Residency matching - does school matter?

[wya2020]

Now with step 1 p/f, is where you go to school that much more important in specialty matching? I would think when step was still scored, as long as you did really well, you could match into a really competitive specialty regardless of where you went to school. Now with classes unranked and step unscored, is going to a less established MD program more detrimental? Would it make it harder to match into a competitive specialty?

how can students stand out for residency matching now?

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[Mad Jack]

School will matter more than ever, as will aways and letters

 

[Med Ed]

For the 400th time, residency programs will shift to Step 2 for a screening metric.

 

[Banco]

School always mattered to some extent, and will continue to matter. However, step 1 isn't the only metric used for residencies. Step 2 is still graded - on top of that you have clinical grades, research, letters of recommendations, away rotations, other ECs etc.

Less-prestigious schools that sent students to competitive residencies at competitive programs before will still be able to do it. PDs aren't going to wake up the next day and exclude school X because it's unranked, when in the previous years they received trainees from it.

 

[wya2020]

For the 400th time, residency programs will shift to Step 2 for a screening metric.

School always mattered to some extent, and will continue to matter. However, step 1 isn't the only metric used for residencies. Step 2 is still graded - on top of that you have clinical grades, research, letters of recommendations, away rotations, other ECs etc.

Less-prestigious schools that sent students to competitive residencies at competitive programs before will still be able to do it. PDs aren't going to wake up the next day and exclude school X because it's unranked, when in the previous years they received trainees from it.

they’ve eliminated step 2 so that’s why I’m curious as to what factors will play more of a role. The school I’m interested in is newer v my other option which is IU and more established

 

[Med Ed]

they’ve eliminated step 2 so that’s why I’m curious as to what factors will play more of a role. The school I’m interested in is newer v my other option which is IU and more established

They eliminated Step 2 CS (Clinical Skills).

Step 2 CK (Clinical Knowledge) has not been touched.

 

[Banco]

they’ve eliminated step 2 so that’s why I’m curious as to what factors will play more of a role. The school I’m interested in is newer v my other option which is IU and more established

I see. Have you been accepted? If you post on the School X vs. Y subforum with details on both schools/costs people can better advise you.

 

[candbgirl]

I see. Have you been accepted? If you post on the School X vs. Y subforum with details on both schools/costs people can better advise you.

But OP remember, they have NOT eliminated Step 2Ck. Wide consensus on SDN is that PD will use Step 2 CK scores instead of Step 1.

 

[Mkif586]

They eliminated Step 2 CS (Clinical Skills).

Step 2 CK (Clinical Knowledge) has not been touched.

I know it has already been beaten to death but still: what was the purpose of eliminating step 1 just to switch all the stakes to step 2? Given that the original idea was to make students focus less on numbers on exams...

 

[Goro]

I know it has already been beaten to death but still: what was the purpose of eliminating step 1 just to switch all the stakes to step 2? Given that the original idea was to make students focus less on numbers on exams...

Step 1 was inducing a hell of a lot of stress in medical students.

Don't assume that step 2 will be the new Step 1 in terms of stress. That's because the material on Step 2 is more of the doing a medicine and not the knowing of medicine.

You're not going to need to know about the details of every step in diabetic ketoacidosis, but you are expected to know how to treat it.

 

[deleted314957]

I know it has already been beaten to death but still: what was the purpose of eliminating step 1 just to switch all the stakes to step 2? Given that the original idea was to make students focus less on numbers on exams...

Maybe they have come to their senses and decided to focus their academic lens at an exam that incorporates basic sciences with medical practice on a more rudimentary scale. Perhaps they realized that regurgitatping the ionization constants of some amino acid is a poor metric.

 

[Med Ed]

I know it has already been beaten to death but still: what was the purpose of eliminating step 1 just to switch all the stakes to step 2? Given that the original idea was to make students focus less on numbers on exams...

Step 1 was not eliminated, it will be switching to pass/fail on January 1 of next year.

This occurred because the entire process of using Step 1 in residency application had become dysfunctional. The exam was being used in a way that it was not designed for, and program directors have had to over-rely on Step 1 as a screening metrics because of overapplication. This has put ever-increasing strain on medical students, and those of us who have been in the business for awhile have seen the effects over time.

The only winners in the whole thing have been the businesses that sell successful Step 1 prep materials. This includes the NBME, which now sells USMLE-style questions to both schools and students.

