The First DO-specific NRMP Charting Outcome!

EEP: Applications for CDC’s Epidemiology Elective Program are open through May 5, 2026. Click here to learn more and apply!
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Advertisement - Members don't see this ad
I don't know why people are saying RIP to DO chances at GS... Looking at the numbers a ton of applicants only ranked 1-5 places. Without knowing USMLE scores we can only make some assumptions obviously but to me this either belies applicants not applying broad enough or applying without the necessary app and only getting a handful of interviews. The people who rank more than that (i.e. Probably have a better app or applied smartly) appear to match just fine. Obviously we can't know without further details, but I still think GS is decently reachable if you put together the right app for it. But this could also be said for about any specialty. Not to mention post merger I doubt MD students will be applying to former AOA spots because they have so many of their own to choose from.
 
AnatomyGrey12 said:
I don't know why people are saying RIP to DO chances at GS... Looking at the numbers a ton of applicants only ranked 1-5 places. Without knowing USMLE scores we can only make some assumptions obviously but to me this either belies applicants not applying broad enough or applying without the necessary app and only getting a handful of interviews. The people who rank more than that (i.e. Probably have a better app or applied smartly) appear to match just fine. Obviously we can't know without further details, but I still think GS is decently reachable if you put together the right app for it. But this could also be said for about any specialty. Not to mention post merger I doubt MD students will be applying to former AOA spots because they have so many of their own to choose from.
Click to expand...

You have to get more than 1-5 interviews for that to happen I imagine. I don't think it's often that many applicants attend 10 interviews for GS tbh.
Likewise I'm going to go on a limb and say that 90% of the applicants who got interviews had a USMLE score. The majority of those who matched had scores between 550 and 700 with the median being 650. At 650 most of them likely had a 230 or higher. It's rare that people have a 400 on their comlex and a 250 on their usmle.
So in short chances are DOs aren't getting interviews even if they have stats that generally would have otherwise gotten them interviews and acceptance had they been MDs.

In short if I was applying GS as a middle of my class DO I'd probably feel uncomfortable missing the AOA match.
 
Drrrrrr. Celty said:
You have to get more than 1-5 interviews for that to happen I imagine. I don't think it's often that many applicants attend 10 interviews for GS tbh.
Likewise I'm going to go on a limb and say that 90% of the applicants who got interviews had a USMLE score. The majority of those who matched had scores between 550 and 700 with the median being 650. At 650 most of them likely had a 230 or higher. It's rare that people have a 400 on their comlex and a 250 on their usmle.
So in short chances are DOs aren't getting interviews even if they have stats that generally would have otherwise gotten them interviews and acceptance had they been MDs.

In short if I was applying GS as a middle of my class DO I'd probably feel uncomfortable missing the AOA match.
Click to expand...
How is any of this new information?
 
Last edited:
Brorthopedic said:
How is any of this is new information?
Click to expand...


It's not. Everything in this information packet can be summarized as: SDN was right. Listen to what ppl on SDN have to say.

It was entirely conformational. But honestly that's what makes it sad. I've always considered SDN to be the far end of the truth. When in reality is that we're actually conservatively in the middle of how it actually is. DOs simply really do legitimately get screwed in the ACGME match unless they're significantly better than their MD counterparts.
 
How much does DO handicap in the match? About 10-15 points on step 1 (assuming not screened out for being DO)?
 
Drrrrrr. Celty said:
It's not. Everything in this information packet can be summarized as: SDN was right. Listen to what ppl on SDN have to say.

It was entirely conformational. But honestly that's what makes it sad. I've always considered SDN to be the far end of the truth. When in reality is that we're actually conservatively in the middle of how it actually is. DOs simply really do legitimately get screwed in the ACGME match unless they're significantly better than their MD counterparts.
Click to expand...

Beats being a Caribbean IMG student.
 
Drrrrrr. Celty said:
It's not. Everything in this information packet can be summarized as: SDN was right. Listen to what ppl on SDN have to say.

It was entirely conformational. But honestly that's what makes it sad. I've always considered SDN to be the far end of the truth. When in reality is that we're actually conservatively in the middle of how it actually is. DOs simply really do legitimately get screwed in the ACGME match unless they're significantly better than their MD counterparts.
Click to expand...

