I think alot of it depends on the whole picture. I can give you my info, and give you some vignettes of others from my school, and where they matched.
I graduated with my MD/PhD in May from a non-"top 20" med school. Not AOA, high passed psych in 3rd year, a number of honors in psych electives fourth year, otherwise all passes. Four publications from my PhD. I'm doing a postdoc this year while my wife finishes her fourth year, playing Mr. Mom, and couples matching.
My PhD is in micro
Step 1 209
Step 2CK 170 (attempt 1), 203 (attempt 2). I studied for 1.5 weeks, with too many balls in the air, and screwed the pooch the first time. Put in a solid month of studying, and pulled myself back over 200 on my second attempt.
I have received interviews at Columbia, Pitt so far. No love from UPenn or Yale, UCSF, or UCLA-NPI. California programs are more difficult to get into if you are not from Cali, or went to med school there. Yale and UPenn I'm assuming are screening me out due to my failing step 2CK score.
I did a rotation at Columbia my fourth year, and spoke with the residency director, Ron Rieder. In our discussion I asked him what he looked for in a candidate, and I'm paraphrasing here, "I'm looking for someone who has passion, and shows that they are serious about it by some concrete exmaples. Whether it is a basic research project, community psychiatry and health policy, clinical research, or something else, I want to see they have a real drive and enthusiasm." So, as opposed to say ortho or rads, where your numbers are everything, in psych, even with okay scores and grades, you can match at a "top 5" or "top 10" program. Over the last couple of years at my school, we have had what were on paper some very average students who had done projects, or were very involved in research or student government that matched at Yale, Harvard-Longwood, Emory, triple board in Hawaii, and Mt. Sinai. None of these people were AOA.
But a word of caution. These "top 5" or "top 10" programs got their reputation not by being great meccas of residency training, but by research funding. Some may be great, others not so much. US News and World Report is not going to give you an inkling of what your residency experience is going to be like. If you are a climate controlled lab rat like myself, you go where the research is, but I can't get a good feel for clinical training until I go to the interview.
1.How much face time does the chair give to residents?
2.What is psychotherapy training like, is it all lecture, or do you receive actual supervision and feedback on real cases?
3.Do you learn psychotherapy from Psychiatrists and Psychologists, or from social workers?
4. What is the call schedule like? Night float?
5. What changes have been enacted based on resident feedback?
6. How are the lectures, a waste of time, or valuable?
7. Are the clinical services independent of residents (better learning, downtime for on the job teaching from attendings), or do they require residents (volume, more psychopathology, but less time for more theoretical teaching from attendings)?
8. Ask yourself, do you prefer a large program with 13-16 residents per class like NYU or Pitt (more opportunity, less community), or do you like a more intimate group of 4-6 residents per class like Rochester, NY or Vermont (more community, less opportunity)?
8. If you are interested in a given subspecialty (forensics, child, geriatrics, addiction, etc.), do they have the faculty there to get you the fellowship you want, and where have their graduates gone, have any of them gone on to do you're favorite fellowship.
I don't mean to insult anyone's intelligence, I just think people get too hung up on the brand name prestige of a given program. Remember, the only value to hoighty toighty programs is if you want to stay in academics and the ivory tower. If you want a good clinical education for private practice, find a great program in an area you think you may want to settle down to practice after residency, you'll make a lot of contacts in your local area, and start getting offers at the end of your PGY-3 year, and certainly by the beginning of your PGY-4 year, per my old classmates who are now attendings or in private practice.
As a US grad, I don't think there's such a thing as a "bad candidate," assuming one does not have any obvious psychopathology, and let's face it, we all know that person in our class going into psych that could just as easily be a future psychiatric patient as a psychiatrist. And after all, Scrubs tells us we're the Walmart greeters of medicine, it can't be that hard.
After 8 years in med school, a little more than 2 cents, but I hope it helps. Good luck.
