How much prestige matters--from a former member of the Stanford admissions committee

<p>Sorry for replying to all posts in one day, but I am on vacation from residency now. So I might as well address everything at once. </p>

<p>regarding the "second rate education" -- your training has implicit and explicit measures. If you trained under the top surgeon in an area of endoscopic surgery, implicit is that you have acquired some of those skills, that the person2 I described will not have. Will you see that on USMLE test? A publication? No. So by merit of your training you are given the benefit because of an implied skill. Now that you have your foot in the door, you need to prove yourself. Person2 will not even get his foot in the door at most places.</p>

<p>I fully agree with you. I really do not see why it is so hard for people to accept this reality. The counter-argument to your point (usually given by norcalguy ) is an old one and always the same, but clearly does not add up.</p>

<p>bigredmed
[quote]
Fifth, going to a community based program =/= low quality. In some cases, (ESPECIALLY in surgery where practice makes perfect), you'll emerge from a community based program a better physician than if you were at a university base program. Not having a bunch of fellows or older residents ahead of you in line to take part in a case can mean a significant amount of experience gained.

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<p>This is total bull. There is a reason why most programs going into the scramble are Community Programs. There is also a reason why most Community Programs are filled with foreign medical graduates and caribbean students. The programs are unatractive because of the amount of scut work, the lack of formal teaching, the lack of top faculty and the lack of exposure to multiple specialties that can not just be possibly available in such programs. </p>

<p>It is absolutely ridiculous to think that a community program will prepare you better as a doctor than a university program. Get real.</p>

<p>Weasel,
Having been on the above committees and on the residency acceptance committees at both major urban and rural schools, I can tell you that you are only partly correct. Pedigree is the second most important factor and a far down the list factor.</p>

<p>The most important is who one's mentor is. I currently pick up the phone and call chairs at many schools for one of my good med. students and every one has been accepted at the school I have called when we feel we have a good fit. </p>

<p>When I applied many years ago, my chair called every residency I applied to and told them to meet me (and invite me for dinner) - but that he wanted me to go to "x" and that is where I went.</p>

<p>The old boy school is still the way the top players are selected and it does not matter whether they go to Harvard or BoonDock Med. When I see someone applying their are three outcomes: they will end up walking on water, they will try hard and be "ok" or they will sink. There is nothing that help determine that better than someone I know and trust telling me that "Sue will walk on water".</p>

<p>
[quote]
This is total bull. There is a reason why most programs going into the scramble are Community Programs. There is also a reason why most Community Programs are filled with foreign medical graduates and caribbean students. The programs are unatractive because of the amount of scut work, the lack of formal teaching, the lack of top faculty and the lack of exposure to multiple specialties that can not just be possibly available in such programs.</p>

<p>It is absolutely ridiculous to think that a community program will prepare you better as a doctor than a university program. Get real.

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<p>I'm not saying that EVERY community program is worth while. I agree, there are a very, very great number that are riddled with problems. But there are enough hidden gems that make it inappropriate to jump to blanket statements. I have a handful of friends in a variety of different fields who have explored a several community programs this year and found some programs that they're pretty keen on. There are quality community programs that do turn out excellent physicians. And again, in general surgery particularly, the chance for greater autonomy has distinct advantages.</p>

<p>
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People can look for themselves and determine which school tends to send people to more prestigious programs... also look closely at competitive specialties: <a href="Stanford%20--%20Class%20Size%2072">NYMC -- Class size 186</a></p>

<p>NYMC class ~ 8% Match at Harvard, Stanford, UCSF, Columbia, UCLA, Hopkins
Stanford class ~ 50% Match at Harvard, Stanford, UCSF, Columbia, UCLA, Hopkins

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<p>Ok, I'm going to call you out on this one - if you are actually a surgical resident, you should know that the "big names" (by which I mean recognized by non-medical people - HYPS, etc.) don't necessarily mean squat when it comes to residency programs. </p>

<p>For example, I'm planning on seeking an emergency medicine residency in a few years, and I would choose UCinn or SUNY Downstate, etc. over Harvard, Stanford, UCSF, etc. for EM residency any day of the week and twice on Sunday :). And in the field of EM, UCinn and other "unknown" names have much better reputations than the so-called "big names".</p>

<p>This is a big thing that I think people don't understand - at the residency level especially, but also for med school itself, the big names don't really mean as much as you'd think.</p>

<p>Icarus -- Yes. Emed programs are great at noname places.</p>

<p>But it's ridiculous to argue the exception. I would imagine that most readers to these posts want to know the answer to the header. Does prestige matter in the various phases of medical training? The answer is yes, from me, and everyone who has credentials to actually speak with some authority on the matter agree. Is it the most important thing? Of course not. But it is important.</p>

<p>Your argument adds nothing to the readers b/c your example is based on:
1) a noncompetitive specialty like emed (<5% unmatch rate)
2) a specialty that's training depends on indigent, low-incoome populations, that thus have high volume ERs, and thus the best programs are along the mexican border or in very poor communities
3) your argument is like saying Hopkins is not the best in tropical foot medicine. See hopkins and places like it are not good places to train.</p>

<p>Great medical centers have earned their reputation.</p>

<p>Readers want to know that if they choose a high prestige place versus a low prestige place will it likely help them? And the answer is yes. Will it help as much with family medicine as much as orthopedic surgery? Who knows? It will help is the answer. And for someone who has not decided what specialty they are going into, why not go to the place that can help you out if all else is equal. If you don't believe me go to a carribean medical school, and then see if you have a hard time getting a combined ortho surgery residency at harvard.</p>

<p>
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It's more subjective than that. School's build up a track record. Harvard has an excellent track record, so people are looked at in that context. At the same time, we know the curriculum extremely well, so we can tell if people have padded their extracurriculars, taken the easier version of a course, not pushed themselves with graduate classes. For example, university of arizona has a good track record as well, so we look at them more favorably. If we took a chance on bloomington U. one year, because the person looked good on paper and got glowing recommendations, and then were a train wreck in med school. We' re going to doubt the recs, and A's that come from that school. Both students may be 3.8 GPAs, 34 MCATs, well-rounded.

