I'm a MSIII, soon-to-be MSIV, at a US medical school. For those of you who will be fortunate enough to be deciding between multiple possibilities for where to attend medical school, a big congratulations to you. I wanted to share my retrospective perspective on what does and doesn't matter when choosing a school.
First of all, what doesn't matter:
- Curriculum, especially pre-clinical curriculum. Does it matter if it's traditional or systems-based? That you have PBL? Honestly, no. The majority of your learning in medical school will be through self-studying and clinical rotations, which is fairly similar anywhere. Although, I do favor the idea of shortened pre-clinical time and step 1 after clinical rotations (my med school didn't do this, I just like it in theory). Shouldn't be a big deal though.
- Match lists. Don't even look at these. There's a lot of subtlety and nuance to match lists that is impossible to interpret, and trying to read into match lists will lead you to more false conclusions than real ones. The number of students going into "competitive specialties" is misleading as it has high annual variance and is overall more reflective of the culture/individual interests of a class than any institutional effect. Looking at what programs students matched into is just as misleading; the most prestigious programs in each specialty are highly variable by field and do not correlate with your implicit usnews-influenced perception of what the best programs are.
What matters the most:
- Location. This one is actually a bigger deal than I had anticipated upon entering medical school. It's not just that you will be spending 4 prime years of your life in this locale: you very likely could be spending much longer. "Inbreeding" is a real and very key phenomenon; it will be easier to get into residency at your home program than any other program of similar caliber. One look at match lists at top 5 schools found that on average one-third of students matched into their home program.
Moreover, geographical selection by residencies is also very real. In other words, residencies (especially in smaller fields) will preferentially offer interviews to those with some connection to that region, those who they believe would be willing to move and live there. If you have a hankering to live in California for residency, it's preferable to attend medical school there, do an away rotation there, or have a home address there (preferably more than one), otherwise it will be an uphill battle. And it doesn't stop with residency; geographical selection probably gets even stronger for fellowship and eventual employment.
All of this is to say, if you have a strong family or personal reason or even just a preference for settling down in a particular region of the United States (particularly a competitive region like California or NY), think hard on it.
- "The vibe." This is really hard to get a sense of and even harder to quantify. But medical school will at times consume your life over the course of the next 4 years. Your classmates will be a big part of your social experience and your happiness in general. Talk to the current students on your interview day or at second look, get a sense of what the general atmosphere of the class is and whether it matches what you want out of your classmates.
- Prestige. This does matter to some extent. Going to a more prestigious school opens more doors for you at the same level of achievement (meaning the quality of your application with board scores, grades, research, etc etc). How much it really matters is complex and varies quite a bit depending on the specialty you're going into. My general impression is that it matters more than the Program Director surveys let on, but less than most pre-meds would imagine. In general, for more competitive specialties, pedigree is valued more highly. Keep in mind the geographical selection effect above though which in many cases will confound or outweigh the pedigree effect.
Some other caveats:
1) Small differences in prestige don't matter. Don't obsess over the relative prestige of medical schools and don't go to a school that's a few spots higher on the "top medical school" rankings just because of a number. I imagine it as more categorized by general tiers and the difference of one tier is not much.
2) Attending a more prestigious school doesn't mean you've made it. You'll still have to bust your ass in medical school.
3) Attending a less prestigious school doesn't close any doors for you. You can still be anything you set your mind to, but the bar for achievement for yourself will just be somewhat higher.
The long and short: I would rank prestige as an important factor to consider but after location and vibe in the overall scheme of things.
Other things to maybe consider:
- "Home department." IF you have your mind set in a certain research-focused, highly competitive specialty, for example Dermatology or Plastic Surgery, consider the strength (or existence) of that department at the medical school. This is important for a few reasons: it will open up opportunities for you to do research early on, it will determine the weight of your recommendation letters, and again "inbreeding", it will be easier to match there than anywhere else. If you aren't really sure or you are interested in something less competitive like EM or neurology or psych, it doesn't matter at all so don't worry about it. There's a high chance your specialty choice will change during med school anyway.
- Lecture attendance during pre-clinical years. I personally abhor attending lectures and found the vast majority of lectures during the first two years of my medical school a complete waste of time. Ask if your school mandates lecture attendance, if they offer lecture videos that you can watch at 2x in the comfort of your own home, how much required class there is, etc. If you are more of a "lecture person," more power for you, this doesn't apply to you.
- Pass/Fail. Another complicated topic. Many people will say only go to a school with pre-clinical pass/fail. However, the dirty secret is that many (actually most) schools that advertise P/F during pre-clinical years keep an internal ranking, which then factors (minor impact compared to clinical grades, but still) into your dean's letter that goes out to residencies. There are schools that are "true" pass/fail during pre-clinical but these are the exception. So the difference between P/F and graded pre-clinical years is often actually the difference between implicit and explicit grades.
Despite saying that, I do think P/F grading is a big boon; it fosters a more collaborative and less stressful learning environment during the first two years, but in the end you're probably going to study incredibly hard anyway, and many of you will have to come to terms with struggling academically, not being top of the class anymore, etc. How much this matters to you comes down to an individual decision.
