Radiology Faculty--Answering Questions/"AMA"

[deleted674723]

Hi Doc, thanks for taking the time to create this incredibly helpful resource for us.

TLDR: how much of a red flag is all high pass in core clerkships? And where does strength of medical school come into your algorithm? Can this make up for average grades?

I read through your detailed explanation of your rank system and am frustrated that my clerkship grades will hurt me. I also read that you had a bit of a rough go on your radiology grade so I know that you are aware that sometimes parts of our clerkship grade can be out of our control. I will likely have mostly if not exclusively high pass on my core clerkship grades. I will absolutely not just pass any, but I keep barely missing honors. I will include anecdotes as an example, but I sincerely am not doing this to complain. I think it’s important for the question. Please skip the next two paragraphs if you aren’t interested in the details.

One rotation I got great comments, multiple “best med student I’ve worked with”, 99th percentile in the shelf, but didn’t “play the game” (read: buddy up with someone who did the rotation recently and know exactly what’s coming) for the standardized patient exam. This resulted in a below average grade on the standardized patient exam which knocked me out of honors because we must be above average in every part of the grading scheme.

Another rotation I was shipped out to a community hospital where the graders are unfamiliar with our extremely vague and strange comment based grading system. I worked incredibly hard, put everything I had into the rotation and surpassed my cohort by more than a standard deviation on the shelf. I met with the course director multiple times to get extra help for the standardized patient exam to make sure my mistakes weren’t repeated... and I high passed again due to “poor” reviews from my community site.

My question is how much of a red flag is all high passes in core clerkship? Can strength of home institution (top 15) make up for this? And finally, how do I explain this in an interview? I legitimately cannot point to a mistake that I am making to miss the grade but I would never explain the situation in this fashion as I know it sounds exceedingly unprofessional and “woe is me.” I’m hesitant to even post this here but I would love some guidance. Thanks again.

---

Members don't see this ad.

 

[RadiologyPD]

Don't sweat it too much. High pass is fine if it is a 3 tier system and it means something--at some places, you can literally only get high pass or honors.

For example (and I'm not picking on any school, just looking at my sheet), the average percentile rank of a student getting high pass in Surgery/IM/Peds/OB at the following schools is listed below (this is averaged together):
Duke: 17%
UCSD: 66%

This means that if you got high pass at Duke in those 4 clerkships, you were in the 17th percentile (bottom quintile of the class). If you got high pass at UCSD in those 4 clerkships, you were at the 66th percentile (2nd highest quintile).

If you are applying to my program, I'll know the context of your high pass. That may not be true at other places.

Also, core clerkships are just one metric.

 

[deleted674723]

Don't sweat it too much. High pass is fine if it is a 3 tier system and it means something--at some places, you can literally only get high pass or honors.

For example (and I'm not picking on any school, just looking at my sheet), the average percentile rank of a student getting high pass in Surgery/IM/Peds/OB at the following schools is listed below (this is averaged together):
Duke: 17%
UCSD: 66%

This means that if you got high pass at Duke in those 4 clerkships, you were in the 17th percentile (bottom quintile of the class). If you got high pass at UCSD in those 4 clerkships, you were at the 66th percentile (2nd highest quintile).

If you are applying to my program, I'll know the context of your high pass. That may not be true at other places.

Also, core clerkships are just one metric.

Thanks for the reply. Sincerely appreciate it. Quick follow up, should I be prepared to explain why I have no honors? Or do you think most programs would only ask about "passes"?

 

[RadiologyPD]

No one will ask. It's just part of your package.

 

[medstudent1718]

.

 

[RadiologyPD]

Sounds fine to me. There's no "deal breaker" aspect of this at all. No one is thinking that your research as a medical student is anything other than a reflection of your interest in sharpening your critical thinking and literature review skills, willingness to explore academic activities, and ability to make progress on a project. If you are interested in education, the opportunity sounds great.

 

[medstudent1718]

Sounds fine to me. There's no "deal breaker" aspect of this at all. No one is thinking that your research as a medical student is anything other than a reflection of your interest in sharpening your critical thinking and literature review skills, willingness to explore academic activities, and ability to make progress on a project. If you are interested in education, the opportunity sounds great.

Thanks so much for responding back and providing clarity to the process

 

[jo_da]

@RadiologyPD Thank you for doing this Q&A. How did this year's match go? Would love to hear a PD's perspective.

 

[RadiologyPD]

We were happy with the class we got.

We reviewed responses to our anonymous post-interview survey, and it is still frustrating to hear that applicants loved the program but ranked others higher due to geographic preferences. Nearly 70% of the applicants ended up saying that they ranked another program higher due to geographic preferences.

I wonder how to make the system better so that applicants who are very likely going to match at ranks 1-3 don't waste their time on interviews at places that they aren't going to rank in the top 5 due to geography. I can't change the geography of my program, and it is the one thing applicants can be sure about when applying. I get it for people who are "aiming high" and willing to go anywhere for that best program, or who don't have ridiculously good metrics, but I'm talking about the many candidates who applied to my program with ridiculously good metrics who ended up matching at ridiculously good places...outside of my geography. We can only interview so many and hate to not interview candidates who do want my geography just because my interview pool is diluted with those who actually don't want my geography.

