Residency Match Process

[dystorsion]

I've been looking around the internet for a little while, and I still cannot find much detailed information about how the residency matching works. Can someone shed some light on the entire process? I want to know what I should do in medical school to get the best possible match.

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[MrBurns10]

I don't exactly understand what you want to know, but in general, people seem to agree that the most important factors in getting a good residency is step 1 score, clinical grades, LORs, and things like research for certain specialties. You typically decide what to apply to by the end of your 3rd year, then you apply to whatever programs you want to apply to via ERAS in your 4th year. You then interview with those programs that invite you, you submit a rank list of places you interviewed at, then you match (hopefully) in March. Was this what you were wondering?

 

[dystorsion]

sort of. I also wanted to know what you submitted as part of the application. i.e. essays, resumes?

 

[Gut Shot]

sort of. I also wanted to know what you submitted as part of the application. i.e. essays, resumes?

There is a standardized electronic application that includes a personal statement, and there is room allotted to list publications, extracurriculars, etc. A med school transcript is forwarded, of course, as are your board scores and your Dean's Letter.

 

[Blesbok]

Do well on step 1 and have a good personality. Everything else is fluff.

 

[Winged Scapula]

Agree with the above, with the exception being that in small fields like Derm and Urology who you know can help.

Therefore, for almost everything else, spend your time studying to do well on Step 1. No one will really care if you volunteered at your school's HIV clinic, were class president or spent the summer between 1st and 2nd year working in a lab.

Outside of being an Olympic athlete and other such high level stuff, there are few ECs that matter.

(NB: BTW, in academics, a resume is called a CV - your curriculum vitae which highlights your educational accomplishments and not the summers you spent lifeguarding)

 

[DarthNeurology]

Agree with the above, with the exception being that in small fields like Derm and Urology who you know can help.

Therefore, for almost everything else, spend your time studying to do well on Step 1. No one will really care if you volunteered at your school's HIV clinic, were class president or spent the summer between 1st and 2nd year working in a lab.

Outside of being an Olympic athlete and other such high level stuff, there are few ECs that matter.

(NB: BTW, in academics, a resume is called a CV - your curriculum vitae which highlights your educational accomplishments and not the summers you spent lifeguarding)

A lot of students take time to do a research year, which I would think, helps some with the residency application process. Also, I would think for pediatrics at least, volunteering in a clinic or some other activity throughout medical school would help with residency application and help students be more optimistic and positive about going into medicine, which would make you more likely to ace the third year maybe. Hard work begets hard work. Sure you have to study a lot, but there are clubs i.e. for surgery, medicine, almost anything that seem a good way to network and to socialize a little during medical school. Did you do any ECs in med school Dr. Cox? It seems like you don't take lightly to them . . .

 

[hippiedoc13]

I think the point about ECs is don't do them for the CV. Do them because you're interested and you want to.

 

[Winged Scapula]

A lot of students take time to do a research year, which I would think, helps some with the residency application process. Also, I would think for pediatrics at least, volunteering in a clinic or some other activity throughout medical school would help with residency application and help students be more optimistic and positive about going into medicine, which would make you more likely to ace the third year maybe. Hard work begets hard work. Sure you have to study a lot, but there are clubs i.e. for surgery, medicine, almost anything that seem a good way to network and to socialize a little during medical school. Did you do any ECs in med school Dr. Cox? It seems like you don't take lightly to them . . .

Sure...but I did them for reasons other than buffing my CV.

I was the bookstore manager - but because it got me a discount on books.

Treasurer and Charter Member of AMSA - they asked, so I said ok.

I'm not trying to discourage people from doing things they enjoy but it would be a huge mistake, IMHO, to do ECs because you think they make a significant difference in residency applications.

Too many med studs think that ECs are just as important for residency as they were for getting into medical school. Tis not true. I cannot say I ever say a faculty member rank someone higher because of their ECs. It comes down to USMLE Step 1, LORs, Class Rank, Step 2 and everything else far, far down the list.

 

[XoQo]

Sure...but I did them for reasons other than buffing my CV.

I was the bookstore manager - but because it got me a discount on books.

Treasurer and Charter Member of AMSA - they asked, so I said ok.

I'm not trying to discourage people from doing things they enjoy but it would be a huge mistake, IMHO, to do ECs because you think they make a significant difference in residency applications.

Too many med studs think that ECs are just as important for residency as they were for getting into medical school. Tis not true. I cannot say I ever say a faculty member rank someone higher because of their ECs. It comes down to USMLE Step 1, LORs, Class Rank, Step 2 and everything else far, far down the list.

One question -- what you wrote definitely seems true based on what i've seen/heard on the gen surg interview trail this year....but does it apply necessarily to non surgical specialties?

...I always wondered...


maybe now that i'm postmatch i can go bug a faculty member from medicine and see how they do it and compare it to surgery....hehe

 

[Winged Scapula]

One question -- what you wrote definitely seems true based on what i've seen/heard on the gen surg interview trail this year....but does it apply necessarily to non surgical specialties?

...I always wondered...


maybe now that i'm postmatch i can go bug a faculty member from medicine and see how they do it and compare it to surgery....hehe

Obviously I would not have as much information about non-surgical specialties but most of my information comes from others, such as aProgDirector, whom have given the same advice.

That is, do ECs if you are genuinely interested, but they still come WAY down on the list of things seen as important by PDs when evaluating your application. Surgery or not. But let us know what your IM faculty says.

 

[DOwannaB]

I don't know where this belongs and I've searched around sdn but I've seen some allopathic residency programs that offer tuition assistance for spouse's of their residents and I was wondering if there are any DO residency programs that do this and which ones.

Thanks!

 

[DarthNeurology]

Sure...but I did them for reasons other than buffing my CV.

I was the bookstore manager - but because it got me a discount on books.

Treasurer and Charter Member of AMSA - they asked, so I said ok.

I'm not trying to discourage people from doing things they enjoy but it would be a huge mistake, IMHO, to do ECs because you think they make a significant difference in residency applications.

Too many med studs think that ECs are just as important for residency as they were for getting into medical school. Tis not true. I cannot say I ever say a faculty member rank someone higher because of their ECs. It comes down to USMLE Step 1, LORs, Class Rank, Step 2 and everything else far, far down the list.

