Second looks are not out of the question. Although I went into pediatrics and the dynamic of most peds residencies was on recruitment of candidates - the intern classes are much larger than in surgical fields and there is a major impetus to fill all those slots both because of appearances in future years to those going through the Match, and because often times the work load necessitates having that many bodies. Second looks are much less likely to occur in more competitive fields.
To give an example of how different competitive fields treat applicants than other specialties…
In pediatrics, many (even the top tier programs that are just as competitive as Derm/Rads/Ortho/ENT) will begin interviews November 1st and have 3-4 interview days every week until February 1st. It is a massive undertaking but the only way to interview enough people to fill a class of 15-40 people.
In ortho - and I’m assuming things have not changed much in 6 years since I had friends go through the Match for ortho - programs had 4-6 interview days total from November to February. And in a particularly unfair method, many of the best ortho programs purposefully scheduled their interview days on the same days as other top programs, forcing applicants (in particular those good enough to get interview offers from multiple top programs) to pick which programs they preferred sight unseen. Some other specialties have this happen as well, but Ortho was most problematic for my friends.
Some other specialties do not have 4 - 6 interview days, there might be 1 - 2 days to fill 2 - 4 spots, while 4 is considered to be a large number. As one example (of real program), it may be 500 applicants, 15 are chosen for interview to fill 2 spots, one interview day apparently. 4 open spots in whole nation after match, no scramble process is available.
It looks like ortho is somewhat less stressful than that.
Jut to clarify, in this sentence, competitive is regarding Step 1 scores/grades/research/AOA/etc. The applicants to top peds programs would be legit in most any field. Obviously overall, getting a spot in a peds residency is not hard if you apply/interview/rank an appropriate range of programs.
How much importance does getting Honors in 3rd year clerkships matter for residency applications? My nephew received Honors in all 6 of his, but is applying to a competitive specialty with a Step 1 and Step 2 score that is just slightly above the mean. How much weight will the Honors across the board help him with interview invites? I am asking on behalf of my sister (his mom) who is blind and can’t post to this board herself. I tried to look on various tables that posters here have linked, but I haven’t found anything.
The 2014 Program Directors (PD) survey should offer some guidance as to what’s important in general and in each specialty as to getting interviews and/or ranking. As to interviews, this survey makes it clear that Step scores outweigh clerkship scores in all specialties. Good luck to your nephew
Regarding the importance of STEP-1 scores for “large” programs (i.e., many slots per program) like IM, I read this from SDN recently (not sure how up-to-date the info is):
364 US seniors applied with 250+ to Internal Medicine in 2011. 104 of them had 260 or higher.
"Top IM programs each have about 30 spots, which means if they want to, they can fill number 1 to 12 with just US seniors with boards >250. Still statistically unlikely?
Of course, more than boards matter. However, while IM average boards is low, it’s a very competitive field at the top. It’s the same damn people on all the interviews and they pretty much all rocked their boards."
In the related thread, some SDNers speculated that, to get an interview to one of the “big 4” IM programs, an applicant may need two out of the following three:
Top step scores (esp. Step-1)
AOA or all/almost all Hs in third year clinical rotations.
Top med school. (This is the most arguable/questionable one.)
And then, it is required to have published something as a first author on ARCO? ( this happens to be the only one I have heard of but there are many other ones that could be more related to IM.)
But it is also said, for IM, there are many many good IM programs and there is no need to be in one of these big four. (What are they? MGH, BWI, JHH on the east coast and UCSF on the west coast, I guess?) Talking about UCSF, it seems there were likely about 12% of the students from DS school who matched to this particular school this year. (Maybe it happens to have too many California kids who want to boomerang back to their home state/region this year? Just a guess here.)
I do not know much about IM, but for the very competitive specialties, AOA was not important last year. In fact, one out of 9 applicants to such specialty had AOA in D’s class and while she matched, she did not match as well as other 7, one did not match though. AOA might be important at some schools, but not so much at others, and not so at p/f schools, when AOA is awarded only to all “H”. Also, publishing was not required either. However, IM might be different.
IM residency is tough, I just pray every day for my D’s first month of floor shifts. After that, she has 6 weeks of electives and then floor shifts again. She said that while first long shift was OK, she felt the effect of being tired in accumulated way during second one and third one is this in couple of days. This is her prelim year and she did not need to be in any “top” programs. In fact, she would prefer the transitional year instead, but it was not available at her location.
I would guess #3 is less about med school name and more about content/writer of LORs. The top med schools are of course more likely to have the better known/respected writers, but I would imagine that a big name doctor at a small name school would pull far more weight than a small name doctor at a big name school.
EDIT: Actually I’m not so sure since upon further thought I know people have had the school name brought up in interviews and such as a positive.
“I would guess #3 is less about med school name and more about content/writer of LORs.” - yes, I agree 100%. Content/writer of LORs - very important, maybe more for selective places / specialties than ordinarily. Positive letter from nationally recognized person will result in interview invites.
I would also agree it’s the letter writer, not the school. D1 had a SLOE from off site preceptor who is nationally known & respected (member of a Presidential Commission, NYT /NPR interviewee multiple times about topics with his specialty, etc), but doesn’t practice at an academic medical center.
Letter writer v school: isn’t it really about the student. I mean these well known letter writers at whatever school aren’t running around with pens in their hands just waiting to write LORs for anyone who asks.
