Should PM&R residency programs give priority to their own Medical Students?

[latinman]

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Hi everyone. I am opening up a topic which I think is interesting. I have done several rotations at other medical institutions, and all of the programs seem to always give priority to their own grads. In addition, the program at which I am currently pursuing my residency training seems to behave in the same way.

However, the medical school in which I obtained my MD doesn't seem to follow this rule. I wanted to stay at the same school for residency training, but then realized that I got ranked below other candidates with lower qualifications than mine, and who are not grads of that medical school. This seems to be an unacepptable behavior in my honest personal view. I guess the argument is that if the residency program is not going to give priority to their own medical students, then why make me waste four years of medical school at that place? I would have been better off going somewhere else for medical school training. I think this has to do with cerain PD's carrying some emotional baggage and being bitter about not getting always the extraordinary candidates (Ultimately it's the applicant's choice whether he wants to stay or go to some other program for training).

 

[Terpskins99]

I wanted to stay at the same school for residency training, but then realized that I got ranked below other candidates with lower qualifications than mine, and who are not grads of that medical school. This seems to be an unacepptable behavior in my honest personal view. I guess the argument is that if the residency program is not going to give priority to their own medical students, then why make me waste four years of medical school at that place?

The match hasn't happened yet, so there is no way to know where you are ranked (assuming you are talking about this application season). And not to get argumentative, but what makes you so sure those other candidates had "lower qualifications" than you? That's a pretty bold statement. Obviously, there are other criteria besides grades and board scores that residency program directors use to evaluate their candidates (especially your interview).

But to address your question: I think its a good thing that a residency is unwilling to show in-house preference for applicants. Residents should be selected based solely upon their qualifications, not because of any ties to the school or program director.

Also, selecting a medical school has nothing to do with any of their affiliated hospital's residency programs. Most people choose to attend a particular medical school because they feel they will receive the best training there. Period. But this notion that you should receive preference simply because you attended their medical school, is nonsense.

 

[PMR 4 MSK]

I'm against inbreeding of medical programs and suggest training at as many different places as possible, so that see how things are done differently all over. Having the same attendings for meds school, residency and even fellowship means you learn less outside views.

 

[latinman]

The match hasn't happened yet, so there is no way to know where you are ranked (assuming you are talking about this application season).

I was talking about a previous year...

But to address your question: I think its a good thing that a residency is unwilling to show in-house preference for applicants. Residents should be selected based solely upon their qualifications, not because of any ties to the school or program director.

I am not sure whether all the PD's and Chairmans would agree with you. I do know of certain programs that will give priority to their grads...

Also, selecting a medical school has nothing to do with any of their affiliated hospital's residency programs. Most people choose to attend a particular medical school because they feel they will receive the best training there. Period. But this notion that you should receive preference simply because you attended their medical school, is nonsense.

I once again disagree with this statement. People many times choose a Medical school because of geographical location, and having all of their family members living close by. I can guarantee you that many people could care less about "prestiege" or "best training" when it comes to choosing where they want to pursue residency training...

 

[Ludicolo]

Hi everyone. I am opening up a topic which I think is interesting. I have done several rotations at other medical institutions, and all of the programs seem to always give priority to their own grads. In addition, the program at which I am currently pursuing my residency training seems to behave in the same way.

However, the medical school in which I obtained my MD doesn't seem to follow this rule. I wanted to stay at the same school for residency training, but then realized that I got ranked below other candidates with lower qualifications than mine, and who are not grads of that medical school. This seems to be an unacepptable behavior in my honest personal view. I guess the argument is that if the residency program is not going to give priority to their own medical students, then why make me waste four years of medical school at that place? I would have been better off going somewhere else for medical school training. I think this has to do with cerain PD's carrying some emotional baggage and being bitter about not getting always the extraordinary candidates (Ultimately it's the applicant's choice whether he wants to stay or go to some other program for training).