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<p>So, you're not arguing for prestige but rather "track record." Many non-prestigous schools have established track records simply because they produce a lot of med school applicants a year. I'm not even sure that a track record can mean all that much since some of the most successful schools in getting applicants into med school are liberal arts colleges that produce only a handful of med school applicants each year.</p>

<p>
[quote]
I fully agree with you. I really do not see why it is so hard for people to accept this reality. The counter-argument to your point (usually given by norcalguy ) is an old one and always the same, but clearly does not add up.

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<p>What counterargument are you referring to? That you can't separate the effects of prestige from the effects of characteristics intrinsic to the applicants themselves? </p>

<p>If you read my recent posts, you'd know that I've been arguing the same thing as the OP (that prestige matters more than many people think). I just think Kilbeez012 does a poor job arguing that point. "Harvard graduates get into top residency blah blah blah" well...duh Would we expect Harvard graduates to get into worse residencies than graduates from University of Missouri? Many of the prestigous residencies are on the West and East Coasts. Many of the graduates from midwest med schools simply don't want to go there for residency. They're fine with doing family med or peds and practicing in their small town. It's hard to separate the effects of the quality of students vs. the desires of students vs. the role of prestige when explaining match lists. Hence, most med schools warn us not to use match lists (or avg. USMLE scores) as a way of judging schools.</p>

<p>
[quote]
Icarus -- Yes. Emed programs are great at noname places.</p>

<p>But it's ridiculous to argue the exception. I would imagine that most readers to these posts want to know the answer to the header. Does prestige matter in the various phases of medical training? The answer is yes, from me, and everyone who has credentials to actually speak with some authority on the matter agree. Is it the most important thing? Of course not. But it is important.</p>

<p>Your argument adds nothing to the readers b/c your example is based on:
1) a noncompetitive specialty like emed (<5% unmatch rate)
2) a specialty that's training depends on indigent, low-incoome populations, that thus have high volume ERs, and thus the best programs are along the mexican border or in very poor communities
3) your argument is like saying Hopkins is not the best in tropical foot medicine. See hopkins and places like it are not good places to train.</p>

<p>Great medical centers have earned their reputation.</p>

<p>Readers want to know that if they choose a high prestige place versus a low prestige place will it likely help them? And the answer is yes. Will it help as much with family medicine as much as orthopedic surgery? Who knows? It will help is the answer. And for someone who has not decided what specialty they are going into, why not go to the place that can help you out if all else is equal. If you don't believe me go to a carribean medical school, and then see if you have a hard time getting a combined ortho surgery residency at harvard.

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<p>I'm not sure how you can determine what the "readers" want. By your definition, 90% of the specialties out there are "non-competitive" specialties. It is likely that more of our readers are interested in mid-range specialties (like emergency med or internal med or anesthesiology) than practicing plastics or derm in Los Angeles. </p>

<p>This all goes back to the fact that the title of this thread is "How much prestige matters" and the poster failed to answer that question. All he/she said is that prestige matters. Again, kinda obvious and "adds nothing to the readers."</p>

<p>
[quote]
If you read my recent posts, you'd know that I've been arguing the same thing as the OP (that prestige matters more than many people think). I just think Kilbeez012 does a poor job arguing that point. "Harvard graduates get into top residency blah blah blah" well...duh Would we expect Harvard graduates to get into worse residencies than graduates from University of Missouri? Many of the prestigous residencies are on the West and East Coasts. ** Many of the graduates from midwest med schools simply don't want to go there for residency. They're fine with doing family med or peds and practicing in their small town.*** It's hard to separate the effects of the quality of students vs. the desires of students vs. the role of prestige when explaining match lists.* Hence, most med schools warn us not to use match lists (or avg. USMLE scores) as a way of judging schools.

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<p>The part in bold is factually erroneous and patently offensive. I know people on the coasts tend to think everyone stuck between Chicago and Denver must be a hick with no aspirations, but this is ridiculous. Yes, location does matter (to the extent that it probably is the #1 most relevant factor that people base residency choices on - even if it so simplistic as to say 'I want to go someplace warm'), and yes, most state schools tend to put a majority of their students into 'local' residencies, but that's true for any state school - even those in New York or California and it has zero to do with 'settling' for lesser specialties. As the future peds resident here, I can promise you that my decision to go into peds had absolutely ZERO basis on the fact that I went to a midwestern state medical school and entirely on the fact that I would have been miserable doing things that are supposedly more prestigious.</p>

<p>The part in italics on the other hand is absolutely true. It's absolutely beyond belief to use match lists as some sort of evidence of fact. We have zero clue to where the applicants applied, what sort of things they were looking for in a program, where they interviewed, how they ranked their choices, or even if they got into their desired specialty to begin with. There are simply far too many confounding factors present to make such an assessment reliable.</p>