MD What ENT programs am I competitive for/where to do away

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Hello,
I'm a 3rd year from a US MD school (not top 40) interested in Otolaryngology. Fourth year is just around the corner, and I was wondering if anyone can lend some insight as far as what tier of programs someone with my stats is competitive for. Also want to see whether or not away rotations at big name programs will be worth doing.

Step 1: 244

3rd year grade:

• High Pass (top 20%) for Surgery/OB/Psych.
• Pass for FM and Peds.
• Haven't done IM.

Research:

• 3 publications. (2 of them ENT related)
• 2 ENT poster presentations. One at AAO annual meeting, and the other at a local conference.
• 1 non-ENT poster presentation at national conference
• NIH summer research internship (non-ENT related)
• Author for USMLE-Rx

Programs that I was thinking about doing away rotation at NYEE, GWU, and OHSU.

1. Where do I stand as far as competitiveness for otolaryngology residency.
2. Assuming that I do well on my away rotation are the listed institutions still to much of a reach for me?
3. Should I do away at lower ranked institutions?

Any comment/suggestion/input is greatly appreciated. Thank you.

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[Redpancreas]

Ask in ENT forum, they don’t bite!

 

[Chelsea FC]

@failedatlife

 

[operaman]

Hello,
I'm a 3rd year from a US MD school (not top 40) interested in Otolaryngology. Fourth year is just around the corner, and I was wondering if anyone can lend some insight as far as what tier of programs someone with my stats is competitive for. Also want to see whether or not away rotations at big name programs will be worth doing.

Step 1: 244

3rd year grade:

• High Pass (top 20%) for Surgery/OB/Psych.
• Pass for FM and Peds.
• Haven't done IM.

Research:

• 3 publications. (2 of them ENT related)
• 2 ENT poster presentations. One at AAO annual meeting, and the other at a local conference.
• 1 non-ENT poster presentation at national conference
• NIH summer research internship (non-ENT related)
• Author for USMLE-Rx

Programs that I was thinking about doing away rotation at NYEE, GWU, and OHSU.

1. Where do I stand as far as competitiveness for otolaryngology residency.
2. Assuming that I do well on my away rotation are the listed institutions still to much of a reach for me?
3. Should I do away at lower ranked institutions?

Any comment/suggestion/input is greatly appreciated. Thank you.

1) Hard to gauge your overall competitiveness. Your step 1 is decent, won't close or open any doors for you, but you would probably benefit from a good performance on CK. Even if you got the same percentile on CK as your step 1, the scaled score would be ~260. Few people seem to understand that the scales are different and may look at the 260 as a jump in score.

Your biggest ding at the moment are your clinical grades. There are many applicants who honor everything or get awfully close. The outright passes in what are generally two easy rotations would concern me. The HP in surgery is also a hit; I'd be curious as to the comments on your MSPE. Do whatever it takes to honor IM if you can.

Your research - are those pubs first author things you quarterbacked yourself or are you Nth author on something where you had miniscule role? I assume the posters were the same project or derivation thereof? Still, it's a good start. I've known buddies who went from 0 ENT research in January of M3 to 5+ pubs by September for ERAS, so it's doable, but they worked their tails off.

Your letters are going to be super important which is another reason to dive into as much research as you can. Your clinical grades make you appear to be a lackluster performer clinically which is a big deal for a field where the largest programs only take 5 people a year. You can help mitigate this somewhat by having some really glowing letters and also improve your chances of matching at your home program.

Overall competitiveness: pretty decent IF you put in some impressive effort between now and September. You will need to apply broadly. Very broadly.

2) Those are a funny grouping of programs for an away -- reasons behind the choice? You talk about Tiers but truthfully I don't think you can easily apply tiers to programs in this field. Even the less prestigious programs will outright reject plenty of kids with 260+ steps and AOA. I would say you could use the Doximity rankings and maybe group very generally in thirds, but even this is problematic. The quality of training at any given program can also be difficult to assess from internet forums and arbitrary rankings. For this, best to speak to faculty mentors you trust who seem to have their finger on the pulse of the field.

