What is a competitive residency, anyway?

[deleted388502]

Hi!

I am an M1 and I just finished my first block. Did not go so well, I studied a lot but failed 1/3 exams (anatomy) and still waiting on shelf results.

Medical school has been an extremely hard transition for me. I have been out of school for two years, seemed to have forgotten how to study, and constantly feel inadequate and like my work does not pay off.

I am trying to focus on not comparing myself to those around me but I find it hard when the standard that I’m working for is no longer the same for everyone and I am surrounded by so many who are capable yet act like they are not.

My question here is that I often hear you must do well in pre-clinicals (I go to a P/HP/H school) to gain a competitive residency and that this generally correlates with good step 1 performance. Obviously, step 1 is important as well.

I’m not talking here about a competitive specialty like derm, ortho, radiology, etc. I’m talking about if you want to go into psychiatry, or OBGYN, or IM- what does it mean to get a “competitive” residency vs an “uncompetitive” residency? Why is everyone so stressed out about residency- what am I missing?

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[mimelim]

Hi!

I am an M1 and I just finished my first block. Did not go so well, I studied a lot but failed 1/3 exams (anatomy) and still waiting on shelf results.

Medical school has been an extremely hard transition for me. I have been out of school for two years, seemed to have forgotten how to study, and constantly feel inadequate and like my work does not pay off.

I am trying to focus on not comparing myself to those around me but I find it hard when the standard that I’m working for is no longer the same for everyone and I am surrounded by so many who are capable yet act like they are not.

My question here is that I often hear you must do well in pre-clinicals (I go to a P/HP/H school) to gain a competitive residency and that this generally correlates with good step 1 performance. Obviously, step 1 is important as well.

I’m not talking here about a competitive specialty like derm, ortho, radiology, etc. I’m talking about if you want to go into psychiatry, or OBGYN, or IM- what does it mean to get a “competitive” residency vs an “uncompetitive” residency? Why is everyone so stressed out about residency- what am I missing?

I am at a competitive program in a competitive field. I reviewed about 50 applications so far this year. Not a single one of them did I look at the preclinical grades. I don't even think our faculty know what preclinical grades are, much less look at them.

On the other hand, probably shouldn't bother applying with less than a 230 step 1 score...

 

[ChrisMack390]

If your interests lie in the primary fields, and you are not dead set on landing at a major academic center in Boston/NYC/California, you probably do not have much to stress about.

If you want to do something hyper specialized and/or do know that you want to end up at a fancy center in a big coastal city, then you need the high step, publications, etc.

 

[SpecializedSurgeon]

I am at a competitive program in a competitive field. I reviewed about 50 applications so far this year. Not a single one of them did I look at the preclinical grades. I don't even think our faculty know what preclinical grades are, much less look at them.

On the other hand, probably shouldn't bother applying with less than a 230 step 1 score...

Agreed.

But still, landing a competitive residency is the same reason you (or others) likely shot for a competitive college, then a competitive medical school, etc. -- it opens some doors for you, in some instances.
That said, all of these educational experiences are just what you make of them... for the most part.

 

[Goro]

Hi!

I am an M1 and I just finished my first block. Did not go so well, I studied a lot but failed 1/3 exams (anatomy) and still waiting on shelf results.

Medical school has been an extremely hard transition for me. I have been out of school for two years, seemed to have forgotten how to study, and constantly feel inadequate and like my work does not pay off.

I am trying to focus on not comparing myself to those around me but I find it hard when the standard that I’m working for is no longer the same for everyone and I am surrounded by so many who are capable yet act like they are not.

My question here is that I often hear you must do well in pre-clinicals (I go to a P/HP/H school) to gain a competitive residency and that this generally correlates with good step 1 performance. Obviously, step 1 is important as well.

I’m not talking here about a competitive specialty like derm, ortho, radiology, etc. I’m talking about if you want to go into psychiatry, or OBGYN, or IM- what does it mean to get a “competitive” residency vs an “uncompetitive” residency? Why is everyone so stressed out about residency- what am I missing?

