<p>Okay, so far, I’ve pointed out that the Match is a very different animal than what most people have experienced so far, and that there are a huge number of considerations that may eventually play a role in how “competitive” a particular student is, but they can’t predict what will matter 4 years down the road.</p>
<p>So what is a newly accepted medical student to do?</p>
<p>Fortunately, it’s a lot of the same stuff they’ve done in the past. Get good grades, score well on standardized tests, perform activities that are meaningful to those who will be evaluating them going forward.</p>
<p>The other important thing is to keep an open mind about specialties and focus on what you actually ENJOY doing rather than what other people lay out as a ‘the best field’. I think that quite often, terms like “ROAD” and “lifestyle” cause students to make choices that ultimately leave them less than satisfied. There are various surveys out there that routinely rank pediatricians and pediatric subspecialists as having the highest job satisfaction among practicing physicians and other surveys that find surgery residents having the highest career satisfaction among residents. These findings fly in the face of concerns about income and “lifestyle” that so many students claim as important. Why are these groups of people satisfied? I think it largely has to do with the fact that they’ve chosen to do things they actually like to do despite knowing they won’t get paid as much or that they’ll work significantly longer hours than others. Doing what you enjoy goes for fellowships too. I’ve had a number of people try to push me towards Peds ER because the hours are better, but even though I like being in the ER, I know that it simply can’t match the enjoyment I get from being in the PICU. I see the same thing in my friends who are Medicine residents as they decide between fields like Cardiology and GI or my friends who are anesthesia residents who know they will take a pay cut by doing Peds anesthesia instead of general anesthesia.</p>
<p>So the goal going in as a student is to do the best you can so that when you do decide, you’ll be able to get into a quality program.</p>
<p>[ul]
[li] Grades</p>[/li]
<p>Yes, they still matter, however, there’s a lot that’s relative in the process. Grades and comments in the third year clerkships generally matter more than pre-clinical grades. That’s across all specialties. People want to know that others think you’ll make a good doctor, NOT just that you know a whole bunch. That said, preclincal grades matter in terms of class rank, AOA status and are positively correlated with USMLE Scores, so their value is not entirely erased. However, if you bomb a particular class, even if you fail it and have to remediate it, it’s not the end of the world and you don’t have to immediately cast your lot to doing family medicine in some godforsaken place. Be a complete tool during third year clerkships though, ring up a few citations for lacking professional behavior, or prove yourself to be dangerous when in charge of patients and you might not match in your desired specialty, forcing you to scramble.</p>
<p>[li] Test Scores</p>[/li]
<p>Specifically USMLE Step 1. The time spent taking this exam is easily the most heavily weighted 9 hours in all of medical school. Simply put, it opens doors. You have to walk through said doors, but bomb the USMLE, and you’ll have an extremely difficult time getting into the highly competitive specialties, or getting interviews at the highly competitive programs in less competitive specialties. However, despite all the talk about getting 240’s on the USMLE, it’s important to remember that the mean scores is about a 218. The mode and median too. There are plenty of absolutely great programs in a variety of fields where a 220 will be more than adequate and won’t leave you helpless to find a spot. Further, even in several fields that are considered more competitive - in particular Anesthesia and ER - there are a lot of spots that need to be filled. I personally know quite a few anesthesia residents who have what many would consider less than stellar Step 1 scores. Are they at the world’s best anesthesia program? No, but they’re going to be anesthesiologists in 2-4 years. Again, that’s one of the most important differences in this whole process. Fewer people are looking for that place they can name drop, they want a place where they enjoy going to work for 3-7 years while learning the skills they need to practice on their own. And for some, the priority is simply to come out on the other end of residency getting to practice the type of medicine they love…you can do anything for 3-5 years if you know at the end, you’ll have achieved your true goal.</p>
<p>Step 2 is less of a worry. For Clinical Knowledge (the multiple choice portion), if you did poorly on Step 1, there’s some thought that a dramatic score improvement can demonstrate an upward trend sort of phenomena but I haven’t really heard that much luck with the idea. On the flip side, there are a number of people who did fantastic on Step 1, applying for difficult specialties who will put off Step 2 until a point when scores won’t be returned until after rank lists are due, just so it’s not an issue that will trip them up. There do seem to be some legs to this rumor. As for Clinical Skills (the patient encounter portion)…this is the portion that Alex on Grey’s Anatomy failed in the very first season…it doesn’t really matter. If you’re a US Grad, you practically have to try to fail on purpose in order not to pass the exam.</p>
<p>[li]Research</p>[/li]
<p>Remember how I said that programs are dependent on who is running them? This is a prime example. There are programs who simply expect some significant research experience. Some programs simply don’t care. All depends on what the program’s goals are - trying to train academic physicians? Better be ready for some sort of research project as a resident. Program claims they’re dedicated to training the most well rounded clinicians possible - might not be as strong towards the research end.</p>
<p>There are fields however, where research prior to residency is a de facto requirement. Radiation Oncology comes to mind. But other than that, in most other specialties, this will be a program to program thing.</p>
<p>[li] Other activities</p>[/li]
<p>Again specialty specific. In pediatrics, I think there probably is an impetus to show at least something that proves your involvement with children. Doesn’t have to be much, but something. Other fields…I think it’s a little bit harder to necessarily find activities that aren’t simply medical school extracurriculars that fit the bill - at least in terms of things that are specific to a particular specialty. Certainly working with a free clinic is broadly applicable and you may be able to spin it into something more. Medical mission trips are the same thing - they don’t push you towards a single specialty for the most part.</p>
<p>[li]Interview</p>[/li]
<p>After Step 1, according to the Program Directors Survey - on the NRMP website - the interview day the next most heavily weighted 8 hours in all of medical school. This isn’t like the med school interview. This is a JOB interview. People are judging you on how you’ll fit in to their program. </p>
<p>I will admit though, every specialty is different, and hopefully Shades will chime in on what surgery interviews are like. I can only tell you that Peds interviews are extremely laid back and while I didn’t interview at places like Boston Children’s, Texas Children’s or CHOP, the upper tier places I visited still spent a significant time selling me on their program, rather than me selling them as to why they should pick me. In the really competitive fields, there are more applicants than spots, and the programs have the advantage, can be much more selective. Other fields may view the interview process as something where the applicants really have to state their case. Regardless of the field you’re going into, you need to make a positive impression on everyone you meet. You really don’t know who will make comments or send information to the people in charge.</p>
<p>For example, many peds programs take the applicants to dinner the night before the interview. It’s a chance to ask the residents what the program is like, but it’s also a chance for the residents to evaluate the applicants. I routinely send emails to my program office staff about applicants I’ve met, and I’ve definitely told them I didn’t want a person to come to our program.[/ul]</p>
<p>Okay, lots of information.
I hope it’s explained a lot about the process, and some important considerations to keep in mind.</p>
</p>