 

[SeisK]

We were happy with the class we got.

We reviewed responses to our anonymous post-interview survey, and it is still frustrating to hear that applicants loved the program but ranked others higher due to geographic preferences. Nearly 70% of the applicants ended up saying that they ranked another program higher due to geographic preferences.

I wonder how to make the system better so that applicants who are very likely going to match at ranks 1-3 don't waste their time on interviews at places that they aren't going to rank in the top 5 due to geography. I can't change the geography of my program, and it is the one thing applicants can be sure about when applying. I get it for people who are "aiming high" and willing to go anywhere for that best program, or who don't have ridiculously good metrics, but I'm talking about the many candidates who applied to my program with ridiculously good metrics who ended up matching at ridiculously good places...outside of my geography. We can only interview so many and hate to not interview candidates who do want my geography just because my interview pool is diluted with those who actually don't want my geography.

Probably can’t make the system better in that regard without sacrificing substantially elsewhere.

 

[Americanbum]

We were happy with the class we got.

We reviewed responses to our anonymous post-interview survey, and it is still frustrating to hear that applicants loved the program but ranked others higher due to geographic preferences. Nearly 70% of the applicants ended up saying that they ranked another program higher due to geographic preferences.

I wonder how to make the system better so that applicants who are very likely going to match at ranks 1-3 don't waste their time on interviews at places that they aren't going to rank in the top 5 due to geography. I can't change the geography of my program, and it is the one thing applicants can be sure about when applying. I get it for people who are "aiming high" and willing to go anywhere for that best program, or who don't have ridiculously good metrics, but I'm talking about the many candidates who applied to my program with ridiculously good metrics who ended up matching at ridiculously good places...outside of my geography. We can only interview so many and hate to not interview candidates who do want my geography just because my interview pool is diluted with those who actually don't want my geography.

A lot of people go into radiology for the lifestyle and that makes geographic preference huge. It also doesn't help that its a 4-5 year commitment(if a categorical program).

I think the biggest problem is every year there is almost a 10% increase in applications sent out. The average radiology applications sent out for each applicant : 43.9(2016)>>47.1(2017)>>50.0(2018)>>55.4(2019). At the same time, there's also way more interviews applicants go on. This itself I feel like is the biggest reason you are getting so many interviewees that interview at your program but rank other places higher because they have many more places to choose from.

 

[RadiologyPD]

Sorry if I didn't state what I meant clearly.

I totally get geography as a factor for some people.

My feeling is that applicants with great metrics overinterview. I can't actually get the data from NRMP, but it would be helpful to applicants to know that if they had USMLE scores > "x" and were in the top "y" percentile of the class on the MSPE, that their chance of matching at their #1-"z" spot was approaching 100%. Then, if you really want to live in one of 3 cities in the country and that's super important to you, don't accept the interview at my program which isn't in one of those 3 cities--in fact, only go on "z" + 2 safety interviews total. It will save you money, save me time, and allow me to give that interview spot to some other person for whom my city is in their geographic preference.

My guess for one set of x-y-z numbers above:
250--top quartile--5

 

[CharlieBillings]

.

 

[RadiologyPD]

No point in arguing about it, and I'm not blaming anyone, just trying to give some perspective to applicants with solid metrics.

As I said, we are pleased with our class.

 

[AFishAnt]

I'm a 3rd year DO student planning on applying to DR. I'm in the 3rd quartile of my class for pre-clinicals but got a 250 on step 1. I'm worried that being in the 3rd quartile will hurt me especially coming from a DO school so I was wondering if I should address this in my personal statement. There's no outstanding reason for my below average performance in pre-clinicals except that I was not prepared for the memorization-heavy material of medical school coming from an engineering background. My clinical grades are far better but they do not get calculated into our class quartile rank.

 

[RadiologyPD]

Yes, that would be useful information to me the way I look at it, because I would not know that your class ranking was dependent only on your pre-clinical scores. Highlight your clinical performance (if you got honors) by including that in the "Awards & Recognitions" section for Medical School (something like "Grade of Honors in x of y core clerkship rotations" or something like that). Then, touch briefly on it in your PS, it could help, especially if you pull in the stuff about how your engineering background gives you an advantage in whatever way you think it gives you an advantage.

 

[sketchy_micro_pharm_path]

How are the RSNA Medical Student Research Grants and Dr. and Mrs. W.C. Culp SIR research grants viewed during your interview selection screening? If a person does not even meet your Step 1/2 cutoffs, would you even see these awards?

Thanks.