You have heard wrong. The reason you need to do well in preclinicals is that they are predictors of Boards performance. Step I score is what PDs look at. Look at the annual program directors survey: http://www.nrmp.org/wp-content/uploads/2016/09/NRMP-2016-Program-Director-Survey.pdf

 

[sliceofbread136]

Does your school factor in preclinicals to AOA and your quartile? Both of these can be extremely important

 

[Goro]

Does your school factor in preclinicals to AOA and your quartile? Both of these can be extremely important

I believe that we show class rank over all and how each student does in their rotations.

 

[sliceofbread136]

I believe that we show class rank over all and how each student does in their rotations.

Was directed to op, but if your school is showing class rank with preclinicals included then preclinicals are important. Being 1st quartile is important for many specialties and especially important for some

 

[Osteoth]

I am at a competitive program in a competitive field. I reviewed about 50 applications so far this year. Not a single one of them did I look at the preclinical grades. I don't even think our faculty know what preclinical grades are, much less look at them.

On the other hand, probably shouldn't bother applying with less than a 230 step 1 score...

So when you're reviewing an application, what is your matrix of approach?

Like, "Name, School, Step1, Rotation grades" in that order, or what do you actually look at in the application?

 

[Redpancreas]

Hi!

I am an M1 and I just finished my first block. Did not go so well, I studied a lot but failed 1/3 exams (anatomy) and still waiting on shelf results.

Medical school has been an extremely hard transition for me. I have been out of school for two years, seemed to have forgotten how to study, and constantly feel inadequate and like my work does not pay off.

I am trying to focus on not comparing myself to those around me but I find it hard when the standard that I’m working for is no longer the same for everyone and I am surrounded by so many who are capable yet act like they are not.

My question here is that I often hear you must do well in pre-clinicals (I go to a P/HP/H school) to gain a competitive residency and that this generally correlates with good step 1 performance. Obviously, step 1 is important as well.

I’m not talking here about a competitive specialty like derm, ortho, radiology, etc. I’m talking about if you want to go into psychiatry, or OBGYN, or IM- what does it mean to get a “competitive” residency vs an “uncompetitive” residency? Why is everyone so stressed out about residency- what am I missing?

Couple things. I'm sorry you're having a bad transition, but just remember others have had longer gaps b/n undergrad and medical school do extremely well so don't chalk it up to that. There may be some other issues to address. With preclinicals, they probably factor into class rank and AOA at many places. If you go to a H/HP/P school, it's possible that up to 50% of your class rank can be based on your preclinical performance. AOA is basically an honor society for the top academic performers. Criteria varies per institution and it's something that can make you stand out from a smaller school when applying to top 20 places. You're not asking about the Surgical specialties, Derm, or Opthalmology but if you want any of those, you need 240+, decent class rank, good clerkship grades, and research to be competitive. Radiology and Anesthesiology are not as competitive as those aforementioned. Competitive residencies in less competitive fields like IM, OB/GYN, or Psychiatry are ones with 1) Prestige 2) Good Locations. Name-recognition or training at an academic center is usually very important for Internal Medicine because fellowships look for that so that's what many IM applicants want. I can't speak to Psychiatry directly, but its competition is creeping the same way ER is even though ER is still more competitive. In regards to OB/GYN, they also have fellowships and one of the most competitive is GYN/ONC which I would imagine would look favorably on OB/GYN residents from academic programs. Lastly, location's important because those who are single perceive bigger cities as places with better dating prospects and those in committed relationships need to keep opportunities for their partner in mind. Now if you don't see any of that as important and just want to train somewhere that will give you solid fundamentals for your field, you've got a great attitude and you're"missing" nothing and have a 95%+ of matching by simply meeting all requirements.

 

[mimelim]

So when you're reviewing an application, what is your matrix of approach?

Like, "Name, School, Step1, Rotation grades" in that order, or what do you actually look at in the application?