Well that is a surprise, not that I am complaining at all as my board scores are the sharpest tool I've got in my toolbox for application for residency (96/99), . . . I feel most proud of ECs I've done because I wanted to do them and felt that they give me more perspective about medical care (read: make me a better future doctor). However, say someone else has board scores similar to mine, but has done a year of research or something else during medical school? I would think that person would "win" or get matched at a more higher ranked place. I am not going into surgery, but have seen more than a couple students who didn't match combined plastics or whatever, or even anticipated not matching and went for a research year after medical school to match into one of these fields. Sure people with higher board scores get more prestigious residencies, but you do hear about people who get dermatology or radiation oncology with *only* an average step 1 say 220 or less, . . . there must be another factor in play, and I think that would involve ECs . . . very interesting comment by Winged Scapula very different from what I would think really happens with PDs

 

[johnnywalker]

.

 

[RTrain]

Just thinking out loud here...

I'm on the fence about the EC thing, and granted I've only come at it from the applicant side, albeit for both residency and for fellowship. I was a competitive applicant for both, from the standpoint of scores/grades/research/letters, but I also did some unusual EC's that I highlighted in my CV (stuff that I enjoyed and did just because I wanted to make the time to do it). Seems that interviewers mostly wanted to talk about the stuff that gave my application a unique personality - we barely touched on my "credentials."

So while I don't doubt that the traditional stats get you in the door, having something interesting that you enjoy talking about will make the interview a lot more fun and productive.

 

[Winged Scapula]

Well that is a surprise, not that I am complaining at all as my board scores are the sharpest tool I've got in my toolbox for application for residency (96/99), . . . I feel most proud of ECs I've done because I wanted to do them and felt that they give me more perspective about medical care (read: make me a better future doctor).

You are presuming that PDs are necessarily looking for what you consider to be a "better doctor".

They are looking for someone who is personality compatible with good board scores ( all the better to increase their chances of passing specialty boards) and who doesn't have a history of being a flake (as far as they know).

However, say someone else has board scores similar to mine, but has done a year of research or something else during medical school? I would think that person would "win" or get matched at a more higher ranked place. I am not going into surgery, but have seen more than a couple students who didn't match combined plastics or whatever, or even anticipated not matching and went for a research year after medical school to match into one of these fields. Sure people with higher board scores get more prestigious residencies, but you do hear about people who get dermatology or radiation oncology with *only* an average step 1 say 220 or less, . . . there must be another factor in play, and I think that would involve ECs .

I don't consider research to be an EC...it may be outside of the curriculum, unless you took a year off to do research during school and it was reflected on your transcript.

Neither do most people consider research an EC. So while I agree with you that it can make a significant difference in matching, especially in some of the more competitive specialties ( you can't walk into a room full of Rad Onc interviewees without tripping over all their PhDs), I think it not relevant to the discussion of ECs.

. . . very interesting comment by Winged Scapula very different from what I would think really happens with PDs

Perhaps we have had different experiences but from 8+ years here, 6+ years in GME training, I've picked up a bit of info along the way. But I think it a mistake to think that, given two identical (hypothetical) candidates, that the one with membership in his Surgical Interest Society or volunteer work for HIV clinics, is going to be ranked higher simply because of those ECs. They may for interesting conversation (if indeed the interviewer even notices them), but that's about it. From the other threads here which frequently comment that interviewers are handed your ERAS profile, right before you walk into the door, do you really think most PDs are going to flip right to your page of ECs? Of course not and I'll bet in many cases (YMMV), they won't read through the packet or know about your ECs unless you tell them.

Some of us were good and got the packets a few days ahead of time and actually read them; not everyone does.

 

[Winged Scapula]

ECs seemed to be never even mentioned during interviews. Research was a big piece, especially at the more academic institutions that i interviewed. I think those people with 'only' 220s matched in competitive fields because they had some kind of 'in' with the program. They were from there, knew faculty, did an away rotation, had a letter writer who is well known in the field, something.... the fact that they were even offered an interview in such competitive fields indicates "its who you know." I doubt doing any EC, while look nice when adding it to ERAS and makes you a more rounded med student" in the long run mean virtually nothing.

Winged Scapula, how much input do residents, if any, have in the decision making, i am actually looking forward to seeing interviews from the other side this upcoming season

It will depend on your program.

At mine, the senior and Chief residents interviewed candidates and participated in the ranking and final matching session. There were many instances in which the faculty liked someone who was voted down by the residents (for whatever reason - usually something weird or inappropriate said or done during the interview or night before dinner). I always felt like my faculty took those comments very seriously as they realize we have to work with these people. And while interns and junior residents didn't formally interview, they did conduct tours, and spend time with the candidates and were always welcome to give feedback as they saw fit.

YMMV.

 

[DarthNeurology]

They are looking for someone who is personality compatible with good board scores ( all the better to increase their chances of passing specialty boards)

I don't consider research to be an EC...it may be outside of the curriculum,


Of course not and I'll bet in many cases (YMMV), they won't read through the packet or know about your ECs unless you tell the

Maybe this advice is more relevent for obtaining a surgical residency, obviously volunteering in an HIV clinic is more irreleveant for surgery than IM say, . . . interviewers do on occassion ask about Extracurriculars though if you do list them in your ERAS essay. Most programs will look at everything that you do in medical school, be it extracurriculars or school work. Of course programs like to get a good feel for an applicant to see if they will be a good match for the program. I don't know which hospital you are referring to, but several in Arizona are all about the feel of the match between the applicant and residency program, i.e. it is 95% percentage subjective, they really emphasize meshing with the faculty and senior residents. . . so there is probably truth in that, but it varies a lot by region and hospital. I think the more you project the image of "I'm one of you all" i.e. in terms of sense of humor, values, work ethic, even style of dress and mannerism of speach the more they will accept you into their program, i.e. hardworking resident group together in the same program, other programs are filled up to their noses in very social residents, whereas other programs have residents that do their work, but have a focus on family outside the program. . . (obviously this describes programs outside of surgery), so programs have a large number of residents that are lazy to a certain extent or at at least complain about working, I've volunteered or rotated at over 25 hospitals including work before medical school and have had numerous interactions with residents and PDs and birds of a feather flock together.

I think Winged learned a new acronym, YMMV, as it is used twice in response to two different posts in the same thread!

