Top Radiology Programs - How Important are Clinical Grades?

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lacrossegirl420

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Very strong academics + research, school pedigree is good (T10). Rec letters should be good.
How important are clinical grades for top 5 rads programs? Will obviously do my best to get as many H’s as possible, but I am aware my academics will probably be stronger than my clinical performance.
Do the very top rads programs want all H’s, or is a mixture of H’s / HP’s / maybe even the occasional P okay?

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To be real - most of your interviewers will not/not look closely at your MSPE. Your application is 50 pages long and there are numerous people interviewing each day. Board scores, letters, and the interview itself are what matter most.
 
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No such thing as a top 5 program. Pick a program based on fit/feel/location and don’t worry about meaningless perceived prestige. It’s all smoke and mirrors. There are dozens of small to medium programs that will give you better training and exposure than the “top programs” who have armies of fellows you’ll be picking up the scraps from.
 
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As a PGY5, literally doesn't matter. Pick based on location you want to live. Ppl from the crappiest community programs match to top fellowships on a regular basis. Amazing fellowships at top places go unfilled every year. Tying your self worth to going to a 'top 5' is unhealthy.
 
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@SpartanWolverine - Thanks! Are there any rotations that are particularly important for Radiology / electives that would help my application?

@clutch21 , @GoPelicans - I appreciate the input, but I have some specific career goals where going to a prestigious residency will definitely make a difference. Would you have any thoughts on my original question?
 
@SpartanWolverine - Thanks! Are there any rotations that are particularly important for Radiology / electives that would help my application?

@clutch21 , @GoPelicans - I appreciate the input, but I have some specific career goals where going to a prestigious residency will definitely make a difference. Would you have any thoughts on my original question?

Even if you are 100% sure you want to go academics and plan on being a high powered researcher in the future, there are still 30+ programs where you can accomplish that goal all the same. Community programs may not be the best fit in your case, but most medium to large academic programs have plenty of research opportunities to get you where you want to go.
 
Here is some data, keeping in mind multiple caveats I have discussed previously including
  • "top" program designations are somewhat dubious
  • med schools are all over the map in terms of what clinical honors means (for some schools, reserved for 10% of class, at other schools up to 50% of the class can get)
I looked at my data for the 2019-2020 application year (matched in 2020, started R1 in 2021) to find all the applicants to my program (regardless of whether or not we interviewed them) that ended up matching at one of the "top" programs (top 25 Doximity rank, as of today--you can go check this, all very good programs, not sure I put much faith in the actual order).

The "clinical grades" metric listed below requires an explanation. I kept track of clinical grades for 4 rotations in my database--Surgery, Medicine, Peds, and OB/GYN. For the raw data, we gave 5 pts for honors, 3 pts for high pass, and 1 point for pass. So 3 Honors and 1 High Pass would translate to 18 points. Remember, we didn't use this raw score for our program, because we then adjusted for the school's grading system, but I can't imagine that other PDs would go to that effort, it was really time intensive to get that baseline data for each school.

Excluding URM candidates (so as not to have the data influenced by a factor that serves as a strong hook), here were the median scores, 25th percentile scores, and 5th percentile scores for the nearly 100 applicants to my program that ended up matching to a "top 25":
  • USMLE Step 1: 250--236--226
  • USMLE Step 2: 261--247--236
  • Clinical grades: 18 points--16 points--8 points
  • Dean's letter "rank": top quartile--2nd quartile--2nd quartile
So, the bottom line:
  • You don't need all honors, but >50% of the applicants matching to top programs have more Honors than other scores. Most applicants had at least 1 of 4 Honors.
  • You need above average Step scores (presumably now just Step 2), with > 50% of applicants matching to top programs having top quartile Step scores
  • You probably have to be considered in the upper half of your class by your MSPE, keeping in mind that not all schools break it out that way.
 
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You will be fine if you have good academics and research from a top 10 school. Also by no means do I mean this to downplay your (or others) achievements, but being a woman makes your app even stronger. Again, not a judgement, just a statement as radiology is very male dominant and programs are trying to get more women. Overall, you will be fine.

Don't get caught up in the names too much though. Some are great for research careers but can be at the expense of clinical training because they are run by fellows. This can make life easier as a resident, but you may not get as broad of an experience as you would like. This is up to your goals, but ask around carefully.

Prestige does not matter in radiology as much as you think. Geography and networking matters a lot more. We have had some particularly poor attendings come out of so-called top 10 programs despite their pedigree and most of our best radiologists trained at mid-tier programs, some with a "top tier" fellowship. What the big ivory towers want in a resident is not always aligned with what makes a good clinical radiologist.
 
