Will doing an AOA traditional rotating internship (TRI) help me get a better IM residency?

[Disimpact22]

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Hi. I'm an OMS III and very keen on IM (hospitalist most likely).
Assuming I was less than competitive at a certain hospital due to grades and not being able to audition there, I was wondering if doing a TRI at that hospital would give me a leg up the next year as a PGY2 applying to an IM residency at the same place? Would doing a TRI anywhere and doing well give me a boost if my scores weren't enough to land an IM res as a PGY1?

I'd love to move back to California and pursue an IM residency at a large/high volume, preferably not-too-abusive hospital. Fine with AOA programs.
BUT my scores are eh. COMLEX I : 511; 3.0 GPA (yeah...trying to boost). My LORs are awesome though, I'm a Fulbright Fellow with a bunch of non-traditional experiences and I've been getting High pass and Honors on all my clinical rotations.

I'm currently in Florida and am looking at AOA residencies here, in Cali, Colorado, and maybe a few other scattered places--trying to stay in states I'd want to settle in.

Questions:
1. Is getting a TRI easier than getting an AOA IM residency at the same hospital, say Arrowhead in Ca or Largo in Fl?
2. Is it possible they could reject me for IM but accept me for TRI? Or if I'm rejected to any of the programs at the site they automatically would deny other applications (yeah, a little clueless)?
3. Is this a viable and/or smart option? Or should I just go balls out IM, forego TRI applications and take what I get? I'm

Thanks a lot all.
* I spent a couple days (free time) searching the forums for answers to this question but nothing hit it on the head.
* Also VERY open to other hospital suggestions in warmer or coastal states if you have any insight.

 

[hallowmann]

This seems risky to me. From what I've heard, many AOA programs look down on students who do a TRI first and then try to apply again/for advanced positions that don't work like that (e.g. most things not AOA Derm). They'll assume you couldn't match categorical, and that there must be something wrong with you. It's kind of stupid, but that's what I've heard.

If I were in your situation, I'd apply straight categorical IM. Your stats aren't amazing, but they are about average and you have a plus with the good clinical grades, so I doubt you'd have any problem getting an AOA IM program, and you might even be fine for an ACGME one. The problem is most Cali ACGME IM programs require the USMLE. I'd still throw out applications to the ones that don't though.

Worst case scenario, you can scramble into a TRI if you don't match categorical, which seems very unlikely to me, unless you don't apply broadly. That way you won't be in any worse of a situation than if you just applied to TRIs, which again I would not recommend.

Also, to give you an idea, from the 2012 AOA match report:

-Out of 397 people that ranked an AOA IM program as #1, 326 (>80%) matched to their #1 choice
-If I'm reading this right, of those that matched to their top choice in AOA IM, the COMLEX Level 1 mean was 468, the median was 463, and they ranged from a low of 279 (failed the first attempt, 83% passed on first attempt) and a high of 810 (they broke the Level 1)

Obviously these include programs you wouldn't want to even apply to, but I really think you'll be fine. Apply broadly in both matches and see what type of interviews you get. At that point you can start narrowing down options.

As far as #2, each PD/program makes decisions independently. Just because one PD at a site doesn't take you, doesn't mean another won't. That said, a lot of people seem to recommend against applying to more than one program within a site, but I don't know if this really applies to TRIs (its usually more about not wanting the programs to think you aren't committed to that residency).

 

[joeDO2]

a 511 comlex will get you into an AOA IM program. don't bother with the TRI. anything you can do to avoid going through the match twice is the better option.

 

[Disimpact22]

Right on guys. Very much appreciated. You really took some time to answer this.

 

[Siggy]

2 quick notes as a TRI who recently scrambled into an IM spot.

1. Arrowhead no longer has a TRI program (the 1 open spot listed in the scramble was a mistake).

2. There are programs out there that will simply not interview TRI applicants. I had one program offer me an interview and, when they realized I was a TRI, rescind it.

 

[GUH]

2 quick notes as a TRI who recently scrambled into an IM spot.

1. Arrowhead no longer has a TRI program (the 1 open spot listed in the scramble was a mistake).

2. There are programs out there that will simply not interview TRI applicants. I had one program offer me an interview and, when they realized I was a TRI, rescind it.

That's pretty rough! I'm assuming that this doesn't apply to programs which start in PGY-2 though, right? Also, is a TRI given lower priority than a medicine internship if you're going into a non-surgical residency?

 

[hallowmann]

...2. There are programs out there that will simply not interview TRI applicants. I had one program offer me an interview and, when they realized I was a TRI, rescind it.

That's just ridiculous. Leave it to AOA programs to think more training is inherently bad.

That's pretty rough! I'm assuming that this doesn't apply to programs which start in PGY-2 though, right? Also, is a TRI given lower priority than a medicine internship if you're going into a non-surgical residency?

As far as I know, you for the most part apply for PGY2 positions the year before (i.e. before intern year). The only real exemption to this is Derm.

 

[Siggy]

That's pretty rough! I'm assuming that this doesn't apply to programs which start in PGY-2 though, right? Also, is a TRI given lower priority than a medicine internship if you're going into a non-surgical residency?

On the AOA side, it doesn't matter since there is no prelim medicine or prelim surgery residencies. The only non-categorical internship is the TRI. How it compares to the ACGME side? I honestly don't know.

 

[Siggy]

That's just ridiculous. Leave it to AOA programs to think more training is inherently bad.

They blamed "funding issues." That said, there are plenty of terrible terrible TRI residencies out there (as a med student I heard the program director of a TRI and a community based FM program tell his interns that he "doesn't want them to think, just do what he tells them to do"). I can see the hesitancy for accepting someone who has a TRI over a fresh med school grad if you aren't sure how much you're going to have to retrain your new intern.