what are my options?

[283412]

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I'm a returning MSTP half way through 3rd year. I posted a while back when I was starting. I've been getting high passes and just got a pass for the first time. I'm not used to get such poor grades. I'm working all the time. I'm not sure what to do. I really love internal medicine and I've been having a great time in 3rd year in all my clerkships. I feel lucky to be having these experiences with patients. My attendings keep telling me I'm doing outstanding work, but give me high pass. I want to match at a top IM residency, so I can keep doing research in the future, but I'm not sure that's possible anymore. I still have a shot at honors in IM, but it seems uncertain at this point. Does anyone have a sense of my options at this point? I'm getting the sense that I'm in trouble at this point. I'll probably have 4 first author papers by the time I apply (~10 total), and my step one was 260. I'm at a top 5 medical school.

I'm being genuine here, do I have any chance of matching in a top IM residency at a university without honors in IM or in the majority of classes? does anyone have a good idea as to the cutoffs? I guess I should try to be happy just matching anywhere. Its just complicated with the research aspect.

Thanks for your help

 

[Mr hawkings]

I'm a returning MSTP half way through 3rd year. I posted a while back when I was starting. I've been getting high passes and just got a pass for the first time. I'm not used to get such poor grades. I'm working all the time. I'm not sure what to do. I really love internal medicine and I've been having a great time in 3rd year in all my clerkships. I feel lucky to be having these experiences with patients. My attendings keep telling me I'm doing outstanding work, but give me high pass. I want to match at a top IM residency, so I can keep doing research in the future, but I'm not sure that's possible anymore. I still have a shot at honors in IM, but it seems uncertain at this point. Does anyone have a sense of my options at this point? I'm getting the sense that I'm in trouble at this point. I'll probably have 4 first author papers by the time I apply (~10 total), and my step one was 260. I'm at a top 5 medical school.

I'm being genuine here, do I have any chance of matching in a top IM residency at a university without honors in IM or in the majority of classes? does anyone have a good idea as to the cutoffs? I guess I should try to be happy just matching anywhere. Its just complicated with the research aspect.

Thanks for your help

Are you ****ing kidding me? Did you just ask what your chances are with a 260 step 1? in IM?
I'm going to go bang my head against a wall now.

I really hope ur a troll

 

[Slevin]

Well, if we are asking questions I'm going to ask one..

If I stand in the middle of the highway during rush hour what are my chances of getting hit by a car or truck?

 

[Instatewaiter]

Are you ****ing kidding me? Did you just ask what your chances are with a 260 step 1? in IM?
I'm going to go bang my head against a wall now.

I really hope ur a troll

Don't think every program in a non-competitive specialty is not competitive. It is harder to match medicine at MGH or hopkins than to match radiology.

So it actually it is a legitimate question. While step 1 is still important, it is behind your third year grades for importance to program directors in IM.

Not having an honors in medicine will be a HUGE hurdle if you want to go to a top medicine program. You may get screened.

You do have a few things working for you- a top school, MTSP, and a very strong step 1 score.

You may not get into MGH or hopkins without that honors but if you do pull out that honors, you will be a very strong candidate for the top programs.

 

[SouthernSurgeon]

I'm a returning MSTP half way through 3rd year. I posted a while back when I was starting. I've been getting high passes and just got a pass for the first time. I'm not used to get such poor grades. I'm working all the time. I'm not sure what to do. I really love internal medicine and I've been having a great time in 3rd year in all my clerkships. I feel lucky to be having these experiences with patients. My attendings keep telling me I'm doing outstanding work, but give me high pass. I want to match at a top IM residency, so I can keep doing research in the future, but I'm not sure that's possible anymore. I still have a shot at honors in IM, but it seems uncertain at this point. Does anyone have a sense of my options at this point? I'm getting the sense that I'm in trouble at this point. I'll probably have 4 first author papers by the time I apply (~10 total), and my step one was 260. I'm at a top 5 medical school.

I'm being genuine here, do I have any chance of matching in a top IM residency at a university without honors in IM or in the majority of classes? does anyone have a good idea as to the cutoffs? I guess I should try to be happy just matching anywhere. Its just complicated with the research aspect.

