What is a "competitive" applicant for residency apps

[deltaJ]

Hi everyone,

Sorry if this has been asked before, but I will be starting medical school this next fall, and something I regret in undergrad is starting to think about the competitiveness of my application too late.

So I'm wondering, how can I best prepare my application in medical school? (I'm not asking about pre-studying lol)

In other words, what would a competitive application look like, for top residencies?

Thanks!

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[ccmscuem]

Hi everyone,

Sorry if this has been asked before, but I will be starting medical school this next fall, and something I regret in undergrad is starting to think about the competitiveness of my application too late.

So I'm wondering, how can I best prepare my application in medical school? (I'm not asking about pre-studying lol)

In other words, what would a competitive application look like, for top residencies?

Thanks!

Great way to plan your time ahead!

1. Scores (especially if you're an IMG or if you're applying to a competitive program or specialty

2. No fails whatsoever - not any course, not any rotation and definitely not your boards. Make sure your transcript is spotless.

3. LORs - From your 3th and 4th year rotations

4. Plan -This is the most imp. Plan your schedule well, plan your rotations in advance. Plan your research. Plan your extracirriculars.

5. Theres a lot. I recommend you listen to 2 episodes (4 hours each), it changed my 3rd and 4th years, and I wish I heard it earlier. The podcast channel is called THE UNDIFFERENTIATED MEDICAL STUDENT. The 2 episodes are called 4TH YEAR EPISODE. From there you'll be able to understand how to plan the next 4 years.

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[ciestar]

Leadership of some sort and research are good things to have. If you like to volunteer, feel free to do so. You don’t need a million activities but some kind of involvement in something is a good thing.

 

[deltaJ]

Great way to plan your time ahead!

1. Scores (especially if you're an IMG or if you're applying to a competitive program or specialty

2. No fails whatsoever - not any course, not any rotation and definitely not your boards. Make sure your transcript is spotless.

3. LORs - From your 3th and 4th year rotations

4. Plan -This is the most imp. Plan your schedule well, plan your rotations in advance. Plan your research. Plan your extracirriculars.

5. Theres a lot. I recommend you listen to 2 episodes (4 hours each), it changed my 3rd and 4th years, and I wish I heard it earlier. The podcast channel is called THE UNDIFFERENTIATED MEDICAL STUDENT. The 2 episodes are called 4TH YEAR EPISODE. From there you'll be able to understand how to plan the next 4 years.

Sent from my SM-G960U using Tapatalk

Thank you! I'll take a listen to those podcasts. And for more context, I'm not an IMG, I'm at a midwest university MD school! Interested in ophthalmology, maybe oncology, need to explore surgery and more.

 

[ciestar]

Thank you! I'll take a listen to those podcasts. And for more context, I'm not an IMG, I'm at a midwest university MD school! Interested in ophthalmology, maybe oncology, need to explore surgery and more.

In that case, youre going to need research for ophtho

 

[deltaJ]

In that case, youre going to need research for ophtho

Should it be research specific to ophtho (if I commit) or is any research ok?

 

[KingD]

If you want just a generally stronger application for surgery/IM/EM/FM less competitive specialities then any research will do. If you're thinking optho, it has to be optho research. When you mention oncology, if you mean IM followed by medical oncology fellowship then you can do any general research, but if you mean radiation oncology, it must be oncology research.

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[aprilfools]

If you want just a generally stronger application for surgery/IM/EM/FM less competitive specialities then any research will do. If you're thinking optho, it has to be optho research. When you mention oncology, if you mean IM followed by medical oncology fellowship then you can do any general research, but if you mean radiation oncology, it must be oncology research.

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This absolutist attitude is a bit misleading.

The MOST competitive applicants will have optho-specific research for applying optho, and rad-onc specific research for applying rad onc. If you have a stellar app and a significant amount of non field-specific research though, you will still be highly competitive.

Find field-specific research if you can, but its totally fine to do something not field specific, and then try to get a project or two specific to your field later on in third/fourth year once you know what that field will be.