No one expects the shift to Step 2 to magically solve everything, but it will probably be an improvement over the current situation. An organization called the Coalition for Physician Accountability has been tasked with revising the UME to GME transition process. I'm not sure how much progress has been made on that little task.

 

[Putkernerinthehall]

Now with step 1 p/f, is where you go to school that much more important in specialty matching? I would think when step was still scored, as long as you did really well, you could match into a really competitive specialty regardless of where you went to school. Now with classes unranked and step unscored, is going to a less established MD program more detrimental? Would it make it harder to match into a competitive specialty?

how can students stand out for residency matching now?

Getting back to the original post and question. The medical school one attends is a factor in residency selection but it is not the primary factor. There is some survey data that AAMC puts out that summarizes/weights these factors, and I think clinical grades, Step 2 CK score, LOR's, research, and the interview all factor more heavily than medical school pedigree.

 

[mdphd123j]

I heard somewhere that Step 2 CK may also be switched to P/F in 5 years. Going into an MD-PhD, that puts me in the cohort that would have no scores whatsoever. Should I be worried if I’m not in a “prestigious” program?

 

[Lucca]

I heard somewhere that Step 2 CK may also be switched to P/F in 5 years. Going into an MD-PhD, that puts me in the cohort that would have no scores whatsoever. Should I be worried if I’m not in a “prestigious” program?

we'd be speculating on a speculation at that point. Prestige of your program always helps. But also you have a PhD length of time to build your research portfolio and network, so you will still likely be in a much better position than an MD at your institution, as you can tell by MSTPs at all institutions tending to match at more "prestigious" academic centers (given they are also the ones that tend to value research more) when compared to the general class. If you want to do like community ortho your PhD will likely help you less than if you want to do academic IM.

 

[proudofmykids]

For the 400th time, residency programs will shift to Step 2 for a screening metric.

At least until they turning p/f as well. It's likely also been discussed.

 

[TehTeddy]

Question for those in-the-know, since I had a related question whenever I see discussions about this here:
How much does the overall ranking of the school matter, vs the reputation of the particular department within the school when applying for residencies? In some cases, otherwise middle-tier schools have very strong departments in specific specialties. Since students would have access to top faculty letters and research opportunities within that field, does that alter the equation?

 

[Banco]

Question for those in-the-know, since I had a related question whenever I see discussions about this here:
How much does the overall ranking of the school matter, vs the reputation of the particular department within the school when applying for residencies? In some cases, otherwise middle-tier schools have very strong departments in specific specialties. Since students would have access to top faculty letters and research opportunities within that field, does that alter the equation?

Yes it can. Strong departments leads to strong mentorship, research, letters from well known people, connections etc. Most of the reason more prestigious schools can help come residency matching time is because they tend to also have strong home departments with lots of opportunities/connections. Combine that with high achieving students, and it's not wonder they match strong.

It may also surprise many on here that the strongest residency programs in many fields are also not necessarily cleanly aligned with medical school rankings many times. For example, Jeff has top tier ortho and ophtho programs, Miami is top tier derm and ophtho, Rush ortho, Temple EM, Downstate urology, Alabama general surgery, Cincinnati EM etc.

 

[Goro]

I heard somewhere that Step 2 CK may also be switched to P/F in 5 years. Going into an MD-PhD, that puts me in the cohort that would have no scores whatsoever. Should I be worried if I’m not in a “prestigious” program?

That was anxious bloviating by hysterical medical students.

Until we see evidence that Step 2 will cause the same pathologies as the current Step I mania, Step 2 scoring ain't going anywhere.

 

[YCAGA]

That was anxious bloviating by hysterical medical students.

Until we see evidence that Step 2 will cause the same pathologies as the current Step I mania, Step 2 scoring ain't going anywhere.

Is the DO equivalent to Step 1 still planning on being scored in the future?

 

[Konigstiger]

Is the DO equivalent to Step 1 still planning on being scored in the future?

COMLEX 1 is also going P/F after 2022 I believe.

 

[Goro]

Is the DO equivalent to Step 1 still planning on being scored in the future?

Nope. They made the switch soon after NBME did. The True Believers were disappointed, but f' em

 

[DOVinciRobot]

Nope. They made the switch soon after NBME did. The True Believers were disappointed, but f' em

I believe they recently stated at a webinar they are creating a way where PDs can translate the percentiles they will report on the “P/F” Level 1 transcripts to numerical scores, which defeats the purpose.

Leave it to the NBOME to over complicate things.

