What is the consensus on the most important factors to get into a competitive specialty?

[CuriousMDStudent]

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From what I’ve seen the most important factors are:
STEP 2 Score, LOR’s/Connections, Research, School Prestige, Clerkship Grades.

These are the five factors that I have seen consistently mentioned. Any other factors I am missing?

I will be attending a T15 medical school in the coming year and am trying to figure out what I need to do to succeed in the coming years.

I feel my plan for the following four years will be:
1st and 2nd year: Study hard to ensure a solid medical foundation. Also seek out research/ mentors. Also try to incorporate STEP 2 studying if possible? (Any input on if this is even possible??)
3rd year: Work hard in clerkships to impress attendings. Get LOR’s. Take STEP 2
4th year: Away rotations at desired residencies and apply to residencies.

 

[longhaul3]

Research, research, research, step 2, research.

There's bound to be a lot of change and uncertainty while you're in med school, but research is the one that you can bet the farm on. In some cases it's already the single most important factor. It sucks, but it's not going to change.

 

[Frogger27]

research (which helps you build connections/get strong LORs), aways, Step 2, clinical grades

thats really all there is now that step 1 is gone lol

 

[PugsAndHugs]

AOA is also very important, other than that your list looks good.

 

[OnePunchBiopsy]

1. Who you know
2. LOR's
3.How you interview
4. Everything else

 

[CyrilFiggis]

Find a mentor in that specialty who ideally is on their interview committee or APD*. They will be honest with you about how your application is shaping up over your med school career.

*A rando attending is OK, but if they don’t know the process and discussions going on behind closed doors they can’t effectively guide you.

 

[crunchywhit]

Will agree that AOA and quality/rep of medical school need to be in there, especially if we are really talking about comp specialties at relatively competitive programs. You can do all the things and if you don’t come from a well regarded school, the cream of the crop will be closed to you.

 

[Goro]

From what I’ve seen the most important factors are:
STEP 2 Score, LOR’s/Connections, Research, School Prestige, Clerkship Grades.

These are the five factors that I have seen consistently mentioned. Any other factors I am missing?

Yes, via years of advice from our wise SDN residents and attendings: don't be a dick. They are looking for someone who will be a teammate for the next 3-7 years.

 

[kb1900]

a single strong connection that will make phone calls for you + LOR will allow you to match with even the most below average of apps for competitive specialties


But for most people without special connections it comes down to the usual stuff like aoa, step, research, aways

 

[Frogger27]

a single strong connection that will make phone calls for you + LOR will allow you to match with even the most below average of apps for competitive specialties


But for most people without special connections it comes down to the usual stuff like aoa, step, research, aways

ehhh idk about that, I feel like you still need to be decent candidate (albeit below average) to actually get the boost from someone making calls for you (aka like a 235 trying to match ortho, not a 200 and bottom quartile). These competitive programs have too many people to pick from and cant risk taking someone who is bottom of the barrel just because someone told them to

 

[slowthai]

ehhh idk about that, I feel like you still need to be decent candidate (albeit below average) to actually get the boost from someone making calls for you (aka like a 235 trying to match ortho, not a 200 and bottom quartile). These competitive programs have too many people to pick from and cant risk taking someone who is bottom of the barrel just because someone told them to

I have heard of sub 230s for both ortho and ENT matching purely because of connections in recent years. And it's not from that nepotism crap, or coming from a top tier school. If you can become a research machine and/or absolutely smash your aways, I believe it can be done. But it's incredibly rare, of course.

 

[Frogger27]

I have heard of sub 230s for both ortho and ENT matching purely because of connections in recent years. And it's not from that nepotism crap, or coming from a top tier school. If you can become a research machine and/or absolutely smash your aways, I believe it can be done. But it's incredibly rare, of course.