 

[Ijustwantdownloadpicture]

Hello, I am a Radiology PD who was asked by an SDN administrator who is friend of one of my former fellows to participate in this thread. My understanding is that there may be at least one other PD (by the handle of "Radiology_Advisor") who will participate for now. Here is the request I received:

We are looking to increase attending presence on the forums especially in those specialties, such as DR, where students may not get a lot of exposure during the premed and med school years. Our "AMA" (Ask Me Anything") threads are immensely popular and of course, having PD input benefits all users as your experience and insight is something that we feel would be invaluable and not easily accessible elsewhere. Would you be interested in participating?

For now I prefer to stay anonymous, but it may help to know a bit about me. I graduated from a big Midwest state medical school almost 30 years ago and did my internship/residency out West. I did not entertain the idea of becoming a radiologist until my M3 year, after doing an elective in Radiology that I chose in order to be more familiar with how to get films/reports on my patients prior to my subsequent Internal Medicine and Surgery rotations (in the old days, students were judged by how good they were at getting what you needed from the radiology records department before rounds!). A big part of the reason I chose radiology is because I enjoyed the one-to-one teaching interactions that I saw the academic radiologists doing more than what I saw the academic internists and academic surgeons doing, and I wanted to stay in academics if possible. I've only been at two academic centers in my career--staying at the institution I did my residency & fellowship as an attending for about 5 years, then moving to my present position, which is also out West. I was a Chief Resident and on the residency selection committee at my former institution, and have been a fellowship program director and more recently am the residency program director at my current institution. As a result, I've been involved with the training of many radiologists.

It might have made more sense to start this thread after the upcoming Match, as I'm sure this forum will be buzzing with the results of the Match for a while, but I'm forging ahead now as requested. Heads up, I'm not going to engage into conversations about which program is better, or "chance me" requests, other than to perhaps direct those sorts of inquiries into more a more general discussion of underlying principles. Nevertheless, feel free to ask whatever, and if I don't particularly feel like I should engage or if I don't have a good answer, I won't hesitate to say so. Also, I may not be able to be as responsive as others, but I'll do my best.

Ok, that's it for now. Good luck to all of you who are awaiting the upcoming Match results!

Hi. What can you say about FMG chances to match into Radiology? For example, if i've got: strong research, visa, USMLE scores higher than medium of AMG, and also I have never been to US, exсept passing the USMLE ( no us clicilal expirience). What is my odds?
Thanks for your response!

 

[pendaflex1]

Hi. What can you say about FMG chances to match into Radiology? For example, if i've got: strong research, visa, USMLE scores higher than medium of AMG, and also I have never been to US, exсept passing the USMLE ( no us clicilal expirience). What is my odds?
Thanks for your response!

RadiologyPD has already answered this Q, I think in on the first page. For his/her program they essentially filter out applicants who are IMGs. However, each year there are always some FMGs who match into radiology. I would look at the NRMP data. Also this isn't a what are my chances thread.

 

[RadiologyPD]

How are the RSNA Medical Student Research Grants and Dr. and Mrs. W.C. Culp SIR research grants viewed during your interview selection screening? If a person does not even meet your Step 1/2 cutoffs, would you even see these awards?

We have pretty low Step 1 filters in order to pick up individuals who shine in other areas. I'll quickly glance at your application if you are in the 215-220 range just to find some diamonds that just don't have good Step 1 scores (keep in mind that our average resident has Step 1 scores in the 240-250 range). But if you are lower than my already low Step 1 filter, it's very doubtful that I will look at your application at all, unless you are geographically very close (within 100 miles--keep in mind I'm out west).

 

[RadiologyPD]

Hi. What can you say about FMG chances to match into Radiology? For example, if i've got: strong research, visa, USMLE scores higher than medium of AMG, and also I have never been to US, exсept passing the USMLE ( no us clicilal expirience). What is my odds?

If you don't need visa support, it helps (that means you are a Permanent Resident or US Citizen, not that you already have a visa that will need to be renewed), because in the current immigration environment, visa sponsorship can get messy and be subject to delays.

AMG Radiology applicants already have USMLE scores higher than the mean of medical students--so your Step 1 needs to be even higher than the average Radiology applicant (i.e., probably over 250)--and even then, it helps you only at those programs that are beholden to USMLE scores.

The way I run our selection, we actually weight relative clinical clerkship results more than USMLE scores (see my previous posts)--so, as a result, because I can't actually compare you to other applicants for that more important metric, we probably won't review your application unless we know you or know of you in some other way.

Be sure to have a native speaker check your application carefully, especially the personal statement. Personally my 2nd language skills suck, so I think it's fantastic that you may be able to speak/write/read very well in English as well as other languages, BUT you just can't have errors like "no us clicilal expirience" and "What is my odds?" in your application because they just set the wrong tone--communication skills will be important.

Some of the best radiologists are IMGs, in my experience. Unfortunately for you, you are just going to have to be so much better than an AMG due to the "risks" a program incurs having an IMG as a resident, especially one that has never been to the US.

Good luck.

