Residency comes next

<p>My background in this area stem from fact that S is currently an IM resident. </p>

<p>Although it’s easy to get overwhelmed by minutiae of website, as a starting point look at FREIDA: <a href=“http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page”>http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page&lt;/a&gt;
This website could at least show D what programs are out there in IM (or any other area of interest) and the locations that D might be interested. You have to set up an account but it’s not difficult.</p>

<p>Also a mom of a current MS3.</p>

<p>In addition to using FRIEDA, your D should be talking with any current IM residents she meets during her clinicals and at her med school’s hospitals. They’ve been thru the process recently and are founts of info about various programs where they interviewed. </p>

<p>Also, most med schools will assign (or students will select) a specialty advisor right before the beginning MS4. (I know D1 had to turn in her potential specialty interest(s) and names for a specialty advisor about 3 weeks ago. She’s already met with one of her advisors.) The department head/asst head/residency director for IM at her hospital, and the program director at her med school will also have some insights about where the med school has been successful in placing students in the past and what kinds of thing they look for in a resident. These are all useful people for your D to talk with.</p>

<p>D1 has been very proactive about seeking out people for advice/mentoring and making contacts within her rotation hospitals.</p>

<p>Another useful tool is book “The Successful Match.”</p>

<p>Adding to wowmom comments: according to the NRMP survey of residency program directors (PD), the most important factors in their decision making is how the med student performed in med school (especially Step 1, third year clinical grades, letters of rec, MSPE (Dean’s letter), etc.). Much of D’s med school record is already in books, but while still in a current clerkship and a couple more till end of the year, initiating or solidifying relationships with potential rec letter writers would be very helpful to D. At some point D will need to make appt with IM Department Chair to ask for rec letter. In addition D’s MSPE will include comments from her evaluations from the attendings, residents, and fellows who she has previously, is presently, or will associate with during third year. So this is another reason to try to make as favorable impression on MDs who she is currently or will be interacting with for the next few months. </p>

<p>Other random thoughts: S felt that doing away rotation during last year for IM residencies was not as critical as away rotations in other specialties. He did not do an away rotation. S’s choice for first 4th elective was to do sub I in the IM subspecialty he is interested in pursuing. Besides interest, he was shooting for an Honors and seeking to cultivate a relationship (rec letter) with MD in an IM subspecialty. I don’t know how helpful this last thought about S’s fourth year choice is helpful as your D may have already registered for summer. Good luck to D. </p>

<p>You could also explore the SDN (student doctor network forums) website for internal medicine applicants and learn more. I say my DD’s STEP scores are pretty average and her clinicals had many honors, plus I think her LORs were good. She had no problem getting 15-20 interview offers in her speciality. That’s with 20-25 site selections.</p>

<p>I have seen many people applying to more and interviewing at more, she has met people on the interview trail doing 30+ interviews, but generally 10-15 seems to be the minimum or usual.</p>

<p>Thanks to all of you above for sharing your valuable experience with us. It looks like I need to start to spend time on learning this in addition to doing the tax return, and FAFSA/NeedAccess stuff. It is not so much to benefit DS directly. It is more for my own sanity :)</p>

<p>I heard that for some time (1 month) in MS4, the students will be trained as if they were residents at DS’s school (for them to get a “taste” of what lies ahead.) It would be tougher than MS3 rotation during that period. (It is as if MS3 rotations were still not tough enough!)</p>

<p>Here’s state-by-state match data by specialty for 2013:</p>

<p><a href=“http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/resultsbystate2013.pdf”>http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/resultsbystate2013.pdf&lt;/a&gt;&lt;/p&gt;

<p>And here’s the most recent “Charting Outcomes in the Match” (2011)</p>

<p><a href=“http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/chartingoutcomes2011.pdf”>http://b83c73bcf0e7ca356c80-e8560f466940e4ec38ed51af32994bc6.r6.cf1.rackcdn.com/wp-content/uploads/2013/08/chartingoutcomes2011.pdf&lt;/a&gt;&lt;/p&gt;

<p>The latter lists what PDs look for in applicants broken down by specialty.</p>

<p>Agree with Jugulator that away residencies are less important for some specialties than others.</p>

<p>@ mcat2</p>

<p>

</p>

<p>Those ‘as if’ rotations are called “sub-I” rotations. (For sub-intern) D2 has 2 sub-I electives scheduled already–one in each of her potential specialties to help her finalize her decision.</p>

<p>D2 said that she was told that generally speaking no student should do a sub-I at an away school because they will be expected to function as interns from day1 even though they don’t know the local hospital’s procedures and protocols. </p>

<p>Thank you mcat2 for the welcome back! It seems that when D made it to this stage, I became more of a reader on the premed forums, with not so much to contribute. </p>

<p>Thank you to all who responded. The information is very helpful. We just hope that with her ‘averageness’, as far as med school goes, she gets accepted to a residency she likes. We tell her that her UG majors will make her a more rounded person in life (having studied philosophy and psychology, speaking a 2nd language, playing the violin, painting, etc.), but it sure has made med school MUCH more of a challenge than she ever anticipated. </p>