As to the OP, yes school matters and can help with residency matching. How much, and how much it actually matters is up for debate.

 

[efle]

Question for those in-the-know, since I had a related question whenever I see discussions about this here:
How much does the overall ranking of the school matter, vs the reputation of the particular department within the school when applying for residencies? In some cases, otherwise middle-tier schools have very strong departments in specific specialties. Since students would have access to top faculty letters and research opportunities within that field, does that alter the equation?

Very much depends on the department more than the school. And it's not necessarily reputation, it's how supportive they are. There are big name places with very weak departments that cannot get near-perfect students to match reliably. There are also "mid-tier" places that consistently slay the match in competitive fields.

But, the vast majority of people have no idea what they'll apply into as a premed deciding where to attend. Many think they want to be surgeons only to change their mind when they understand the life of a surgeon. Many have never considered unique niches like rads or psych until they get exposure in med school. So I wouldn't target by department unless you know for certain what you want to do

 

[MedScat]

I know it has already been beaten to death but still: what was the purpose of eliminating step 1 just to switch all the stakes to step 2? Given that the original idea was to make students focus less on numbers on exams...

Woah I thought you were me and i was like uhhhh i dont remember posting this...the unoriginality of the google stock photo

 

[Mkif586]

Woah I thought you were me and i was like uhhhh i dont remember posting this...the unoriginality of the google stock photo

😆😆😆😆😆

 

[DrVan Nostrand]

Yes it can. Strong departments leads to strong mentorship, research, letters from well known people, connections etc. Most of the reason more prestigious schools can help come residency matching time is because they tend to also have strong home departments with lots of opportunities/connections. Combine that with high achieving students, and it's not wonder they match strong.

It may also surprise many on here that the strongest residency programs in many fields are also not necessarily cleanly aligned with medical school rankings many times. For example, Jeff has top tier ortho and ophtho programs, Miami is top tier derm and ophtho, Rush ortho, Temple EM, Downstate urology, Alabama general surgery, Cincinnati EM etc.

excuse the ignorance but are there published rankings for these residency programs? like the top 10 urology programs? I found the doximity rankings, but I don't know if that is regarded as the standard when talking about this

 

[efle]

excuse the ignorance but are there published rankings for these residency programs? like the top 10 urology programs? I found the doximity rankings, but I don't know if that is regarded as the standard when talking about this

There's two "residency rankings"

US News is a survey of med school deans and other senior faculty. It only covers the handful of largest specialties.

Doximity is a survey of site members. It covers more of the small specialties, though still not all of them.

Generally it's the same ~10 places that get the most nominations in both lists, just in different orders.

 

[Banco]

There's two "residency rankings"

US News is a survey of med school deans and other senior faculty. It only covers the handful of largest specialties.

Doximity is a survey of site members. It covers more of the small specialties, though still not all of them.

Generally it's the same ~10 places that get the most nominations in both lists, just in different orders.

I'll also point out to the inexperienced pre-meds, that while these rankings can give a decent idea of general tier/reputation, they are not at all comprehensive, have faulty methodology to some extent, and fluctuate all the time. Lastly, they obviously don't take into account many features of programs that some applicants might find valuable, while others won't (i.e. location, patient population, operative autonomy etc.) So when the time comes, don't only look at this to make your rank lists! I have seen many people fall into that trap. Go for the place that is best for you and your values - often that ends up being the famous places, but often it isn't.


As a practical example, when it came time to make rank lists this year, I put a historically "top 10" program all the way at the bottom of my list, and put quite a few "less prestigious" programs above it. Personal and fit factors are important too. The hilarious thing is that if I dropped to the bottom of my list, someone might look at the match list for my school and be impressed with it, while I would be pissed because I really didn't want it. That's why match lists can sometimes be deceiving too.

 

[efle]

when the time comes, don't only look at this to make your rank lists! I have seen many people fall into that trap

For real? After interviewing your friends put worse fits higher because Doximity said so? That's wild

 

[YCAGA]

I'll also point out to the inexperienced pre-meds, that while these rankings can give a decent idea of general tier/reputation, they are not at all comprehensive, have faulty methodology to some extent, and fluctuate all the time. Lastly, they obviously don't take into account many features of programs that some applicants might find valuable, while others won't (i.e. location, patient population, operative autonomy etc.) So when the time comes, don't only look at this to make your rank lists! I have seen many people fall into that trap. Go for the place that is best for you and your values - often that ends up being the famous places, but often it isn't.


