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.