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Step 1 Score and the Match

Discussion in 'Medical Students - MD' started by PDsquash83, May 3, 2007.

  1. PDsquash83

    PDsquash83 Member

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    Hi All,

    So it is widely acknowledged that your Step 1 score is a vital part of your application to residency. I have heard that you need above a 220 to be competitive at most places. However, if this is true, then why is the average of board scores so high at most schools? Take for example Keck med, there average board score is 232 (http://www.usc.edu/hsc/info/pr/1volpdf/pdf06/1227.pdf) . It would seem that they would have their pick of specialities if there grades and research are kept constant? Is this true? How does this account for the relatively large amount of people who go unmatched each year (~20% urology)? Something isn't adding up here?

    Is this the same analogy as a lot of 38+ on the MCAT don't get into a top 10 school? I thought residency was more of a numbers game so that your board score would have more predictive value.

    Help a lost MS0,
     
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  3. Tired

    Tired Fading away

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    Um, I'm not totally sure what your question is. Let me just address a couple things in your post.

    Not true. The "required" board scores are very very specialty-dependent. 220 may be competitive for Gen Surg, but not for Urology. 220 is extremely competitive for most IM or FP programs.

    Most schools? I don't have hard numbers (and most schools, as I understand it, don't publish their Step 1 averages), but I can pretty much promise you the average at most places is well well below 232.

    Urology is special. Like neurosurg it is extremely competitive, with a high degree of self-selection. The vast majority of U.S. seniors will match.
     
  4. Critical Mass

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    Well most here would say that PGY programs are more subjective, as in the interview, 3rd year evals, and LOR's carry more weight than they did for pre-med. Don't get me wrong, you usually need a solid step 1 to land the interview, but remember that with residency you're being evaluated by people who hope to make you a peer in contrast to med school adcoms who will usually never have to work with you as an associate after they decide your fate.

    Step 1 averages aren't usually published because then USN would get their hands on the data and cause more nonsense for the pre-allo crowd to kick around.

    I'll nonetheless take the 232 average at face value for the sake of argument. For urology, my feeling is that a 232 is not competative for that specialty; so at least half or so of the class wouldn't do that great if they wanted to play with OPP as a career.

    Remember that in the case of USC, there will be tons of competition from UCLA and UCSD grads who are pretty much all superstars.

    Let's get Long Dong to comment on this one.
     
  5. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    You also need to remember there are only a finite number of residency spots per specialty. You could have 400 applicants all with 260's applying for 200 urology spots . . . 50% match . . .

    Step 1 opens the door - it's a "gatekeeper" after you've got the interview you better hope everything else is order
     
  6. PDsquash83

    PDsquash83 Member

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    Urology was just an example of a specialty that was particularly difficult to get into.

    But my point is more that, if you are going to a school like USC, on average their graduates, will be able to pass the "gatekeeper test" of the USMLE for most specialities. I.e. they will be able to interview at the speciality of their choice (on average and saying nothing about the particulars of the residency) on average.
     
  7. WhoisJohnGalt

    WhoisJohnGalt NYC Psychiatrist
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    How is this a point? Even IF the average step 1 score at USC is 232 (certainly, questionable), that doesn't mean that YOU will get a 232 if you go there. The vast majority of students that do well on step 1 do so because of the tremendous amount of work that they put into studying on their own time, outside of class. The people that are motivated to do that are going to do so no matter where they are, and the people that aren't, won't.

    I think you're trying to get us to tell you to spend ridiculous amounts of money going to a "prestigious" school, but that's dumb. I'm sure you're going to anyway, but in a year (when you're $60,000+ in debt ALREADY) you'll be wishing you'd listened.

    I've really got to stop paying attention to M0 posts... it's raising my blood pressure ;)
     
  8. jdh71

    jdh71 epiphany at nine thousand six hundred feet
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    Ok. My point was one mroe factor you had not looked at.

    Step 1 score, at the end of the day, is your responsibility. It matters little where you go to school.

    USC probably has higher Step 1's for the same reason it probably has higher MCATs - the type of students that go there - NOT the school. Getting into a California school is harder than average and getting into medical school itself . . . you do the math.
     
  9. Law2Doc

    Law2Doc 5K+ Member
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    Agreed. Step 1 is very much an individual challenge, not one your school has a great deal of impact on. The same person who scores 232 at USC probably would have scored it going to a lower ranked school. Most schools teach the same basic material. Everyone uses the same basic Q-bank and First Aid. What you accomplish in your preparation time will largely determine who does better. FWIW when a schools average is 232, that usually means some folks still did somewhat poorly, but got averaged out by some high scorers. You pass no "gatekeeper test" unless your score is high.
     