@jugulator20 Yes, but it will be much easier for a great student to impress a big wig if you’ve actually met them because there are multiple at your school (vs. if you have none), and if your school has big wigs in multiple specialties then it becomes much easier to impress a big wig in your specialty than if your school has a big wig in only one specialty that is not your own. You’re right that a bad student will never get an outstanding LOR from these people, but many good students don’t either due to circumstance.
To use an older classmate of mine as an example: Your school has a big wig (he discovered a disease and its named after him) who doesn’t usually interact with med students anymore because of age and decreased clinical duties so your advisor recommends you set up an elective specifically to work with him. This student could have been the greatest student my school had ever seen (she wasn’t) and she still wouldn’t have gotten a letter from this guy had it not been for her advisor telling her to seek him out.
I agree IWBB. I just think some people wrongfully conclude that getting admitted to some well known school with well known people is the end all. I think that well known people place great value on their signatures and that once admitted to wherever it will be up to the student to convince whomever by their words, deeds, etc (especially post admittance to med school) that a student is deserving of a LOR. That’s all.
"Letter writer v school: isn’t it really about the student. I mean these well known letter writers at whatever school aren’t running around with pens in their hands just waiting to write LORs for anyone who asks. "
-Correct…and they do NOT ALWAYS provide a positive letter either. The ones that are really being valued out there, tend to be very truthful, positive or negative, they just write it as is. It is great to built a closer relationship with a person like this. Being good student or bad student is not enough there. You got to go beyond, be a great team member, etc., show willingness to move forward despite of all obstacles in a world, many factors included there, certain personality is one of the most important here.
LOR’s as a criterion are a hugely complex entity with lots of permutations of student/letter writer name/letter content/school name/recognition by the recipients.
Bottom line in 99% of cases, students should want a great letter from someone who knows them over a mediocre letter from anyone else.
The specialty one is entering affects the degree to which I think a big name writer matters. As a pediatric intensivist, do I expect any pediatric residency director (even at big name places like CHOP/Cinci/Texas/Boston) to get excited by Jerry Zimmerman writing a letter on behalf of a medical student? He’s a huge name in my field, but I wouldn’t expect a general pediatrician (even in academia) to know him from the guy down the street. There is a Peds ENT surgeon where I did my peds critical care fellowship that is one of the best surgeons I’ve ever met. If I saw a letter from that person, I’d be impressed, but would a neuro-otologist who happens to be an ENT program director recognize the credentials? I don’t know. And if you’re getting a letter from someone outside your desired specialty, name recognition is likely zilch.
I’d also say that a well connected (and hopefully well liked) letter writer is better than someone who is hugely productive from an academic output standpoint. Call it an old boy network if you want, but a personal phone call or email can go a lot further than an outstanding LOR. This is true even when moving onto first attending jobs after training in many fields. Personally, when I get to that point where I contribute to hiring decisions in the future, I’m pretty sure that even a text from the people who were my co-fellows, or that I went to residency with, will generate a lot more traction for the applicant.
The key point in all of this though is that for 4th year medical students going through this process, much of the die has already been cast years in advance. They had to make a decision that placed enormous limitations on their potential pool of letter writers as pre-meds and with no idea what direction they were headed for their career. A big name school might have a larger pool of well-knowns but it’s no guarantee that a student will be able to capitalize on that resource.
I found something on Internet (that I normally do not consult) that contradicts my prior perception of the specialties that are considered the most competitive. These comments were specifically for the 2015 Match. So, I concluded that the “selectivity” is a fluid term that may change from year to year. Here it is:
“Some of the most competitive specialties included dermatology, medicine/psychiatry, obstetrics/gynecology, orthopedic surgery, pediatrics/primary care, physical medicine/rehabilitation, and thoracic surgery. ALL OF THE VACANCIES IN THOSE SPECIALTIES WERE FILLED , the NRMP statement said.
General surgery, neurological surgery, otolaryngology, plastic surgery, and radiation oncology had FEWER THAN FIVE UNFILLED POSITIONS after the matching algorithm was processed, according to the NRMP.”
So, scramble process was down the drain for the above this year!
FYI, the scramble (a literal free for all for unfilled slots) was nixed a few years ago and replaced with SOAP (Supplemental Offer and Acceptance Program, a very structured/regulated method for filling unfilled spots).
Honestly, the fact that PM&R managed to fill all its slots while plastics didn’t doesn’t mean anything to me. That certainly isn’t going to make me say PM&R is a more competitive specialty than plastics when we compare the AOA%, step 1 scores, and match rates of the two (5.5% vs. 39.0%; 220 vs. 245; 89%vs. 71%).
Less than five unfilled spots is still very few.
I use scramble because I cannot remember the name of the new one. What I meant by that, that while I was aware of the Derm not taking anybody even when few spots are available because they want to take their time to select, I was not aware at all that something like psychiatry, which is considered the least competitive, got filled all the spots also and whatever you call the process to get matched in few days between Monday and Friday of the matching week, that process was basically is not there for that many specialties (I am sure that if there are less than 5 spots, then one cannot SOAP or whatever to these spots). I know that the matching rate for Derm dropped in 1 year from 70% to 60% for seniors. But again, certain schools may have it much higher, which only means that other schools will have it lower (wow, lower than 60% is simply unimaginable after knowing what these applicants went thru).