 

[MaxPlancker]

Hi RadiologyPD,

Thanks so much for the detailed insight into the process, it's very interesting for those of us on the other end. I have a few questions which would be interesting to get your perspective on:

1) For schools that have P/F only clerkships, how do you evaluate their clinical score?
2) How important is the Sub-internship or advanced elective? Is one's performance in this more or less important than in the clerkship? How is this factored into your clinical score?
3) How much do the MSPE comments matter, if most of them are essentially an exchange of superlatives?
4) Do you think a candidate's physical features play a role in the personality score? It does appear that some resident classes have majority good-looking residents!

 

[RadiologyPD]

1) For schools that have P/F only clerkships, how do you evaluate their clinical score?
2) How important is the Sub-internship or advanced elective? Is one's performance in this more or less important than in the clerkship? How is this factored into your clinical score?
3) How much do the MSPE comments matter, if most of them are essentially an exchange of superlatives?
4) Do you think a candidate's physical features play a role in the personality score? It does appear that some resident classes have majority good-looking residents!

1. When the school doesn't provide clerkship grades, I have to rely more on USMLE scores for those students, and then also consider more carefully research/LOR/etc at the "invite" stage (things we would have done at the interview stage). I also then rely more on school prestige.
2. Sub-internship experience doesn't factor in. I don't even look at it, because not everyone has done it and most people seem to do well.
3. Agree--MSPE comments aren't very helpful, other than the "relative rank" comments at the end.
4. Ha ha. Subconscious or unconscious bias research suggests that looks confer advantages, but we try not to make it about looks.

 

[MaxPlancker]

Thanks for answering! Out of curiosity, how do you view LOR/MSPE comments such as "best that I have worked with in XX years"? Are those dime a dozen now to where they make little difference or still rare enough to grab your attention? How, if at all, does purely the letter writer's status (eg clerkship director, famous guy, instructor, etc) play a role?

 

[RadiologyPD]

Unfortunately, LORs are so subjective that they aren't good discriminators of who will make a better resident. I've written posts about this before--see #124 and #126

There's a bit of literature on how PDs see LORs and you can review that if you want details beyond my bias.

See this article: "https://doi.org/10.4300/JGME-D-17-00712.1"

According to the literature, the best phrases are indeed "I give my highest recommendation" or "best I have worked with in XX years".

But I tend to agree with the commentary written by Dr. Mark Nehler that was tied to a recent article on this subject:

See this article: "https://doi.org/10.4300/JGME-D-18-00258.1 "

"If the applicant is a superstar in all aspects, a letter of recommendation pointing that out is a bit redundant, in my opinion. Most frequently, I use letters of recommendation to find the occasional potential star who does not stand out, with typical metrics, in the application." So an outstanding LOR is most helpful if you aren't killing it in other aspects of your application to highlight aspects of your application -- habits, behaviors, attitudes, personality--that might get overlooked by standard metrics.

 

[MaxPlancker]

Super interesting! Thanks!!

 

[carriaway]

If you don't need visa support, it helps (that means you are a Permanent Resident or US Citizen, not that you already have a visa that will need to be renewed), because in the current immigration environment, visa sponsorship can get messy and be subject to delays.

AMG Radiology applicants already have USMLE scores higher than the mean of medical students--so your Step 1 needs to be even higher than the average Radiology applicant (i.e., probably over 250)--and even then, it helps you only at those programs that are beholden to USMLE scores.

The way I run our selection, we actually weight relative clinical clerkship results more than USMLE scores (see my previous posts)--so, as a result, because I can't actually compare you to other applicants for that more important metric, we probably won't review your application unless we know you or know of you in some other way.

Be sure to have a native speaker check your application carefully, especially the personal statement. Personally my 2nd language skills suck, so I think it's fantastic that you may be able to speak/write/read very well in English as well as other languages, BUT you just can't have errors like "no us clicilal expirience" and "What is my odds?" in your application because they just set the wrong tone--communication skills will be important.

Some of the best radiologists are IMGs, in my experience. Unfortunately for you, you are just going to have to be so much better than an AMG due to the "risks" a program incurs having an IMG as a resident, especially one that has never been to the US.

Good luck.

Thank you for taking the time to answer our questions. I had a question regarding electives as an FMG.
In your opinion, do you think as an FMG, the applicant should undertake all three electives in DR/IR or would you like to see letter from medicine and surgery electives too?

 

[MaxPlancker]

How much focus on clinical excellence is there for selection of chief residents? It seems to be the well-liked, outgoing, schmoozing type people...

 

[knosway14]

Hi radiology PD.

I did apply to radiology in the 2017-2018 and did not Match. So I joined a radiology residency program in Spain (Europe).

I'm considering to re-apply.

Question is : Do you think 2 years of radiology residency experience would increase my chances significantly ?

I'm a FMG, I would need a visa sponsorship.

YOG Dec 2014.
Steps 243/238/228.
A few pubs and few abstracts.

Thanks.

 

[RadiologyPD]

In your opinion, do you think as an FMG, the applicant should undertake all three electives in DR/IR or would you like to see letter from medicine and surgery electives too?

Electives only good if they translate to impressing a decision-influencer in that residency of your value to the residency. Pick those that give you consistent experience with a small group of faculty who have some influence. Letters that come from non-radiology rotations are usually not that impactful.