  10. DryDoc

    DryDoc Member

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    You may want to check this document out (it's available on line). It identifies a number of variables associated with matching to different specialties. It's interesting that one of the strongest predictors of successful matching in a specialty is the number of programs applied to/interviewed at. The data suggests that it's possible to get into a competitive specialty if you're willing to "go anywhere" for residency.




    Charting Outcomes in the Match
    Characteristics of Applicants Who Matched to
    Their Preferred Specialty in the 2005 NRMP
    Main Residency Match
    A collaborative project of the National Resident Matching
    Program and the Association of American Medical
    Colleges
    Paul Jolly, PhD
    Division of Medical School Services and Studies
    Association of American Medical Colleges
    July 2006
     
  11. PDsquash83

    PDsquash83 Member

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    Well it is on the school's website: read my first post.

    Perfect that is what I wasn't getting. I was thinking that your primary prep for Step 1 would be through your school coursework but it apparently isn't that simple.

    I wasn't but way to jump to conclusions. :confused:
     
  12. Law2Doc

    Law2Doc 5K+ Member
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    That too is an individual process. Most schools cover the same material, and most students use the same study guides, and board review materials. A student could do a better job of preparing himself for the boards throughout the duration of the coursework, but, having seen a number of syllabi, it would be a stretch to say that many schools do a whole lot different to prepare those students. All places cover the topics covered by Step 1 in fairly comprehensive detail. Most look at what past classes seemed weak on and make adjustments to improve the coverage. So in the end, every med school is going to be a decent initial round of board prep, but the real work to get prepared falls to the student on his/her own, not the school.
    The main thing some schools do that seems to me would be beneficial is some give students longer periods off before the boards for studying independently.
     
  13. dbhvt

    dbhvt Senior Member

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    l2d, this doesn't make sense. If step 1 performance is independent of school curricula, how can educators at individual schools use the performance of their students on step 1 to evaluate weak/strong areas in their curriculum.
     
  14. soeagerun2or

    soeagerun2or Banned
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    Don't read too much into the numbers from each school. The "average" can mean the mean, median, or mode for that matter and often the school makes adjustments such as excluding those who fail or remediate essentially dropping the bottom out. Schools purposefully don't report their scores, their sampling methods, or error values.

    If we look at the mean in and of itself it isn't very useful either. For example, if 2 students score 200 (are well below the mean) and one scores 260 (well above) the mean is above the national average. Thus, if the class is a bimodal distribution of high-achievers and under-achievers as a whole the class will seem above average. This may fool you into thinking "If I go to school X, which has a high Step I average I'll have a high Step I score." This is only the case, however, if you're in the lucky group who does score well at school X.

    The best way to judge how one will do best on Step I is to take NBME practice exams, NBME subject tests, national registry board review question banks (Qbank etc.), MCAT, and 1st & 2nd year performance and correlate it (in decreasing order of best fit) to Step I. Thus if you do well on a NBME exam you're much more likely to do well on Step I than if you do well in class or go to a school with a high average.
     
  15. student101

    student101 Member

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    Actually, I think you are misreading the data. The data suggests that those with the longest rank order lists have a greater chance of getting in. You can only rank those programs at which you receive an interview. The highly qualified applicants get more interviews and, thus, are able to rank a greater number of programs. Just applying to a lot of programs doesn't necessarily correlate with the data. You could apply to all 150+/- dermatology programs and only get 5 interviews and, thus, only have a rank order list with 5 programs. So, what the data really shows is that the more interviews you get the greater chance you have to get in, but you have to be a highly qualified applicant to get a large number of interviews. Although, I think we all would agree that, in general, the more programs you apply to, the greater your chances of getting in.
     
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  17. student101

    student101 Member

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    Because, if all (or most) of the students from the school are doing poorly in one specific area, it shows a weakness in the curriculum. Even though studying for step 1 is an independent process, a weakness in one area might indicate a weakness in the core education a student must have even before he/she prepares for step 1.
     
  18. dbhvt

    dbhvt Senior Member

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    conclusion:
    step 1 scores are not independent of medical school.

    And before you get bent out of shape, I do think that the biggest predictor is time/quality of self study, but I also think the party line that your schools curriculum has nothing to do with step 1 performance is ridiculous.
     
  19. student101

    student101 Member

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    I completely agree. It's an independent study process for the most part, but I don't doubt that your medical education can definitely have some kind of an impact.
     
