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 Peds. 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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[earmuffs]

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 Peds. 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

You're probably not in too bad shape for peds. CHOP and Boston are a reach at this point...same with some of the top tier places that are in highly desirable cities. But with positive LORs, your research experience, good 3rd year evals, and some improvement on Step II, I bet you could do very well in the match.

I'm basing this on a pretty good friend & her experience with similar CV/grades as you, except she failed Step I 1st time around. She ended up getting a number of interviews, including one at Wash U/St. Louis Childrens, ultimately matched at one of her top choices, and will be a chief resident at a pretty good peds program next year. Check out the hidden gem peds programs thread on here...a few of those were also places that seemed to like her as well...
http://forums.studentdoctor.net/showthread.php?t=226335

Best advice I could give is what you already know...be prepared for Step II & take it early to prove that Step I was an outlier. Don't know what she got on it or what a target score for you would be though.

Good luck!!
-RW

 

[14022]

I agree with the above, but I just wanted to point out that it is not necessary to be at a top-tier peds program to do well in the field, with one exception. If you have a goal of doing ground-breaking research and eventually being a chairman of a major children's hospital, then you would need to train at the best children's hospital as you can.

I interviewed at a wide range of programs (in terms of size, selectivity, and prestige) from Boston and CHOP to a small community program of which no one has ever heard. In each program, there were residents matching into competitive fellowships. Fellowships in pediatrics right now for the most part are wide open, with the exception of maybe cardiology and ER, so as long as you improve on step 2 you will likely match into a great program. If you are interested in general pediatrics, you will get a job after training at any program.

Also, you would be the ideal person to do an away rotation at a few of your top choices in order to show your stuff and have them overlook your step 1 score...ideal meaning that to the top progams you have a red flag on your app (step 1 score) but have the clinical skills to make up for it and would need to show them this by rotating there. Once youre in, it seems like your work ethic and clinical aptitude will lead to much success.

So relax and please ease up on the overdramatic garbage ("scared and vulnerable?"...please...the violins are kind of annoying).

 

[mstein81]

Thank you all for your input...hearing your advice and suggestions are more reassuring. I will try my best to make up for my deficiencies. Thanks guys. I am new to the forum...so hopefully you guys will permit me to ask future questions...well uh...less dramatics Take care and thanks again!

 

[Os4prez]

Let me tell you a story about someone i know. He did pretty bad in basic sciences. did ok in clinicals - A in peds i think. Got awesome LORs from 3rd and 4th year. Did OK on step 1, and got really good interviews. Places in big cities like NY/Cali stuff probably has cutoffs for GPA and USMLE scores - but top places like chop and so on that are outside of a desired geographical area have no cutoffs. so if they like your application theyll call you for an intervew. Once you get an interview anything can happen.

Its all good though - work with passion - Peds is a passion. People will take note, kids will get better, and you'll have a good fun career. Good luck!

peace

 

[Natataheako]

Is the OP for real? You can be brain dead and on a ventilator and you will still match into peds. Peds is not competitive. I mean, maybe the top programs are out, but in reality, how many people train at the top programs in any of their respective fields? A very small percentage. The reality is that there are more peds spots than peds applicants, which means that you will match somewhere.

 

[TheOneTwo]

I know you posted this on the IM forum too (guessing you're choosing between IM and peds right now), but for some perspective (coming from somebody who also replied to you on the IM board) for peds:

I come from a mid-tier state school, definitely NOT anywhere close to top 20 in reputation or quality or anything else ...

One of my friends in my class applying to peds has the following stats:
Step 1 - 195
Step 2 CK - 180 (not released to the programs)
Step 2 CS - pass (not released to the programs)
1st + 2nd year: Mostly pass/high pass, couple of honors
3rd year: 1 Honors in Psych, all the rest high pass (def no awards)
4th year: Honors in sub-I in peds
Overall: "very good" in the class, which is the third quintile (40-60%)
Good LOR's from people in her school (aways done with letters from attendings sent to wherever she did those aways)
Very well-received personal statement
1 Publication (2nd author) from her 1 research project
A few leadership/volunteer activities, all in 2nd year

She received interviews at all of the NYC programs except for Cornell. She did aways at Sinai and Columbia and subsequently received interviews there and has also gotten interviews from top-notch programs in other cities (Philly, Boston, DC) - not CHOP, Children's National, CHOB, UPitt, but the tier right below them (St. Chris and others).

