in a Fourth-Year Emergency Medicine Clerkship. - PubMed - NCBI, Variation and imprecision of clerkship grading in U.S. medical schools. - PubMed - NCBI)

 

[dIehaRd]

Hi RadiologyPD

Thank you for taking the time to answer my question. I was wondering how radiology PDs across the country value clerkship grades as a critical factor in interview/ranking selection given their known highly subjective manner and poor interrater reliability

This is what confuses me about your process for assessing applicants, @RadiologyPD. You admit that clerkship grades vary considerably between institution and, at best, you can only guesstimate the relevance of clerkship grades based on the "relative difficulty of getting honors at each medical school". Then you mentioned that any score above a 240 is equivocal for Step examinations. In the context of the modern USMLE examinations, scoring 240, 250, 260+ are very different and represent very different levels of skill and knowledge. We're talking getting a B/B+ (240) vs. getting an A+ (260+) on the end-all-be-all examination for medical students, and the only standardized metric for assessing applicants. Once in a while a student will slip through the cracks, score 230 on all of their practice exams, and have a lucky day and score 260+. This is an anomaly, however, and in most cases, scores on this examination are a very good gauge of the quality of students' basic science foundation. Ask any student what their average on the 8+ NBME/UWSA practice examinations were and I will guarantee most score within 5-10 points of their practice tests, meaning these examinations do accurately portray a student's ability and, make no mistake, there are variations in ability between those who score 240, 250, and 260.

Knowing that USMLE Step 1 is the staple result of every student's basic sciences education, why would you make the cutoff 240? Why hold clerkship grades to such high regard when, as you admit, they are more subjective and less reliable than Step 1? It's bizarre, because you come off as a PD from a top 20 program, and I would assume you would want applicants who are self-motivated, intuitive, and strong test-takers, the combination of which usually result in a strong (250+) or superb (260+) Step 1 score. Isn't it widely known that charisma, "apparent" work ethic, and personality play the largest role in the subjectivity of clerkship grades, which are all factors that can be assessed at an interview by your selection committee after filtering more stringently using USMLE scores?

Just seems odd to me that you have an extremely useful metric at your disposal for meticulously comparing applicants and you brush it off and dismiss anything above a 240 as basically the same thing as a 260+. Obviously this selection process works at your institution and you are content with the applicants you get, so I'm just offering this up for discussion. I will say that it's honestly a bit insulting to those of us who know that there is a stark difference in the mindset and work ethic between the student who scores 240 and the student who scores 260+. The spreadsheet made it clear that the notion that "everyone scores in this range so 240+ is the cutoff for a great score" is incorrect. The majority of students applying radiology actually score <260.

Thanks for hearing me out.

 

[RadX]

This is what confuses me about your process for assessing applicants, @RadiologyPD.

Just seems odd to me that you have an extremely useful metric at your disposal for meticulously comparing applicants and you brush it off and dismiss anything above a 240 as basically the same thing as a 260+. Obviously this selection process works at your institution and you are content with the applicants you get, so I'm just offering this up for discussion. I will say that it's honestly a bit insulting to those of us who know that there is a stark difference in the mindset and work ethic between the student who scores 240 and the student who scores 260+. The spreadsheet made it clear that the notion that "everyone scores in this range so 240+ is the cutoff for a great score" is incorrect. The majority of students applying radiology actually score <260.

Thanks for hearing me out.

I think RadiologyPD mentioned in a very early post that their formula punishes 250+ scores in the calculated total score for an applicant but that doesn't mean 250 is similar to 260.A higher score still adds to the final applicant score but to a lesser extent than say 230 to 240 or 240 to 250.

 

[greg1184]

This is what confuses me about your process for assessing applicants, @RadiologyPD. You admit that clerkship grades vary considerably between institution and, at best, you can only guesstimate the relevance of clerkship grades based on the "relative difficulty of getting honors at each medical school". Then you mentioned that any score above a 240 is equivocal for Step examinations. In the context of the modern USMLE examinations, scoring 240, 250, 260+ are very different and represent very different levels of skill and knowledge. We're talking getting a B/B+ (240) vs. getting an A+ (260+) on the end-all-be-all examination for medical students, and the only standardized metric for assessing applicants. Once in a while a student will slip through the cracks, score 230 on all of their practice exams, and have a lucky day and score 260+. This is an anomaly, however, and in most cases, scores on this examination are a very good gauge of the quality of students' basic science foundation. Ask any student what their average on the 8+ NBME/UWSA practice examinations were and I will guarantee most score within 5-10 points of their practice tests, meaning these examinations do accurately portray a student's ability and, make no mistake, there are variations in ability between those who score 240, 250, and 260.