My advice for while youre still figuring stuff out: do research in the MOST competitive field you are interested in, and/or research that bridges two fields (research related to retinoblastoma, for instance, if you are interested in oncology and optho).

 

[Dwan]

Your academic performance is priority as many have said. Research in general is the most high yield EC you can have. Even in IM, people were most interested in my research vs the other random ECs and leadership I had. Of course, the other stuff can't hurt and may have come up more often as interview topics for others, but I think research went a long way in getting me competitive interviews I shouldn't have based on my scores. In the competitive fields, I've seen average students match top places due to extensive research (year off generally required if that's the plan).

 

[deltaJ]

This absolutist attitude is a bit misleading.

The MOST competitive applicants will have optho-specific research for applying optho, and rad-onc specific research for applying rad onc. If you have a stellar app and a significant amount of non field-specific research though, you will still be highly competitive.

Find field-specific research if you can, but its totally fine to do something not field specific, and then try to get a project or two specific to your field later on in third/fourth year once you know what that field will be.

My advice for while youre still figuring stuff out: do research in the MOST competitive field you are interested in, and/or research that bridges two fields (research related to retinoblastoma, for instance, if you are interested in oncology and optho).

That last comment is very helpful actually, as I know I have a deep interest in oncology for the molecular side of medicine, but haven't explored surgery as much simply due to my not shading surgeons. I'll try to bridge them if I can like that! I'll stick to preparing for the MOST competitive field as well.

Your academic performance is priority as many have said. Research in general is the most high yield EC you can have. Even in IM, people were most interested in my research vs the other random ECs and leadership I had. Of course, the other stuff can't hurt and may have come up more often as interview topics for others, but I think research went a long way in getting me competitive interviews I shouldn't have based on my scores. In the competitive fields, I've seen average students match top places due to extensive research (year off generally required if that's the plan).

So it looks like research is now more important (compared with undgrad to MS, where research was an unwritten rule to most competitive places, but not necessarily THE deciding factor). Thanks!

 

[Dwan]

So it looks like research is now more important (compared with undgrad to MS, where research was an unwritten rule to most competitive places, but not necessarily THE deciding factor). Thanks!

Yep, I had strong research for an undergraduate too (first author publication) but it didn't help too much, I got interviews at schools in line with my scores. For IM, I'm getting much "better" interviews than I should for my numbers, but people who have the numbers have a higher quantity of top interviews. And for top fellowships, research becomes one of the most significant controllable factors. It goes up in significance the more specialized the field, for the most part. My friends in surgery and the competitive specialties got a bigger "boost" from research relative to the rest of their app.

 

[WedgeDawg]

In order of importance:

1. Scores (mostly Step 1) - these will be what might close the door to competitive specialties or programs within specialties; they're a necessary but not sufficient component
====== small gap
2. Clinical grades - the more honors the better, and doing well in the core rotation most important to your specialty of interest is helpful (for ophtho, that would be surgery and medicine, for IM that would be medicine, for surgery that would be surgery, etc). AOA is helpful, especially if you're aiming for a top program, a highly competitive specialty, or if your step 1 score isn't as excellent as you wanted it to be
3. 4th year sub-internships - you need to honor them and likely get rec letters from them (varies a bit by specialty) and rec letters are hugely important in some specialties
4. Research - important for the most competitive fields (surgical subs, derm), helpful for everything else
====== big gap
5. pre-clinical grades - don't fail anything, if they factor into AOA, up to you how much time you want to invest
6. other ECs - doesn't really matter, but can be fun talking points at interviews (which are important to do well on obviously)
7. School you're coming from - not something you can really change once you're in, but be aware that top schools are disproportionately represented in the more competitive specialties and the top programs within the less competitive fields

 

[Lawpy]

In order of importance:

1. Scores (mostly Step 1) - these will be what might close the door to competitive specialties or programs within specialties; they're a necessary but not sufficient component
====== small gap
2. Clinical grades - the more honors the better, and doing well in the core rotation most important to your specialty of interest is helpful (for ophtho, that would be surgery and medicine, for IM that would be medicine, for surgery that would be surgery, etc). AOA is helpful, especially if you're aiming for a top program, a highly competitive specialty, or if your step 1 score isn't as excellent as you wanted it to be
3. 4th year sub-internships - you need to honor them and likely get rec letters from them (varies a bit by specialty) and rec letters are hugely important in some specialties
4. Research - important for the most competitive fields (surgical subs, derm), helpful for everything else
====== big gap
5. pre-clinical grades - don't fail anything, if they factor into AOA, up to you how much time you want to invest
6. other ECs - doesn't really matter, but can be fun talking points at interviews (which are important to do well on obviously)
7. School you're coming from - not something you can really change once you're in, but be aware that top schools are disproportionately represented in the more competitive specialties and the top programs within the less competitive fields

do some core rotations carry more importance than others? as an example, is someone still in good shape if they honor IM, surgery, OB/GYN, and peds but HP the rest?

or would you suggest to simply try to honor as many rotations as possible?

 

[WedgeDawg]

do some core rotations carry more importance than others? as an example, is someone still in good shape if they honor IM, surgery, OB/GYN, and peds but HP the rest?

or would you suggest to simply try to honor as many rotations as possible?

Do as well as you can, but don't worry about any specific grade after you've gotten it (because you can't change it).

It varies by specialty though. For IM for example, not having honors in your IM rotation(s) can get you screened out at some top programs. In general though, they're all important, but the most important ones for you specifically are the ones most closely related to your specialty(ies) of interest.

It's important to recognize that your clinical grades are looked at in context with the rest of your application and not in a vacuum. In the grand scheme of things (FOR EXAMPLE), someone with a strong application and 3/7 honors and 4 HPs and someone with an equally strong application with 5/7 honors and 2 HPs from the same school will overall be equally competitive applicants. So there is no hard and fast rule as to what constitutes a "good" clinical performance because context is literally everything.

 

[mehc012]

In order of importance:

1. Scores (mostly Step 1) - these will be what might close the door to competitive specialties or programs within specialties; they're a necessary but not sufficient component
====== small gap
2. Clinical grades - the more honors the better, and doing well in the core rotation most important to your specialty of interest is helpful (for ophtho, that would be surgery and medicine, for IM that would be medicine, for surgery that would be surgery, etc). AOA is helpful, especially if you're aiming for a top program, a highly competitive specialty, or if your step 1 score isn't as excellent as you wanted it to be
3. 4th year sub-internships - you need to honor them and likely get rec letters from them (varies a bit by specialty) and rec letters are hugely important in some specialties
4. Research - important for the most competitive fields (surgical subs, derm), helpful for everything else
====== big gap
5. pre-clinical grades - don't fail anything, if they factor into AOA, up to you how much time you want to invest
6. other ECs - doesn't really matter, but can be fun talking points at interviews (which are important to do well on obviously)
7. School you're coming from - not something you can really change once you're in, but be aware that top schools are disproportionately represented in the more competitive specialties and the top programs within the less competitive fields

Is research essential to be competitive for top residencies within specialties that aren't necessarily super competitive on the whole? For example, would a candidate with minimal research but a 260 Step and all clinical honors still be DOA at top IM or gen surg residencies?

 

[WedgeDawg]

Is research essential to be competitive for top residencies within specialties that aren't necessarily super competitive on the whole? For example, would a candidate with minimal research but a 260 Step and all clinical honors still be DOA at top IM or gen surg residencies?

I am not applying into either of those specialties so take what I have to say with a grain of salt.

Top IM (I'm talking the big 4 of MGH, BWH, Hopkins UCSF) generally looks for the following - high Step 1, AOA or at least H in your IM rotations, and pedigreed school (the more elite the better). The next tier of top IM residencies (Penn, Columbia, Duke, etc) look for these but are a little more lenient. It keeps getting a bit less competitive then until you get out of the top-ish tier. Everyone I know applying to these types of IM programs (coming out of my own top 10 med school with a top 10 IM residency as well as out of other top 10 med schools with their own top 10 IM residencies) has some sort of research. It's not all super fancy and some of it is actually not fancy at all, but I don't know anyone who has 0 research applying to these types of places so I can't really give you any solid answer to that particular problem. If I had to guess, I think that no research would be problematic, but some research even if it kind of sucks would be okay in an otherwise great application.