How much focus on clinical excellence is there for selection of chief residents? It seems to be the well-liked, outgoing, schmoozing type people..

The chief resident role in our program:
1. Advocate and spokesperson for resident concerns (has the trust of the other residents)
2. Attention to collective resident wellness, including helping develop sense of community amongst the residents (motivated to see that others are doing well)
3. Assist with mechanics of interview process for resident selection (be inspirational to potential applicants)
4. Liaison between Program Administration and residents (good communication skills, on top of things)
5. Attend AUR meeting (chief resident part of the meeting) and represent our program well (be impressive, don't be a jerk)
6. Adjudicate issues related to residents (fair, thoughtful)
7. Help oversee process of making certain aspects of the resident schedule (though I have a large role in this, which may be different than at other programs) (organized)
8. Attend department Education Committee meetings (able to be effective resident advocate, interested in resident education)
9. Help organize and improve resident efforts for medical student education/rotations (cares about the experience of students)

"Clinical excellence"--not really that important for any of the above tasks, BUT often the best residents for those tasks are the best clinically because they've worked the hardest, have the trust of the faculty, etc. Since some of the tasks take excellent people skills, being well-liked helps (not easy to have people trust you/support you if you are the most clinically excellent but smart-ass resident)

I did apply to radiology in the 2017-2018 and did not Match. So I joined a radiology residency program in Spain (Europe).

I'm considering to re-apply.

Question is : Do you think 2 years of radiology residency experience would increase my chances significantly ?

I'm a FMG, I would need a visa sponsorship.

YOG Dec 2014.
Steps 243/238/228.
A few pubs and few abstracts.

Thanks.

If you had completed a residency elsewhere, and even more so if you have experience as a radiologist but were not too far from training, it might be a hook that could help. Not sure a few years will help much by itself. You need a hook, see earlier posts.

 

[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 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.

@RadiologyPD just wanted you to know, I ended up matching IR/DR. I really appreciate your advice last year, it helped me get through a really rough time. I worked hard over the summer on aways and applied broadly and continued networking as much as I could.

I've just started intern year and although the imposter syndrome as an intern is strong, I'm really grateful and humbled to be here.

Your thread helps a lot of people, so thank you for doing what you do.

 

[RadiologyPD]

Congratulations on the IR/DR match. Not an easy feat in the current environment, so you must have plenty of other attributes that more than made up for your disappointing Step 1. Truth be told, I find that to be a reasonably good predictor of future success (that is, I find individuals who made up for a disappointing Step 1 with excellent subsequent metrics/attributes to be fairly successful in radiology), so feel confident that you can/will succeed.

 

[Subsegmental]

Congratulations on the IR/DR match. Not an easy feat in the current environment, so you must have plenty of other attributes that more than made up for your disappointing Step 1. Truth be told, I find that to be a reasonably good predictor of future success (that is, I find individuals who made up for a disappointing Step 1 with excellent subsequent metrics/attributes to be fairly successful in radiology), so feel confident that you can/will succeed.

I just want other SDN users to know not everyone is or has to be "265 Step 1" student to match in rads. I feel like that is what's seen more often on the internet than the reality of average to below avg. (hopefully not as low as my below avg.) scores that some people have. Mind you, I worked my @$$ off to get my step 2 score up 40 points, and as you said, I worked hard to show I was more than a 3 digit score. It wasn't easy but it happened.

I even had friends this year re-apply after taking a year off doing research and match IR. It is something that takes a lot of effort and a lot of networking and some amount of luck, but it can be done.

All in all, thank you for your kind words and confidence. Best wishes to all those applying in future cycles

 

[MouseChair]

Hi @RadiologyPD. Thanks for all that you do. Invaluable advice in here.

I applied to a different specialty last year and unfortunately did not match. However, I am ultimately happy that this happened - I discovered Radiology and have realized I would be happier in this field than my original plan. I delayed my graduation by one year.

Should I explain this in my Personal Statement, or leave the discussion for my interviews? I want to be open and honest about my past, but I don't want to highlight my application's weakness/red flag if I don't have to. Thank you.

 

[RadiologyPD]

In my recollection, when this happens the applicant explains it in some way--sometimes just in the "explanation of extended training" section (there's a section in ERAS where you have to say "YES" if there was an extension of training and then can write a few sentences to explain why it took you more than 4 years to finish medical school). You don't have to dwell on it in the personal statement if you don't want to make it an organic part of the personal statement. I've seen it done both ways and it can work either way (the applicant makes it an organic part of the PS theme and uses a paragraph in the PS to describe the non-traditional route OR the applicant just makes a reference to the training extension in the PS and relies only on the "explanation of extension of training" to describe what happened).

To ignore it completely isn't going to fool anyone and just makes people wonder. You should control the narrative, but not get bogged down by it--it doesn't define you.