1) All applications are screened by the coordinator. Must be an American medical grad with a step 1 score of 230+ and no red flags. That gets you on the PD's desk.
2) The program director then does a simple pass. If letters and everything else looks reasonable, then an invitation to interview is typically granted. Sometimes the PD will farm out some of the applications to other people for screening.
3) Prior to interviews, most people read applications. Everyone has a single printout with their name, school and scores which I glance at. Then I usually start with LOR. The people we are looking for universally have strong letters. If someone has a bunch of form letters from faculty that obviously are just writing the letter because thats what you do, it is obvious really quick and I can spend my time doing something else. I also look over the MSPE because I think there are always nuggets that others miss in there that are useful to know. I never really put much stock in anything individually because it is so easy for some random comment or opinion to end up in there, but between LOR and MSPE I think you can get a pretty solid idea of a candidate. 90% of the time, it is more about what is NOT in there than what is.

Mimelim, while this is true, would you look at a student in the bottom half of their class because often class-rank can weigh preclinical grades surprisingly heavily.

Nobody that knows anything about the practical realities of medical education take class-rank seriously. Just like AOA.

 

[Frogger27]

Nobody that knows anything about the practical realities of medical education take class-rank seriously. Just like AOA.

This is refreshing to hear.

 

[Osteoth]

1) All applications are screened by the coordinator. Must be an American medical grad with a step 1 score of 230+ and no red flags. That gets you on the PD's desk.
2) The program director then does a simple pass. If letters and everything else looks reasonable, then an invitation to interview is typically granted. Sometimes the PD will farm out some of the applications to other people for screening.
3) Prior to interviews, most people read applications. Everyone has a single printout with their name, school and scores which I glance at. Then I usually start with LOR. The people we are looking for universally have strong letters. If someone has a bunch of form letters from faculty that obviously are just writing the letter because thats what you do, it is obvious really quick and I can spend my time doing something else. I also look over the MSPE because I think there are always nuggets that others miss in there that are useful to know. I never really put much stock in anything individually because it is so easy for some random comment or opinion to end up in there, but between LOR and MSPE I think you can get a pretty solid idea of a candidate. 90% of the time, it is more about what is NOT in there than what is.

Nobody that knows anything about the practical realities of medical education take class-rank seriously. Just like AOA.

1. So what constitutes a red flag besides failing something/getting arrested?
2. On average what would you say is the multiplier for interview:available spots? I know for medical school applications someone floated the idea that it was 4 interviews to a spot, then 1.5-2 offers depending on the school.
3. What do you mean whats not in there? Aka "this person was the best, highly recommend, etc?". Seems like best way to make yourself shine beyond scores + research is how much the faculty in your specialty like you.

Furthermore, how do you guys about ranking people? Best first and then see how it goes? People who are more likely to attend?
How is sussing out of an applicant's true feelings/interest determined by an institution?
Do feelings get hurt if someone doesn't rank you as highly as you thought?

Sorry for all the questions, but not often you get the inside scoop on this stuff.

As to your point on AOA, I've heard of AOA screens in derm & plastics...

 

[libertyyne]

1) All applications are screened by the coordinator. Must be an American medical grad with a step 1 score of 230+ and no red flags. That gets you on the PD's desk.
2) The program director then does a simple pass. If letters and everything else looks reasonable, then an invitation to interview is typically granted. Sometimes the PD will farm out some of the applications to other people for screening.
3) Prior to interviews, most people read applications. Everyone has a single printout with their name, school and scores which I glance at. Then I usually start with LOR. The people we are looking for universally have strong letters. If someone has a bunch of form letters from faculty that obviously are just writing the letter because thats what you do, it is obvious really quick and I can spend my time doing something else. I also look over the MSPE because I think there are always nuggets that others miss in there that are useful to know. I never really put much stock in anything individually because it is so easy for some random comment or opinion to end up in there, but between LOR and MSPE I think you can get a pretty solid idea of a candidate. 90% of the time, it is more about what is NOT in there than what is.