Nobody matches "purely based on connections". People may match in spite of a less than stellar step 1, but the rest of their app must be strong (I.e "connections", LORs, research, step 2, aways, etc). These programs have way too much on the line to let Lil' pot smoking johnny with a 200 step 1, straight P's and poor work ethic into their ortho program just because his daddy knows some people

Just to clarify: Becoming a "research machine" and "crushing aways" is A LOT harder to actually do compared to what you read on the internet

 

[slowthai]

Nobody matches "purely based on connections". People may match in spite of a less than stellar step 1, but the rest of their app must be strong (I.e "connections", LORs, research, step 2, aways, etc). These programs have way too much on the line to let Lil' pot smoking johnny with a 200 step 1, straight P's and poor work ethic into their ortho program just because his daddy knows some people

Just to clarify: Becoming a "research machine" and "crushing aways" is A LOT harder to actually do compared to what you read on the internet

Granted, I don't know the stories or the apps of the people that I mentioned, but the work ethic and the likeability factor had to be there. Otherwise they wouldn't have had these mentors backing them, putting their reputation on the line for someone that's a potential sub-par future resident. All I'm saying is that a poor step score can be overcome by developing these relationships. These relationships only come from working very hard and playing the game how it's meant to be played. Of course, it's a rare individual that can be so extraordinary as to accomplish this.

 

[sab3156]

Nobody matches "purely based on connections".

Yes, they do. Friend from a top school -> high step 1, but absolutely zero research... yet he had connections at a top Ortho program. Had maybe 2 or 3 interviews total, with tons of applications sent out. He was not competitive whatsoever, with absolutely zero ortho interest shown on his application. His connections at the program got him in. That's how the world works sometimes.

 

[Frogger27]

Yes, they do. Friend from a top school -> high step 1, but absolutely zero research... yet he had connections at a top Ortho program. Had maybe 2 or 3 interviews total, with tons of applications sent out. He was not competitive whatsoever, with absolutely zero ortho interest shown on his application. His connections at the program got him in. That's how the world works sometimes.

high step 1 and top school...

 

[sab3156]

high step 1 and top school...

If your point is that someone with a 194 Step 1 and zero pubs and coming from a DO school probably won’t match Plastics even with connections, I agree with you. But people with weak applications overall who definitely would not have matched at a particular program, or even matched at all, without serious connections do exist and it happens all the time. I guess you gotta show at least something worth considering on your app, I agree.

 

[operaman]

I got 35 interviews out of 45 applications to the top programs of the most competitive speciality. Factors IMO:

-High board scores
-Research, ideally in your field
-Commitment to your field: attending conferences, membership, leadership in interest groups
-Excellent clinical grades and evaluation comments: I cannot stress how important this is, almost every interviewer I had mentioned how I got all honors M3
-a strong LOR by someone connected in the field
-AOA

for what it’s worth, I come from a mid tier school and the vast majority of applicants I interviewed with were from mid tier schools, even at top 10 residency programs.

This mirrors my own experience a few years back. Also noticed the same distribution of schools. I think the fact that there are so few “top” schools yet quite a few mid tier ones that you’ll always have more of the latter. I’m sure if you did the math the top ones are proportionally more represented but that’s getting pretty deep in the weeds.

Agree that all honors gets noticed and I’ve noticed anecdotally that it correlates with good residents. It says that you have the ability to get along well with everyone even if you aren’t going into their field. Probably 20-25% of applicants I see have aced MS3 and nearly 100% have a very strong performance with mostly all honors and maybe 1 or 2 HPs tossed in there.

 

[catnip12]

A strong support system whatever that means to you!! You’ll be putting yourself through the meat grinder to become a competitive applicant and you’ll need at least someone to lean on when the going gets tough.

 

[Scrubs101]

This mirrors my own experience a few years back. Also noticed the same distribution of schools. I think the fact that there are so few “top” schools yet quite a few mid tier ones that you’ll always have more of the latter. I’m sure if you did the math the top ones are proportionally more represented but that’s getting pretty deep in the weeds.

Agree that all honors gets noticed and I’ve noticed anecdotally that it correlates with good residents. It says that you have the ability to get along well with everyone even if you aren’t going into their field. Probably 20-25% of applicants I see have aced MS3 and nearly 100% have a very strong performance with mostly all honors and maybe 1 or 2 HPs tossed in there.