Thanks for your help

1) I tend to agree with some of the above posters that you are going to match very well even as is

2) That said, your goal right now is to do everything you can to get that honors. As someone who got a high pass in my chosen field, I wish I could go back and do the clerkship over again - I felt like I was working hard at the time but now I know I could give so much more. Here are some suggestions for what to do:

(a) ASAP (like today or tomorrow) - schedule time with your attendings. Tell them you want to go into IM, you love the field, really have enjoyed working with them, and want to do everything you can to do your best on the rotation. Get feedback from them. Be specific on this - don't just accept a general "you are doing great" comment - have a couple of things in mind that you want to work on.
(b) Make sure your residents know the same thing. Make sure everyone knows you are IM-bound. It shouldn't matter for your grades, but it does. Ask for feedback from them as well.
(c) Along the lines of interacting with attendings - if there is anyone you "clicked" with, ask them about research opportunities. Your MD/PhD background is a strength - use it
(d) Bust your a** for the shelf. If you haven't signed up for Kaplan or USMLE world yet, do it. Do a ton of review questions.
(e) Pick up more patients on the wards. Be the first one there, be the last to leave. Help your team and your interns. Be organized, be efficient, be smart. Bring papers to discuss to rounds (do so tastefully though). Ask informed questions about your patients. In short (and yes, I know it is easier said that done) be an all-star.
(e) In summary - if your goal is to match at an MGH/Penn/Hopkins type place - go all out these next few weeks. Do everything you can to maximize your chances. If you do that, at least you will know you did your absolute best, and then you just have to let the chips fall where they may.

 

[ACSurgeon]

Are you ****ing kidding me? Did you just ask what your chances are with a 260 step 1? in IM?
I'm going to go bang my head against a wall now.

I really hope ur a troll

Dude, you should have some respect for someone who is senior to you, especially when you don't know what you're talking about. The OP isn't worried about going unmatached, (s)he is worried about not getting into a top IM program, which as someone eluded to, can be more difficult than matching at some ROAD programs.

Also, as important as step1 scores are, they are never a guarantee to matching.

 

[ACSurgeon]

Well, if we are asking questions I'm going to ask one..

If I stand in the middle of the highway during rush hour what are my chances of getting hit by a car or truck?

see my post above

 

[Mr hawkings]

Don't think every program in a non-competitive specialty is not competitive. It is harder to match medicine at MGH or hopkins than to match radiology.

So it actually it is a legitimate question. While step 1 is still important, it is behind your third year grades for importance to program directors in IM.

Not having an honors in medicine will be a HUGE hurdle if you want to go to a top medicine program. You may get screened.

You do have a few things working for you- a top school, MTSP, and a very strong step 1 score.

You may not get into MGH or hopkins without that honors but if you do pull out that honors, you will be a very strong candidate for the top programs.

The OP is acting like a High-pass is a failure. Secondly, he/she states that they want to go to a top program so they can do research. I dont think you have to be in the top 3 IM programs in the country to do research. While a strong step 1 score is not a guarantee for a good match outcome, its pretty close. Especially since the OP is likely to get good letters of rec from the attendings who say he/she is doing great work.

 

[Mr hawkings]

Dude, you should have some respect for someone who is senior to you, especially when you don't know what you're talking about. The OP isn't worried about going unmatached, (s)he is worried about not getting into a top IM program, which as someone eluded to, can be more difficult than matching at some ROAD programs.

Also, as important as step1 scores are, they are never a guarantee to matching.

I've been on SDN long enough to know that people in the same position as the OP more often than not end up pretty happy on match day.
And btw, while i might not know everything, this is my second go around at med school. My original class became attendings in 2009 in IM. I'm not as clueless as your average M1 but point taken.

 

[SouthernSurgeon]

The OP is acting like a High-pass is a failure.

There were rumors going around the interview trail this year that MGH's medicine program screened out candidates with high-pass in medicine. If that program or its peers is the OP's goal, then it matters. And frankly, an MD/PhD with a 260 step 1 and 10+ publications should be shooting for the best of the best programs.

 

[283412]

Thanks for the constructive responses everyone. I'm not trolling. From reading the forums here I have gotten the impression that honors is a cut off just like step one > 230. Additionally, from talking to a number of people, I get the impression that a 260 is not > 230 and that the PhD doesn't really improve competitiveness to a great extent anymore. But of course this is largely subjective. I wish there were some statistics on this, but I haven't found any. I've been doing my best this year, but as one of my friends put it, "coming back to 3rd year after being in grad school for five years is like running a race with a broken leg". I think U world questions are a great suggestion. I'm going to do that if I get time. It's just tough to have time to study in the inpatient months. I have to finish MKSAP first. Also I'm going to do a subinternship and I could still get honors there potentially.

Another question, I suppose, is how does step II factor in? I read somewhere that UCSF requires step II scores now? Thanks again everyone.

 

[kdburton]

My friend scored >260 on step 1, junior AOA, honored all rotations 3rd year. She applied for IM at UCSF and got rejected. She matched at Mass General and was disappointed. The only thing is that she wasn't at a top 5 med school like this guy. Its possible to not get your top choice in a "non-competitive" specialty even if you've got an application like that.