Some programs seem to prefer their own students. Attendings have worked directly with these students, and come rank time, know what they’d be getting. If you performed well, you will be placed on their ROL. I’ve seen this work to a student’s disadvantage as well. If a student has trouble on a given rotation, why would someone want to rank them highly? (BTW – I have no idea about your qualifications/how you performed. I’m just saying…) And understand that, while places may prefer their own, no residency program is under any obligation to provide residency spots for its affiliated med school students.

As far as qualifications go, Terpskins99 has a point. There is no standard formula based on your scores, grades, LORs, interview performance, etc. that allows us to rank one candidate over another. We may be willing to overlook a mediocre Step I score if you have great clinical grades and experience. We may be willing to overlook the fact that you had only one PM&R rotation if you rocked the boards and had a LOR from that rehab attending stating that you were one of the best students he’s ever worked with. If you went to a school that happened to have graduated some of our existing residents, and they are not performing up to expectations, then we might look at your package with a little closer scrutiny.

 

[Chrom0zone]

I'm just a lowly hard working student, but I do know that programs choose who they would like to work with for the next 3-4 years. PM&R is a field that requires a lot of cooperation and teamwork.

Programs will take this to heart when selecting applicants. More qualified does not necessarily mean they can be a "team player" or have good bedside manner.

I would rather avoid the incestuous programs and work with a diverse team.

Just my 2 cents.

 

[ShrikeMD]

Some programs seem to prefer their own students. Attendings have worked directly with these students, and come rank time, know what they'd be getting. If you performed well, you will be placed on their ROL. I've seen this work to a student's disadvantage as well. If a student has trouble on a given rotation, why would someone want to rank them highly? (BTW – I have no idea about your qualifications/how you performed. I'm just saying&#8230😉 And understand that, while places may prefer their own, no residency program is under any obligation to provide residency spots for its affiliated med school students.

Agreed. Familiarity is a decided advantage if the medical student performs well in their clinical rotations. Consistently excellent performance on clinical rotations will trump average or even slightly less-than-average (but not near-failing) scores/grades on basic sciences. (The reverse is true too; average clinical performance will detract from above average grades and scores.) One important advantage conferred by participating in external rotations at a particular program is that you increase your familiarity to those who will rank you for positions in that program. I believe this is why students at some medical schools tend to receive favorable attention; their clinical performance, motivation, and character are better known to the attendings. These factors are extremely important in achieving success as a physician, and are more easily discerned from direct observation and interaction. In summary, the apparent preference is usually based on familiarity, not on the school affiliation.

 

[wadigga33]

I agree with some of the previous posts. I think that your application should be merited based on your qualifications not on what school you attended or your ties to an university. Programs and applicants alike, should try to look for the best fit, both on a personal level as well as academically.

 

[Kinjal350z]

Agreed. Familiarity is a decided advantage if the medical student performs well in their clinical rotations. Consistently excellent performance on clinical rotations will trump average or even slightly less-than-average (but not near-failing) scores/grades on basic sciences. (The reverse is true too; average clinical performance will detract from above average grades and scores.) One important advantage conferred by participating in external rotations at a particular program is that you increase your familiarity to those who will rank you for positions in that program. I believe this is why students at some medical schools tend to receive favorable attention; their clinical performance, motivation, and character are better known to the attendings. These factors are extremely important in achieving success as a physician, and are more easily discerned from direct observation and interaction. In summary, the apparent preference is usually based on familiarity, not on the school affiliation.

i think this is a very accurate statement... at the type of pm&r programs most of us would like to work with. at programs where it is obvious that they did not necessarily take into account personality and work ethic.. who knows how they fill their spots. i for one have no desire to end up spending 3 critical years at a place such as that

 

[Kinjal350z]

also, i think that rather having a hospital be linked to your school, the fact that you are able to spend at least a month working with the staff on a rotation is the most important. its hard to judge a candidate in 1 day during an interview. most places know that, and often like to take people who have rotated at the institution. lesson is: rotate at the places you want to goto and work your ass off. when it comes time for the interview, you have an obvious edge because they know you

 

[Llenroc]

People here frequently like to point out that in PM&R they look "beyond the numbers", usually when somebody points out that PM&R has the lowest Step 1 scores.