I actually wonder if the fact that this is now confirmed in a public document will facilitate a slow change. Before it was all anecdotal and just an oral history passed down but now it is a hard, obvious fact shown in print. This could cause a little bit of backlash. Maybe that percentage on the ACGME board could actually do something worthwhile and raise a concern. Maybe it also lights a fire under the AOA and COCA to make sure that schools take care of rotation issues to address PD's concerns about clinical education and take away their reasons for passing on DOs.
 
AnatomyGrey12 said:
I actually wonder if the fact that this is now confirmed in a public document will facilitate a slow change. Before it was all anecdotal and just an oral history passed down but now it is a hard, obvious fact shown in print. This could cause a little bit of backlash. Maybe that percentage on the ACGME board could actually do something worthwhile and raise a concern. Maybe it also lights a fire under the AOA and COCA to make sure that schools take care of rotation issues to address PD's concerns about clinical education and take away their reasons for passing on DOs.
Click to expand...

What could they do? Require that PDs don't filter out DO? That won't stop them from deleting them manually from their interview list.
Making a quota would be bad for many, many reasons. So, I don't see how they can fix it short of COCA doing their dang job finally.



Sent from my iPhone using SDN mobile
 
AnatomyGrey12 said:
Maybe it also lights a fire under the AOA and COCA to make sure that schools take care of rotation issues to address PD's concerns about clinical education and take away their reasons for passing on DOs.
Click to expand...
That's not happening as long the COCA is taking in charge of DO school accreditation. The LCME needs to take over and then it will pressure DO schools to overhaul their mediocre clerkship. Anyway, many residency programs can afford to pass on DO students or only take 1 in a few years b/c there are many quality MD students out there. If you're an employer, it would be your best interest to pick the best and most fit students for your program. There's nothing that you or DO deans or AOA can do to stop a PD from filter out Step 1 <220 or non-US MD students. You can say that it's inequitable and why you see DOs are happy when someone get to break the ceiling.
 
Advertisement - Members don't see this ad
Mjolner said:
So, I don't see how they can fix it short of COCA doing their dang job finally.
Click to expand...

Oh I wasn't talking about a quota. Not having to have a better app than an MD to match the same spot would be nice but you can't make people think differently. I think making COCA address PD concerns would actually be a good step. Clean up clinical education and stop accrediting schools who rotate in the local Peds clinic.

Also maybe get rid of the DO filter. At least someone might get curious and actually look at an app or two that way.
 
A little confused about some of the data over here. Is there any way to know if the people who participated in the ACGME gen surgery match participated in the AOA match as well or not? For instance, if say 30-40 percent of the applicants in this report failed to match in the AOA, and then still kept going forward to try in the ACGME and inevitably failed again then that would make this report a little less gloomy.



AnatomyGrey12 said:
I actually wonder if the fact that this is now confirmed in a public document will facilitate a slow change. Before it was all anecdotal and just an oral history passed down but now it is a hard, obvious fact shown in print. This could cause a little bit of backlash. Maybe that percentage on the ACGME board could actually do something worthwhile and raise a concern. Maybe it also lights a fire under the AOA and COCA to make sure that schools take care of rotation issues to address PD's concerns about clinical education and take away their reasons for passing on DOs.
Click to expand...

That's a lot of maybes to expect out of groups that seem to consistently disappoint.[emoji57]



Sent from my iPhone using SDN mobile
 
AnatomyGrey12 said:
Also maybe get rid of the DO filter. At least someone might get curious and actually look at an app or two that way.
Click to expand...

They're fully aware there are some rockstars in the DO world killing it with 260+, but there aren't many. Additionally, it comes down to clinical training. There are DOs as smart or smarter than some of the best MDs, but it's a rare, rare diamond in some pretty brutal rough and PDs can be more efficient with their time just looking at MD students they know will be ready to go as an intern. Lots of DO schools send students to places that don't prepare them for intern year.
It's sad, but it's a fact. Ask @MeatTornado he's right on this one for sure.


Sent from my iPhone using SDN mobile
 
Mjolner said:
They're fully aware there are some rockstars in the DO world killing it with 260+, but there aren't many. Additionally, it comes down to clinical training. There are DOs as smart or smarter than some of the best MDs, but it's a rare, rare diamond in some pretty brutal rough and PDs can be more efficient with their time just looking at MD students they know will be ready to go as an intern. Lots of DO schools send students to places that don't prepare them for intern year.
It's sad, but it's a fact. Ask @MeatTornado he's right on this one for sure.