Knowing that USMLE Step 1 is the staple result of every student's basic sciences education, why would you make the cutoff 240? Why hold clerkship grades to such high regard when, as you admit, they are more subjective and less reliable than Step 1? It's bizarre, because you come off as a PD from a top 20 program, and I would assume you would want applicants who are self-motivated, intuitive, and strong test-takers, the combination of which usually result in a strong (250+) or superb (260+) Step 1 score. Isn't it widely known that charisma, "apparent" work ethic, and personality play the largest role in the subjectivity of clerkship grades, which are all factors that can be assessed at an interview by your selection committee after filtering more stringently using USMLE scores?

Just seems odd to me that you have an extremely useful metric at your disposal for meticulously comparing applicants and you brush it off and dismiss anything above a 240 as basically the same thing as a 260+. Obviously this selection process works at your institution and you are content with the applicants you get, so I'm just offering this up for discussion. I will say that it's honestly a bit insulting to those of us who know that there is a stark difference in the mindset and work ethic between the student who scores 240 and the student who scores 260+. The spreadsheet made it clear that the notion that "everyone scores in this range so 240+ is the cutoff for a great score" is incorrect. The majority of students applying radiology actually score <260.

Thanks for hearing me out.

IMO You give the USMLE exams, especially step 1, way too much credit. I fully understand it is a nice and easy "standardized" way to filter out applicants, however it is a licensing exam, not an IQ test.

 

[GadRads]

Your post is another example of the over-elevation of test scores in the current era. I believe scoring high on the USMLE only means that, scoring high on the USMLE. Scoring a 260 means you are better at the USMLE than the other person who scored a 250, but I would need to see any link connecting the difference in scores to overall success in life or even general skill in practical medicine.

For example, a colleague in my medical school scored 230. I did much better. However, on clinical rotations, she was as sharp as anyone. It was clear that she had strong preclinical knowledge. She also had a better class rank than I did, had slightly better medical knowledge, but I just happened to be a better test taker. And she worked harder than I did in medical school, at least when it came to general medicine (I spent a lot of time on research). She was so strong clinically that I would take a chance on her smoking you clinically. In another instance, a bunch of folks in my class had better scores than the top ranked student, which is not unusual at other medical schools. I recently met a resident with a flat 240, but given all his very intellectually demanding accomplishments, I would place him higher than some others with 260s and 270s.

Seriously, you are placing waaaay too much emphasis on differences in scores and what they really mean. It seems you worked so hard to get a high score that your identity is now dependent on it.

This is what confuses me about your process for assessing applicants, @RadiologyPD. I will say that it's honestly a bit insulting to those of us who know that there is a stark difference in the mindset and work ethic between the student who scores 240 and the student who scores 260+

 

[RadiologyPD]

Good discussion.

I wish there were a metric I could find that differentiated applicants for what we want in our residency. From post #41, we want residents with high scores on the following items--
• Enjoy working with: obvious
• Trust them to do the best job: potential for developing excellent clinical skills, demeanor, motivation
• Interactions with clinical colleagues: If the most arrogant surgeon comes down to review a case, will this person be able to handle it well?
• Help us recruit: are they likeable, present themselves well, will they pursue the best possible fellowships
• Excited to see: obvious
• Inspiring career trajectory: Leadership (private practice, organized radiology, or academics), Academics, Community service.

Medical knowledge (for which USMLE scores are a proxy) is important for residents/radiologists to "do the best job". If you don't know the diseases and how they manifest, you won't be able to make observations.

The thing is, at some point, you've got enough medical knowledge. You can be a fantastic radiologist and score 220 on USMLE exams. You can be an a**hole and score 260 on USMLE exams.

USMLE exams are also a reflection of some other things, to some extent:
-self-motivation, work ethic: yes, we want students who work harder and know how to excel
-ability to take tests: yes, we want students who won't have problems taking the Radiology Core Exam at the end of R3 year and Certifying exam 15 mo after residency

So we don't consider 240 = 260. It's just that 260 isn't that much higher than 240 in our books, and is easily overcome by better clinical clerkship scores or other aspects of the application. We don't let USMLE dominate an applicant's assessment.