 

[Winged Scapula]

Maybe this advice is more relevent for obtaining a surgical residency, obviously volunteering in an HIV clinic is more irreleveant for surgery than IM say, . . . interviewers do on occassion ask about Extracurriculars though if you do list them in your ERAS essay. Most programs will look at everything that you do in medical school, be it extracurriculars or school work. Of course programs like to get a good feel for an applicant to see if they will be a good match for the program. I don't know which hospital you are referring to, but several in Arizona are all about the feel of the match between the applicant and residency program, i.e. it is 95% percentage subjective, they really emphasize meshing with the faculty and senior residents. . . so there is probably truth in that, but it varies a lot by region and hospital. I think the more you project the image of "I'm one of you all" i.e. in terms of sense of humor, values, work ethic, even style of dress and mannerism of speach the more they will accept you into their program, i.e. hardworking resident group together in the same program, other programs are filled up to their noses in very social residents, whereas other programs have residents that do their work, but have a focus on family outside the program. . . (obviously this describes programs outside of surgery), so programs have a large number of residents that are lazy to a certain extent or at at least complain about working, I've volunteered or rotated at over 25 hospitals including work before medical school and have had numerous interactions with residents and PDs and birds of a feather flock together.

Absolutely, so we are arguing the same thing. Nothing you've said above convinces me (and believe me I have trained and been at numerous other hospitals in other states as well) that ECs are a significant factor in matching. As you point out, fitting in and sharing several values are important and these factors are assessed during the interview. The most important factor generally is this and your academic record. ECs may be interesting to talk about but I'll doubt in any one of your 25 hospitals that any resident was selected because of their time spent working in an HIV clinic (IM resident or not).

Your argument that residents and PDs seem to be similar may also be flawed...it is well recognized that groups that spend time together become more similar over the course. Without knowing the residents before they matched, it would be hard to say whether they were like each other prior or became more like each other during residency.

I think Winged learned a new acronym, YMMV, as it is used twice in response to two different posts in the same thread!

I know you rather enjoy thinking you pwnd the attending but I have been quite familiar with the term YMMV for several years. It just happens to be a coincidence that I have used it more than once in recent threads.

 

[DarthNeurology]

As you point out, fitting in and sharing several values are important and these factors are assessed during the interview. The most important factor generally is this and your academic record. ECs may be interesting to talk about but I'll doubt in any one of your 25 hospitals that any resident was selected because of their time spent working in an HIV clinic (IM resident or not).

Your argument that residents and PDs seem to be similar may also be flawed...it is well recognized that groups that spend time together become more similar over the course. Without knowing the residents before they matched, it would be hard to say whether they were like each other prior or became more like each other during residency.

What would you say about that by 2011 it appears that step 1 and step 2 may become combined AND only a passing score may be be issued, i.e. no numbers. . . I guess class rank will be super important then? This will make it hard to figure who can pass the board exams later on I guess? One piece of consideration for residency missing here is the supposedly even more important rotation evaluation in your field of choice, i.e. you need Honors in surgery to get a residency, . . . one guy who wanted plastics was pretty well known by surgery attendings before he started the clerkship via Surgery Club and networking, so when he got in the clerkship he sort of already had browney points and got to do more stuff, i.e. more surgeries given to him and all the residents were sort of impressed with everybody he knew, so in that way I think that ECs help network a lot in terms of getting good LORs, which are important to a certain degree for medicine at least, and just knowing the ins and outs of the specialty. I would guess that a great LOR from a big time surgery department head goes a long way, . . . if your goal is to just get a surgery residency at an average university program then probably just focus on acing the boards, but if you want to really figure out which programs to apply to and get doors opened for you then ECs viewed as networking are a good idea and critical for getting a great match I would think

 

[Winged Scapula]

What would you say about that by 2011 it appears that step 1 and step 2 may become combined AND only a passing score may be be issued, i.e. no numbers. . . I guess class rank will be super important then? This will make it hard to figure who can pass the board exams later on I guess?

Agreed...this will make it harder to evaluate candidates. Although the boards were never designed to be used in this fashion, they obviously have become a common measure of competitiveness. So, if they become pass/fail then yes, programs will have to use other measured...class rank, LORs, etc. as being even more important than they are now.

One piece of consideration for residency missing here is the supposedly even more important rotation evaluation in your field of choice, i.e. you need Honors in surgery to get a residency,

Not true, at least not everywhere. Some schools do not award Honors and their students are still successful in matching into surgery. No denying that it can be helpful and perhaps will become more so if the USMLE does become pass/fail.

. . . one guy who wanted plastics was pretty well known by surgery attendings before he started the clerkship via Surgery Club and networking, so when he got in the clerkship he sort of already had browney points and got to do more stuff, i.e. more surgeries given to him and all the residents were sort of impressed with everybody he knew, so in that way I think that ECs help network a lot in terms of getting good LORs, which are important to a certain degree for medicine at least, and just knowing the ins and outs of the specialty. I would guess that a great LOR from a big time surgery department head goes a long way, . . . if your goal is to just get a surgery residency at an average university program then probably just focus on acing the boards, but if you want to really figure out which programs to apply to and get doors opened for you then ECs viewed as networking are a good idea and critical for getting a great match I would think

Obviously connections, especially in smaller surgery subspecialties like Plastics, are immensely important but it would be untrue to assume that the only way you get these is through ECs. As a matter of fact, I would venture that most people who match into those fields do so by simply meeting faculty during their rotations or research projects. Every school I've been affilitated with has had some sort of Surgery Interest Club and I'd be willing to bet large sums of money that the faculty have no idea who is involved in it. They may recognize a face but not the name, so your example is probably a rare one. Besides, its not fair to generalize from an extremely competitive field like Plastics to the grand scheme of residency matching. I'm not saying that ECs are never important no more than I would say that for connections and networking; but for most residents, they are not worth spending their time on.

Look, I get that you believe that ECs are vitally important to a residency application. I'm sure you can come up with a thousand anecdotes about a successful application with loads of ECs. I can come up with just as many to show you that ECs are at the bottom of the list of importance. Even at big time programs...you can match very well, in a competitive field, with little more than academic success and absolutely no ECs. Do you have to network and get to know the faculty for LORs? Sure....but EVERY resident, regardless of field and competitiveness, has to do that. There is nothing special here.

My point, which I am getting increasingly tired of arguing, is that for most people, for most programs, for most specialties, the ECs are not a significant factor in matching. They may get you some connections, they may be something interesting to talk about during interviews, they may separate you out from the crowd if they are exceptional (ie, world class athlete), but you and others are fooling themselves if they think that spending a great deal of time on these activities will make a big difference when it comes to matching. Spend your time studying and working hard during your clinical rotations - that will make much much more difference.