Sent from my iPhone using SDN mobile
Click to expand...

This is true but from talking with my MD colleagues, their rotations weren't that great either. Sure, they were "in" an academic medical center but it doesn't mean they actually got to do anything meaningful.

Medical school clerkships/clinicals are a problem for all medical students these days with new hospital rules and such preventing medical students from doing documentation/procedures/etc. Also, the 80 hr work week for residents has had an effect of residents doing all of the procedures and such that used to flow downhill to the medical students.

A 4th year medical student used to act like an intern. That rarely happens anymore whether you're MD or DO.
 
Mjolner said:
They're fully aware there are some rockstars in the DO world killing it with 260+, but there aren't many. Additionally, it comes down to clinical training. There are DOs as smart or smarter than some of the best MDs, but it's a rare, rare diamond in some pretty brutal rough and PDs can be more efficient with their time just looking at MD students they know will be ready to go as an intern. Lots of DO schools send students to places that don't prepare them for intern year.
It's sad, but it's a fact. Ask @MeatTornado he's right on this one for sure.


Sent from my iPhone using SDN mobile
Click to expand...

I get that but I honestly think it is a cop out so they don't have to say "because your a DO" My cousin rotated places where they told him "we think you are great, but you are a DO and we don't match DOs, if you were an MD you would match for sure." This was after he did a sub-I and got great feedback on his rotation. I do agree that we need much more consistent clinical rotations in DO education, no argument from me there. Some of it is great but some is horrible (looking at you LMU). I have nothing wrong with a Step filter either, just the idea of cutting out an application without even taking a look.
 
Cubsfan10 said:
This is true but from talking with my MD colleagues, their rotations weren't that great either. Sure, they were "in" an academic medical center but it doesn't mean they actually got to do anything meaningful.

Medical school clerkships/clinicals are a problem for all medical students these days with new hospital rules and such preventing medical students from doing documentation/procedures/etc. Also, the 80 hr work week for residents has had an effect of residents doing all of the procedures and such that used to flow downhill to the medical students.

A 4th year medical student used to act like an intern. That rarely happens anymore whether you're MD or DO.
Click to expand...
I guess you'd have to define meaningful for me.

Having completed my intern year a few years ago and now reflecting, the things you think are important for a medical student rotation are not actually as important as you may think.

Keys to being a good intern is mainly just being responsible. How is that accomplished during a clerkship? Hard start times, staying til work get done, not complaining etc. The structure of an academic resident team more often accomplishes this.

Learning how to take an efficient H&P, document your H&P satisfactorily to billing standards, thinking through a differential diagnosis and coming up with a rudimentary assessment and plan then presenting in a rationale and organized fashion will get you 75% of the way there.

Learning how to call a consult as well as complete a consult while on a subspecialty service is also important.

Things that are overemphasized heavily include procedures as the learning curve will even people out over the first year but the intellectual and practical deficits are harder to correct.
 
Cubsfan10 said:
This is true but from talking with my MD colleagues, their rotations weren't that great either. Sure, they were "in" an academic medical center but it doesn't mean they actually got to do anything meaningful.

Medical school clerkships/clinicals are a problem for all medical students these days with new hospital rules and such preventing medical students from doing documentation/procedures/etc. Also, the 80 hr work week for residents has had an effect of residents doing all of the procedures and such that used to flow downhill to the medical students.

A 4th year medical student used to act like an intern. That rarely happens anymore whether you're MD or DO.
Click to expand...
 
why aren't all the surgical specialties, dermatology, rad/onc represented in the osteopathic charting the outcomes?
 
DrBowtie said:
I guess you'd have to define meaningful for me.

Having completed my intern year a few years ago and now reflecting, the things you think are important for a medical student rotation are not actually as important as you may think.

Keys to being a good intern is mainly just being responsible. How is that accomplished during a clerkship? Hard start times, staying til work get done, not complaining etc. The structure of an academic resident team more often accomplishes this.

Learning how to take an efficient H&P, document your H&P satisfactorily to billing standards, thinking through a differential diagnosis and coming up with a rudimentary assessment and plan then presenting in a rationale and organized fashion will get you 75% of the way there.