As a practical example, when it came time to make rank lists this year, I put a historically "top 10" program all the way at the bottom of my list, and put quite a few "less prestigious" programs above it. Personal and fit factors are important too. The hilarious thing is that if I dropped to the bottom of my list, someone might look at the match list for my school and be impressed with it, while I would be pissed because I really didn't want it. That's why match lists can sometimes be deceiving too.

This is a great thing to clarify. I still see medical students talking about match lists as if they give any useful info in terms of a schools quality.

Your experience is a perfect example of why match lists are worse than horoscopes. There is no way to interpret them without knowing every M4, their application/competitiveness, and their goals, and then also know what are “good” programs in 20+ specialities.

 

[efle]

This is a great thing to clarify. I still see medical students talking about match lists as if they give any useful info in terms of a schools quality.

Your experience is a perfect example of why match lists are worse than horoscopes. There is no way to interpret them without knowing every M4, their application/competitiveness, and their goals, and then also know what are “good” programs in 20+ specialities.

Devil's advocate - there's almost always something that will fit you among the "top" programs. Whichever area of the country, or size city, or cost of living, etc. As an example in radiology the "top" includes everything from Bay area to midwest to south to mid-atlantic to northeast. And thanks to the tools I linked above, it's easy to eyeball the most nominated programs.

So when you look at the last few years of matches in DR at a given school and it looks like this ("top 20" matches bolded):

Brigham
Columbia
Duke
Duke
Hopkins
Hopkins
Hopkins
Mallinckrodt-WashU
Mayo (AZ)
Penn
Sinai
Stanford
Stanford
UC Irvine
UCSF
UCSF
UCSF

It's not exactly tea leaves and horoscopes to presume that school will set you up hella well for radiology.

 

[Banco]

Top radiology programs are determined by how dark and inaccessible to patients the reading rooms are, so that’s a ranking we can easily objectively determine.

 

[YCAGA]

Devil's advocate - there's almost always something that will fit you among the "top" programs. Whichever area of the country, or size city, or cost of living, etc. As an example in radiology the "top" includes everything from Bay area to midwest to south to mid-atlantic to northeast. And thanks to the tools I linked above, it's easy to eyeball the most nominated programs.

So when you look at the last few years of matches in DR at a given school and it looks like this ("top 20" matches bolded):

Brigham
Columbia
Duke
Duke
Hopkins
Hopkins
Hopkins
Mallinckrodt-WashU
Mayo (AZ)
Penn
Sinai
Stanford
Stanford
UC Irvine
UCSF
UCSF
UCSF

It's not exactly tea leaves and horoscopes to presume that school will set you up hella well for radiology.

What if their match rate for rads is 70% because of horrible advising? Just a hypothetical but you are making the exact kind of mistake I am talking about. Or what UCSF was at the bottom of everyone’s rank list and the program is actually insanely malignant, regardless of the name brand. Another hypothetical but you hopefully can see my point.

 

[efle]

What if their match rate for rads is 70% because of horrible advising? Just a hypothetical but you are making the exact kind of mistake I am talking about. Or what UCSF was at the bottom of everyone’s rank list and the program is actually insanely malignant, regardless of the name brand. Another hypothetical but you hopefully can see my point.

I can tell you first hand that it's 100% and that UCSF is the #1 program and interviews the least number of candidates per seat to fill up; you have to really suspend reality not to recognize glance value in that list.

 

[YCAGA]

I can tell you first hand that it's 100% and that UCSF is the #1 program and interviews the least number of candidates per seat to fill up; you have to really suspend reality not to recognize glance value in that list.

Right, so you’re informed first hand that the match rate is high and that UCSF is the top program in that particular speciality. You’re still proving my point. You find that match list so impressive because you have a lot more background information than a premed looking at it on their website.

 

[efle]

Right, so you’re informed first hand that the match rate is high and that UCSF is the top program in that particular speciality. You’re still proving my point. You find that match list so impressive because you have a lot more background information than a premed looking at it on their website.

Let me rephrase - it's safe to assume T20s have strong match rates in fields like rads. Nationally, you can have a 220 step and still be at ~95% matchrate. You might need nuance to read this year's 3-person Ortho match, but when you look at a half decade in medicine, rads, gas, etc and it looks like that, it's meaningful information. It's why they hand this stuff out at interviews/second looks.