<p>MidwestParent, mcat2: adding to my earlier post about “initiating or solidifying relationships with potential rec letter writers…. D will need to make appt with IM Department Chair to ask for rec letter.”</p>

<p>The application period for applying to residencies will be in mid September 2014. It will be here sooner than you/Ds think. Your Ds will want to be fully ready to apply at that time which in part means having rec letters ready to submit. Give rec writers plenty of time to write letters. Rec writers may ask for different things (e.g., CV, personal statement, etc.), so Ds should be ready for these types of requests. These things as in case of personal statement don’t have to be final version that Ds plan to submit with application, but they should look and sound polished, no typos. </p>

<p>As to “…appt with IM Department Chair…. As IM is most popular residency choice, Department Chairs among their other responsibilities can be very busy interviewing students seeking rec letters. Ds may want to consider making these appts as early as Chair’s office will allow. And I think for all rec letters give writers at least 3 weeks to write. I’d allow a couple extra weeks for potential slowpokes.</p>

<p>Midwestparent: once D begins to get interview offers, the question tends to shift from is she qualified (if she got invite she’s qualified) to one of can this interviewee “fit” in with other residents/staff for next 3 years. People can look pretty on paper but not so much in person. From your post it sounds like D’s background could serve her well while interviewing.</p>

<p>Good luck.</p>

<p>Thank you Jugulator20 - all good points. I have relayed the info to D.</p>

<p>Midwest, do not get caught up in “average.” Yes, ones scores can be high, low, middle, but that does not necessarily correlate to your DD’s ability as a doctor, there will be high scoring students who are lousy at Dx or people skills and vice-versa.</p>

<p>The Step numbers do provide a range of specialities, meaning yes, you’d better score high to get into derm or plastics and others, and yes, probably better be nearer the top of the class in marks. But, her MS3 year is her year to prove she can do it for real, that she can get great marks & reports from the doctors working the wards with her. She should try to honor as many of these rotations as she can. DD has one friend who decided to ‘expand’ meaning she will graduate the next year, why? Because her clinicals in MS3 had too many “pass” not enough honors.</p>

<p>Honors, high pass, pass, fail can have different standards at different schools, but usually are a combination of marks from the residents/attendings and marks from a shelf exam or school final exam. Hopefully your DD is having an overall strong showing, but her IM advisor should be able to tell her that!</p>

<p>Thank you somemom. I really am not dwelling on D’s “averageness”, just wanted to make note of it as it seems that CC focuses on those at the tip top (I know because that was my D in high school and college!). D’s father (my husband) is an excellent Internist in our smaller town, so D has been around medicine her entire life. In fact, part of her personal statement when applying to med school said, “in essence I have been ‘shadowing’ a doctor my entire life”, which is true. If he got called in for something interesting, she would often go. Over school breaks she has gone in and worked with him during med school, and he says she does an excellent job (and he is trying not to be biased!). I do admit I worry when I read CC and SDN - I worry that her “averageness” may make it harder for her to place in a residency she would desire. I do think she will interview well, so that should help. Also keeping fingers crossed for a stellar Step 2 score! She knows what she needs to do in her clinical rotations, and it is up to her to put forth the extra effort to get those coveted ‘honors’ scores.</p>

<p>Thanks again to Jugurator20 and somemom for teaching us newbies about this (newbie as a parent whose child will go through this process.) Somemom also helped me a lot during the med school app cycle. (E.g., it takes some time before TMDSAS would receive the check by snail-mail.) Much appreciated.</p>

<p>Re: “different (med) schools may have different standards (about the grading.)”</p>

<p>I read somewhere on SDN that this is true in general, just like in UG, some professors in some department (physics? philosophy?) may give out fewer “good” grades. But I think the “beauty” for the majority of specialties is that the student only needs to be good enough. Also, there are multiple ways to show that the student is good in his own way. An analogy is that an engineering student does not have to have a stellar grade to get a job. Other factors than just the grades may be more important.</p>

<p>Re: “relay the information to D.”
It must be relatively easy for you to relay the information to your loved one. I am envious. I think that at DS’s stage of life right now, he prefers to get information from his peers rather than from us. (At least this did not happen when he was in the middle school or high school!)</p>

<p>Grading are only at Med. Schools that grade. Many are p/f and grading exists only for rotations. Many times it is extrememly subjective and has nothing to do with the Shelf exam score. I mean that student can get over 90% and still did not get “H”. The unofficial “rule” at D’s place is that your exam score can lower your grade but it cannot make it jump up, it is strictly based on evals, and the person who is making the final grade many times is not even familiar with the student and base the final grade strictly on evals. Now, you may have somebody who really likes you, but hesitant to write eval because it is not in his/her habit to do so. So, your evals might be from others who are more or less indifferent. What I am saying, a lot of the grading is just pure luck. Student could do all above and beoynd, come there first, leave the last day after day, do several presentations, be complimented many times, get extremely high Shelf exam score and at the end NOT get the “H” anyway. </p>