So what I'm saying is in peds you will definitely get offered very good interviews and opportunities at very well-respected programs and even the top tier if you do aways and perform well. Pediatrics, more than some other fields, seems to care about the individual more than about the scores. Also, the programs tend to receive far fewer applications than other fields which means the programs are much more likely to look beyond the Step 1 score and actually read your application (most of the top tier IM programs will NEVER read any applications below their step 1/medicine honors "cut off" as an example).

The fact that you've performed very well clinically is a HUGE plus (the award in IM for example) and this should shine through in your letters as well. So if you did choose to do peds, I wouldn't worry so much about getting a very good place. Just continue to perform well clinically, do a couple of aways at top tier programs, and get letters from people who know you well.

 

[mstein81]

Thanks One Two...and everyone else for your posts. I am contemplating doing Med/Peds....but the Step 1 score...has me contemplating whether I would be more successful choosing one path. I'm at a serious crux that I don't want to take lightly. I really found an interest in Oncology and wondering about Medical Oncology vs Pediatric Oncology. Anyone have any thoughts...The One Two...any thoughts about taking the Med track vs Peds Track (since you have visited both forums), given the subspeciaties of interest and the ease of the process in Peds vs Meds, from top tier programs?

Anyone feel free to share your thoughts

Marc

 

[SurfingDoctor]

Residency competition wise, IM and Peds are very similar. Both have many spots go unfilled each year and both have good programs available to students who aren't necessarily top 25% or whatever. That being said, they both still have competitive programs that are harder to match to. However, it is unrealistic to say that you will be more "successful" in IM over Peds or visa versa based on your step score, or even Med/Peds for that matter. Do whatever you are most interested in.

As far as fellowship, there are some fellowships that are harder to match into and the residency you go to will affect to some degree your competitiveness for fellowship. However, Hem/Onc is not really a competitive fellowship from my understanding. The difference between the two lies in the types of cancers you see and the overall survival rates (much better in peds). But again, go with whatever you want to do for the rest of your life and don't let one test scor dictate that decision.

 

[TheOneTwo]

Med/Peds is an interesting field and allows for many options down the road. I was seriously considering it at some point because of an interest in pediatric cardiology but also adult cardiology. The problem is cards isn't a field that lends itself well to doubling up especially in light of my specific interests for subspecialization.

Oncology may be different though. You could be able to do both pediatric and adult oncology after doing med/peds assuming you do the fellowships (I'm not sure if there's any combined fellowships). The issue I have with med/peds is I feel (and I know there are some others that feel) like it isn't as good as just choosing one or the other. For clinical medicine it could be okay. But I feel like its medicine and pediatrics lite. The only time IM residencies are willing to cut down your training to 2 yrs is when you do a clincal investigator research track (which is really just for people not interested in clinical medicine but in research/academic medicine).

I also feel that having the IM background doesn't make you less competitive for peds fellowships (because from the adolescent level on up, it all becomes very similar, and many IM docs are even involved in tx of adolescents in certain regions). However, the peds portion may make you less competitive for IM fellowships since IM is all about how much IM stuff you've seen and there's far less contribution from the peds-specific things to your adult patient care knowledge. (All I'm saying is peds is a wider knowledge base and you need to know things at multiple levels up to the adult while IM is at least a tiny bit more focused.)

Also, pediatric fellowships are generally easier to get than IM fellowships across the board. Hem/Onc at the IM level is actually somewhat competitive. It isn't at the level of allergy/immunology, cardiology, or GI but it is at the level just below those fields.

Most people who do med/peds end up practicing one or the other. However, you can definitely practice both. However, fellowship possibilities in which you can practice both for the rest of your career decrease (fields like cardiology are very different at the peds and adult levels). But this is all debatable and depends on personal outlook. I would honestly say choose one unless you have some clear career desire that combines both (you've research combined peds/adult hem/onc opportunities), I'd say pick one and be really good at that one.