Learning how to call a consult as well as complete a consult while on a subspecialty service is also important.

Things that are overemphasized heavily include procedures as the learning curve will even people out over the first year but the intellectual and practical deficits are harder to correct.
Click to expand...

I couldn't agree more with the bolded statements...these things just aren't happening as much as they should be on clinical rotations for the majority of medical students MD and DO from what I've heard/seen/asked. There is definitely a higher percentage of MDs than DOs who are getting that experience but definitely not where it needs to be and not where it was 10/20/30 years ago. I only mentioned procedures because they are more quantifiable.
 
Advertisement - Members don't see this ad
cgk said:
what does an osteopathic student do if he or she has an interest in one of the above fields?
Click to expand...

Same thing MD students do when they shoot for those fields, have a good backup
 
Apply broadly and wisely and always have backups.don't listen to these selfhating losers.
 
Advertisement - Members don't see this ad
cgk said:
why aren't all the surgical specialties, dermatology, rad/onc represented in the osteopathic charting the outcomes?
Click to expand...

They aren't included because (1) there were <7 that matched, (2) there were <50 that applied or (3) both 1 & 2. It explains it in the report.

So few DOs go into those fields because either they aren't competitive enough, they go strictly AOA, they don't have a chance as DOs in those specialties, or there is just low interest (<1% each) when it comes to most of those programs.

Super small specialties like RadOnc basically require amazing connections and/or a research year (as in a year off from med school doing nothing but research) at a specific program. For RadOnc this is basically true whether you're an MD or DO.
 
hallowmann said:
They aren't included because (1) there were <7 that matched, (2) there were <50 that applied or (3) both 1 & 2. It explains it in the report.

So few DOs go into those fields because either they aren't competitive enough, they go strictly AOA, they don't have a chance as DOs in those specialties, or there is just low interest (<1% each) when it comes to most of those programs.

Super small specialties like RadOnc basically require amazing connections and/or a research year (as in a year off from med school doing nothing but research) at a specific program. For RadOnc this is basically true whether you're an MD or DO.
Click to expand...

Yet I find it strange that the IMG report shows derm, rad onc, plastic surg., etc. and their numbers are also microscopic. For example, rad onc had 3 match and 4 not match.
 
IslandStyle808 said:
Yet I find it strange that the IMG report shows derm, rad onc, plastic surg., etc. and their numbers are also microscopic. For example, rad onc had 3 match and 4 not match.
Click to expand...

Yeah even if the numbers are low it would still be nice to see. I honestly think some fields might have no one apply some years. It wouldn't surprise me if there are years where a DO applies to MD NS for example
 
AnatomyGrey12 said:
Yeah even if the numbers are low it would still be nice to see. I honestly think some fields might have no one apply some years. It wouldn't surprise me if there are years where a DO applies to MD NS for example
Click to expand...

Even if you get a negative correlation for the USMLE to matching, having data is better than having no data in this case.
 
Sent from my iPhone using SDN mobile app
 
Drrrrrr. Celty said:
It's not. Everything in this information packet can be summarized as: SDN was right. Listen to what ppl on SDN have to say.

It was entirely conformational. But honestly that's what makes it sad. I've always considered SDN to be the far end of the truth. When in reality is that we're actually conservatively in the middle of how it actually is. DOs simply really do legitimately get screwed in the ACGME match unless they're significantly better than their MD counterparts.
Click to expand...

You have no idea how glad I am to read these words

In every thread even tangentially about DOs, you all act like I hate DOs when I've just been trying to tell you guys how it is
 
Psai said:
You have no idea how glad I am to read these words

In every thread even tangentially about DOs, you all act like I hate DOs when I've just been trying to tell you guys how it is
Click to expand...


I think it's the quantity and repetition of the statements with limited encouragement or advice towards matching 'as well as we can' that drives most of osteo to find some unsavory words for you and MT.

And whether that's difficult for you or not your personality won't really change people's perceptions unfortunately.
 
Psai said:
It's not my problem if you can't face facts. I just tell you how it is, what you do with the information is totally up to you
Click to expand...

You also don't need to take that defensively either. I'm not exactly insulting you or trying to diminish your factualness in this situation. I'm simply saying that there's a correct way of disseminating information and there's a way to make people tune you out.
 