  20. Law2Doc

    Law2Doc 5K+ Member
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    Well, I would argue that they try to tweak their curriculum to do things better, but it is largely an exercise in futility. That med schools want to play a role in students' success is clear, but that doesn't mean they actually manage it better than the others. And all schools are doing the same thing -- it's not like you are getting substantially better education or Step 1 prep at X vs Y, I don't think, since the subject matter is pretty consistant across the board, the review books are the same, and all schools make adjustments based on what they don't think they addressed well enough each year. (Again that doesn't mean they really didn't address it fine the first time). Individual profs here and there probably do a better job of distilling info in ways that stick, but there is no evidence which schools they are at (they could certainly be at schools with lower average scores, since not all courses are equivalently tested). That schools do make tweaks is pretty obvious (and schools tend to admit this), but at the end of the road it's still the student and his First Aid/Qbank regimen that really has to get him/her over the finish line. A lot of this battle is dependant on the abilities and motivation of the students recruited. I see school impact as sort of like the role of a baseball GM -- they can affect the results by the talent they recruit, but by and large the success of the team is driven by the talent of the players on the field.
     
  21. dbhvt

    dbhvt Senior Member

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    You're talking around the point again.
    Scenario A:
    School looks at step 1 scores, sees a trend of poor performance in a particular area over several years.
    School directs a curricular intervention toward improving usmle performance in that area.
    After intervention, step 1 scores in that area improve.

    Scenario B:
    School sees a problem with curriculum, and makes a few specific changes.
    School measures impact of that change on (a) the variable that drew their attention in the first place and (b) step 1 scores.
    School sees improvement in both variables.

    These are educational interventions that happen at my school, and lead to improved step 1 scores. It is hard for me to believe, in the face of these data, that step 1 scores are independent of curriculum. And if curricular tweaks impact board scores, then it's hard for me to believe that the differences between curricula at different schools don't impact step 1 scores.

    The SDN attitude that there is no difference between US allo medical schools may be well intentioned... you might think it discourages pre-allo competitiveness, elitism, etc. But when you really look at it carefully, it encourages this loan gunner mentality. It's not the school, it's you. Isolate yourself with First Aid, study by yourself, don't go to class, etc.
     
  22. student101

    student101 Member

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    Maybe I'm confused, but it sounds like you and Law2Doc are saying essentially the same thing. :p
     
  23. Law2Doc

    Law2Doc 5K+ Member
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    The bolded part is the part I find speculative. Since each group of students year to year is new, and we both seem to agree that independent preparation is the biggest factor, the confounding variables are enormous here. A school can never really take credit for improvements with any confidence, because the game may be already won or lost at the admissions stage.

    As for the SDN attitude issue, I would suggest that it's actually the schools that don't do as well on Step 1 tend to make more tweaks and put more effort in trying to improve things (to little avail). It's the top schools that spend more time experimenting with PBL, and other stuff that does not directly translate to Step 1.
    So I still say, exercise in futility.

    No way to really know the answers to any of this, of course, since most places are pretty secretive about their board scores. But there's enough evidence out there that the folks who have the most discipline and best memories and standardized test skills tend to prevail regardless of wherever they go. Heck, a good chunk of the students at the schools with top scores probably never attend lecture anyhow, and are just good self studiers. It would be hard to credit the schools with anything more than admitting them.
     
  24. naegleria brain

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    ok lets get back on topic.

    not every student from keck wants to go into urology/nsg/ortho, etc. these guys are 200 grand in debt and some are over 30 years old. not all of em have it in them to go through a grueling 120 hr/wk ortho residency or a seven year kick-in-the-balls nsg residency just to start making money over a decade later. most will want to do internal, peds, and fp, like most other medical schools.

    yes, they probably have more kids who are successful at attaining these positions, but by proportion, its still a small number.

    remember, not everyone can be a neurosurgeon, but not everyone WANTS to be a neurosurgeon either. i dont want to bring in a stereotype, but think about the hearty emotion-filled girl with big hopes and dreams for the world in being a savior for humanity. she doesnt want to go into plastics and do boob jobs, she wants to save babies, and to peds she will go, 270 or 220 alike.

    it comes down to personal preference
     
  25. PDsquash83

    PDsquash83 Member

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    I tried to keep my original post neutral about preference for speciality. I just used urology as an example. I wasn't implying they all want to go into a competitive field but I was saying a high USMLE scores helps you get what you want, whatever that might be. Sorry for the confusion.
     
  26. dbhvt

    dbhvt Senior Member

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    PS It wasn't speculative. True, there are confounding variables, but when the admissions process hasn't changed, and you have a trend based on several years data that changes concurrent with a specific intervention designed to change that trend, it's hard to believe that everyone got better at epi, for example, for some independent reason.