Top Gen Surg is a bit more research driven and a little (read: little) bit less stats driven. I would say that strong numbers and strong grades but literally no research would make you not very competitive for top of the top Gen Surg to a worse degree than for someone with the same situation applying IM.

Literally anyone in either of these specialties please feel free to correct (eviscerate) me on any of these points. Again, I am not applying into either of these specialties and all of my info are from friends going through / who have recently been through the IM/GS application process.

 

[mrbreakfast]

As everyone else has said, academics is #1. I would say the order of importance is Step 1 >> clinical grades >= Step 2 > pre-clinicals, but they all go hand in hand.

I'd give the following advice:
1) Focus on learning everything well. Even M1 topics are on step 1, and as an M4 I still get pimping questions on stuff I learned 3+ years ago. Honestly, you might periodically review previous topics as you progress through pre-clinicals, just to keep things fresh for step 1.
2) "Interesting" extracurriculars can boost your application, because they stand out. I'm not talking about "I was president of ortho club," but things that involve interesting things the average gunner won't do. I can't get more specific, but I got more interview questions about my extracurricular activities than anything else on my application.
3) Be open minded and explore things, particularly the competitive things. My understanding is that a competitive plastics/derm/ophtho/etc applicant will start their work in their first year.

Is research essential to be competitive for top residencies within specialties that aren't necessarily super competitive on the whole?

Talking to fellow applicants, and to residents, on the interview trail, not really. Seems like a lot of people have nothing, and getting something small is easy. I have ortho friends who are getting lots of interviews with little research.

Personally, I didn't interview at any of the absolute "top" programs in my (non-competitive) field, but ended up getting a lot of great invites, including pretty much all of my top choices. In terms of what interviewers asked about, I would say what helped me most was scores = letters (note: letters are extremely important) > grades > extracurriculars = research, and I did a ton of research (too much, in retrospect - leave a little time for fun too).

 

[Justabronco]

Applying to gen surg. Top gen surg programs (MGH, UofM, JHU...etc) are both research driven AND stats driven. Really for most academic programs it's both the stats and research. Most programs have a cutoff for step scores that automatically filter you out if you're below. When you interview at these top programs, you literally see the same applicants everywhere. I've been to at least 5 or 6 interviews in which the same 2-3 students are with me at each one, which is nice because the familiar faces makes both the traveling and the interview dinners extremely fun!

Stats mean both step scores, as well as class rank and having honors in surgery. I know of programs that will reject you based on having class rank not in the top half or top quartile despite having step 1 in 250s.

 

[mehc012]

Applying to gen surg. Top gen surg programs (MGH, UofM, JHU...etc) are both research driven AND stats driven. Really for most academic programs it's both the stats and research. Most programs have a cutoff for step scores that automatically filter you out if you're below. When you interview at these top programs, you literally see the same applicants everywhere. I've been to at least 5 or 6 interviews in which the same 2-3 students are with me at each one, which is nice because the familiar faces makes both the traveling and the interview dinners extremely fun!

Stats mean both step scores, as well as class rank and having honors in surgery. I know of programs that will reject you based on having class rank not in the top half or top quartile despite having step 1 in 250s.

Meh, our class doesn't have rankings and AOA is not released until after residency apps are submitted, so for me it's really just going to be Step, clinical grades, and my nonexistent research. Which I imagine will filter me out most everywhere.

 

[Dwan]

There's some data on characteristics affecting high ranking at some of the top gsurg programs in this paper: Characteristics of Highly Ranked Applicants to General Surgery Residency Programs.
"On multivariate adjustment, the likelihood of being ranked by highly competitive programs increased 1.36 times (95% CI, 1.23-1.50, P < .001) for every 10-unit increase in the USMLE I scores, 2.20 times for students with publications (1.34-2.46, P = .001), 1.62 times for students with better personal statements (1.02-2.60, P = .04), and 1.70 times for Asian students compared with white students (1.25-2.31, P = .001)."