Take everything here with a grain of salt. This is just one student's perspective. Happy to answer any questions here or by PM.
First of all, what doesn't matter:
- Curriculum, especially pre-clinical curriculum. Does it matter if it's traditional or systems-based? That you have PBL? Honestly, no. The majority of your learning in medical school will be through self-studying and clinical rotations, which is fairly similar anywhere. Although, I do favor the idea of shortened pre-clinical time and step 1 after clinical rotations (my med school didn't do this, I just like it in theory). Shouldn't be a big deal though.
- Match lists. Don't even look at these. There's a lot of subtlety and nuance to match lists that is impossible to interpret, and trying to read into match lists will lead you to more false conclusions than real ones. The number of students going into "competitive specialties" is misleading as it has high annual variance and is overall more reflective of the culture/individual interests of a class than any institutional effect. Looking at what programs students matched into is just as misleading; the most prestigious programs in each specialty are highly variable by field and do not correlate with your implicit usnews-influenced perception of what the best programs are.
What matters the most:
- Location. This one is actually a bigger deal than I had anticipated upon entering medical school. It's not just that you will be spending 4 prime years of your life in this locale: you very likely could be spending much longer. "Inbreeding" is a real and very key phenomenon; it will be easier to get into residency at your home program than any other program of similar caliber. One look at match lists at top 5 schools found that on average one-third of students matched into their home program.
Moreover, geographical selection by residencies is also very real. In other words, residencies (especially in smaller fields) will preferentially offer interviews to those with some connection to that region, those who they believe would be willing to move and live there. If you have a hankering to live in California for residency, it's preferable to attend medical school there, do an away rotation there, or have a home address there (preferably more than one), otherwise it will be an uphill battle. And it doesn't stop with residency; geographical selection probably gets even stronger for fellowship and eventual employment.
All of this is to say, if you have a strong family or personal reason or even just a preference for settling down in a particular region of the United States (particularly a competitive region like California or NY), think hard on it.
- "The vibe." This is really hard to get a sense of and even harder to quantify. But medical school will at times consume your life over the course of the next 4 years. Your classmates will be a big part of your social experience and your happiness in general. Talk to the current students on your interview day or at second look, get a sense of what the general atmosphere of the class is and whether it matches what you want out of your classmates.
- Prestige. This does matter to some extent. Going to a more prestigious school opens more doors for you at the same level of achievement (meaning the quality of your application with board scores, grades, research, etc etc). How much it really matters is complex and varies quite a bit depending on the specialty you're going into. My general impression is that it matters more than the Program Director surveys let on, but less than most pre-meds would imagine. In general, for more competitive specialties, pedigree is valued more highly. Keep in mind the geographical selection effect above though which in many cases will confound or outweigh the pedigree effect.
Some other caveats:
1) Small differences in prestige don't matter. Don't obsess over the relative prestige of medical schools and don't go to a school that's a few spots higher on the "top medical school" rankings just because of a number. I imagine it as more categorized by general tiers and the difference of one tier is not much.
2) Attending a more prestigious school doesn't mean you've made it. You'll still have to bust your ass in medical school.
3) Attending a less prestigious school doesn't close any doors for you. You can still be anything you set your mind to, but the bar for achievement for yourself will just be somewhat higher.
The long and short: I would rank prestige as an important factor to consider but after location and vibe in the overall scheme of things.
Other things to maybe consider:
- "Home department." IF you have your mind set in a certain research-focused, highly competitive specialty, for example Dermatology or Plastic Surgery, consider the strength (or existence) of that department at the medical school. This is important for a few reasons: it will open up opportunities for you to do research early on, it will determine the weight of your recommendation letters, and again "inbreeding", it will be easier to match there than anywhere else. If you aren't really sure or you are interested in something less competitive like EM or neurology or psych, it doesn't matter at all so don't worry about it. There's a high chance your specialty choice will change during med school anyway.
- Lecture attendance during pre-clinical years. I personally abhor attending lectures and found the vast majority of lectures during the first two years of my medical school a complete waste of time. Ask if your school mandates lecture attendance, if they offer lecture videos that you can watch at 2x in the comfort of your own home, how much required class there is, etc. If you are more of a "lecture person," more power for you, this doesn't apply to you.
- Pass/Fail. Another complicated topic. Many people will say only go to a school with pre-clinical pass/fail. However, the dirty secret is that many (actually most) schools that advertise P/F during pre-clinical years keep an internal ranking, which then factors (minor impact compared to clinical grades, but still) into your dean's letter that goes out to residencies. There are schools that are "true" pass/fail during pre-clinical but these are the exception. So the difference between P/F and graded pre-clinical years is often actually the difference between implicit and explicit grades.
Despite saying that, I do think P/F grading is a big boon; it fosters a more collaborative and less stressful learning environment during the first two years, but in the end you're probably going to study incredibly hard anyway, and many of you will have to come to terms with struggling academically, not being top of the class anymore, etc. How much this matters to you comes down to an individual decision.
Take everything here with a grain of salt. This is just one student's perspective. Happy to answer any questions here or by PM.