Nobody that knows anything about the practical realities of medical education take class-rank seriously. Just like AOA.

Considering that MSPE letters/AOA/class rank are all related at some schools does that change your perception? At my school MSPE letter states " exceptional" only if you honor first three years.

 

[mimelim]

1. So what constitutes a red flag besides failing something/getting arrested?
2. On average what would you say is the multiplier for interview:available spots? I know for medical school applications someone floated the idea that it was 4 interviews to a spot, then 1.5-2 offers depending on the school.
3. What do you mean whats not in there? Aka "this person was the best, highly recommend, etc?". Seems like best way to make yourself shine beyond scores + research is how much the faculty in your specialty like you.

Furthermore, how do you guys about ranking people? Best first and then see how it goes? People who are more likely to attend?
How is sussing out of an applicant's true feelings/interest determined by an institution?
Do feelings get hurt if someone doesn't rank you as highly as you thought?

Sorry for all the questions, but not often you get the inside scoop on this stuff.

As to your point on AOA, I've heard of AOA screens in derm & plastics...

1) Red flags for us are the things that the coordinator can pick up on easily, I doubt they would even notice if you failed a pre-clinical course unless someone mentioned it or you were delayed. Convictions are there, visa issues, failing boards, etc.
2) Depends entirely on the program itself, there are obviously trends among specialties. For us, ~200 applications for 40 interviews and 2 spots. The lowest I've heard in my specialty is 10 interviews for 1 spot.
3) If you go to a school with a vascular department and are applying to vascular surgery, your chairman and local PD should know your name, who you are and what you are looking to do. If we call them (which we routinely do for our top 10 or so applicants), they better know who you are when we say, "Hey, we are calling about Johnny, what do you think of him?" They sure as **** shouldn't say, "who was that again?". LOR should reflect that and for strong applicants they do. We only have to fill 2 spots. We can be picky.

There is no gaming the matching process. We rank based on who want in our program, top to bottom. There is no incentive to rank people higher if people are more likely to attend.

Feelings/interests... We spend a lot of time with our applicants. The dinner the night before is always well attended by our residents and faculty. It is generally pretty nice, but very informal. It is not atypical for me to be there for 3+ hours talking to people. It is not atypical for us to have more than half of our residents there that long. During the interview day, if you aren't doing your 1 on 1 interviews, our residents are hanging out with you or taking you on a tour. Overall, it is a lot of interaction. It is far from perfect, but we make it very clear, we do not try to play games with the rank list. We rank based on who we think would fit our program the best because there is zero advantage to trying to modulate based on who is 'likely to come'.

We rarely go outside of our top 4-5 choices and tend to get who we expect, so that hasn't really been an issue. Most of also recognize that this is all about fit and applicants should be ranking based on where they think they would do the best. That may not be our program. We have an extremely good program. We are the best program in the country, for SOME applicants. I expect that a fair number every year should rank us #1 on their list. But, we are far from the best for EVERYONE. Hard to get ruffled about someone serving their own interests in an application process.

You wouldn't believe me if I told you the screening criteria I've heard of at random programs across the country. Program directors are not uniformly good. They are not uniformly up to date on how medical schools work. They all have their own biases on different components of the application. In addition, there are plenty of racists out there, those that prefer one gender, etc. Personally, I don't know how anyone can take AOA seriously. I think it is an incredibly poor metric for anything. Academically, if you know how the status is determined, it doesn't make a ton of sense that you would use it in residency recruiting. From a real world experience perspective, I find for my field at least, AOA is weakly INVERSELY correlated with people we would actually want.

Considering that MSPE letters/AOA/class rank are all related at some schools does that change your perception? At my school MSPE letter states " exceptional" only if you honor first three years.

MSPEs are not letters. Every school does them slightly different, but for the most part they are simply an aggregate document of things written by a dean and then usually copy and pasted sections of clerkship evals. The evals themselves typically are what I look at. I'm not really reading details. I'm getting a flavor for how remarkable an applicant is. If it is all boilerplate, filler, then I move on pretty quick.

