Updating the FAQ thread on the top

Discussion in 'Internal Medicine and IM Subspecialties' started by Kalel, Apr 9, 2004.

  1. Kalel

    Kalel Membership Revoked

    Feb 1, 2004
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    Hey guys,
    I was thinking that since many of us who frequent this forum right now are fourth years and we have all just gone through the match, now might be a good time to update/correct my FAQ sticky thread on top. I have cut and paste different sdn user's advise regarding evaluating how competetive they are in IM and what it takes to be competetive, but I wanted to post up what I am thinking about adding to the FAQ to see if you guys had anything else you wanted to add or if you wanted to change anything. Thanks!

  2. Kalel

    Kalel Membership Revoked

    Feb 1, 2004
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    What makes a competetive applicant in IM? Do grades matter then USMLE scores?

    Due to the controversial nature of this question and the fact that different programs look for different attributes among applicants, multiple sdn user's opinions were solicited. Here are a few examples:

    From sdn user: SoCalDreamin'
    ?My conclusions regarding strength of application are as follows:

    1.) An outstanding Step I score and/or AOA is the ticket for the ultra-competitive specialties, and we all know what they are.

    2.) For Medicine, two factors bear more weight that an outstanding Step I score and/or AOA; such factors include:

    a.) Strength/rank/reputation of your medical school
    b.) Getting letters of recommendation from nationally renowned physicians

    However, these statements in no way imply that one should not try hard to obtain a good Step I score and a high class rank. These two factors might get you that top interview, even if your medical school's rank or the prestige of letter writers is not super-stellar. With this information in mind, let's consider the following 2 applicants:

    On the one hand, we have med student X with the following statistics:

    * Step 1 = 245
    * AOA
    * Attends a medical school that is not ranked in terms of NIH research funding or in US News & World Report
    * Has letters of rec from 3 faculty members that are not well-published

    On the other hand, we have med student Y with the following statistics:

    * Step 1 = 225
    * No AOA
    * Attends a medical school that is ranked in terms of NIH research funding or in US News & World Report (e.g. Stanford, UCSF, HMS, UT Southwestern)
    * Has a letter or rec from Dr. Topol of the Cleveland Clinic that is based on a cardiology elective he did there at the beginning of his fourth year

    Of these two candidates, whom do you think will be more likely to land interviews at MGH and Brigham & Women's? If you said med student Y, then you are correct.

    Luckily for me, I am not hung up on silly things such as rankings and academic reputation, so none of the above information mattered to me when it came down to deciding where I wanted to go for residency. Much larger factors weighed on my mind, such as work environment and house staff support, and most importantly, if I was going to be happy at a particular program. Things worked out just the way I wanted them to, and I couldn't be any happier.?

    From SDN user: SuFiBB
    ?from my experience from going through the whole application ordeal, some programs indicated that they place significant emphasis on the IM department chairman's letter which reflects your performance in your sub-I because most of what you do in your internship is similar to your sub-I rotation. whatever you do, do as well as you can for your sub-I to form the basis for a good chairman's letter. read before, learn the pocket intern survivor's guide, take a few electives beforehand, learn cross-cover emergency stuff, learn how to write orders such as admit orders, and prepare & memorize each presentation you give about a patient during rounds to your attending.?

    From SDN user: Renovar
    ?I would have to say that looking at my experience and my classmates', the biggest break point for competitive IM, at least for interview purposes, is going to be:

    1. AOA vs non AOA


    2. The "eliteness" of your med school - top 10 vs Top25 or so vs the rest

    Step 1 score is massively overrated for IM. I agree, higher is ALWAYS better, but there is a point where any higher wont do you any more good - and this point is surprisingly low. I'd boldly say that anything above mid-230's (mid-high 90's on 2 point) should keep all doors open, and it will be up to your other stats to get you interviews.

    I ran into this dude on my interview trail from HMS, openly stated that he is below average in his class and got below average Step 1, and still got interviews at everywhere he applies (places like Stanford, UCSF, JHU, HMS hospitals, etc). That just goes about saying how much advantange an elite med school carries you in this process.?

    My thoughts on the subject:
    I agree with many of the things stated above. In IM, I think that step I is mainly used as a cutoff. However, after seeing a few of my classmates who I know had below avg step I scores but seemingly strong clinical skills not match where they wanted to go (but got interviews at), I wonder how much of a factor it really is used to evaluate your app in IM. In general, AOA and avg step I will probably get you farther in IM then 260 step I and poor clinical evaluations. I don?t know how much of their below average step I score played into where they matched, but I did notice that my classmates who scored above average on step I were able to match into one of their top 2-3 choices. A confounder in this observation is that those who did not do as well on step I probably do not do as well on their shelves, which can adversely effect their clinical grades as well. I strongly agree with the assertion that a school?s reputation plays a huge role in where one will be able to get interviews at. I know of a student at a top 5 medical school who had below average step I and clinical grades but who was able to secure a good number of interviews at top-ranked schools which were not interviewing many of my classmates who had better step I scores and grades but who came from my state school. I still don?t think that it?s worth a lot of extra money to go to a top 20 school just so that you can get into a top 20 IM residency because many students from unranked schools are still able to secure top IM residencies (they just have to be a little bit more competitive), and there are many ?unranked? IM residencies that are still excellent training programs and have very high placements ratios in all competitive fellowships. Ultimately, if you are good, I think that you will be able to get whatever specialty you want to in IM coming from whatever school you are coming from in the US.

    Adding the following link:
  3. Renovar

    Renovar Senior Member
    7+ Year Member

    Jan 29, 2002
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    Horray, this is a good overall summary, and I second the above opinions especially in regard to the fact that if you are good and are willing to work hard and learn a lot, you will have your chances regardless of the decisions you made. That applies to choosing state medschool but shooting for good residency, or decide to go to a non-top-ranked residency and applying for fellowship.

    There is always going to be argument about saving money/state school vs elite private $$$ med schools, and I am not going to get into an argument here. You can find success (and failure) stories from both sides, ultimately, if you can prove that you are good from both sides of the ledger you will do fine coming from either side. This certainly applies for IM, I am not sure I can say the same about some other specialties where elitism dominates the market (derm, rad, etc.)

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