Something else to consider is what your ultimate career goals are. If you plan to general private practice afterward, you may want to look for programs with great surgical volume and less research time and opportunity. If you're looking for an academic career, then you'll want to go somewhere with opportunities and connections that will help you get there. So I would think less in "tiers" and more in terms of what you hope to get out of training.

2.5) You need to figure out why you're struggling clinically before you do your aways. Most students do not do themselves any favors on an away. My back of the napkin estimation is 10-20% end up helping their chances (just dividing rough ballpark of past rotators and how many I saw get interviews). That's 10-20% of people with stats high enough to feel like they have a shot of matching. You've got to figure out why you are not honoring rotations or else you're going to shoot yourself in the foot.

3) You should do aways for the right reason. What are you hoping to get out of an away? I've thought about making a sticky or end a standalone website that lays out the details of each program's away rotation, it's plusses and minuses, just for ENT. So much depends on what you hope to accomplish with your away (ie. match there, get a letter because you have no home program, letter to open up a region, exposure to a different program, etc).

 

[Snoopy2006]

My general advice for medical students going into competitive fields - especially those with a competitive but not a slam dunk application - is to utilize your home department. If you have a strong rapport with any home faculty, find out where they trained and/or are well connected when deciding on your aways. Work hard to get an advisor in your corner who will give you honest advice and advocate for you. And be friendly with the residents. I've taken med students out when asked and talked to them about what to work on, and how to kill their away rotations. Find a resident who you vibe with who can give you some honest, useful feedback. I agree with @operaman - in my experience, 20% of away rotators actually hurt their application, 70% are solid to good but not spectacular, and then 10% really blow us away when they come through our department. So if you can get a couple friendly residents at your home institution to give you advice on what to correct, you'll be that much more prepared to make a strong impression on your aways.

In my field (not ENT) we definitely note clinical grades when evaluating applicants. Almost everyone we interview is sitting on a 240+ with several pubs, so any small weakness catches people's eye. My general sense is you have a solid application but you'll need to overcome your biggest weakness - your clinical grades - with strong away performances and stellar letters. Come up with a good plan for M4 year, and it's very doable.

 

[$5 Reward]

1) Hard to gauge your overall competitiveness. Your step 1 is decent, won't close or open any doors for you, but you would probably benefit from a good performance on CK. Even if you got the same percentile on CK as your step 1, the scaled score would be ~260. Few people seem to understand that the scales are different and may look at the 260 as a jump in score.

Your biggest ding at the moment are your clinical grades. There are many applicants who honor everything or get awfully close. The outright passes in what are generally two easy rotations would concern me. The HP in surgery is also a hit; I'd be curious as to the comments on your MSPE. Do whatever it takes to honor IM if you can.

Your research - are those pubs first author things you quarterbacked yourself or are you Nth author on something where you had miniscule role? I assume the posters were the same project or derivation thereof? Still, it's a good start. I've known buddies who went from 0 ENT research in January of M3 to 5+ pubs by September for ERAS, so it's doable, but they worked their tails off.

Your letters are going to be super important which is another reason to dive into as much research as you can. Your clinical grades make you appear to be a lackluster performer clinically which is a big deal for a field where the largest programs only take 5 people a year. You can help mitigate this somewhat by having some really glowing letters and also improve your chances of matching at your home program.

Overall competitiveness: pretty decent IF you put in some impressive effort between now and September. You will need to apply broadly. Very broadly.

2) Those are a funny grouping of programs for an away -- reasons behind the choice? You talk about Tiers but truthfully I don't think you can easily apply tiers to programs in this field. Even the less prestigious programs will outright reject plenty of kids with 260+ steps and AOA. I would say you could use the Doximity rankings and maybe group very generally in thirds, but even this is problematic. The quality of training at any given program can also be difficult to assess from internet forums and arbitrary rankings. For this, best to speak to faculty mentors you trust who seem to have their finger on the pulse of the field.