Well, what is that "beyond the numbers"? One would presume that they tend to give more preference than other specialties to candidates that they know personally, most likely to be ones from that institution. Everyone at my medical school who went into PM&R did 2-3 rotations within the department. Outside rotators did at most 1.

So if PM&R as people like to claim is looking "beyond the numbers" to evaluate candidates more personally, then it would make sense that they would tend to take more of those that they know well.

Either that or maybe the field just does end up with a lot of low scoring candidates.

 

[PMR 4 MSK]

People here frequently like to point out that in PM&R they look "beyond the numbers", usually when somebody points out that PM&R has the lowest Step 1 scores.

Well, what is that "beyond the numbers"? One would presume that they tend to give more preference than other specialties to candidates that they know personally, most likely to be ones from that institution. Everyone at my medical school who went into PM&R did 2-3 rotations within the department. Outside rotators did at most 1.

So if PM&R as people like to claim is looking "beyond the numbers" to evaluate candidates more personally, then it would make sense that they would tend to take more of those that they know well.

Either that or maybe the field just does end up with a lot of low scoring candidates.

I'd like to see an honest, confidential survey to see how many rehab residents and/or attendings went into the field as their first choice, and how many would have done it if they could have chosen any other field and been guaranteed a spot. NMRP makes assumptions for their data.

By the time it came to apply, I didn't want to do anything else. At least one of my classmates, and several who came before and after me in my residency program (all those centuries ago...) were only doing it because it was one of the only things they could get in to and had the best potential lifestyle of their remaining choices. Not my words, just paraphrasing them.

Does anyone know where I can get ahold of the concrete data about board scores, etc as they relate to specialty matching? I don't find this data on either NMRP or USMLE websites.

 

[Taus]

I'd like to see an honest, confidential survey to see how many rehab residents and/or attendings went into the field as their first choice, and how many would have done it if they could have chosen any other field and been guaranteed a spot. NMRP makes assumptions for their data.

By the time it came to apply, I didn't want to do anything else. At least one of my classmates, and several who came before and after me in my residency program (all those centuries ago...) were only doing it because it was one of the only things they could get in to and had the best potential lifestyle of their remaining choices. Not my words, just paraphrasing them.

Does anyone know where I can get ahold of the concrete data about board scores, etc as they relate to specialty matching? I don't find this data on either NMRP or USMLE websites.

There is a PDF called "Charting Outcomes in the Match" that you can find if you google that title. Our field (I guess I can start including myself in the "ours") is on the low end of the spectrum in most categories.

 

[PMR 4 MSK]

There is a PDF called "Charting Outcomes in the Match" that you can find if you google that title. Our field (I guess I can start including myself in the "ours") is on the low end of the spectrum in most categories.

Thank you for the google! That's what I needed.

 

[Ludicolo]

People here frequently like to point out that in PM&R they look "beyond the numbers", usually when somebody points out that PM&R has the lowest Step 1 scores.

Well, what is that "beyond the numbers"? One would presume that they tend to give more preference than other specialties to candidates that they know personally, most likely to be ones from that institution. Everyone at my medical school who went into PM&R did 2-3 rotations within the department. Outside rotators did at most 1.

So if PM&R as people like to claim is looking "beyond the numbers" to evaluate candidates more personally, then it would make sense that they would tend to take more of those that they know well.

Either that or maybe the field just does end up with a lot of low scoring candidates.

I don't know how your program ranked everyone, but did you and your fellow classmates all rank your home program #1?

 

[Xardas]

I'm against inbreeding of medical programs and suggest training at as many different places as possible, so that see how things are done differently all over. Having the same attendings for meds school, residency and even fellowship means you learn less outside views.

I agree inbreeding is bad but in my opinion moreso when there are too many faculty from the same residency program.

With students its not as much of a big deal. At our program (large institution), the director likes home institution students. This way we can scope out their work habits, professionalism, interest level better, as opposed to getting burned with a student who interviews well, but we know very little about behind the scenes, and turns out to be a horrible resident (we have a couple of these guys right now).