You don't have to believe me, nor do you have to respect my opinion but given that I was asked what I believe and have seen to be true, I would venture that I probably know more about this topic than you do as a student.

/explanation and discussion of this topic

 

[DarthNeurology]

Do you have to network and get to know the faculty for LORs? Sure....but EVERY resident, regardless of field and competitiveness, has to do that. There is nothing special here.

My point, which I am getting increasingly tired of arguing, is that for most people, for most programs, for most specialties, the ECs are not a significant factor in matching. They may get you some connections, they may be something interesting to talk about during interviews, they may separate you out from the crowd if they are exceptional (ie, world class athlete), but you and others are fooling themselves if they think that spending a great deal of time on these activities will make a big difference when it comes to matching.

You don't have to believe me, nor do you have to respect my opinion but given that I was asked what I believe and have seen to be true, I would venture that I probably know more about this topic than you do as a student.

/explanation and discussion of this topic

I wouldn't suggest that students shouldn't work hard on rotations, or study hard, I certainly come first, never leave before anybody else and read everyday, and tried and accomplished acing the boards to a certain degree of success. Of course this will help and may get you your residency of choice. For FMGs, of which you appear to be based on your profile, it is very important to get high board scores as this allows PDs differentiate students from schools they don't know. Say you have a student who went to Harvard Medical School, this person the PD will rank higher with equal grades and evals compared to someone from perhaps an equally great school in Australia. Likewise, if you get a LOR from a big time professor in the surgery department with whom you have interacted with multiple times during Surgery Interest Groups then this will help some, if nothing Surgery Interest Groups bring in attendings to talk about various subspecialties in Surgery and how to apply for surgery residency, I feel that if you are an active participant in these clubs then you are "plugged in", and will indirectly greatly benefit in your residency application apart from any real direct benefits. For example in internal medicine, say you do the HIV clinic for a summer, and say you do HIV research part-time in medical school. When medicine rolls around, i.e. the real clerkship, and you have an HIV patient you will ace presenting this patient if you have seen 100+ such patients in HIV clinic. Medicine is about trying to conquering a small meadow of knowledge and then moving to other areas, so if you don't a little in one area no matter how small at least you know it as well as a resident. Such benefits from ECs are mostly indirect, and part of what I meant in increasing your chances of matching in a residency. Many residencies don't care about ECs, these are middle of the road residencies I believe who want a warm body with good/great boards, good evals, end of story. Great residencies want good/great boards, good evals, good ECs too that demonstrate leadership, i.e. if you have 100 applicants with 99/99 applying for Medicine at MGH, and one spent four years in the HIV clinic and did research on it, and maybe started a program, this one gets the leg up. Also you assume, very falsely I believe, that you can't do both EC and focus on studying and clinical work. I would whole heartedly disagree as hard work begets hard work, I did BETTER in basic sciences when I was working on time-draining ECs as well, and yes I did think it is paradoxical, but you have to learn to multitask to be an excellent resident, IMHO, i.e. do your own ADLs, take care of family if you have it, do the research , see the patients, etc . . . I would bet big money if you could show me a medical student who felt that if they had less ECs they could have gotten better grades, (I am talking about 4-8 hours per week, even so there are people with JD who practice part time on the weekend and still manage to get excellent evals, . . . ) Reminds me of the story of the college student who maintained a 3.9, worked part-time, and trained 8 hours a day for a statewide athletic event, and went on to win a Gold Medal in the Olympics, . . . people have more free time than you would think. In terms of connections helping people (I know we should be a meritocracy, but who you know matters), there is the story of the young entrepeneur who went to visit J.P. Morgan at the turn of the 19th Century on the floor of wall street to ask for a loan, he came with all the research and numbers he could find to buttress his case and to show that he put hard work into his proposal, and Mr. Morgan said, "Let me give you something more valuable" and he held his arm around this young man's shoulder and walked with him around the floor of the stock market, which everybody noticed and gave him almost instant credibility in the financial world. It pays big time to know people in high places, or rather to rub shoulders with them and see how they became successful practicioners of whatever specialty. At the very least doing extracurriculars as a student, i.e. in an HIV clinic gives you a lot of self-confidence, so when your self-esteem is whittled away in third year at least you started at a higher baseline. Based on this the advice of, "Just focus on getting high grades on the boards and doing well in the clinicals" I would say it is important to do well in boards and on clinicals, and doing a moderate to heavy number of ECs helps big time. I have used my research probably 3 times for formal presentations on clinical rotations, (impressed people) and helped me to narrow down the differential diagnosis in several situations, i.e. I knew what the patient couldn't have, . . . I really was able to talk with confidence about this topic during rounds at any time of the day, every medical student should have at least a couple pet topics they have done research in and read more than 20 papers, . . .

Also, I do respect Winged's opinion, I just am stating my point of view, with thousands of residency programs out there it is easy to generalize, but undoubtedly there are some programs that scrutinize more than others.

 

[AlternateSome1]