Why look at clinical clerkship scores at all? dlehaRd said--"Isn't it widely known that charisma, "apparent" work ethic, and personality play the largest role in the subjectivity of clerkship grades,which are all factors that can be assessed at an interview by your selection committee after filtering more stringently using USMLE scores?". So let's analyze that statement--
-"Isn't it widely known that charisma, "apparent" work ethic, and personality play the largest role in the subjectivity of clerkship grades...": yes, and believe it or not, some of this stuff is important to being a radiologist that clinicians value as well as a resident that is easy to work with
-"all factors that can be assessed at an interview by your selection committee ": each of my interviewers meets each candidate for 15 min. Each clerkship is 4-6-8 wks long. Why wouldn't we factor in team experiences that reflect an experience that is far longer than our 15 min interaction?

In the end, we do factor in our collective 15 minute interactions a lot. But it would be dumb not to consider clerkship scores. We also do factor in USMLE scores. For us, as I said earlier, it's about 50% interview & other aspects of the record (our assessment of "grit" and "go-get-em" as evidenced by academic efforts/leadership/LOR/etc), 25% USMLE, 25% clinical clerkship scores.

 

[LittleFoot]

This is a good discussion and I think that it is invaluable to see into the mind of a Radiology PD. However, I think that it's important to remember that RadiologyPD does not speak for ALL 195? Radiology PDs. I'm sure there are programs out there that put much more value into the USMLE and much less value into clerkships. And I'm sure they too, have plenty of good reasons to do it that way. It just depends on the values of the program itself and the perceived value of each aspect of the application. While maybe one program filters you out because of your clerkship grades, you may snag an interview at a program that values board scores more and clerkship grades less. Yes, the whole package matters but the individual value of each aspect of your application is going to vary widely from program to program.

 

[NeuroticTwilightSparkle]

Thanks for this thread! It's been extremely insightful

I had a couple of questions
1) How do you weigh someone in the bottom quartile from a top 10 US MD vs someone in the top half or top quartile from a mid or lower tier program?
2) A lot of programs, even less reputable ones, have fantastic fellowship lists with graduates going to MGH/UCSF/MIR, but isn't this somewhat the product of radiology being less competitive a few years ago? As radiology residency becomes more competitive, is fellowship competitiveness going to catch up?
3) What is your criteria for choosing chief residents?

 

[RadiologyPD]

I had a couple of questions
1) How do you weigh someone in the bottom quartile from a top 10 US MD vs someone in the top half or top quartile from a mid or lower tier program?
2) A lot of programs, even less reputable ones, have fantastic fellowship lists with graduates going to MGH/UCSF/MIR, but isn't this somewhat the product of radiology being less competitive a few years ago? As radiology residency becomes more competitive, is fellowship competitiveness going to catch up?
3) What is your criteria for choosing chief residents?

1. Top half at most schools (80%) will be seen more favorably than bottom quartile at "top school". If you are in bottom quintile school, then you'll have to be in top quartile for sure to be seen favorably compared to any student from a "top school". But these sorts of comparisons are meaningless, since there are so many other factors involved, some objective (USMLE scores).
2. Not all fellowships at all "top" programs are equal. I would look at the internal fill rate of fellowship spots at a top program to understand desirability--if the top program (like UCSF) is in a desirable location (like UCSF) and has a large graduating class (like UCSF) and seldom gets internal candidates to do a particular fellowship, there's an issue with that particular fellowship. Some fellowships at top places are like this. I have not done the math, but it seems to me that there are more fellowship slots overall than graduates looking to do fellowships. When radiology is "less competitive", it usually means the job market is struggling--paradoxically, that is when fellowships are more competitive.
3. Rather than articulating one program's approach, let me speak in generalities. In general, chiefs are selected based on affability/likability/popularity (with the program leadership/faculty and with coresidents), extent of time at the institution (residents who were med students at the place sometimes have an edge), responsibility (timely communicator, gets administrative tasks done), interest, and to a much lesser extent "competence". The most brilliant resident who is an a**hole rarely if ever is selected as a chief. A likable, popular, responsible resident with average interpretation skills is more likely to be chief than a quiet, unassuming, unengaging resident with outstanding interpretation skills.

 

[sired]

Dear @RadiologyPD , what was your experience from this year's match?