 

[Davey Havok]

Thanks for the constructive responses everyone. I'm not trolling. From reading the forums here I have gotten the impression that honors is a cut off just like step one > 230. Additionally, from talking to a number of people, I get the impression that a 260 is not > 230 and that the PhD doesn't really improve competitiveness to a great extent anymore. But of course this is largely subjective. I wish there were some statistics on this, but I haven't found any. I've been doing my best this year, but as one of my friends put it, "coming back to 3rd year after being in grad school for five years is like running a race with a broken leg". I think U world questions are a great suggestion. I'm going to do that if I get time. It's just tough to have time to study in the inpatient months. I have to finish MKSAP first. Also I'm going to do a subinternship and I could still get honors there potentially.

Another question, I suppose, is how does step II factor in? I read somewhere that UCSF requires step II scores now? Thanks again everyone.

There actually are statistics for this. Check out the most recent charting outcomes in the match to get an idea of how people with a PhD or other degree fare in the match. It's broken down by specialty, but here are some comparisons for competitive specialties and IM (all from the US grad category):

Derm without a PhD: 254 matched, 123 didn't ~ 2:1
Derm with a PhD: 32 matched, 2 didn't 16:1

Diagnostic Rad w/o PhD: 884 matched, 147 didn't ~ 6:1
Diagnostic Rad w/ PhD: 47 matched, 8 didn't ~ 6:1

IM without a PhD: 2598 matched, 63 didn't ~ 41:1
IM with a PhD: 238 matched, 3 didn't ~ 79:1

Neurosurg w/o PhD: 153 matched, 40 didn't ~ 4:1
Neurosurg w/ PhD: 20 matched, 4 didn't 5:1

Plastics without PhD: 83 matched, 70 didn't ~ 1.2:1
Plastics with PhD: 2 matched, 7 didn't ~ 0.3:1

Just based on these comparisons (and there's tons of data there for you to peruse), you can see that the PhD seems to have various effects depending on the specialty: 8x better match rates in Dermatology, 2x better in IM, Radiology and Neurosurgery about even, and 4x LESS likely to match in Plastics.

Now you're right that this doesn't tell you anything about the quality of the program you're matching in, which I think is the bigger question for your scenario. My advice for this is two-fold:

1. Try for honors. Your ONLY worry about this is that it is used as a screen. If you are not completely bereft of all social skills, your application will be extremely competitive at top programs. All you need is the interview.

2. If you do not get honors and are worried, network. Find out who at your school trained at the institutions you want to interview at. See if they can place a phone call or two. If that's not an option, talk to your medicine PD. A phone call from an alum or a fellow PD to a program director can get your application looked at no matter what. You might not get an interview, but chances are with your background the PD will thank the person who called them and invite you up.

As a fellow MD/PhD I feel your pain about third year. Play to your strengths, work on your weaknesses, and you'll do fine.

 

[leopanther]

If you weren't at a top school, not getting honors in IM would be a very valid concern when applying to top residency programs. Unless you have connections, it is very unlikely to even get an interview (filters). However, since you are at a top 5 med school, this completely does not apply. I believe the filters are not the same for people from top tier schools. I think the difference between the ROAD specialties and IM is that the former are more focused on numbers while IM is more about rep of med school, AOA...things they can put on their residency website. After hearing many opinions of people who have gone through application process, things that matter for top programs: School ranking > AOA > third year medicine grade. Things that don't matter at all if you don't have these 3 factors and will not compensate for their absence: boards once they are above national average (225=260), grades in other rotations, subI and overall class rank unless it leads to AOA.

 

[McGillGrad]

Look to a place to do a Sub-I that has faculty with a lot of pull with LOR.

 

[werd]

I'm a returning MSTP half way through 3rd year. I posted a while back when I was starting. I've been getting high passes and just got a pass for the first time. I'm not used to get such poor grades. I'm working all the time. I'm not sure what to do. I really love internal medicine and I've been having a great time in 3rd year in all my clerkships. I feel lucky to be having these experiences with patients. My attendings keep telling me I'm doing outstanding work, but give me high pass. I want to match at a top IM residency, so I can keep doing research in the future, but I'm not sure that's possible anymore. I still have a shot at honors in IM, but it seems uncertain at this point. Does anyone have a sense of my options at this point? I'm getting the sense that I'm in trouble at this point. I'll probably have 4 first author papers by the time I apply (~10 total), and my step one was 260. I'm at a top 5 medical school.

I'm being genuine here, do I have any chance of matching in a top IM residency at a university without honors in IM or in the majority of classes? does anyone have a good idea as to the cutoffs? I guess I should try to be happy just matching anywhere. Its just complicated with the research aspect.

Thanks for your help

yeah man, you're still in the running for whatever IM program you want. no one's application is perfect. while ms3 grades are important, it's more a preponderance of the evidence when it comes to getting interviews and ranking. you have enough other highlights that it still creates a very positive picture. my advice is to get an "honors" in your medicine AI. you'll probably get interviews at some of the top places, from there it's all about the interview.

 

[MonkeyNuts!]

Dude, you should have some respect for someone who is senior to you, especially when you don't know what you're talking about.