Scared and Vulnerable

[mstein81]

I wanted to get some brutal truth (for better or worse). As an applicant, I have performed average during the basic science and clinical years, but received great evaluations during the 3rd year (even receiving an award in IM). I have a couple of non-published research experiences, including one experience at Sloan Kettering, a number of commendable leadership activities and a USMLE Step 1 victim of 190. What chances would I have of being matched? If matching is a possiblity, what programs (realistically) could I get into with those kinds of cred., assuming great CV and LORs? What would I need to do (ie Step 2 scores, away electives) to make myself a more competitive applicant for top tier programs in IM. Please help me out with any advice or suggestions. I feel that, although I'm not competitive, my heart, compassion and will to care for patients, as an Internist...has been overwhelmingly been praised and would be an asset to any program. What can I do???? Thanks in advance MStein

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[PrimaMD]

It's a sad thing to say but a lot of programs use step I scores as a way to screen applications being that they recieve so many. I would try to take step II as soon possible so that the score shows up when you are applying. Try for >220. It's possible. An away rotation with stellar performance is also key to getting invites that you may otherwise had not recieved.

Also, with a step I of 190 top tier programs such as MGH and Hopkins may be reach but 2nd or 3rd tier programs such as U of Maryland, Baylor, Case Western, etc., would be possibilities.

 

[TheOneTwo]

It will be hard and you'll have to work at making yourself a stronger applicant ...

Honoring medicine is a key factor in making yourself competitive for not just top tier but second tier programs. Also, what school you went to may be important. You won't get interviews at MGH/Hopkins/etc unless you've done something phenomenal (major and I mean MAJOR NEJM-worthy research or things like that).

Also, do your sub-I early. The trick is when one part esp something like Step 1 is down, you need to do whatever you can to bring the rest up. This also includes away rotations at places that are a reach but not totally out there (ie, MGH may not be the best place to do an away rotation but places like Case and other 2nd tier programs may). You should use connections where you can too. If you truly did that phenomenally in IM, the attending(s) with whom you've worked should be more than willing to make a phone call for you. This is important because many top tier programs may not otherwise read your application after looking at Step 1 and coursework which are used by almost all the top programs and even many 2nd tier programs as a means of deciding which applications to read. A phone call may force the PD to actually take a look at your application, just like an away would.

 

[inositide]

You will most certainly match to internal medicine. If you are a student at an American medical school, you will most certainly be able to match at a university medicine residency program.

The only question is where. The 190 probably severely hurts your chances for top tier medicine programs (ie. MGH, UPENN, Hopkins,etc) but you certainly a good candidate for dozens and dozens of other programs.

These include the 2nd tier programs. Decide which region you want to be in. Apply broadly when it comes time for ERAS, see where you get invited and go from there.

Definitely take Step 2ck and CS sooner in 4th year. Maybe during July or August. Do your medicine sub-i early and do well. Try to do an away elective where you might be able to grab a letter of rec from a fairly known physician. Usually in internal medicine away rotations are not at all required but in your case it might help because unfortunately some programs use step 1 as a screening tool.

Keep a good relationship with your home school's program director or other faculty members so that you can get strong letters of rec and strong endorsements.

 

[mstein81]

Thank you guys for your input!!! It is greatly appreciated! If anyone else, has more to add plz feel free to respond to the original question. I am new to this forum (first timer...or in the case of this reply second timer). I have a few more questions, if you permit me.

1. What would you all consider a great rank list of 2nd and 3rd tier programs??

2. When you guys say do my sub-I early in IM, are you referring to sub-I @ my home school or away sub-I? How will an early sub-I help?(ie towards a strong LOR?) What would be considered an early time to take a sub-I?

3. As far as away electives, what advice do you have on the timing of the electives (ie close to interview season) and type of aways (subspecialties I'm strong in..etc)

By the way, I am an AMG @ a top 20 medical school.
Once again, thank you all....your input has allowed me to be less "scared and vulnerable."

 

[open sesamoid]

Also, with a step I of 190 top tier programs such as MGH and Hopkins may be reach but 2nd or 3rd tier programs such as U of Maryland, Baylor, Case Western, etc., would be possibilities.

Hey, I go to U of Maryland, and I saw flyers for an address by the dean called "Reaching the top tier: we did it our way." He he he he he.

 

[coogmed]

With regards to the sub-i

I don't know how your school does it, but if grades are in any way involved, then a strong showing and another "honors" or "A" or "90" or whatever they call it at your school will go a long way. The second will be for the LOR. I had several interviewers make positive comments about my strong letter from my MICU sub-i (and I had to explain to several that my fourth year, sub-i inculded, isn't graded...). As far as away and sub-i's are concerned, I wouldn't really know. The one thing I would recommend is go with strengths- if you stink at Pulm, for example, don't go to a dream school trying to blow the socks of someone...

