Three questions

[mercaptovizadeh]

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Clerkship vs. Sub-I: it seems from perusing the forums that the clerkship grade is more important (or at least equally) to the sub-I (e.g. IM, in this case). I thought the sub-I involved a greater level of independence, and therefore would be more important and could somewhat compensate for a weaker clerkship. What is the actual case in terms of the importance of these two for residencies?

Time off: Why is time taken off during medical school and spent in a "non-productive" way, i.e. MPH, PhD, research, etc. perceived in such a bad light? If you excel during the actual med school years, why would an extra year be such a negative?

Locum tenens: are there generalists who do this fulltime? Is it perceived as a bad thing when you apply to a private practice job if, say, you were doing almost entirely locum tenens work as an attending at a variety of locations for a number of years? (granted academia, once left, is hard to get back into).

 

[BlondeDocteur]

1) Sub-is do indeed mimic internship and performance is considered as such. However, grading on sub-is is more lenient and you're not compared to your entire medical school class but rather only to other sub-is on service at the time. If you're doing an away rotation they are an extremely important factor in that program's consideration of you, as it's really a "month long interview."

2) Not sure where you heard this, but it runs absolutely counter to both common sense and anything I've ever heard. No one considers a PhD or relevant research to be "non-productive." An MPH is less likely to make a difference in your ultimate application as they are considered less rigorous and clinically relevant, but they certainly don't hurt. In many fields a year + of research is required to be competitive at the top programs (derm, neurosurgery). "Non-productive" years would include time off to work on Wall Street, medical leave, etc.

3) There are people doing this fulltime, but it's rare and quite contrary to traditional family life (imagine uprooting a spouse or school-age children every few months). I can't comment as to the latter question.

 

[mercaptovizadeh]

1) Sub-is do indeed mimic internship and performance is considered as such. However, grading on sub-is is more lenient and you're not compared to your entire medical school class but rather only to other sub-is on service at the time. If you're doing an away rotation they are an extremely important factor in that program's consideration of you, as it's really a "month long interview."

2) Not sure where you heard this, but it runs absolutely counter to both common sense and anything I've ever heard. No one considers a PhD or relevant research to be "non-productive." An MPH is less likely to make a difference in your ultimate application as they are considered less rigorous and clinically relevant, but they certainly don't hurt. In many fields a year + of research is required to be competitive at the top programs (derm, neurosurgery). "Non-productive" years would include time off to work on Wall Street, medical leave, etc.

3) There are people doing this fulltime, but it's rare and quite contrary to traditional family life (imagine uprooting a spouse or school-age children every few months). I can't comment as to the latter question.

Thanks for your answers.

1.) OK, that was my suspicion, i.e. the lack of an internal comparison and shelf exam.

2.) No, I recognize the PhD, MPH, research years as "productive" for residencies. It seems that things outside of that, barring extenuating circumstances such as a death of a close family member or childbirth, are seen as weaknesses. For instance, if someone honored a good amount of the pre-clinical years, got a 260 on their Step 1, and honored most of 3rd year, but took a year off between 2nd and 3rd year to step back from medicine and ponder career goals, while doing "unproductive" activities on the side and perhaps a non-healthcare job to pay the bills, this would be perceived as a glaring weakness, would it not? I'm not sure I understand why, since the curriculum was completed satisfactorily, or even superbly.

3.) Yes, I realize that that kind of lifestyle would be incompatible with family. It might make sense for a young person who likes variety. Although, as related to point 2, I'm wondering if PP would see this, too, as a sign of weakness and lack of dedication (to a particular location, group, etc.)

 

[Dral]

I guess trying to see #2 from a PD's standpoint may help? I'm not a PD, but if it is looked badly upon, I'd say it's because residency is a continuation of education, yet there is arguably more responsibility as it is technically also a job where you are getting paid. Time off happens once, who's to say it won't happen again during residency. If I were a PD and had 2 candidates basically equal except one took a year off to 'step back'...well, it doesn't seem difficult to decide who I'd pick.