    And your suggestion just doesn't fit with my experience. I'd be surprised if my school is the only 'top' school that looks at a board scores as one indicator of curriculum success.. and tweaks as necessary.
     
  27. Critical Mass

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    Just to throw this out there, my school doesn't seem to have made a change to its basic science material (either exam questions or lectures) in many years. I honestly don't think that they'd ever admit that other schools have the right idea with the systems-based approach or pass/fail grades.

    They finally gave in to the need to provide better PE skills in M1/2 only after they figured out that the students were failing USMLE II CS much more than at other schools.
     
  28. Law2Doc

    Law2Doc 5K+ Member
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    The admissions process absolutely changes every year because the applicant pool is made up of different people each year, often some of the adcoms and interviewers are different each year, and the notion of "good fit" is actually tweaked each year based on successes and failures of past admittees. Classes are bigger at most places this year, numerical stats are higher, more women, non-sci majors and nontrads. It's not unusual for med school test averages to differ a bit year to year, and I've certainly seen one year's class score substantially higher on average in tests in courses such as epi, as compared to the preceding year. It's really not a leap to think that the level of discipline these different admittees bring with them is different, year to year. The game can be won or lost long before that epi tweak.

    All schools tweak, but as I said before, the more substantial tweaks seem to come from the bottom scorers, not the top of the pack (again, not saying the top ranked schools are the top scorers because anecdotally some aren't), and the more experimental educational experiments (eg PBL) come from the top of the pack down (presumably because they have the luxury of being able to play with novel things without tarnishing their reputation). That schools are trying does not mean they are making a difference. A small change in First Aid likely would have a much greater impact.
     
  29. student101

    student101 Member

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    ... and so they can maintain their image of being "progressive"
     
  30. dannylee718

    dannylee718 The Village Idiot

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    :luck: dbhvt, congrats on being a MS at a 'top' school. :thumbup:

    But, I'm with Law2Doc on this one. It just seems you can't accept the fact that your 'top' school has not much more to offer (pertaining to USMLE) than any other joe-schmoe school in the boondocks. It would be impossible for one to consider the USMLE a standardized test if certain schools were able to provide a clear advantage over others. If that is the case, I'd say "DOWN WITH THE USMLEs!!!"

    However, your 'top' school probably does provide other advantags. Maybe it offers a stronger research or clinical experience. Maybe it gives the the opportunity to meet/network with influencial people in a particular field.

    :)
     
  31. Miami_med

    Miami_med Moving Far Away
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    #1: A good score will help you

    #2: The school is 10% of step one, and every school will probably give you 9+ out of 10. A high level school isn't necessarily better than a low level at this 10%, and the higher level applicants to the elite schools will confound all attempts at comparison.

    There is no reason for everyone to get bent out of shape over this issue.
     
  32. dbhvt

    dbhvt Senior Member

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    Oh god, I didn't think this would come off like that. I only mentioned that I went to a 'top' school because l2d was off on another one of his speculation and misinformation kicks (top schools don't pay attention to the USMLE). The topic in particular is annoying to me, not because I want to believe that my school does a better job at preparing me for the USMLE than any other school, but because I'm interested in how medical education is done. I know we do tinker with how things are done, and it seems pretty clear that it works. I am probably getting a little bent out of shape on this because I don't want to believe that all that work is just hand-waving. I also regularly get pissed at the stuff I see l2d spewing that, from where I'm sitting, doesn't seem to have much to do with reality. This is a good site, and I think it can be really helpful to students, but you often see bullshiit posted as fact... and skepticisim is doled out in different doses to different ideas, with a fairly predictable pattern.
     
  33. Long Dong

    Long Dong My middle name is Duc.

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    That depends on specialty. From here: http://www.nrmp.org/matchoutcomes.pdf It looks like the Median Step 1 Scores for Matched US Seniors is as follows

    Plastics 242
    Derm 239
    Ortho 237
    NeuroSurg 236 average Source
    RadOnc 235
    Rads 235
    Optho 231 average Source

    Path 223
    IM 220
    Surgery 220
    EM 219
    Anesth 219

    Peds 215
    OBGYN 212
    FM 209
    Psych 209
    PM&R 208

    And I think from an old post that uro and ent was in the 230s as well. If I can find that old post or link I'll post it.

    But don't let these averages fool u. You've got to remember there are also outliers at the lower end the averages, who have something special, that if you took them out, the competitive rez's averages might be even higher. Like the student who is married to faculty/son of faculty/parents donated mad $/extra degrees (jd/mba/phd)/been doing research in that field since they came out of the womb. If you don't fall into one of these catergories for the more competitive fields, even if you did score the average for those matched in that field, you might not match.