 

[ShrikeMD]

I agree inbreeding is bad but in my opinion moreso when there are too many faculty from the same residency program.

With students its not as much of a big deal. At our program (large institution), the director likes home institution students. This way we can scope out their work habits, professionalism, interest level better, as opposed to getting burned with a student who interviews well, but we know very little about behind the scenes, and turns out to be a horrible resident (we have a couple of these guys right now).

I agree with you. In principle, I think programs are strengthened by strong faculty with diverse training backgrounds.

That being said, I recall Dr. DeLisa telling me that one reason he hired faculty from his residency program was that the program invests in its residents and fellows. It is thus difficult to try to encourage them to leave and work elsewhere when you feel strongly they would make strong contributions as faculty members.

 

[Ludicolo]

Yes, diversity is a good thing. And I will agree that an individual in training may be best served in the long run going to medical school one place, residency/fellowship at another, and working somewhere else.

But let’s look at some of the inbred programs. Mayo immediately comes to mind. RIC has more than a few of its graduates on staff. ShrikeMD mentions Dr. DeLisa and Kessler. Is inbreeding really all that bad?

 

[ampaphb]

How many times did you hear an attending start off by saying "In my day, Dr. X taught us to ..." If the majority of teaching faculty were taught by the same Dr. X or his progeny, it inherently limits the diversity of approaches to a problem. Any institution that makes reference to "the **** way", IMHO does a disservice to those it trains. Residents ought to leave their training with more than the ability to recite by rote "how things were done where I trained" - they should be able to view the good and the bad of multiple approaches, and decide for themselves what will work best for their future practice.

 

[drusso]

Here it is:

http://www.nrmp.org/data/chartingoutcomes2007.pdf


It is an interesting read.

There does seem to be less "cross-fertilization" in academic physiatry compared to other specialties. I think this also contributes to the "regionalization" of the specialty.

I think it can lead to an echo chamber effect when inbred programs try to innovate, but discover they have very a narrow spectrum of ideas to choose from because their core faculty have all trained in the same place (and usually have little or no real world private practice experience). I was always most impressed by my trainers who had left their residency institutions and develop deep knowledge and experience in other settings or in private practice before returning to train residents. They seemed to have more credibility that the "straight shots" who go from being a senior to resident to a junior faculty overnight.

In general, in our specialty, based upon where you trained and where you practice, what a physiatrist actually does can vary tremendously.

 

[Llenroc]

Being fresh off the interview circuit, I tend to agree that most programs I went to whether ranked highly or low had a surprising number of people who did all of their training at that institution, certainly moreso than is the case for other specialties.

 

[Ludicolo]

Regarding academic PM&R being more inbred than other specialties: anecdotally I agree, this does appear to be the case. Wonder if there is any data anywhere to support this? Don’t feel like looking up the faculty lists in every department at every institution.

I do agree with the majority of people on this thread. When it comes to individual training, variety is the spice of life. Individuals are best served learning from a wide range of viewpoints, practice patterns, techniques, etc. Ultimately, wherever they end up, they can utilize and adapt these tools to best fit their needs. To be fair, not all academic physiatrists practice within the vacuum of their own institution. They are aware of the literature and research going on at other areas, and are able to (or should be able to) integrate these findings into their own practice. And not everyone on staff has gone to that institution’s med school and residency. There is always some degree of variability.

But looking at it from the Institution’s/Program’s side: familiarity is a valuable commodity. Transition periods like med school to residency, residency/fellow to attending, are difficult times. Helps to know who would succeed quickly in a given environment. Matching a med student who excelled on an audition rotation, or retaining a recent residency grad who was well liked and was outstanding on her clinical evaluations, is felt to be less risky than an outside candidate whom I can only talk to for 20-30 minutes, all other things being equal.

I find it interesting to note that a lot of these programs do have a high retention rate in faculty. And a number of these physiatrists, as drusso points out, have worked elsewhere, and eventually “came back home”. Those programs I listed are certainly not bad programs, and I would hazard a guess that they are not bad places to work either, if you are interested in pursuing an academic career. Then again, academics are not for everyone.