Something else to consider is what your ultimate career goals are. If you plan to general private practice afterward, you may want to look for programs with great surgical volume and less research time and opportunity. If you're looking for an academic career, then you'll want to go somewhere with opportunities and connections that will help you get there. So I would think less in "tiers" and more in terms of what you hope to get out of training.

2.5) You need to figure out why you're struggling clinically before you do your aways. Most students do not do themselves any favors on an away. My back of the napkin estimation is 10-20% end up helping their chances (just dividing rough ballpark of past rotators and how many I saw get interviews). That's 10-20% of people with stats high enough to feel like they have a shot of matching. You've got to figure out why you are not honoring rotations or else you're going to shoot yourself in the foot.

3) You should do aways for the right reason. What are you hoping to get out of an away? I've thought about making a sticky or end a standalone website that lays out the details of each program's away rotation, it's plusses and minuses, just for ENT. So much depends on what you hope to accomplish with your away (ie. match there, get a letter because you have no home program, letter to open up a region, exposure to a different program, etc).

Thank you for your prompt response and help! I am particularly interested in the Head and Neck aspect of ENT, and was hoping to go to a program with large H&N volume hence Sinai and OHSU. Ultimately I wish to match at the programs that I do my away rotations at, but wasn't sure if an excellent away performance can make up for other aspects of my application that's lacking. I'm just unsure how much weight do these away rotations carry.

 

[operaman]

Honestly, I think there’s a pretty sizeable head and neck volume most places, especially larger programs. I think most ent programs do free flaps now with a couple exceptions, though those tend to be more more of a fellow thing unless a resident expresses interest. I don’t personally know any residents at larger programs that are grumbling about getting enough head and neck cases, though maybe that does become an issue at really small places. I tend to hear more of the opposite, that head and neck volume becomes all consuming and providing coverage can be tricky. Obviously the two you mention are pretty big and would have excellent head and neck experiences.

Aways CAN make up for other things, especially something like poor clinical grades which is your particular issue. They do this simply because if you really shine, people may just chalk up your clinical grades to the inherent subjectivity of third year. However, as I’ve said above, be VERY careful in that aways can really bite you. Hard. There overwhelming majority of our rotators don’t even get an interview, but of those that do, about half end up matching here.

There’s a great sticky in the ent forum about how to be a good away rotator. The honest truth is that if you had acted like a superstar away rotator on any of your past clerkships, You would have honored with flying colors. Just being there and making friends with everyone isn’t enough; you really have to be good. Residents are especially brutal and unforgiving in how we judge our potential fellow residents because none of us want someone who is going to make our lives miserable. The last class we matched will be the junior residents on call with me for the next two years...You want to talk about how picky my classmates and I were?! That’s the difference between 2 years of sleep and 2 years of having to check behind someone you don’t trust. I don’t really remember looking that hard at clinical grades during interviews but that was because everyone had honored everything or almost everything so I didn’t bother looking; obviously the faculty who selected the candidates had valued that highly.

So yes you can overcome your grades, but the bar is very very high. You’ve got to crush everything else you do and especially crush your home sub i. Anything less than honors in your home sub I and you would be well advised to aggressively pursue a backup option. Sorry to be so blunt but people deserve to know where they stand. Good luck!

 

[$5 Reward]

Honestly, I think there’s a pretty sizeable head and neck volume most places, especially larger programs. I think most ent programs do free flaps now with a couple exceptions, though those tend to be more more of a fellow thing unless a resident expresses interest. I don’t personally know any residents at larger programs that are grumbling about getting enough head and neck cases, though maybe that does become an issue at really small places. I tend to hear more of the opposite, that head and neck volume becomes all consuming and providing coverage can be tricky. Obviously the two you mention are pretty big and would have excellent head and neck experiences.

Aways CAN make up for other things, especially something like poor clinical grades which is your particular issue. They do this simply because if you really shine, people may just chalk up your clinical grades to the inherent subjectivity of third year. However, as I’ve said above, be VERY careful in that aways can really bite you. Hard. There overwhelming majority of our rotators don’t even get an interview, but of those that do, about half end up matching here.