    I'd say most schools averages aren't that high, and it only seems that way. Just like when you go to the mcat or step 1 forums and only see post that every one is 1 S.D. above the mean. Only those that did well report their scores, and the ones who didn't do above average are less likely to have it out there.

    I also think having more time off from school to study for step 1 might have something to do with it. I remember Jalby from USC saying he got like 12 weeks or some ridiculoulsy long amount of dedicated study time for step 1. I think if I had a few more weeks I could've squeezed out another 2-4 points. In retrospect I would say more vacation time would've been a better investment cuz I was pretty burnt out at the begining of 3rd year from step 1 studying.

    Like others have said step 1 is the gatekeeper once you get past the cut offs other things come into play and must be in order as well. Critical Mass was on point when he/she said interviews, 3rd year evals, and LOR's carry more weight cuz they are training you to be a peer and they have to work with you for the next 3+ years.

    Just look at the derm stats there were people with 260+ who didn't match.:eek: Like most things in life who you know can matters more then what you know.

    Also remember there are superstars who go into fields that aren't seen as competitive. This is anecdotal but some of the smartest guys/girls in my class went into internal medicine, and the top girl in my class went into ob/gyn. Thank god they didn't go into the same specialty as me, it was already tough enough as it was.

    Don't over think it, do the best you can and "get all your ducks lined up" a quote from banned guy named 4skin.
     
  34. deuist

    deuist Stealthfully Sarcastic
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    LongDong,

    How did you come up with the averages for Step I? The AAMC does not provide those numbers.
     
  35. Long Dong

    Long Dong My middle name is Duc.

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    Are you talking about averages for school or specialty? If for schools, I don't really know. I just think that most schools can't all have a 230+ average, I don't think that that is possible. If you are talking averages for specialty gotto page 11 of the nrmp report for the medians of us seniors who matched per specialty.
     
  36. deuist

    deuist Stealthfully Sarcastic
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    Oh, I had this PDF for almost six months and have never seen that page! I always jump straight to the specialty pages without ever reading the rest of the document.
     
  37. PDsquash83

    PDsquash83 Member

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    I agree with most of your post and thanks for putting it out there. But this doesn't seem right, the Step 1 score is reported from the USC website and I just don't believe that they report their average by taking out the low scores or some other deceptive strategy.
     
  38. dilated

    dilated Fought Law; Law Won

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    You're kidding right? You can't be that naive. You're talking about a system where they had to ban schools from telling prospectives what percentage of their students matched to their top 3 choices... because schools were pressuring their students to change their rank list to put likely matches in the top 3 to make it look better. You think if they did that they won't "favorably" report their step 1? You are in the big leagues now. US news rankings can get administrators fired and schools will do what it takes to get the people they want.
     
  39. Law2Doc

    Law2Doc 5K+ Member
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    I think schools sort of do this anyhow -- they call it advising. That's why so few students at most schools have to scramble. You don't think folks at the bottom of the class want to go for a hail mary now and then?
     
  40. Long Dong

    Long Dong My middle name is Duc.

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    You got me all wrong. I'm not saying they are doing anything deceptive like that. I actually do believe there are some rock stars over at the university of spoiled children (go bruins) :D . I'm just saying that it sounds like so many schools have step 1 averages over 230 because only the schools w/great averages make it public. Podunk U or High and Mighty IVy U would less likely make there schools average step 1 public if it was below the national average.
     
  41. dbhvt

    dbhvt Senior Member

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    From what I understand of the match algorithm, ability to match isn't affected by the order (e.g. ranking a likely match over a hail mary vs. a hail mary over a likely match). You should rank in the order of your preference. You run into scramble problems when your rank list is not long enough, not when you put it in the wrong order.

    http://www.nrmp.org/res_match/about_res/algorithms.html

    Take home: advising that suggests you rank programs you are likely to match in first is piss poor advising, as dilated suggests.
     
  42. Doctor Bagel

    Doctor Bagel so cheap and juicy
    Moderator Emeritus

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    I think Law2Doc is talking more about advising over which specialty to apply in instead of how to construct your rank order list. The hail mary would be the kid at the bottom of his class who wants to shoot for derm or radiology. From what I understand, most schools do tell students whether or not they're competitive for whatever residency the student is interested in, so this type of advising is alive and well and does serve to reduce the number of people scrambling.
     
  43. dbhvt

    dbhvt Senior Member

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    ^This is true, doctor bagel, and I agree that it is good advising.

    ^This is poor advising, and doesn't reduce your chance at scrambling.
     
  44. Law2Doc

    Law2Doc 5K+ Member
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    Yes, that was what I was trying to say.
     

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