<p>Forgive my ignorance, but what happens to those who don’t ‘match’. I see there were 974 applicants for 670 positions. Where do those 300 students end up? What are their options?
Don’t remember the specialty–one of the surgeries.</p>

<p>Regarding honors on clinical rotations, in reading & talking to SDN/CC people it seems to vary school to school. One doctor told me they only offer 10% honors, one told me you better get honors in your chosen speciality and 2-3 related fields, which would be a lot only 10% got honors.</p>

<p>At DDs school the honor, high pass, pass is a product of the shelf exam + the evaluations, you could get honors level & recommendation on your evaluations, but do poorly on the shelf and not be granted honors.</p>

<p>There are more applicants than there are residency spots by the time you include DOs, MDs, and US students who went abroad (Carib mainly) and international grads (IMGs) who all want to do an MD residency in the US. Most of the US MDs get a match spot, for any one who does not match, the first choice is SOAP.</p>

<p>The student is notified on a particular day as to whether or not they matched, this is a few days before everyone finds out where they matched. In that interim time it is a mad scramble of PDs trying to fill the empty spots with unmatched students.</p>

<p>As far as I know after that, being unmatched, one could expand and stay in school a bit longer, could do research, etc. and try to match the next year.</p>

<p>If you’re looking at one specific specialty, I believe some of those unmatched just mean “unmatched to that specialty” so while they didn’t match to that one, they may have matched to something else.</p>

<p>IWBB is right, there are people applying to tough specialities who also may apply for a back up, like Ortho & GenSurg or Plastics & GenSurg</p>

<p>MidwestParent (and others!)–</p>

<p>I’m also probably pretty average as far as med student numbers are concerned. My first two years are pass/fail, and I passed everything…but so did most people. My step 1 score is a standard dev and some change better than average, but among the lowest of my friends. My third year grades have been fine so far, some great evals, some OK evals, no bad ones. Fine performance on shelves (lowest was 75%ile), but haven’t hit that magic combination of great evals + high enough shelf score to get honors in a clerkship yet. I’ve been quite involved with leadership stuff and have presented research at a few poster presentations and sat on a few panels, but haven’t published anything.</p>

<p>I too am interested in IM at this point, and for whatever reason (maybe I’m just nuts!), I’m choosing not to worry too much about matching. For one, I’m sure I’ll match somewhere, and I am pretty flexible regardless. For another, IM historically isn’t a ridiculously competitive field, so I really think being average to above average when compared to my peers will have to be fine for me. Plus, there’s only so much time left in third year and so much time before residency apps are submitted that by now, it seems like a good chunk is out of my control.</p>

<p>As far as figuring out where to apply, I’m planning to rely heavily on my advisor (who is quite well known in the research field I’m interested in), my IM clerkship director (similarly well known in the research field I’m interested in), and a few attentings (who will write me LORs) and maybe some residents (who recently “been there, done that”). I’m purposely not relying on SDN and am probably not going to rely solely on FREIDA etc because I’m interested in staying in the region I’m currently in, and I imagine leveraging relationships I’ve been building for a few years will be a reasonable start. </p>

<p>Anyone care to advise? Always up for new ideas.</p>

<p>Kristin - Thanks so much for chiming in! Your plan sounds good to me! My D also doesn’t seem to be too worried about matching (it is just her neurotic mom who is worrying!!). She says she just does the best she can each and every day, and figures she can’t ask much else of herself. It all just seems so nebulous, as there is no ‘manual’ to guide one step by step. She met with the IM director last week, who was only mildly helpful. Luckily, she has her IM clinical rotation in March and April, so she will hopefully get a better idea of how things work and how to proceed. </p>

<p>"one told me you better get honors in your chosen speciality and 2-3 related fields, which would be a lot only 10% got honors.</p>

<p>At DDs school the honor, high pass, pass is a product of the shelf exam + the evaluations, you could get honors level & recommendation on your evaluations, but do poorly on the shelf and not be granted honors.
-Yes, doing poorly on the shelf is ditching your Honors for shure. However, doing absolutely great on the shelf has no consequences, it will not pull the student final grade for rotation at D’s school. I am not sure though if it depends on the Med. School at all. They do rotations at various locations and only one is somewhat connected to the Med. School, the others (including D’s current) are not connected to her Med. School. She heard that some places are harsher on the final grade based on the evals than others. As I said and as D. has learned, you can only count on your LUCK if you are doing absolutely everything above and beyond your normal requirements. This was an eye openner for her as she has relied on her hard work and efforts her entire life and was getting exceptional results. Not any more. I do not know if it is such a negative lesson. There are many events in life that no matter what you do, you will not get desired results because of forces outside of your control. Maybe it is better to learn it while still in school.</p>