 

[dragonfly99]

2) I think a candidate with a 260 and who honored a bunch of 3rd year clerkships would likely get a good residency even if he/she took a year off to travel or something...if it was to contemplate why he/she even did medicine in the first place, it might give some program directors pause, since it might suggest lack of commitment to medicine. I had a friend who took a year between 1st/2nd years and still matched into a pretty prestigious anesthesia residency..the year was ostensibly to travel and see family who lived abroad in Asia, but also he was burned out. If you are a good student and really want to take the year off, I wouldn't be too terrified to do so if your school is OK with it...I'd really only worry if you are gunning for derm, ortho, plastics, maybe neurosurg. Mostly your class rank and LOR's and decent boards will guarantee you a decent residency...
3) I think the reason folks who did solely or a lot of Locum Tenens were traditionally looked down upon is that it was felt these were the people who could not find "Real jobs", i.e. either nobody wanted them or they had some bad track record they were trying to get away from by moving from place to place. However, I think now that stereotype is less prevalent and there are more Locum Tenens docs. A lot of semiretired docs do this. In fields like ER or anesthesia I don't think doing this for a few months or even a year or two would necessarily be looked down on, but you'd have to ask some private practice groups if you want a really sound answer.

 

[PeepshowJohnny]

Re: SubI vs. Clerkship grades. There's a couple reasons clerkship grades matter. Clerkships are multiple evaluations across the spectrum of your third year experience. Even if, for example, an Internal Medicine PD might not care if you high passed or honored OB/Gyn, if you bomb it (or by the same token, get many unfavorable comments that go into your Dean's letter) that's going to look poorly on you. It's completely conceivable that tudents might have difficulty in certain rotations that aren't their strength, but poor comments and grades reflect poorly on you as a candidate no matter the specialty.

The other thing is, 4th year grades, tend to be inflated because people want to "Help" you get into their field (usually). For example, let's say I'm applying for a field like Ortho. Assuming your Ortho rotation guys like you and you're not a huge loser, they might play you up in their grades because they want to see you succeed. Heck, just choosing to rotate in someone's field when it's elective versus another is already a step in making you popular since it makes you seem like you are interested in the field.

However, in third year it's more level playing field: you're competing against everyone in this class and there's relatively less sense of "This person wants to be in my field, so I'll grade him/her better" It happens, but not to the extent I've seen in fourth year. I think many attendings who grade in core clerkships take their duty pretty seriously.

 

[DarthNeurology]

Clerkship vs. Sub-I: it seems from perusing the forums that the clerkship grade is more important (or at least equally) to the sub-I (e.g. IM, in this case). I thought the sub-I involved a greater level of independence, and therefore would be more important and could somewhat compensate for a weaker clerkship. What is the actual case in terms of the importance of these two for residencies?

Time off: Why is time taken off during medical school and spent in a "non-productive" way, i.e. MPH, PhD, research, etc. perceived in such a bad light? If you excel during the actual med school years, why would an extra year be such a negative?

Locum tenens: are there generalists who do this fulltime? Is it perceived as a bad thing when you apply to a private practice job if, say, you were doing almost entirely locum tenens work as an attending at a variety of locations for a number of years? (granted academia, once left, is hard to get back into).

I think that clerkship grades are more important for some residency programs as they may screen applications based on whether you got an honors or not. Obviously, just passing a medicine clerkship will not rule out an internal medicine residency. I think mostly program directors feel that an honors in third year clerkships indicates a hardworking medical student, which is what clerkship directors in general want. Obviously, there is not a 100% correlation, and grading varies amoung schools.

For some residency programs if you just "passed" say internal medicine, but then honored the Sub-I in medicine, this shows that you have learned how to be more efficient and have sort of redeemed yourself in some PD's eyes.

I think a year off can be tremendously helpful in deciding what field you want to enter, and can give you some times to do a research project or engage in an internal health project, both of which are worthwhile and broad a physician's scope of experience. I don't think such activities are bad at all in terms of applying for residency and make you look like a more rounded candidate. Indeed as BD noted, some specialties such as plastics like candidates to do a year of research or some candidates do this to be more competitive. That being said, whatever you during your time off will lead to questions during residency application, and if you say that you took the year off to return to working in real estate for a year to ponder a career in medicine this could look odd, but wouldn't necessarily bomb you from getting a residency.

A lot of doctors do locum tenems, mostly because the like to move around the country and I think it pays better as you have to be able to move a lot. I doubt a private practice would find this concerning, and probably like it that you can handle working in a multitude of environments. A lot of locum tenems are near retirement or starting out early in their career, meaning they are not tied down to a geographical area yet. Some doctors do it right out of residency.