I wouldn't suggest that students shouldn't work hard on rotations, or study hard, I certainly come first, never leave before anybody else and read everyday, and tried and accomplished acing the boards to a certain degree of success. Of course this will help and may get you your residency of choice. For FMGs, of which you appear to be based on your profile, it is very important to get high board scores as this allows PDs differentiate students from schools they don't know. Say you have a student who went to Harvard Medical School, this person the PD will rank higher with equal grades and evals compared to someone from perhaps an equally great school in Australia. Likewise, if you get a LOR from a big time professor in the surgery department with whom you have interacted with multiple times during Surgery Interest Groups then this will help some, if nothing Surgery Interest Groups bring in attendings to talk about various subspecialties in Surgery and how to apply for surgery residency, I feel that if you are an active participant in these clubs then you are "plugged in", and will indirectly greatly benefit in your residency application apart from any real direct benefits. For example in internal medicine, say you do the HIV clinic for a summer, and say you do HIV research part-time in medical school. When medicine rolls around, i.e. the real clerkship, and you have an HIV patient you will ace presenting this patient if you have seen 100+ such patients in HIV clinic. Medicine is about trying to conquering a small meadow of knowledge and then moving to other areas, so if you don't a little in one area no matter how small at least you know it as well as a resident. Such benefits from ECs are mostly indirect, and part of what I meant in increasing your chances of matching in a residency. Many residencies don't care about ECs, these are middle of the road residencies I believe who want a warm body with good/great boards, good evals, end of story. Great residencies want good/great boards, good evals, good ECs too that demonstrate leadership, i.e. if you have 100 applicants with 99/99 applying for Medicine at MGH, and one spent four years in the HIV clinic and did research on it, and maybe started a program, this one gets the leg up. Also you assume, very falsely I believe, that you can't do both EC and focus on studying and clinical work. I would whole heartedly disagree as hard work begets hard work, I did BETTER in basic sciences when I was working on time-draining ECs as well, and yes I did think it is paradoxical, but you have to learn to multitask to be an excellent resident, IMHO, i.e. do your own ADLs, take care of family if you have it, do the research , see the patients, etc . . . I would bet big money if you could show me a medical student who felt that if they had less ECs they could have gotten better grades, (I am talking about 4-8 hours per week, even so there are people with JD who practice part time on the weekend and still manage to get excellent evals, . . . ) Reminds me of the story of the college student who maintained a 3.9, worked part-time, and trained 8 hours a day for a statewide athletic event, and went on to win a Gold Medal in the Olympics, . . . people have more free time than you would think. In terms of connections helping people (I know we should be a meritocracy, but who you know matters), there is the story of the young entrepeneur who went to visit J.P. Morgan at the turn of the 19th Century on the floor of wall street to ask for a loan, he came with all the research and numbers he could find to buttress his case and to show that he put hard work into his proposal, and Mr. Morgan said, "Let me give you something more valuable" and he held his arm around this young man's shoulder and walked with him around the floor of the stock market, which everybody noticed and gave him almost instant credibility in the financial world. It pays big time to know people in high places, or rather to rub shoulders with them and see how they became successful practicioners of whatever specialty. At the very least doing extracurriculars as a student, i.e. in an HIV clinic gives you a lot of self-confidence, so when your self-esteem is whittled away in third year at least you started at a higher baseline. Based on this the advice of, "Just focus on getting high grades on the boards and doing well in the clinicals" I would say it is important to do well in boards and on clinicals, and doing a moderate to heavy number of ECs helps big time. I have used my research probably 3 times for formal presentations on clinical rotations, (impressed people) and helped me to narrow down the differential diagnosis in several situations, i.e. I knew what the patient couldn't have, . . . I really was able to talk with confidence about this topic during rounds at any time of the day, every medical student should have at least a couple pet topics they have done research in and read more than 20 papers, . . .

Also, I do respect Winged's opinion, I just am stating my point of view, with thousands of residency programs out there it is easy to generalize, but undoubtedly there are some programs that scrutinize more than others.

I do not believe that Winged ever expressed an assumption about not being able to work hard and do ECs. She simply stated that she felt, as an attending and as someone with previous experience in reviewing residency applications, that she felt solid grades and board scores were much more important. This seems pretty reasonable to me, as no amount of Olympic training, HIV clinic starting, or general saving the world is going to have as much effect on residency performance as clinical knowledge and critical reasoning skills.

 

[johnnywalker]

...

 

[buckley]

Okay...what is YMMV and why is it causing such a ruckus?
I actually had to google it...it's not in wikipedia
I'm getting "your mileage may vary" ?

I always thought ECs were the stuff that you do that normally isn't a part of your field of study..extra + curricular...outside the curriculum? like tennis or volunteer work. I don't think they matter so much in getting a residency/ job. They surely won't hurt, and they can even help, as long as you don't slack off on your studies because of too much EC's. And I have seen that happen with a lot of people. I think it's sort of do the curriculum first before worrying about the extra's. But hey, if it makes you happy, it makes you happy.


"If you are not enjoying yourself, you are wasting your time." --Susan Jeffers

 

[DarthNeurology]

First off I am a US MD to be, and interviewed at highly ranked and less highly ranked IM programs, . . .

No way the great residencies care more about ECs. And after they hit the board scores and LORs that you mentioned above, they'll hit other qualities like...Who does he/she know? was he or she completely unimpressive or say inappropriate things that send up red flags during an interview or while meeting with the residents? Who does he/she know? What is his/her medical school?

Well, I never said that ECs are more important than board scores, I was just countering the point that Winged seemed to state that the name of the game was to solely focus on boards and rotations. If the name of the game is to get "a residency" in surgery or whatever field and then you will be happy with that then fine, maybe you will be successful, maybe not. What Winged offers is a "tactical piece of advice" to go after acing the boards and rotations (without mentioning how, but for most of us that is obvious) and then you get residency, end of story. Winged's advice seemed simplistic and potentially unintentionally misleading to me and I felt the need to paint a biggger picture.

But the story doesn't end there, residencies are different even in the same field, career choices post residency are different, how you jockey for positions, influence or whatever is different. . . to succeed you need more than a few obvious tactics, which everyone knows. It is like telling young drivers that to drive all they really need to know is how to go through an intersection and change lanes, obviously these are fundamentals, similar to what Winged offers, and no problem you will pass and get a driver's license, . . . but of course there may be a written driver's test or parallel parking.

What I am advocating is a grand strategy, (something more broad sweeping than just tactics which are used to accomplish the strategy), my strategy involves both studying hard and acing boards and doing a couple ECs which give perspective of the medical field and inform your later decisions in ways you can't understand if you don't do them. There are many hidden bonuses to doing some ECs, like maybe 4-8 hours/week in medical school that will have a good to great chance of improving your residency application, and most certainly will make you more comfortable with and aware of your choices later on.

 

[Winged Scapula]

What I fear you are failing to understand is that while my answer may be simplistic to you, it is shared by thousands of US PDs across the country. Time and time again, surveys of important factors in assessing residency applications are published and ECs are no where near the top of the list.

And this is not about surgery, as you seem to be fixated on. These are the results from surveys of PDs in ALL fields of medicine. Are there individual PDs who might look more highly on ECs than others? Sure. Just as there are individual PDs and faculty who actually read your personal statement, there are just as many who don't even glance at it. I for one am glad my residency PD read my PS before interviewing me, but I have no doubt that had I not had the scores that it wouldn't have made a difference how well rounded or eloquent I was.

I suppose I could have told the OP that there is no conventional wisdom/answer on how to get the best residency because every faculty member across the US is looking for something different. But that wouldn't be helpful nor is it true...there are some conventional wisdoms that hold up, and getting good USMLE scores, LORs and clinical evals is one of them. Your grand strategy is fine but the vast majority of residents will not be helped by it without these prerequisites. It may assist the borderline student but I believe you are doing a disservice to advocate that ECs are anywhere near significant when it comes to matching.