 

[16fca]

Hello,

I am writing on a throwaway account. I apologize if my question has been asked before. I'm an R1, ie I started radiology residency 4 weeks ago. In med school I was deciding between radiology and anesthesia. I picked radiology. I did an IR and a DR rotation in summer of fourth year, and felt like I would like radiology a lot. I matched at a good DR program. For my intern year I did a TY and had a good experience - I enjoyed clinical medicine a lot more as an intern than I did as a med student. I was still excited my entire intern year to finish and start radiology. But ever since the first week of R1 I have felt that I really really dislike what I'm doing. My program is great and the schedule is wonderful, but I am so incredibly unhappy. I know it's early in the year and maybe my feelings are normal, but I can't help but feel I dislike being a radiologist way more than I am supposed to. I apologize for saying this, but I feel like I'm working an office job instead of being a doctor. All my coresidents seem much happier. I think about switching to anesthesia to get back to clinical medicine every day. I still want to give radiology a chance to see if I will learn to like it, but I feel very pessimistic right now. I don't want to put my program in a bad situation, and I also don't want to wait so long that switching would not be possible. At what point should I consider approaching my PD regarding this? How long should I continue radiology to feel I have given it a fair shot? I don't know anything about switching specialties. We also have an anesthesia program at my hospital and I have wondered if I should talk to the anesthesia PD. I did will in med school with board scores in 245-250 range, and received good feedback from my intern year program. Thank you for any advice, I am just incredibly stressed and feel I'm starting to get depressed.

 

[RadiologyPD]

Sorry to hear about your predicament.

I tell my new residents that the R1 year is very challenging because the learning curve is so steep. It is normal to have 2nd thoughts about Radiology when you've just spent 3 years essentially doing mostly hospital-based medicine and have probably gotten pretty good at managing patients through the admission-discharge cycle. Thrown into Radiology, most R1s feel stupid and useless.

There's also a change in the model that you grew up with for most of medical school and internship, from mostly inpatient to mostly outpatient. Maybe you had a clinic experience as an intern, maybe not--outpatient medicine is not something most med students and interns spend a lot of time doing. I'll be honest, my last outpatient experience as "a clinician" was in my internship, consisting of managing "my patients" every Wednesday afternoon regardless of what service I was on in my TY training while I was at a Catholic hospital that had interns run a substantially reduced cost clinic 1/2 day/week . I liked the people I worked with and tried my best to manage patients (and their expectations), but it wasn't something I enjoyed much intellectually, if truth be told.

I'm not trying to rip on outpatient medicine--where I am going with this is that even if you read films in a hospital, most Radiology rotations are "outpatient experiences"--sitting at the workstation, case after case. Nothing like the "inpatient team" experience to which medical students and interns grow accustomed.

So it's really important to understand what you "really really dislike" about Radiology. If it's the absence of that "inpatient team" experience, then you may be reacting to something you will encounter with many fields once you get to the more ubiquitous "outpatient" experience that exists in most (although admittedly not anesthesia). If it's the feeling of being unhelpful or superfluous, or the volume of medical knowledge you must know, then it gets a lot better with time.

Having said that, since I've counseled a number of residents contemplating a switch out of Radiology over my many years, the expression "I really really dislike what I'm doing" is a poor prognostic indicator. Not loving Radiology is one thing--"really really disliking" Radiology is a whole 'nother level of antipathy.

You have to figure out what you hate and if you can get over it, and if you want to get over it. Let me put this into perspective: most new radiology residents actually LIKE what they are doing. Some new radiology residents learn to like what they are doing. Some radiology residents stay indifferent to what they are doing. Few (perhaps no) successful radiology residents HATE what they are doing.

I'm personally not a big believer that there is some "perfect match" of one profession for everyone. I think you end up liking (even loving) the things that you are good at, and getting really good at something is usually related to the "10,000 hour" rule. Of course, people can have natural talents. It helps tremendously in Radiology if you have a "good eye". I'm sure there are natural traits that help with other fields. But with the variety of subspecialty choices in Radiology--some with procedures, others not; some which require attention to tiny details, others not--you can usually find a niche if you are receptive to doing so.

I would definitely talk to your PD--he/she may have resources that would be helpful (like putting you in touch with other residents who went through the same thing). It's late July, and you are the most replaceable as an early R1 resident--so don't worry about putting the program in a bad situation, it will only get worse as you delay addressing this.

 

[RadiologyPD]

It's a blemish but not fatal. If you have a good succinct way of explaining it without having it dominate the personal statement (PS), I might explain it.

Up to last year, the computer display for the PD or anyone in the program reviewing the ERAS application had a small red exclamation point on the USMLE tab for anyone with a fail in any aspect of USMLE (including CS), so it was easy to see who had a blemish. I say "up to last year" because I heard a rumor that they are eliminating that flag this year, but I'm not sure that is true, since ERAS isn't open yet.

If that is true, then it might be possible that a program won't see the blemish in the screen for selecting candidates to interview. That might not be a good thing for you. The worst thing for you is to get an interview at a place that really cares about it and where they didn't notice it in the screening process , but then they notice it later in the in depth review during the interview and ding you badly for it in the ranking process. If they weren't inclined to interview you with the CS fail, then discovering it later only means you probably wasted your time and money going there.