Not the greatest study, but pretty consistent with what's been stated here.

 

[Justabronco]

Meh, our class doesn't have rankings and AOA is not released until after residency apps are submitted, so for me it's really just going to be Step, clinical grades, and my nonexistent research. Which I imagine will filter me out most everywhere.

Pedigree of the medical school also matters in some top surgery programs (sometimes even mid-tier ones). For example, UofM surgery wouldn't interview students from Beaumont, regardless of how qualified their applicants might be. However, if you come from an established school, like Yale or CCF, where it's truly P/NP without ranking, it PDs understand that and will take that into account and not hold it against you. As an somewhat unrelated aside, there's absolutely a bias against DOs and IMGs in surgery. I've been in interviews were PDs actually stressed the fact that all the applicants they invited are US MDs as "evidence" of the greatness/competitiveness of their program.

If your step 1 score is >220, you usually won't get filtered out of programs outside of the top 1/4 of programs (this is is a complete estimate and rankings of programs are widely inaccurate anyways). Most surgery programs have minimum of 220 for step 1 and if you apply broadly enough with >220 you will get the desired # of interviews. Some programs require step 2 score (and some have minimum cutoffs for step 2 as well). If you do well on step 2, that does get taken in to account for the most part. So I recommend taking step 2 before ERAS is due.

Less programs filter with class rank. (and it's not as big of a detriment to you if you aren't top of the class...etc) since that's not a data point on ERAS(and depends on them reading through your MSPE, but some programs still do. If you look at data for those matching into surgery, AOA is not huge percentage at all. Even for programs like The Ohio State (who sent interviewees details about those who matched at their program previously, including AOA status and where OSU ranked them on their list), you see that majority of residents do NOT have AOA.

If your Step1 score is <220, then it gets increasingly tricky for you as you move away from 220. I don't have too much advice on how to deal with that in applying to gen surg other than the generic apply broadly and have a back up plan.

 

[mehc012]

Pedigree of the medical school also matters in some top surgery programs (sometimes even mid-tier ones). For example, UofM surgery wouldn't interview students from Beaumont, regardless of how qualified their applicants might be. However, if you come from an established school, like Yale or CCF, where it's truly P/NP without ranking, it PDs understand that and will take that into account and not hold it against you. As an somewhat unrelated aside, there's absolutely a bias against DOs and IMGs in surgery. I've been in interviews were PDs actually stressed the fact that all the applicants they invited are US MDs as "evidence" of the greatness/competitiveness of their program.

If your step 1 score is >220, you usually won't get filtered out of programs outside of the top 1/4 of programs (this is is a complete estimate and rankings of programs are widely inaccurate anyways). Most surgery programs have minimum of 220 for step 1 and if you apply broadly enough with >220 you will get the desired # of interviews. Some programs require step 2 score (and some have minimum cutoffs for step 2 as well). If you do well on step 2, that does get taken in to account for the most part. So I recommend taking step 2 before ERAS is due.

Less programs filter with class rank. (and it's not as big of a detriment to you if you aren't top of the class...etc) since that's not a data point on ERAS(and depends on them reading through your MSPE, but some programs still do. If you look at data for those matching into surgery, AOA is not huge percentage at all. Even for programs like The Ohio State (who sent interviewees details about those who matched at their program previously, including AOA status and where OSU ranked them on their list), you see that majority of residents do NOT have AOA.

If your Step1 score is <220, then it gets increasingly tricky for you as you move away from 220. I don't have too much advice on how to deal with that in applying to gen surg other than the generic apply broadly and have a back up plan.