Do you happen to know where programs look for honors in your app? My schools transcripts just list P/F (but list honors as an option but med school clinical rotations dont go here as its more for undergrad use at my school) while the MSPE lists our clinical rotation honors.

im having this unrealistic anxiety over programs seeing my transcripts lacking honors and missing where theyre actually located in the MSPE

 

[operaman]

Do you happen to know where programs look for honors in your app? My schools transcripts just list P/F (but list honors as an option but med school clinical rotations dont go here as its more for undergrad use at my school) while the MSPE lists our clinical rotation honors.

im having this unrealistic anxiety over programs seeing my transcripts lacking honors and missing where theyre actually located in the MSPE

Both really. The MSPE usually gives you some context for the grades plus it has the comments. Really it’s the context that matters precisely because the transcript doesn’t have the grading scales. I’d say 99.9% of reviewers will look at both and have no difficulty figuring it out.

 

[Scrubs101]

Both really. The MSPE usually gives you some context for the grades plus it has the comments. Really it’s the context that matters precisely because the transcript doesn’t have the grading scales. I’d say 99.9% of reviewers will look at both and have no difficulty figuring it out.

Awesome! Thank you!!

 

[Gilakend]

I got 35 interviews out of 45 applications to the top programs of the most competitive speciality. Factors IMO:

-High board scores
-Research, ideally in your field
-Commitment to your field: attending conferences, membership, leadership in interest groups
-Excellent clinical grades and evaluation comments: I cannot stress how important this is, almost every interviewer I had mentioned how I got all honors M3
-a strong LOR by someone connected in the field
-AOA

for what it’s worth, I come from a mid tier school and the vast majority of applicants I interviewed with were from mid tier schools, even at top 10 residency programs.

Besides being a normal person and being prepared, how did you manage to honor all rotations? I feel like that is crazy uncommon (at least at my school, but I've been told we have a hard clinical grading system).

Congrats!

 

[Engrailed]

Besides being a normal person and being prepared, how did you manage to honor all rotations? I feel like that is crazy uncommon (at least at my school, but I've been told we have a hard clinical grading system).

Congrats!

can you elaborate on what you mean by a “hard clinical grading system?”

 

[Gilakend]

can you elaborate on what you mean by a “hard clinical grading system?”

The percent that get honors is generally what I'm talking about. At some schools it's 60% at some schools it's 10%. Apparently, at some of the new Florida schools it is almost 90% according to some people involved in residency interviews at my school.

 

[kb1900]

Besides being a normal person and being prepared, how did you manage to honor all rotations? I feel like that is crazy uncommon (at least at my school, but I've been told we have a hard clinical grading system).

Congrats!

Not the person you’re responding to but also have all H so far with just 2 rotations left. I’ve found that it’s all about having your team see that you’re a useful and productive person to work with.

So being available and to pick up simple tasks like med recs/anaswering pages/doing h and ps/ calling in consults / talking to nurses - whatever it is that makes the day go by faster.

that and just being friendly/getting a long with your team. this part is a little dubious since you can’t possibly expect to click with everyone in medicine, but imo is something to strive for.

the last thing I’d say is try to do a least 1-2 teaching things during your rotation. With limited time with your attendings who may only hear you present for 1 minute every day, bringing in a teaching topic to rounds might be the only thing that elevates an attendings opinion of you.

I go to a school where shelves are only 10-15% of our grades at most but obviously if your shelf is 90% of your grade you should focus on that

 

[AnatomyGrey12]

can you elaborate on what you mean by a “hard clinical grading system?”

Only ~10% of our entire class can get honors in any given specialty. So that means about 1 per rotation give or take. Even the best students that everyone loves and that consistently dominate the shelves apply to residency with only 2-3 Honors on their transcript. You can even get recommended for Honors, Honor the shelf, and then not get honors because the quota for it was already met that month. It sucks.