"tought" specialties from carribean

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There's stuff all over these forums that going to the carribean, it's very hard to escape from not going into FP/IM, as my statistical comparison showed though, nearly half go into other specialties.

Anyway, what have the people who get into the tough specialties do? Are really high scores by themselves it, or is it really about if you know the right people, or what?

 

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Anyway, what have the people who get into the tough specialties do? Are really high scores by themselves it, or is it really about if you know the right people, or what?

This has been answered already, but here goes:

1. Most people choose the specialty they want, not vice versa. The majority of my fellow students who went into FP did so because they wanted to. I know several that had 220+ on both Steps.
   
2. Some ultracompetitive specialties are, for the most part, going to remain out of reach (e.g., Derm, Optho, Rad Onc, Neurosurg, etc). This is also true for the majority of U.S. grads as well. As far as Carib grads go, there are (of course) exceptions to this rule.
   
3. Board scores do not "rule in" to a residency. They may "rule out" for an interview. For example, a residency program may use, among other criteria, a Step 1 cut-off to determine who gets invited to an interview. If you have a low board score, you may be "ruled out" from being invited. But, if you are invited, the bar is reset and you will be evaluated, again among other criteria, on how you do during that interview. For example, if two candidates are invited to interview, a person who got a 254 on Step 1 will not necessarily get the residency spot (i.e., automatically "ruled in" because of their score) over someone who has a 215 on Step 1. The 254 person may not be a good "fit" personality-wise (etc.) for that program. (I know this happens for a fact because I got a spot at a program that a colleague, who technically looks much better on paper than I do, ranked higher than I did. In other words, I had lower board scores yet "stole" his spot because I performed better at the interview.)
   
4. Despite what I say in (3), if you want to get into a more competitive specialty, the best bet is to do as well as you can on the boards (i.e. 230+), get awesome LoRs from reputable and known people in the field you're applying to, and do a few "audition" clerkships, especially (and if possible) at the hospital you want to match at. The latter two things will help you far more than just great board scores and otherwise applying blindly with mediocre letters.
   
5. Choice of school matters. Many Program Directors have experience working with graduates of certain schools and, based on their track record of experience with students from those schools, they have a strong general idea about how well-prepared and ready a graduate from that school will be to enter residency training. Bottom line is that no PD wants a problematic resident, and grads from lesser-known (or unknown) schools represent a greater upfront risk. Not saying that they won't take a stellar candidate from such a school, but it is more likely that if you come from an SGU, a Ross, or an AUC over some school in "Uniqueistan", you are going to have a higher success rate at getting interviews. And, getting in the door is half the battle.

Top specialties are not completely out of reach for Carib grads coming from the better known schools. You will hear U.S. seniors say on these forums that, as far as they're concerend, "all Carib grads are the same." This may be true in their eyes, but it certainly is not true in the eyes of the Program to which you're applying. Bottom line is, you have to work extra hard to get into a competitive specialty, and still there are no guarantees. But, a sure way to shoot yourself in the foot and end-up in a FP residency on some Indian reservation in the middle of Wyoming (hey... if that floats your boat, more power to you) is to attend some unknown school, fail the Steps once or twice before barely passing, have crappy LoRs, not do any "away" electives, put out your ERAS application late, and generally don't take your education seriously.

-Skip