If the USMLE blemish flag is still there this year, then explaining it in the PS may help. Truth be told, the PS may not be a screening document for many programs--too hard to read through them all (see my earlier post #9 and #77). So if your step 1 and 2 scores are very good, and your clinical grades and/or relative ranking in the MSPE are good, chances are the program may not read your personal statement at all prior to giving you the interview. On the other hand, if you are on the fence for them because of your CS fail, they may look at your PS more carefully and having it explained in the PS might help. You also get to control the narrative by addressing it.

 

[RadiologyPD]

It looks like they reduced the number of things that will trigger the USMLE Alert/Indicator. Now it seems the only thing that triggers the alert is an "Irregular Behavior Letter". Not a failing score.

https://www.aamc.org/download/498152/data/pdwsgettingstartedguidewithoutptal.pdf

So with that in mind, my guess is that most people won't see your CS fail during the screening process. Some will. I don't know how you should play it. If you mention it, it should be short and definitely not dominate. But with this new change, you can make an argument for not mentioning it at all until the interview, since it may not be apparent until then. At least you won't have the dreaded "USMLE Alert/Indicator" on your application.

To be honest, I've never run across someone who mentioned or explained the CS fail, but it has been a head scratcher for me when I review some applicants. More common for someone to explain why Step 1 wasn't so good. I tend to like those, since it shows self-recognition and controls the narrative.

PDs get to see ERAS applications on Sept. 15.

 

[awimboway]

Two questions, if you don't mind.

1. Feelings aside, we all know that in general residency applicants are looking out for what's best for themselves, and Program Directors are looking out for what's best for their program. That's a given. Would a program director ever place an applicant that is couples matching LOWER on the rank list based solely on the fact that they are couples matching? Programs directors understand that couples matching is 'harder' than non-couples-matching (because there are more variables), so wouldn't the PD be more inclined to rank someone that is couples matching lower? I might do so if I was a PD (why would you risk using up a high rank spot on someone that may likely match halfway down their own rank order list?)

2. Isn't it in one's best interest, as an applicant, to withhold claiming they are couples matching? Let's say Applicant A and Applicant B are average applicants in two separate specialties. However, they are only willing to couples match with each other if they get a sufficient number of interviews. They would rather be split across two different cities than not match at all. They also know that their chances of a successful match go up with an increasing number of interviews, leading to more permutations on their linked lists. If the applicants do not claim on ERAS that they are couples matching, Program Directors will not have any inherent bias towards that applicant, likely rank them higher, and then the applicants can sign up to couples match right before the rank order list is due. This would make it so Program Directors do not judge their applicant on any extraneous details and instead just view the applicant by their merits.


Of course I would never recommend anyone do that because I believe you should be open and honest in your interviews/application... and this is purely a hypothetical thought experiment. But I hope you'll humor me.

 

[bobjonesbob]

why would you risk using up a high rank spot on someone that may likely match halfway down their own rank order list?

You clearly don't understand how the match algorithm works. The only incentive for a PD to not rank applicants in order of their true preference is some misplaced desire to be able to say "we matched all our top ranked applicants." A program is in no way hurt ranking applicants that end up matching elsewhere as long as their list is long enough to fill their class.

 

[RadiologyPD]

Two questions, if you don't mind.

1. Feelings aside, we all know that in general residency applicants are looking out for what's best for themselves, and Program Directors are looking out for what's best for their program. That's a given. Would a program director ever place an applicant that is couples matching LOWER on the rank list based solely on the fact that they are couples matching? Programs directors understand that couples matching is 'harder' than non-couples-matching (because there are more variables), so wouldn't the PD be more inclined to rank someone that is couples matching lower? I might do so if I was a PD (why would you risk using up a high rank spot on someone that may likely match halfway down their own rank order list?)

2. Isn't it in one's best interest, as an applicant, to withhold claiming they are couples matching? Let's say Applicant A and Applicant B are average applicants in two separate specialties. However, they are only willing to couples match with each other if they get a sufficient number of interviews. They would rather be split across two different cities than not match at all. They also know that their chances of a successful match go up with an increasing number of interviews, leading to more permutations on their linked lists. If the applicants do not claim on ERAS that they are couples matching, Program Directors will not have any inherent bias towards that applicant, likely rank them higher, and then the applicants can sign up to couples match right before the rank order list is due. This would make it so Program Directors do not judge their applicant on any extraneous details and instead just view the applicant by their merits.


Of course I would never recommend anyone do that because I believe you should be open and honest in your interviews/application... and this is purely a hypothetical thought experiment. But I hope you'll humor me.

I agree with bobjonesbob. There's nothing inherently more valuable about a "high rank" position compared to a "low rank" position for a program. We rank them as we think they fit in our program. There is nothing "wasted" f we don't match our high ranks.