I never said that ECs didn't serve some purpose. They are fun, they can make you a more well rounded person, and they may serve as an interesting topic of conversation during an interview. But to tell a student driver (to use your analogy) that tuning the radio station to classic rock is as important as knowing how to brake, accelerate and use the turn signals is patently false.

 

[DarthNeurology]

It may assist the borderline student but I believe you are doing a disservice to advocate that ECs are anywhere near significant when it comes to matching.

I never said that ECs didn't serve some purpose. They are fun, they can make you a more well rounded person, and they may serve as an interesting topic of conversation during an interview.

Ok Winged, let's look at two fields perhaps where you don't have as much experience, 1. Emergency Medicine Residency, and 2. Fellowship application post IM residency (Something to consider in the future when doing ECs in medical school):

1. From the article by Joseph T. Crane, Selection Criteria for Emergency Medicine Applicants, ACADEMIC EMERGENCY MEDICINE: January 2000 Volume 7, Number 1. (EM is a competitive field more so than IM): Conclusions: "Our results suggest that the most important criteria in EM resident selection are those that specifically relate to EM, with EM rotation grade the most important factor." Their list of most important factors are:

1. Emergency Medicine Rotation Grade
2. Interview
3. Clinical Grades
4. Other
5. Recommendations (Students get great letters from professors they interacted with during the whole time in medical school, not just plowing through a four week elective, ECs anyone?)
6. Grades Oveall
7. Elective at Program Director's Institution (Done if you do ECs in the ED at your home institution, i.e. they know you well.)
8. Board scores overall
9. Step II
10. Interest expressed (Hello? ECs you can talk about during interview show interest!)
11. USMLE Step 1
12. Awards/Achievements
13. AOA status
14. Medical School attended
15. Extra-curricular activities
16. Basic science grades
17. Publications
18. Personal Statement

"Although extra-curricular activities ranked relatively low , this information provides insight into the applicants interest, hobbies, and activities outside of medical school." Also, the article noted that extracurricular activities are noted in the Dean's letter, so this information shows up in a couple of places in the application. I would wager that type of ECs I would promote, such as volunteering in an ED during medical school is the same as basically doing an ED elective at your school, i.e. you know the names of all the big-shot ED attendings volunteering to do H and Ps in the ED and they will be happy to whip out an excellent LOR, at the very least involvement in Emergency Medicine solid ECs will almost certainly help you ace the all important Emergency Medicine elective, i.e. if you see patients in the ED as a first and second year informally then you get a leg up. If you do a research project in the ED as a first and second year you get a big leg up as you get an excellent LOR from that academic ED attending. It is simplistic to say ECs are low so don't do them, nothing could be farther from the truth I believe, especially since they take so little time. Who knows what is in the "other" category. . .

Now let's look at selection for fellowships in Internal Medicine:

1. Fellowship Interview
2. LOR from known specialists
3. IM Program Director LOR
4. Univeristy Based Residency
5. Research Interest
6. No H-IB Visa
7. Elective at fellowship site
8. USMLE scores
9. Publications
10. US Medical school
11. US citizen
12. Research experience
13. Chief Residency
14. Phone call from IM Program Director
15. Well-written personal statement
16. LOR from attendings not in fellowship field
17. Applying during residency
18. Extracurricular activities

While extracurricular activities are low, research activities are not, and LORs from people in field is not. So I would wager that good ECs help in the long-term, i.e. I would consider research an EC, except obviously for that which is done in an MD/PhD program, i.e. it puts you in contact with big names in the field which helps getting a good residency positions, and apparently if you can do research during residency it helps a lot.

My point I guess is that good ECs have overlap into other areas such as research and getting to know people. I am NOT talking about hobbies such as carving floating beach wood which I believe is unfairly mixed into the general category of ECs. . . Obviously doing research helps as does most likely working on substantiative projects with attendings outside of the regular curriculum.

I will admit that Winged is correct that objective measures of medical student performance such as Step 1 and 2 are more important than most students realize, as well as grades on third year clerkships are more important than most students realize and such objective measures become more important as competition for residency increases. That being said I believe you can have your cake and eat it too, i.e. if I were to go back in time and decided I wanted to do Emergency Medicine I would volunteer in an ED on day #1 of medical school and start a research project in the ED on day #1 in basic sciences. Why for? Because this would give me excellent experience working with ED patients and excellent research experience. I would study very hard for Step 1 during basic science years, trying to see what my school's curriculum missed during those years, and of course study well for examinations in school, but with a goal of acing Step 1 and then Step 2 and clerkship exams. I think my advice is better suited to first and second years.


Check out this resource at : http://edaff.siumed.edu/Year4/expectations_of_incoming_residents.htm

Dermatology:

• What expectations does your residency program have regarding research experiences? Are entering residents expected to have engaged in or published research either independently or in conjunction with others?

• Exposure to research and participating in research are preferable. More importantly is attempt at publication and experience in scientific writing.

Family Medicine on USMLE:

• What do you look for in USMLE scores? How do you use them in evaluating a candidate's application?

• Passing necessary, prefer average or better, one criterion used in ranking applicants, not the most important.
• Passing at a minimum, but higher Part II is better.
• As long as they are average, we do not base acceptance on high scores.
• Not to have failed – Progressive from USMLE I to II.

Internal Medicine:

• What do you look for in USMLE scores? How do you use them in evaluating a candidate's application?

• 80 for Steps 1 & 2. This is not a clear cut call, but close.
• The higher, the better.
• I prefer scores above 200, I also want the USMLE II in particular to be good. These scores are used as an overall part of the assessment of a candidate.
• We have a minimum USMLE requirement for non-US Grads. No such requirement is in place for US Grads. US Grads made up only 30/35% application received this year to our program.
• Greater than 220. Not our highest priority. Professional skills are key.

Pediatrics:

• What do you look for in USMLE scores? How do you use them in evaluating a candidate's application?

• Difficult. I am concerned if they have to re-take a step (Fail the first time).
• Not much. Greater than 190.

​

 

[XoQo]

on a completely *unrelated* note (excellent discussion above i might add)...

...DarthNeurology....why do u have a coconuts eaten count?

 

[DarthNeurology]

on a completely *unrelated* note (excellent discussion above i might add)...