The question is whether there's a research filter. I'm interested in gen surg programs in the NE (family ties, went to undergrad up there, miss the area), but a lot of those programs are beastly good. My step won't be screened anywhere, and my clinical grades are quite good. If our school had those other factors, they would help me, not hurt me. My med school is well established and reasonably well known - not Yale or CCF, but not too far off either - and has a true P/NP, no ranking (we don't even get numeric scores on our exams), as well as intentionally taking AOA out of the picture.
My issue is, while I will have to have research of some sort in order to graduate, it certainly won't be robust, since I'm getting near the end of 3rd year and have nothing, not even any idea where to look for something. I have plenty of interests and extracurriculars, but no research as of yet. I'm worried that at this point, I'm already sunk before I've even figured out where I want to apply. :/

 

[mehc012]

I'm not sure if programs have an automatic "# of research" filter, since it's widely known that the numbers reported by us on ERAS are pretty much inflated. In addition the quality (e.g. 1st author pub) matter more than quantify (e.g. 10 poster presentation and no pubs, or multiple middle-author pubs vs one 1st author pub) I have met other interviewees who have done next to none research, but they probably get asked about that. For example, at one particular program, there is a panel interview that consist of you and a couple other applicants being interviewed together and the interviewers would grill us on our application and what makes us better than the applicant sitting next to us. It was pretty uncomfortable and you better be ready to defend any perceived weakness (e.g. lack of research in the case of my fellow interviewee) in your application. So I think it will hurt you in some ways, but to what extent, I don't know.

HOWEVER. Take comfort in knowing that there are ALOT of extremely amazing surgery programs that do not place that heavy of an emphasis on research (majority of surgery programs don't, actually). So you are far from being shut out of top notch surgery residency by having no research.

I think you will find that, as you go on different interviews next year, it becomes apparent what matters most in searching for a program is the people and culture at that program, not any perceived ranking based on Doximity or US News. In fact, some programs that you might think is elite (e.g. CCF) might actually not be the best place for general surgery residency due to a variety of reasons, despite being #2 in the nation (as they love to stress).

Yeah, I'm not particularly enamored with the atmosphere at CCF, largely because of their insistence on stressing such things.

My favorite was when they sent me some mail, and the envelope proudly proclaimed "One of the top 2 hospitals in the nation!"

...just put #2, guys, everyone knows what it means and you'll sound better.

 

[djsbaseball2014]

When we talk about research, are we talking from a strictly wet lab/clinical research lens? I have did some community based research in undergrad and want to seek out similar opportunities when i start medical school. Would there be a problem with this? I also want to get more into clinical research as well and would ideally have a mix of both.

 

[WedgeDawg]

When we talk about research, are we talking from a strictly wet lab/clinical research lens? I have did some community based research in undergrad and want to seek out similar opportunities when i start medical school. Would there be a problem with this? I also want to get more into clinical research as well and would ideally have a mix of both.

Depends on your intended specialty, your productivity, your goals, and how you sell it.

 

[djsbaseball2014]

Depends on your intended specialty, your productivity, your goals, and how you sell it.

What about for anesthesia? The one thing I am worried about at my medical school is we have a biomedical sciences research division, but we don't have our own home hospital, just a few community hospitals in the area that we will rotate at. If "gas" specific research is needed would you suggest just contacting those attendings and asking about any research projects they are currently working on?

 

[WedgeDawg]

What about for anesthesia? The one thing I am worried about at my medical school is we have a biomedical sciences research division, but we don't have our own home hospital, just a few community hospitals in the area that we will rotate at. If "gas" specific research is needed would you suggest just contacting those attendings and asking about any research projects they are currently working on?

I know next to nothing about anesthesia but the impression I’ve gleaned is that they don’t reallt care too much about research. However I wouldn’t trust what I’m saying and would talk to someone is applying or recently applied anesthesia for a more secure answer. Sorry I can’t be of more help.

 

[djsbaseball2014]

I know next to nothing about anesthesia but the impression I’ve gleaned is that they don’t reallt care too much about research. However I wouldn’t trust what I’m saying and would talk to someone is applying or recently applied anesthesia for a more secure answer. Sorry I can’t be of more help.

You have been a great help to everyone on these forums! Thank you

 

[LBJLA23]

What about for anesthesia? The one thing I am worried about at my medical school is we have a biomedical sciences research division, but we don't have our own home hospital, just a few community hospitals in the area that we will rotate at. If "gas" specific research is needed would you suggest just contacting those attendings and asking about any research projects they are currently working on?

Anesthesiology is not competitive anymore.