 

[masaraksh]

I am at a competitive program in a competitive field. I reviewed about 50 applications so far this year. Not a single one of them did I look at the preclinical grades. I don't even think our faculty know what preclinical grades are, much less look at them.

On the other hand, probably shouldn't bother applying with less than a 230 step 1 score...

@mimelim so if I have poor preclinical grades but am able to show an uptrending ankle brachial index over the 4 years, how do you look at that?

 

[Redpancreas]

1) Red flags for us are the things that the coordinator can pick up on easily, I doubt they would even notice if you failed a pre-clinical course unless someone mentioned it or you were delayed. Convictions are there, visa issues, failing boards, etc.
2) Depends entirely on the program itself, there are obviously trends among specialties. For us, ~200 applications for 40 interviews and 2 spots. The lowest I've heard in my specialty is 10 interviews for 1 spot.
3) If you go to a school with a vascular department and are applying to vascular surgery, your chairman and local PD should know your name, who you are and what you are looking to do. If we call them (which we routinely do for our top 10 or so applicants), they better know who you are when we say, "Hey, we are calling about Johnny, what do you think of him?" They sure as **** shouldn't say, "who was that again?". LOR should reflect that and for strong applicants they do. We only have to fill 2 spots. We can be picky.

There is no gaming the matching process. We rank based on who want in our program, top to bottom. There is no incentive to rank people higher if people are more likely to attend.

Feelings/interests... We spend a lot of time with our applicants. The dinner the night before is always well attended by our residents and faculty. It is generally pretty nice, but very informal. It is not atypical for me to be there for 3+ hours talking to people. It is not atypical for us to have more than half of our residents there that long. During the interview day, if you aren't doing your 1 on 1 interviews, our residents are hanging out with you or taking you on a tour. Overall, it is a lot of interaction. It is far from perfect, but we make it very clear, we do not try to play games with the rank list. We rank based on who we think would fit our program the best because there is zero advantage to trying to modulate based on who is 'likely to come'.

We rarely go outside of our top 4-5 choices and tend to get who we expect, so that hasn't really been an issue. Most of also recognize that this is all about fit and applicants should be ranking based on where they think they would do the best. That may not be our program. We have an extremely good program. We are the best program in the country, for SOME applicants. I expect that a fair number every year should rank us #1 on their list. But, we are far from the best for EVERYONE. Hard to get ruffled about someone serving their own interests in an application process.

You wouldn't believe me if I told you the screening criteria I've heard of at random programs across the country. Program directors are not uniformly good. They are not uniformly up to date on how medical schools work. They all have their own biases on different components of the application. In addition, there are plenty of racists out there, those that prefer one gender, etc. Personally, I don't know how anyone can take AOA seriously. I think it is an incredibly poor metric for anything. Academically, if you know how the status is determined, it doesn't make a ton of sense that you would use it in residency recruiting. From a real world experience perspective, I find for my field at least, AOA is weakly INVERSELY correlated with people we would actually want.



MSPEs are not letters. Every school does them slightly different, but for the most part they are simply an aggregate document of things written by a dean and then usually copy and pasted sections of clerkship evals. The evals themselves typically are what I look at. I'm not really reading details. I'm getting a flavor for how remarkable an applicant is. If it is all boilerplate, filler, then I move on pretty quick.

Not all fields follow the trends you've laid out and part of the reason why is they lack the insight you've demonstrated here. I just want to say you've probably made the most substantial contribution to educating people about vascular surgery out of anyone in the field given your SDN presence, frank honesty, insight into how the system works, and your dedication.