...DarthNeurology....why do u have a coconuts eaten count?

"Coconuts" are a unit for something else I am tracking and I so I will update it as I "eat more coconuts" I should have made just a list on my computer but I wanted something I could add "cocounuts" to anywhere, in other words you would have to guess and if you got it right then maybe I would tell you , heh heh Believe it or not, but you just reminded me to "eat more coconuts today . . ." so I guess it helped having this counter already!

 

[Winged Scapula]

Darth, I get that you are very passionate and committed to your argument and I thank you for posting a reference which proves my point. But I'll ask you not to make assumptions or put words in my mouth to try and bolster your argument.

To whit:

- I never said research wasn't important. As a matter of fact, I have, on multiple occasions, noted that it is essentially required for some residencies, PRS and Rad Onc, frequently being mentioned.

- I never said LORs weren't important. Obviously they are and we look at them carefully. So much so that a letter from someone who doesn't know you clinically is essentially worthless in many cases. Thus, please don't try and make the claim that I don't understand that letters are important nor try and convince me that an LOR from an attending who met you at your "EM Interest Society" (or whatever) will be anywhere near as relevant as someone with whom you spent a considerable amount of time with in a clinical rotation. This is conventional wisdom and you will be hard pressed to find someone who doesn't prefer a letter from clinical faculty who have watched you in a clinical manner rather than from someone who has not...regardless of the length of your interaction with them.

- I never said ECs didn't make for interview fodder. As a matter of fact, I mention this as a by-product of ECs. If I see someone who describes an interest or research work in nutrition, we very often spend some time talking about how that can be dovetailed into residency training. But I have never ranked a candidate higher, nor has anyone I've spoken to, because of their ECs.

- We have not discussed fellowship before. If you had asked me what fellowship directors looked for in a candidate, I would not tell you its USMLE scores, other than the fact that you've passed. Clearly things like interview presence, ITE scores, clinical evals and LORs are most important when assessing a fellowship candidate and I would have told you the same, had you asked. You did not, but rather assumed I was wrong on this front as well. So I'll ask you to stop trying to make an argument where none exists.

- Clearly I was not talking about wood carvings when speaking of ECs and its a bit insulting for you to assume I was talking about such lightweight things. All the data you've provided shows ECs WAY down on the list of things that are important to residency program directors.

The whole point, which you are missing time and time again, is that in almost all cases, for almost all students, USMLE scores, clinical evaluations and LORs are going to be vastly more important than ECs. Other factors such as school attended, need for visa, etc. are also more important but since students can't do much to change that, its not worth mentioning when the OP asks about what he can do to strengthen his residency application. ECs are just not powerful enough a factor to carry much weight in most situations. If you are the rare student that hooks up with a clinical faculty member as an MS-1 and works closely with them for 4 years and gets a fantastic letter from them, more power to you. Most students do not and recognize that is ONE piece of information in your application and not the deciding factor.

Obviously you believe you know more about this than I, despite the data you've provided above which proves me right. If it makes you feel better, I promise to look more closely at applicant's ECs this year when evaluating their applications. We will not agree on this argument and therefore, I have no more interest in continuing the discussion with you and will post no more about it.

 

[DarthNeurology]

Darth, I get that you are very passionate and committed to your argument and I thank you for posting a reference which proves my point. But I'll ask you not to make assumptions or put words in my mouth to try and bolster your argument.

To whit:

- I never said research wasn't important. As a matter of fact, I have, on multiple occasions, noted that it is essentially required for some residencies, PRS and Rad Onc, frequently being mentioned.

- I never said ECs didn't make for interview fodder. As a matter of fact, I mention this as a by-product of ECs. If I see someone who describes an interest or research work in nutrition, we very often spend some time talking about how that can be dovetailed into residency training. But I have never ranked a candidate higher, nor has anyone I've spoken to, because of their ECs.

If you are the rare student that hooks up with a clinical faculty member as an MS-1 and works closely with them for 4 years and gets a fantastic letter from them, more power to you. Most students do not and recognize that is ONE piece of information in your application and not the deciding factor.

By the by, you've made an excellent choice with Neurology as your field, as you seem to possess an enduring interest in mental masturbation over things you cannot change.

I don't believe I have ever asserted that ECs are more important than step scores or clinical evaluations. You took the positions that ECs practically do not count at all. The definition of ECs in many students minds includes research, which you did not mention in your original post in this thread when you blindly critizing activities such as volunteering in the HIV clinic". Some US schools are very small and people you interact with during ECs that you deride may very well be the same people you see on clinical rotation. Regardless, just the benefit of interacting with more attendings will improve a student's performance on clerkships. Let's say a driving student passes the test for a driver's license, you would say that is solely due to the fact they took the official driver's school course and studied for the test, but I would say also if in addition if they drove on their uncle's farm, played videos games to improve hand-eye cooridnation, and know how to bicycle that helps some too (transferable skills). The skills you learn in good high quality medical school ECs are transferable to places where it counts, i.e. clinical clerkships and board exams. I don't need to believe I know more about a topic than someone to post a piece of advice, which in this case as residency application is very subjective. Maybe we should only allow the most knowledgeable people on each topic on SDN present their point of view. If I was applying for surgery residency I would take the advice of 20 students who just went through the process over you as you are just one person, whereas these students interacted with probably 20 PDs this year and each have valuable advice about the residency game. But you seem to confuse two issues:

1. You think I am saying ECs are more important than step scores, wrong, or more important that clinical rotation grades, wrong, wrong, wrong.

2. Optimization of your residency application may involve minimal ECs 4-8 hours a week, and plus research when you can do it, and networking is positive. You are arguing that you should spend 100% of allocatable time in medical school to studying, I am arguing more for a 85% study/15% EC approach, after all you can only study so much, and ECs give you a fresh perspective on residency decisions that may lead you to apply to different fields. Please don't denigrate this strategy with your "ECs don't matter" comments. In the end shining on clinical rotations has to do with how prepared you are, if you already have spent 200 plus hours in the ED or in another hospital department/clinic you won't be freaked out about when you do IM in third year because you are afraid you will look like you don't know anything. Winged's blue print for sucess in medical school doesn't offer any advice about how much studying should be done.