I could literally use up ranks 1-200 for people who I didn't even interview. My chances of getting those people are zero (I'm not going to be in their rank list, they don't think I'm ranking them). Then fill my spots starting with rank 201, for example. Makes no difference--if I rank someone #201 and they rank me #1, if I'm not filled by the time they come up on my list, they have my spot.

So, with that:
1. No, PDs don't rank a person who is couples matching lower BECAUSE that person is couples matching. IF, on the other hand, both individuals in the couple were applying for the same specialty, PDs MIGHT rank one of them lower in their own match list because they don't want a couple in the same class--especially if the program is a small program. I have never really had that concern, but I have heard of that. The argument is that if the couple breaks up, you've got a problem.
2. It doesn't help you to withhold your couple match status. If anything, if you are a strong candidate, knowing that you have a partner who is in a different field MIGHT encourage the PD to reach out to his/her fellow PD in the area of interest of the candidate's partner to encourage an interview, or higher rank. Or vice versa--I've been contacted by other PDs at my institution encouraging me to uprank an individual who was the partner of someone they wanted.

 

[RadiologyPD]

Thanks for the helpful information. It looks like I will have to think about this one for a while. One last question regarding this, I am guessing everyone will see it and bring it up at the interview. However, if nobody says anything do you think it is something I should bring up myself and mention? In the case that they missed it and saw it later when I am getting ranked and at that time I cannot be there to explain anything? Or should I just let the interviewer dictate the situation?

If you have a good narrative, use it. Don't perseverate on it though.

 

[JoshSt]

@RadiologyPD - any thoughts on the core exam and its record fail rate this year?

 

[awimboway]

I agree with bobjonesbob. There's nothing inherently more valuable about a "high rank" position compared to a "low rank" position for a program. We rank them as we think they fit in our program. There is nothing "wasted" f we don't match our high ranks.

I could literally use up ranks 1-200 for people who I didn't even interview. My chances of getting those people are zero (I'm not going to be in their rank list, they don't think I'm ranking them). Then fill my spots starting with rank 201, for example. Makes no difference--if I rank someone #201 and they rank me #1, if I'm not filled by the time they come up on my list, they have my spot.

So, with that:
1. No, PDs don't rank a person who is couples matching lower BECAUSE that person is couples matching. IF, on the other hand, both individuals in the couple were applying for the same specialty, PDs MIGHT rank one of them lower in their own match list because they don't want a couple in the same class--especially if the program is a small program. I have never really had that concern, but I have heard of that. The argument is that if the couple breaks up, you've got a problem.
2. It doesn't help you to withhold your couple match status. If anything, if you are a strong candidate, knowing that you have a partner who is in a different field MIGHT encourage the PD to reach out to his/her fellow PD in the area of interest of the candidate's partner to encourage an interview, or higher rank. Or vice versa--I've been contacted by other PDs at my institution encouraging me to uprank an individual who was the partner of someone they wanted.

Understood, thanks!

 

[RadiologyPD]

@RadiologyPD - any thoughts on the core exam and its record fail rate this year?

Not really.

There may be a relationship between the lack of competitiveness for spots in the Match of 2015 and the Core performance in 2019. Keep in mind that the class of 2020 (the people who took the core in 2019, who started residency in 2016) is the group that matched in 2015, which was a low year for Radiology competitiveness. Many programs went unfilled and had to scramble. The % of positions filled with US grads (usually a metric that signals the competitiveness of the field) was at a historic low.

My prediction is that board passage rates will progressively increase over the next few years.

 

[meltingbones95]

How many personal statements have made you laugh and/or captivated you?

When my sister applied to law school, her "reach" school called her personally to tell her that her PS was the only one that had ever made the committee laugh. It makes the prospect of having an entertaining essay seem rather bleak.

 

[RadiologyPD]

There have been some good ones, but I'm not actually looking for humor. Just trying to understand the person a bit for the interview. Most are well written, and I can see that the person put some thought and effort into it. As a result, most do not differentiate between candidates. The best ones serve as fodder for interview banter.

A few are weird. I've never ranked anyone "higher" because of the personal statement, but I remember one that was just awful--the candidate said he thought radiology was a good fit because radiologists work alone and because radiologists make good money. Never got to meet the candidate, we did not interview.

 

[NegzDO]

Just got my step 2 CK score back and I’m disheartened. Had a 21 point drop from 238 on step 1 to 217 on step 2. Assuming the rest of my application is fine, do I still have a shot at matching radiology?

 

[RadiologyPD]

This isn't a "chance me" thread, but thoughts from a PD:

1. Depends on other factors (3 biggest: are you IMG vs. AMG, relative rank in med school, honors in clinical clerkships). Again, would rather not get into a whole chance me discussion but if these are not favorable, then hurts.
2. Can you can speak to the cause or show that this was an anomaly?
3. What were your goals in terms of matching? If your goal was any program (including weak ones), then yes it's possible but not a shoo in.
4. Do you have any legitimate hooks?

No lie, that's going to hurt--217 on Step 2 is essentially below 10th percentile.

If you can develop a hook at a program, do so (i.e., work with them, get them to like you).