 

[Osteoth]

1) Red flags for us are the things that the coordinator can pick up on easily, I doubt they would even notice if you failed a pre-clinical course unless someone mentioned it or you were delayed. Convictions are there, visa issues, failing boards, etc.
2) Depends entirely on the program itself, there are obviously trends among specialties. For us, ~200 applications for 40 interviews and 2 spots. The lowest I've heard in my specialty is 10 interviews for 1 spot.
3) If you go to a school with a vascular department and are applying to vascular surgery, your chairman and local PD should know your name, who you are and what you are looking to do. If we call them (which we routinely do for our top 10 or so applicants), they better know who you are when we say, "Hey, we are calling about Johnny, what do you think of him?" They sure as **** shouldn't say, "who was that again?". LOR should reflect that and for strong applicants they do. We only have to fill 2 spots. We can be picky.

There is no gaming the matching process. We rank based on who want in our program, top to bottom. There is no incentive to rank people higher if people are more likely to attend.

Feelings/interests... We spend a lot of time with our applicants. The dinner the night before is always well attended by our residents and faculty. It is generally pretty nice, but very informal. It is not atypical for me to be there for 3+ hours talking to people. It is not atypical for us to have more than half of our residents there that long. During the interview day, if you aren't doing your 1 on 1 interviews, our residents are hanging out with you or taking you on a tour. Overall, it is a lot of interaction. It is far from perfect, but we make it very clear, we do not try to play games with the rank list. We rank based on who we think would fit our program the best because there is zero advantage to trying to modulate based on who is 'likely to come'.

We rarely go outside of our top 4-5 choices and tend to get who we expect, so that hasn't really been an issue. Most of also recognize that this is all about fit and applicants should be ranking based on where they think they would do the best. That may not be our program. We have an extremely good program. We are the best program in the country, for SOME applicants. I expect that a fair number every year should rank us #1 on their list. But, we are far from the best for EVERYONE. Hard to get ruffled about someone serving their own interests in an application process.

You wouldn't believe me if I told you the screening criteria I've heard of at random programs across the country. Program directors are not uniformly good. They are not uniformly up to date on how medical schools work. They all have their own biases on different components of the application. In addition, there are plenty of racists out there, those that prefer one gender, etc. Personally, I don't know how anyone can take AOA seriously. I think it is an incredibly poor metric for anything. Academically, if you know how the status is determined, it doesn't make a ton of sense that you would use it in residency recruiting. From a real world experience perspective, I find for my field at least, AOA is weakly INVERSELY correlated with people we would actually want.

MSPEs are not letters. Every school does them slightly different, but for the most part they are simply an aggregate document of things written by a dean and then usually copy and pasted sections of clerkship evals. The evals themselves typically are what I look at. I'm not really reading details. I'm getting a flavor for how remarkable an applicant is. If it is all boilerplate, filler, then I move on pretty quick.

First of all, great post, thank you.

So you guys do 20 interviews/1 spot. When you get to the interview process, what are you really looking for? How do you define the culture of your program and differentiate the people who would do well vs. not well there? Of course removing the obvious community v. academic screen.

Furthermore, how many away rotations do you guys generally give out for 2 spots? Has there been a positive correlation with people coming for aways and ending up becoming residents, or have you seen the opposite?

 

[Gurby]

I just want to say you've probably made the most substantial contribution to educating people about vascular surgery out of anyone in the field given your SDN presence, frank honesty, insight into how the system works, and your dedication.

I think the word is out!

 

[mimelim]

First of all, great post, thank you.

So you guys do 20 interviews/1 spot. When you get to the interview process, what are you really looking for? How do you define the culture of your program and differentiate the people who would do well vs. not well there? Of course removing the obvious community v. academic screen.

Furthermore, how many away rotations do you guys generally give out for 2 spots? Has there been a positive correlation with people coming for aways and ending up becoming residents, or have you seen the opposite?

What are we really looking for and the culture of our program are intimately tied together. I've said this before many times on here, if you are an MS4, regardless of the field you are going into, you should care about 3 things above all else. #1 Availability of a large amount of pathology. You need patients and lots of them. If you are a pathologist, you need slides, autopsies, etc. If you are IM, you need huge wards, full of sick people to hone your skills on. If you are surgery, you need a huge number of cases, both bread and butter as well as quaternary care oriented. In short, you want to be operating your brains out. #2 You need faculty and seniors that are going to teach you how to deal with that pathology. They can not just be the world expert in something, they need to be able to teach you how to be THE doctor, so that when you graduate, you have the confidence to treat and help people. And lastly #3 You need to fit into the ethos of the program.