Your impression of neurology is obviously dated, i.e. neurologists DO a lot more these days than in the past, including TPA, including medical management, including a multitude of new clinical trials, including interventional neurology. Thanks for denigrating a field that takes care of the millions of Americans with devastating neurologic disorders, at least Neurology had a Decade of the Brain, i.e. intensive research into neurological disorders, and we are begining to reap the rewards.

Take into consideration than middle of the road General Surgery residency is much less competitive than in past, and perhaps my comments are better suited to students who are applying to more competitive specialties where questions about what will you bring to the field are most closely scrutinized such as dermatology, radiology, radiation oncology, ENT, Urology, Neurosurgery, Plastics, Combined Vascular, top anesthesiology, top IM programs, top Peds programs, top pathology programs, opthalmology, top ob/gyn programs. So if you just want "a general surgical residency" then perhaps following Winged's advice is sufficient, I can't really comment on that specific scenario.

 

[RTrain]

The definition of ECs in many students minds includes research, which you did not mention in your original post in this thread when you blindly critizing activities such as volunteering in the HIV clinic".

Actually, WS did specifically say that she is not including research in her definition of extracurriculars:

I don't consider research to be an EC...it may be outside of the curriculum, unless you took a year off to do research during school and it was reflected on your transcript.

Neither do most people consider research an EC. So while I agree with you that it can make a significant difference in matching, especially in some of the more competitive specialties ( you can't walk into a room full of Rad Onc interviewees without tripping over all their PhDs), I think it not relevant to the discussion of ECs.

This is all quite comical: a student who is arguing with an attending who reviews residency applications and interviews candidates about what people who review applications and interview candidates think. Why don't you just accept that she is giving you valuable information about what is in the minds of those people who review residency applications? When you're reviewing apps, you can do so in whatever way you wish.

 

[johnnywalker]

...

 

[DarthNeurology]

Therefore, for almost everything else, spend your time studying to do well on Step 1. No one will really care if you volunteered at your school's HIV clinic, were class president or spent the summer between 1st and 2nd year working in a lab.

(NB: BTW, in academics, a resume is called a CV - your curriculum vitae which highlights your educational accomplishments and not the summers you spent lifeguarding)

Working in a lab in between years 1 and 2 could pehaps lead to a bigger research project. This statement by Winged sort of makes it look like research doesn't count, later does she change course. Again, I think there are intangible benefits from doing ECs beyond what a program director looks at when reviewing your ERAS, i.e. indirect benefits.

 

[DarthNeurology]

Fine, whatever, students have a different perspective. So, why don't you all just go home and study 14 hours a day and don't both to participate in any HIV clinic, summer of research, Surgery club or anything else, Winged says it doesn't matter so don't do it so why on earth would you do something that won't advance your career? I am sure all the medical schools in the southwest have Winged come in on orientation and list the only important things: 1. USMLE and 2. Clinical Grades. It would be a quick presentation, about 30 seconds, the schools could save a lot of money by not having to pay for frivilious and wasteful activities like HIV clinics, internal medicine interest groups, medical spanish clubs.

 

[BlondeDocteur]

To re-stir up this little tempest in a teapot, I'll add my two cents...

Numbers get your foot in the door. They're a hurdle to be cleared.

ECs/resume is what could seal the deal, assuming they're of interest. In my experience, limited as it may be, my CV has been the source for most of my interview discussion, both for med school and with current PDs. Though this is to be taken with a huge grain of salt since I haven't gone through the interview process yet...

 

[DarthNeurology]

To re-stir up this little tempest in a teapot, I'll add my two cents...

Numbers get your foot in the door. They're a hurdle to be cleared.

ECs/resume is what could seal the deal, assuming they're of interest. In my experience, limited as it may be, my CV has been the source for most of my interview discussion, both for med school and with current PDs. Though this is to be taken with a huge grain of salt since I haven't gone through the interview process yet...

I wouldn't doubt this given your much more than average ECs, borderline olympic stuff here (based on past posts), ECs do help to have something to talk about when asked why you want to do a certain specialty at least on rotations I've been on. Being fluent in a couple languages has helped me too, i.e. the residents have to wait for me to see some patients, heh heh

 

[johnnywalker]

...

 

[XoQo]

hey folks...anyone out there care to submit a real example of how your EC made a difference in getting you to where ya wanted to be for residency? sorry DN, looking for someone that has finished ERAS, interviewed and successfully matched, not someone who only has assumptions...

I just went thru applications/interviews/match for gen surg this year. I don't think i can offer you anything concrete beyond speculation.

why?


1.) i don't know where i was on the match list for where i matched, or the grades/scores/ECs for those who were ranked near me.

2.) I'm not comfortable asking my new PD why he ranked me high enough to match, mainly cuz i'm afraid he'll change his mind and fire me before i even start (yes paranoia, I know. the program would be sanctioned by NRMP if he did that. But frankly i'm humbled by the fact that i matched where i did and i don't want to rock the boat. at all!).

3.) my personal speculations are that for at least general surgery (i have NO clue about ANY other specialty) programs might be doing something like this:

-before you even interview, you get stratified based on scores/grades/letters/research into broad groups of "rank highly" "rank in the middle" or rank as safety so we make sure we fill
-at the interview, you are more likely to get move around within your strata than to move into a different one. if a particularly cogent EC comes up (maybe you did an international away rotation and the program you interview at does surgery in foreign countries for a month or two at at time ---> then you might gain a few ranks or two for it if you speak intelligently about it).

-i *don't* think ECs like being on the surgical interest group at your school really helps. might help you network a bit and make the faculty at your school more easily look favorably upon you. But that very likely does not affect your ranking. Nor does your volunteering at community clinics. Funny thing. I never wrote on ERAS about my volunteer work. Mainly cuz it was sporadically me showing up at clinics whenever i felt like it -- and i didn't think it was enough of a commitment to record it in ERAS. Never once was I asked during an interview: " so how come you never did any volunteer work during med school" =)


Again i emphasize that my experiences have been with only the general surgery interview/match process. Who knows if this is true for other specialties. And i have no idea if my suspicions are even true. Maybe at some programs i got dinged a few ranks cuz there was no mention of volunteering -- and they just never asked about it. All speculation on my part.

In the end, my choices in med school for what i did and did not do boiled down to: i didn't want to do the stupid high school (or undergrad) ratrace. I did the things that i enjoyed. And didn't do the things that i thought were ******ed. For me, it seemed to work out in the end and i'm ecstatic about matching to my #1.

But had my #1 been a different school, i might not have matched there successfully either. There are just too many damn variables!