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Thanks for the thoughts so far everyone.
@RadiologyPD - That’s very interesting. It’s pretty intimidating to see the median is H, H, H, HP (18 points) though - if that’s the case for T25 programs, does that mean T5 programs would want straight H’s?
@clutch21 - Appreciate the input. A lot of my career goals are actually in entrepreneurship/industry/etc. In this case, would going to a brand-name radiology program help? My current med school is “brand name”, but people always say it’s the last phase of training that matters the most?
 
In your unique case, I could maybe see a recognizable brand name place being more important, just purely from a perception standpoint from non-radiologist outsiders. I still would argue you should pick a place for location and fit, rather than getting too caught up in a “top 5” or bust mindset. I wish you the best of luck!
 
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Would this mean that an applicant with 16 points would not have a good chance as an applicant to such a program? I was a bit confused why there are only these 4 clerkships considered - what if the applicant had 5/7 honors but only 16 points due to the HPs falling into these four?

These are descriptive statistics, not prescriptive. These were for applicants who applied to our program the final year I was PD who matched at a "Doximity top 25" program. Yes, my program was/is in that list, but the vast majority of the applicants did not match with us.

By describing the median, I am letting the OP know the level where half of the applicants were at/above the level, with half below the level. Same principle applies for the 25th centile and 5th centile numbers I provided.

Every applicant has a host of metrics to consider, some not easily quantifiable and purely subjective (see my previous posts in another thread about how our program did it--this is just our program, not any other program, each program has its own process). The reason we only recorded 4 instead of being completely detailed and trying to analyze every rotation reflected our approach to sampling, the level of scrutiny and effort it took to figure out the grade distribution of scores for each of those rotations at each medical school and use formulas to adjust each applicant's actual "points" to make them comparable between schools, and the fact that practically all of the applicants had done rotations in these 4 areas as M3 students allowing for comparisons.

Try not to get lost in the details. The OP asked "how important are clinical grades". All I can answer is that applicants who match to "top programs" do well on clinical rotations. How well? Well, usually more honors than not, but not always. Does that mean you have to have all honors to match at a "top program"--obviously not, look at the 25th percentile, about 25% of applicants who end up in a "top program" had 50% honors and 50% high pass for the 4 clerkships (or 75% honors and 25% pass).

None of these metrics are independent. Medical students who do well on USMLE exams often do well on clinical clerkships, often have higher number of publications, often have better MSPE "rankings". So, using our method, does the student who has 16 points have less chance than the student who has 20 points?--maybe, but not because of the clinical grade difference at all, but rather because the student with 20 points is more likely to also have higher USMLE scores, higher MSPE rankings, higher # of publications--and, truth be told, more likely to have a better interview. We used the clinical grades as part of multiple metrics to figure out who to interview--but I don't actually ever recall ever using clinical grades to distinguish how we were going to relatively rank two candidates AFTER we interviewed them.
 
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Thanks for the thoughts so far everyone.
@RadiologyPD - That’s very interesting. It’s pretty intimidating to see the median is H, H, H, HP (18 points) though - if that’s the case for T25 programs, does that mean T5 programs would want straight H’s?
@clutch21 - Appreciate the input. A lot of my career goals are actually in entrepreneurship/industry/etc. In this case, would going to a brand-name radiology program help? My current med school is “brand name”, but people always say it’s the last phase of training that matters the most?
My question is if your goal is to leave clinical medicine for industry, will people even know or care what the "best" rads programs are? WashU and NYU are technically top tier rads programs according to doximity, but Yale (ranked in the 30's by doximity) is recognized as a far more prestigious institution around the world and by most other fields.
 
Yea going to Yale over WashU will get you cred from investors but not people who actually know radiology. At the end of the day, if you leave medicine and academics, what's the point of all this hand-wringing over prestige? Just enjoy your millions.
 
Yea going to Yale over WashU will get you cred from investors but not people who actually know radiology. At the end of the day, if you leave medicine and academics, what's the point of all this hand-wringing over prestige? Just enjoy your millions.

This is mostly true, but training probably doesn't vary a whole lot globally across most of the top 30-40 (or more) programs, as long as they are part of a large academic center that sees a lot of pathology. If you want academic radiology, doubtful that either Yale or WashU will hold you back. If you want to be in the midwest, WashU would probably have more contacts and Yale for the northeast. For non-clinical work on the business or consulting side, Yale is probably better known but WashU is hardly some small unknown school.

In the big picture I agree that prestige is largely overrated. Having a good name on your CV won't do much for you in radiology outside of academics. It may make a small different if you ever move to a different field, but that would be more like Yale or Harvard vs a random non-university program (even if it's good clinically). The difference between a Yale and WashU is negligible and has more to do with your skills and network.
 
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