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Some Thoughts For Those Of You Applying For IMED Residency

Discussion in 'Internal Medicine and IM Subspecialties' started by SoCalDreamin', Apr 7, 2004.

  1. SoCalDreamin'

    SoCalDreamin' Member
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    Based on having followed SDN for the past year and having gone through the entire application, interview, and match process, here are a few things I would like to share with those of you who will be applying for an Internal Medicine residency position. These views are based on my personal perspective, but I feel that they are valid and are good to consider when taking that next big step in your careers. Hopefully, ckent will incorporate this thread into his FAQ questions thread at the top of the page so that future applicants will have easy access to what is stated here.

    My conclusions regarding strength of application are as follows:

    1.) An outstanding Step I score and/or AOA is the ticket for the ultra-competitive specialties, and we all know what they are.

    2.) For Medicine, two factors bear more weight that an outstanding Step I score and/or AOA; such factors include:

    a.) Strength/rank/reputation of your medical school
    b.) Getting letters of recommendation from nationally renowned physicians

    However, these statements in no way imply that one should not try hard to obtain a good Step I score and a high class rank. These two factors might get you that top interview, even if your medical school's rank or the prestige of letter writers is not super-stellar. With this information in mind, let's consider the following 2 applicants:

    On the one hand, we have med student X with the following statistics:

    * Step 1 = 245
    * AOA
    * Attends a medical school that is not ranked in terms of NIH research funding or in US News & World Report
    * Has letters of rec from 3 faculty members that are not well-published

    On the other hand, we have med student Y with the following statistics:

    * Step 1 = 225
    * No AOA
    * Attends a medical school that is ranked in terms of NIH research funding or in US News & World Report (e.g. Stanford, UCSF, HMS, UT Southwestern)
    * Has a letter or rec from Dr. Topol of the Cleveland Clinic that is based on a cardiology elective he did there at the beginning of his fourth year

    Of these two candidates, whom do you think will be more likely to land interviews at MGH and Brigham & Women's? If you said med student Y, then you are correct.

    Luckily for me, I am not hung up on silly things such as rankings and academic reputation, so none of the above information mattered to me when it came down to deciding where I wanted to go for residency. Much larger factors weighed on my mind, such as work environment and house staff support, and most importantly, if I was going to be happy at a particular program. Things worked out just the way I wanted them to, and I couldn't be any happier.

    __________________________________________________

    One last thing to really put this whole prestige / academic rank issue into proper perspective. One of the places I interviewed at is nationally renowned. I found it to be an outstanding institution with famous academicians, an awesome Chairman, and a top 5 rank in terms of NIH funding. Not only that, it is affiliated with a very good medical school, and as I was told on my interview day, ALL residents from this program who were interested in GI or Cards have matched successfully during the past two years. For this reason, I placed this school very high on my rank list...although it was not number one, it was in my top three.

    Then, shortly before Match day, I read the following review on SDN, which was submitted by one of the program's PGY-3s:

    "I would say the Achilles' heel in the program is the office of the program director. Many would use the term "unhelpful" in their relationships with her. With the caveat that I did not need a letter from her, I had several graduating seniors from last year complain to me that she did not know them and that their letters of support consisted of a few lines about their conference attendance records. Several of these people did not match and when they asked for her to call programs on their behalf, she did not do so. Recently, she sent an email out to the housestaff to discourage them from making schedule trades on call days because of the administrative burden it placed on her office. One outspoken resident emailed back that if we as housestaff are willing to cover for each other so that we can attend important personal events, secretarial time should be a secondary concern. I personally feel, for example, that my being maid of honor for my best friend's wedding should take precedent over a few hours of secretaries' time. There's also been some issue over a past intern who left from years ago whose confidential info was not so confidentially dealt with....... No inquiries, I'm afraid."


    Needless to say, I was shell-shocked when I read this info., as I knew that there would be a chance that I could match into this program. For me, there is nothing in the world (e.g. most prestigious program, #1 ranked in this and that) that can make up for the things described in the review listed above. Having your program's support, honesty, and their being forthcoming, as well as your being happy at your particular program are the most important things when it comes time to commit yourself to a residency. If these vital things are missing, it will be a long three years, regardless of where you are.
     
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  3. Kalel

    Kalel Membership Revoked
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    I will work on incorporating your post and any other advise people have (through cut and paste, if you don't mind, to avoid having too many sticky's at the top of this forum), thanks for posting! I agree with your thoughts regarding PD's. IMO, these people can either be excellent people to write your LOR, but more often, I suspect that they are poor people to choose to write your LOR. My impression is that many PD's get asked to write so many LOR's because everyone assumes that they will write a good one that they get "stingy" with their praise. PD's interact together, and I guess that the last thing they want is for their "good word" to not mean as much in the PD circles. Also, this may sound somewhat cynical, but a PD's loyalty is towards their residency program, not towards the med students or med school. If the PD is at all interested in ranking the student on their list, that kind of provides an incentive to only write a mediocre letter so other programs won't "steal" the student. Therefore, unless you are 100% sure that your PD loves you, I wouldn't ask your PD for a LOR. Your chairperson's letter (which is required anyways) is usually much more generous, and I have heard of chairpeople and student dean's being good about calling other programs for you. I wasn't even aware that some people were asking their PD to call other programs for them, that just seems counterintuitive if your program was one of the programs that you were planning on ranking. Anyways, thanks again for posting!
    -ckent
     
  4. avendesora

    avendesora Senior Member
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    True for residency application when you are a med student.

    I believe (residents correct me) that when you finish residency the PD is duty-bound to write a composite letter that evaluates your performance during residency -- kind of like your MSPE. This is used for fellowships and remains on file with the residency office. Whenever you need credentialling in the future you provide a copy. I heard this from one PD that I talked to, so not sure if this holds at all places.

    I can see how it would be a benefit to know the PD well so they can actually write something representative in this letter rather than just quote your attendance record.

    I believe this is what that quoted review was talking about.
     
  5. Kalel

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    I see. The previous post was referring to applying for fellowships, not med students applying for residency. I agree that looking for a PD who you could see getting along with is important in this sense; they ultimately will be your boss and determine a lot about your employment prospects after you finish residency. I've got to start actually reading posts before responding to them, sorry about that, I skim a lot. :)
     
  6. SuFiBB

    SuFiBB Member
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    from my experience from going through the whole application ordeal, some programs indicated that they place significant emphasis on the IM department chairman's letter which reflects your performance in your sub-I because most of what you do in your internship is similar to your sub-I rotation. whatever you do, do as well as you can for your sub-I to form the basis for a good chairman's letter. read before, learn the pocket intern survivor's guide, take a few electives beforehand, learn cross-cover emergency stuff, learn how to write orders such as admit orders, and prepare & memorize each presentation you give about a patient during rounds to your attending.
    good luck
     

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