Advertisement - Members don't see this ad
Likewise I doubt you're doing it just purely out of the desire to be correct. Not you specifically but some posters on here have a situation where they essentially superimpose a difficult personality, a desire for validation, and correct information and then complain that DOs aren't accepting reality when they think you're being an ass.

The easiest solution is to say it, give some feedback, and then to say that applying to so and so or getting this and that is significantly more facilitatory and beneficial.
 
I'm not complaining or being defensive. I really don't care if current DO students believe me or not as it's too late for you. What I care about is what premeds who are deciding their future think. I don't want them to buy into the DO propaganda that you guys are hellbent on propagating in every thread as if saying that there's no bias makes it true. It's obvious that there's a bias and it's obvious why.
 
Psai said:
I'm not complaining or being defensive. I really don't care if current DO students believe me or not as it's too late for you. What I care about is what premeds who are deciding their future think. I don't want them to buy into the DO propaganda that you guys are hellbent on propagating as if saying that there's no bias makes it true. It's obvious that there's a bias and it's obvious why.
Click to expand...

I'm not sure why you assumed that people buy into an unreasonable DO propaganda. Everyone accepts that DOs match poorer in the ACGME match than MDs. We also likewise accept the reality that much of the bias has to do with that DOs do preform poorer than MDs on the boards, but a lot of it is simply because they're DOs. But that's fine, not everyone is aiming on high tier or the like. Plenty of MDs are in community programs as well.

And yes, you're being defensive.
 
@Psai Do you really believe that students choose DO because they want to be a primary care practitioner trained in the Still's methodology so they can treat somatic dysfunctions utilizing the hidden OMT arts?

Or do they consider it because they have heavy student loans, some grade replacement, a mediocre MCAT, and are a non-trad that sees DO as enabling them as a means to become a physician without running through thirty hoops to suffer from rejection/heartbreak.
 
Psai said:
You have no idea how glad I am to read these words

In every thread even tangentially about DOs, you all act like I hate DOs when I've just been trying to tell you guys how it is
Click to expand...

You and MT's bluntness about the difficulties DOs face in the match is much appreciated. Where we disagree is about whether that difficulty is warranted.
 
Psai said:
I'm not complaining or being defensive. I really don't care if current DO students believe me or not as it's too late for you. What I care about is what premeds who are deciding their future think. I don't want them to buy into the DO propaganda that you guys are hellbent on propagating in every thread as if saying that there's no bias makes it true. It's obvious that there's a bias and it's obvious why.
Click to expand...

Nobody propagates some "there's no discrimination!" propaganda, and you're not doing this for altruistic reasons. Please. People have been giving you thoughtful, carefully worded arguments and you lost your temper and showed the ugly side of your ego pretty much every time. Nobody's going to dig through your "DO's are inferior" snobbery to try to find the rare actually helpful fact you slip in.
 
Psai said:
I'm not complaining or being defensive. I really don't care if current DO students believe me or not as it's too late for you. What I care about is what premeds who are deciding their future think. I don't want them to buy into the DO propaganda that you guys are hellbent on propagating in every thread as if saying that there's no bias makes it true. It's obvious that there's a bias and it's obvious why.
Click to expand...

I usually agree with the majority of posts and you do have good points. However, I can never understand how you or MT believe we osteopathic students are telling pre-meds that there is no bias. This is far from true. I think by far the current osteopathic student posters are probably the most realistic I have seen in years. We have all hounded go MD first if you want more options.

There are times where the matching process has a lot of shades of gray. MT at one point stated that IMGs and DOs have similar interview/ranking/matching outcomes, yet with the current PDs report and charting outcomes, this has been proven false. The differences in fields with preferences should also be taken into account when stating whether a DO has a fair chance or not.
 
IslandStyle808 said:
MT at one point stated that IMGs and DOs have similar interview/ranking/matching outcomes, yet with the current PDs report and charting outcomes, this has been proven false. The differences in fields with preferences should also be taken into account when stating whether a DO has a fair chance or not.
Click to expand...

I have quite purposefully stayed out of this thread because the charting outcomes data, as a few have pointed out, are pretty useless and unenlightening however i've now been mentioned in about half a dozen posts and there is one falsehood quoted above that needs to be corrected.

I have indeed stated that IMGs and DOs have similar match outcomes. The PD survey and the match lists of all DO schools support this.