So, what am I looking for? I'm looking for the other half of #3. My program is busy. We work extremely hard for many hours every week (just like most other surgery programs). We are not a formal program, you will never find a resident wearing a tie, frankly because it gets in the way of being efficient. I'm looking for humility, but with the capacity to grow into a confident intern who will turn into a confident resident. I'm looking for someone that is driven and has their life together because we demand a lot from our residents. I'm looking for my future junior residents that are going to be better than I was when I was at their level. I'm willing (like many of my co-residents and my faculty) to invest a lot of time and energy into looking out for their education, I'm looking for residents that will take that commitment seriously and not only maximize their own training, but also pay it forward down the line. In short, people that take their education and training seriously and are willing to work and sacrifice for that, while also not taking THEMSELVES too seriously. Barrier #1 you are going to be around these people 80+ hours a week, if you can't laugh with each other, it is going to be a very long residency.

A little bit beyond the recruiting process, but I tell every intern rotating with me, their responsibility is to keep my ORs running smoothly. My first case needs to start on time. My second case needs to be ready to follow. Issues need to be anticipated and dealt with before they slow something down. In return, my responsibility is to guide their education and training. That means teaching them how to be an effective house officer, get them into the OR as much as is possible and watch out for them. As long as we both keep our ends, we will both leave exhausted, but we will both get what we came for.

We do not cap the number of people doing aways with us. We can handle 3-4 MS4s with us in any given month and never really run into spacing issues. 30% of our residents either did an away with us or did research with us prior to joining our program. So, I would say that it historically has impacted rotators positively in our program. By the same token, you can also argue that 70% of our residents (including yours truly) did not have any prior affiliation, so it certainly can give a big leg up, but it isn't the end all, be all. Aways will push you in one way or another, very rarely do you have a 'neutral' response from the faculty and current residents.

 

[Redpancreas]

I think the word is out!



View attachment 224673

Oh my goodness, why?!

 

[Shams al Deen]

1) All applications are screened by the coordinator. Must be an American medical grad with a step 1 score of 230+ and no red flags. That gets you on the PD's desk.
2) The program director then does a simple pass. If letters and everything else looks reasonable, then an invitation to interview is typically granted. Sometimes the PD will farm out some of the applications to other people for screening.
3) Prior to interviews, most people read applications. Everyone has a single printout with their name, school and scores which I glance at. Then I usually start with LOR. The people we are looking for universally have strong letters. If someone has a bunch of form letters from faculty that obviously are just writing the letter because thats what you do, it is obvious really quick and I can spend my time doing something else. I also look over the MSPE because I think there are always nuggets that others miss in there that are useful to know. I never really put much stock in anything individually because it is so easy for some random comment or opinion to end up in there, but between LOR and MSPE I think you can get a pretty solid idea of a candidate. 90% of the time, it is more about what is NOT in there than what is.



Nobody that knows anything about the practical realities of medical education take class-rank seriously. Just like AOA.

Regarding the selection criteria for interviews, it seems like most of the 200 applicants you get would qualify for an interview. Most people applying to competitive places have 230+, no red flags, and a reasonable app otherwise, right? I'm wondering how you get from 200 apps to only 40 interviews? Maybe our idea of "reasonable" is different.

 

[mimelim]

Regarding the selection criteria for interviews, it seems like most of the 200 applicants you get would qualify for an interview. Most people applying to competitive places have 230+, no red flags, and a reasonable app otherwise, right? I'm wondering how you get from 200 apps to only 40 interviews? Maybe our idea of "reasonable" is different.

I am in a relatively small field, that 200 likely represents almost everyone applying to vascular surgery each year. I don't have the exact numbers, but some don't have the scores and many have boiler plate letters and everything else. Most medical students don't know how boring they look on paper or in other people's writing.