 

[YCAGA]

It's why they hand this stuff out at interviews/second looks.

lol yes, but because it’s marketing. “Look how many people matched into ortho! That can be you!” Just like talking about pass/fail preclinical classes during interviews and second look even though the vast majority of schools don’t have true pass/fail.

 

[efle]

lol yes, but because it’s marketing. “Look how many people matched into ortho! That can be you!” Just like talking about pass/fail preclinical classes during interviews and second look even though the vast majority of schools don’t have true pass/fail.

It's also marketing when Wharton advertises that their MBA grads have the highest average starting salaries afterwards. Doesn't make it useless, misleading, or incorrect.

 

[Banco]

For real? After interviewing your friends put worse fits higher because Doximity said so? That's wild

None of my friends, but I know for sure it certainly influences people beyond a reasonable level, and then you see every year after match day "I picked a prestigious program that I shouldn't have" etc.

I think people just fall into the prestige trap too often, especially with online echo chambers (see the google sheets). And frankly most people aren't really aware of the methodologies and faults of these rankings.

They did a study a few years back about it for EM: Impact of Doximity Residency Rankings on Emergency Medicine Applicant Rank Lists - The Western Journal of Emergency Medicine

 

[efle]

None of my friends, but I know for sure it certainly influences people beyond a reasonable level, and then you see every year after match day "I picked a prestigious program that I shouldn't have" etc.

I think people just fall into the prestige trap too often, especially with online echo chambers (see the google sheets). And frankly most people aren't really aware of the methodologies and faults of these rankings.

They did a study a few years back about it for EM: Impact of Doximity Residency Rankings on Emergency Medicine Applicant Rank Lists - The Western Journal of Emergency Medicine

Wow I'm actually shocked at how little people seemed to care in that study!

Less than half of applicants had looked at the rankings. Only 10% said they thought the rankings were a positive tool. <10% dropped any programs after looking, and there was <1 program rank change up/down per capita after looking.

I must be too cynical, I thought people would be using the ranks as a starting point/draft list and adjusting from there or something insane like that.

 

[Banco]

Wow I'm actually shocked at how little people seemed to care in that study!

Less than half of applicants had looked at the rankings. Only 10% said they thought the rankings were a positive tool. <10% dropped any programs after looking, and there was <1 program rank change up/down per capita after looking.

I must be too cynical, I thought people would be using the ranks as a starting point/draft list and adjusting from there or something insane like that.

I suppose that's the positive reading of it. I just feel bad for the poor sods who got roped into it.

I wonder if it's different/more prevalent now, as the article is from 2016 and Doximity came out 2014-15.

 

[Davidfromcali]

Very much depends on the department more than the school. And it's not necessarily reputation, it's how supportive they are. There are big name places with very weak departments that cannot get near-perfect students to match reliably. There are also "mid-tier" places that consistently slay the match in competitive fields.

But, the vast majority of people have no idea what they'll apply into as a premed deciding where to attend. Many think they want to be surgeons only to change their mind when they understand the life of a surgeon. Many have never considered unique niches like rads or psych until they get exposure in med school. So I wouldn't target by department unless you know for certain what you want to do

So true. I didn't realize just how important a supportive department can really be. Seems to really make the difference for students who are applying into small fields where everyone knows each other

 

[deleted314957]

excuse the ignorance but are there published rankings for these residency programs? like the top 10 urology programs? I found the doximity rankings, but I don't know if that is regarded as the standard when talking about this

Yes. And they are about as meaningful as med school rankings. You are far better off going to a place where you like the folks and they like you and you can begin job networking.

 

[NickNaylor]

Didn't read all of this thread, but to answer the OP's question: the short answer is yes. The long answer is it's more complicated. "Prestigious" institutions are likely to be viewed more positively by residency programs and may make it easier for you to match to more competitive specialties/programs. But going to Harvard is not, in and of itself, going to allow you to float into any program of your choosing. The key is taking advantage of the opportunities available to you at whatever institution you attend. The "prestigious" schools tend to have more of these opportunities available, but that doesn't mean that they're necessary to your success. The high cost of a "prestigious" institution may not be outweighed by the "opportunities" that that institution has to offer you.

So yes, school matters, but I don't think it's as simple as "go to the best school that you can." There are many factors that students should consider, and factors like P/F, ranked/unranked, etc. are a relatively small part of the picture, IMO. The truth of the matter is that even if an institution advertises itself as "unranked" and "P/F," most will include some kind of grade distribution data in the letter that they send to residency programs. Most programs will be able to ascertain, at least in a general sense, where you land within your cohort.