Often DOs will quote that 72% of PDs will consider DOs and just leave it at that completely out of context. To put it in context that same number is 98% for US MDs and 64% from US IMGs. Now I'm no math genius but 72% seems a heck of a lot closer to 64% than it is to 98% (8% difference vs 26% difference). When you parse the numbers out even further you see that they're actually even more similar. When broken down you find that those programs that say they interview DOs "often" or "seldom" adds up to 86%. Which incidentally is the exact same for US IMGs. It's 98% for US MDs with 95% in the "often" category vs. only 52% for DOs. It's true that DOs have an edge in the "often category on IMGs by about 20% but are still 33% behind US MDs. So yes the numbers for DOs in the PD survey are clearly a lot closer to those of US IMGs than US MDs.

Rank lists are admittedly nuanced but if you look at IM you'll see that the programs that DOs match into (small community programs in undesirable locations) are almost identical to those on Caribbean match lists whereas at US MD schools the majority of programs are university teaching hospitals.

Source: @Goro posted a screenshot of the charts here http://forums.studentdoctor.net/thr...they-think-of-do-grads-just-ask-them.1223016/
 
There is a world ( Presumably life too) outside of IM, MT.
 
MeatTornado said:
I have quite purposefully stayed out of this thread because the charting outcomes data, as a few have pointed out, are pretty useless and unenlightening however i've now been mentioned in about half a dozen posts and there is one falsehood quoted above that needs to be corrected.

I have indeed stated that IMGs and DOs have similar match outcomes. The PD survey and the match lists of all DO schools support this.

Often DOs will quote that 72% of PDs will consider DOs and just leave it at that completely out of context. To put it in context that same number is 98% for US MDs and 64% from US IMGs. Now I'm no math genius but 72% seems a heck of a lot closer to 64% than it is to 98% (8% difference vs 26% difference). When you parse the numbers out even further you see that they're actually even more similar. When broken down you find that those programs that say they interview DOs "often" or "seldom" adds up to 86%. Which incidentally is the exact same for US IMGs. It's 98% for US MDs with 95% in the "often" category vs. only 52% for DOs. It's true that DOs have an edge in the "often category on IMGs by about 20% but are still 33% behind US MDs. So yes the numbers for DOs in the PD survey are clearly a lot closer to those of US IMGs than US MDs.

Rank lists are admittedly nuanced but if you look at IM you'll see that the programs that DOs match into (small community programs in undesirable locations) are almost identical to those on Caribbean match lists whereas at US MD schools the majority of programs are university teaching hospitals.

Source: @Goro posted a screenshot of the charts here http://forums.studentdoctor.net/thr...they-think-of-do-grads-just-ask-them.1223016/
Click to expand...
I'm inclined to agree. The numbers really aren't that far off once you actually get to the match.

However, the people who start at a DO school are statistically much more likely to get to the match than Carib students because the school's accreditation actually depends on it. DO is actually a viable, sane alternative (provided you don't want a surgical subspecialty) as opposed to the Carib which is basically a gamble. Fact is, DO is the most practical choice for non-trads/people who don't want to postpone years of attending salary or accrue MORE debt in the form of SMPs. Again, provided these same people are sure they don't want a competitive specialty.

Who's better off? The guy who got into an MD program after multiple failed cycles, is 300k in debt thanks to an SMP, and is now doing a PMR residency, or the guy who got in the first time, has less debt, and is doing PMR at the same place, only with DO behind his name?
 
Advertisement - Members don't see this ad
You must log in or register to reply here.

Similar threads

MonsterGod
  • Question Question
How do I ask my doctor if they’re covering the publication fee?
Replies
6
Views
1K
AlbinoHawk DO
AlbinoHawk DO
H
  • Question Question
DO school matching
Replies
4
Views
2K
Ho0v-man
Ho0v-man
N
D’Youville University to launch Western New York’s first College of Osteopathic
Replies
21
Views
6K
Goro
Goro
Ho0v-man
Charting outcomes for 2022
2
Replies
97
Views
8K
Rogue42
Rogue42
RitikiTan
  • Question Question
I withdrew from medical school after completing the first 3 years including COMLEX Level 1
Replies
7
Views
3K
OncePreDent
OncePreDent
Top Bottom