 

[Newyawk]

I am at a competitive program in a competitive field. I reviewed about 50 applications so far this year. Not a single one of them did I look at the preclinical grades. I don't even think our faculty know what preclinical grades are, much less look at them.

On the other hand, probably shouldn't bother applying with less than a 230 step 1 score...

Thank you for taking the time to respond to questions. Im curious to know, after the step 1 cutoff set by programs, how much a specific score plays a role in the decision process? And at which point, if any, does increasing score no longer matter?

 

[Goro]

I am in a relatively small field, that 200 likely represents almost everyone applying to vascular surgery each year. I don't have the exact numbers, but some don't have the scores and many have boiler plate letters and everything else. Most medical students don't know how boring they look on paper or in other people's writing.

Are particular schools feeders to your program?

 

[mimelim]

Thank you for taking the time to respond to questions. Im curious to know, after the step 1 cutoff set by programs, how much a specific score plays a role in the decision process? And at which point, if any, does increasing score no longer matter?

This depends on the specialty and the program itself. Even within individual programs there can be differences of opinions about scores. I'll give the example of my program... We have a strict 230 cut-off for interviews. For me, anything above that is not helpful when figuring out who to recruit. Sure, we all 'prefer' higher if two applicants are otherwise identical, but the reality is that no two applicants are identical and I'd never trade Step 1 points for just about any other characteristic assuming that they are 230+. On the other hand, I used to have a program director that got giddy about all of the 260+ people that were applying. At the end of the day, ability to perform on a standardized test is important, but it barely cracks the top 10 of most important things in a future resident.

Are particular schools feeders to your program?

No feeders. In general smaller programs don't have 'feeders'.

 

[sloop]

With regards to preclinical grades, they are not that important, assuming you do well on the boards. This said, the most proven way to do well on boards is to do well in preclinicals. People always have this idea that they can disregard the average or below average grades they were getting and then just blow Step 1 out of the water without realizing that this situation is pretty much by definition an uphill battle.

With regard to what successful applicants to competitive residencies in otherwise less competitive fields look like: I can only speak for psychiatry in my n=1 program which I think most people would see as a top/competitive program. About 30% of my intern class is composed of MD/PhDs, many are from top medical schools. I am neither but did very well in medical school and scored ~250/260 on steps 1/2, got multiple awards, etc. Many of my cointerns have interesting life stories. Most have done some degree of research in psychiatry. They are all super sharp and dedicated, and from my experience having gone to a medical school with a much less renowned psychiatry program, all of my cointerns I have seen manage patients recently (September-October) seem equally or more proficient than PGY-2s were at my alma mater.

So I guess I’ll just say that people want to be at good programs and good programs are competitive, regardless of field. The people who wind up at good programs have great track records in various ways and seem to be, on average, better physicians than their peers.

 

[mvenus929]

I'm in a non-competitive field, and going into an even less competitive subspecialty.

In my field, competitive programs have 1) volume to provide a variety of bread and butter, as well as abnormal pathology. You should be able to see the majority of the things you will encounter on board exams during your residency, and 2) have research opportunities--thus most competitive programs have lots of research funding. There are also a few other things that help out--stand alone children's hospitals tend to be more competitive than 'hospital within a hospital' models, which goes back to #1. They also tend to have faculty that are well known in the profession. You will realize as you get higher in the ranks that the field gets smaller and smaller, so having one of the 'experts' in some field sets the programs apart. In my fellowship, a good marker for 'competitiveness' is the size of the program--more fellows means more patients and more research opportunities.

Of course, there are programs that aren't necessarily competitive, but are still good programs. For residency, I went to a program that didn't have many fellowships, in large part because it had volume, but ultimately because I felt I fit in well with the program. We don't have dozens of wet labs, but the faculty are very supportive of resident research and are easily accessible because they work directly with us all the time, rather than having a fellow in between.