There’s a great sticky in the ent forum about how to be a good away rotator. The honest truth is that if you had acted like a superstar away rotator on any of your past clerkships, You would have honored with flying colors. Just being there and making friends with everyone isn’t enough; you really have to be good. Residents are especially brutal and unforgiving in how we judge our potential fellow residents because none of us want someone who is going to make our lives miserable. The last class we matched will be the junior residents on call with me for the next two years...You want to talk about how picky my classmates and I were?! That’s the difference between 2 years of sleep and 2 years of having to check behind someone you don’t trust. I don’t really remember looking that hard at clinical grades during interviews but that was because everyone had honored everything or almost everything so I didn’t bother looking; obviously the faculty who selected the candidates had valued that highly.

So yes you can overcome your grades, but the bar is very very high. You’ve got to crush everything else you do and especially crush your home sub i. Anything less than honors in your home sub I and you would be well advised to aggressively pursue a backup option. Sorry to be so blunt but people deserve to know where they stand. Good luck!

Thank you again for your insightful information, they are extremely useful and I will definitely keep them in mind as I move forward. Best of luck to you as well!

 

[$5 Reward]

My general advice for medical students going into competitive fields - especially those with a competitive but not a slam dunk application - is to utilize your home department. If you have a strong rapport with any home faculty, find out where they trained and/or are well connected when deciding on your aways. Work hard to get an advisor in your corner who will give you honest advice and advocate for you. And be friendly with the residents. I've taken med students out when asked and talked to them about what to work on, and how to kill their away rotations. Find a resident who you vibe with who can give you some honest, useful feedback. I agree with @operaman - in my experience, 20% of away rotators actually hurt their application, 70% are solid to good but not spectacular, and then 10% really blow us away when they come through our department. So if you can get a couple friendly residents at your home institution to give you advice on what to correct, you'll be that much more prepared to make a strong impression on your aways.

In my field (not ENT) we definitely note clinical grades when evaluating applicants. Almost everyone we interview is sitting on a 240+ with several pubs, so any small weakness catches people's eye. My general sense is you have a solid application but you'll need to overcome your biggest weakness - your clinical grades - with strong away performances and stellar letters. Come up with a good plan for M4 year, and it's very doable.

Thank you very much for your time and input, they are very helpful and have definitely helped me realize my weaknesses.

 

[spiker268]

Current applicant here; I think you've gotten some great advice already from operaman and others. I think another thing to think about is whether you want to do aways at programs that give interviews to everyone there. There are two thought processes behind this that I've heard. One, that these interviews are just "courtesy" invites and the other that they do add to your yield. I think once again it comes down to how good you are as a rotator. I think that it is hard to tell sometimes; I rotated at my away and during my month I cannot point to anything that separated any of us rotators, however, I was the only one who got an interview. So, going in with the understanding that sometimes the process isn't clear is important.

I also agree that the clinical grades may be something that comes up. At most of my interviews, people have commented on my clinical grades, and it will be something that you should be prepared to discuss at interviews, especially for those courses you passed. Its important for you to explain how you learned from it and how you took that experience to help you throughout the rest of the year.

As far as competitiveness I think honestly sometimes it is hard to tell why x vs y person got a program. The applicants from my school all have similar stats, and the interviews we have gotten and not gotten sometimes don't have any rhyme or reason. I also know people who numbers wise were "less" competitive, but are absolutely crushing interviews and have gotten some very prestigious invites. For them, they said that their letters were what they would point to. Not only did they get letters from very well known people, but those letters were outstanding. So, if possible you need to try to get a great letter from your home program. I think this is another reason why choosing your away is important as well; it is important to get a great letter from an away. Some chairmen at aways don't give letters, and some aways aren't set up in the most conducive way to get a letter from any attendings. So, looking into different programs and talking to applicants the year above you, etc, to get that information will be key.

 

[Wordead]

Echo all of operamans advice above.

Do you not have a mentor or two within the field that can provide suggestions? Picking programs out of a hat based on random impressions is not a good idea. Whoever is writing you letters should be able to call on some contacts and set you up for success.