With regards to "2nd tier", programs, this is just my opinion.... some of these may be 1st tier programs that I'm overlooking, but are probably still well within your reach! (maybe with a well-timed away rotation...)
In no particular order:
Dartmouth, Brown, Umaryland, Case Western, UC Davis, U Utah, U Minn, U Wisc., Rush, UIC, Kentucky, George Washington, Georgetown, UNew Mexico, UTHouston, UMass, Tufts (?), UCincinatti, Ohio St., USC, U Indiana, Wake Forest, prob. some of the NY programs, I'm very unfamiliar with all of those!

So, the point is not the individual names, but that you'll have ample opportunity for a great education at a univ. program, get a decent fellowship spot (again, some of us on this forum agonize if its not Penn or Duke cards, but these would get you into good/great clin. GI/Cards programs with the right motivation)

But again, don't be afraid to put some "reaches" on your list when you apply. Never sell yourself short!

 

[BigBadBix]

In no particular order:
Dartmouth, Brown, Umaryland, Case Western, UC Davis, U Utah, U Minn, U Wisc., Rush, UIC, Kentucky, George Washington, Georgetown, UNew Mexico, UTHouston, UMass, Tufts (?), UCincinatti, Ohio St., USC, U Indiana, Wake Forest, prob. some of the NY programs, I'm very unfamiliar with all of those!

I agree with this list and would add a couple others - URochester, Montefiore, OHSU, Cedars-Sinai, UCLA-Harbor.

Many of these have excellent training but suffer from being in an undesirable location or a lack of name recognition. They are therefore less competitive than comparable programs, but would get you where you want to go.

If you get honors in medicine and >220 on Step 2, I think you probably could get a few higher-tier interviews as well.

-BBB

 

[mstein81]

Thank you all for your input....I must say that it is refreshing to get the advice, in the manner that you are dishing it out. I think it is a testimony to this forum and to the character of the students, a part of this forum. So I take my hat off to you all.

I will try my best and keep u all posted on my progress...and of course ask a hell of alot more questions...only because you guys give honest and solid advice/suggestions.

Take care MS

 

[Waiting4Ganong]

Hey - just wanted to say that I've found this list of 2nd tier places pretty useful too. Refreshing to have something that isn't "help me rank MGH vs B+W vs UCSF vs. Hopkins" for a change.

How would you guys rank places like Yale Primary Care, Hopkins Bayview etc in that list? (ie: affiliates of big name places)

Cheers,

W4G.

(also does some brave soul want to rank these 2nd tier places in terms of prestige/fellowship match...?)

 

[Clemson Doc]

I am also curious to know whether places like Yale (primary care track) and Hopkins-Bayview are considered first tier or second tier.

 

[Waiting4Ganong]

bump

 

[DrNick2006]

Yale - New Haven is good. Primary care doesn't really make a difference, other than less people apply.

 

[Waiting4Ganong]

Yale - New Haven is good. Primary care doesn't really make a difference, other than less people apply.

Good as in a good training or good as in desirable program/competitive to get a place? I imagine that New Haven location makes it less desirable than it would be if it were elsewhere for example. Ditto Hopkins Bayview and Baltimore.

Would you place it then as more "Competitive" than all the other 2nd tier places listed? (UCDavis, Georgetown, UMass etc).

 

[gutonc]

I agree w/ most of what's been said here. B/c programs are now getting more apps (w/ ERAS it's no longer a matter of extra work, just extra cash to apply to a hojillion programs) they have to have a first-pass cut-off and Step scores are usually it. My school's IM program (which is a 3rd-tier University program at best) has used a cutoff of between 80-85 (two digit raw score) in the past few years. So, if your Step 1 score doesn't hit that mark, you need to get a Step 2 score in there to buff things up.

Once you get past that hurdle, it sounds like your clinical stuff and extra-curriculars will make you a pretty good applicant. Assuming you can pull a better Step 2 score (and I managed to add 30 points to my Step 2 score so it's certainly do-able) IMHO you should apply to a variety of 1st and 2nd tier programs and see what happens. I say go for a few reaches (I did MGH, Stanford, UCSF, Hopkins as my reaches and got interviews at half of them) and apply to a bunch of the "2nd tier" places. What actually constitutes a 2nd tier program and where the line is drawn between 1st and 2nd tier depends on who's doing the line-drawing. A lot of the 2nd tier programs are really great programs in places that aren't so popular or are in the shadows of other true 1st tier programs. On my list I would place OHSU, Mt. Sinai, UW-Madison and a couple of others in the 2nd tier and those are 3 of my top 5 slots.

You'll definitely match in IM and if you can pull off a stellar Step 2 score you'll be in good shape.

Good luck,
BE