Chance at matching high-tier IM?

[Heat45]

Hello all, going through my clerkship grades I have a few honors and the rest high passes. There are a couple left and I’m obviously hoping for the best, but in the case I finish with the rest high passes does that rule out high tier IM? I have a 257 on my step 1, solid research and expecting good LORs but most likely won’t be AOA.

Just wondering how the lack of all honors and AOA will impact my application. Thank you in advance!

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[LunaOri]

What do you consider "high tier"? Were you able to do an away rotation at any of those programs? Is there any particular program where you see yourself being a great fit?

 

[Heat45]

What do you consider "high tier"? Were you able to do an away rotation at any of those programs? Is there any particular program where you see yourself being a great fit?

I’m not entirely sure where I see myself as a great fit as I haven’t interviewed yet (just in the planning process). As far as what I consider high-tier, I guess top 15 according to doximity rankings would be the system I go by. No I was not able to do an away, I heard for IM they weren’t as critical to do.

 

[Hzreio]

Hello all, going through my clerkship grades I have a few honors and the rest high passes. There are a couple left and I’m obviously hoping for the best, but in the case I finish with the rest high passes does that rule out high tier IM? I have a 257 on my step 1, solid research and expecting good LORs but most likely won’t be AOA.

Just wondering how the lack of all honors and AOA will impact my application. Thank you in advance!

What’s solid research?

 

[Heat45]

What’s solid research?

4 publications all first author
7 poster presentations all first presenter
1 podium presentation that was honorable mention at the competition

 

[GoSpursGo]

Top 15 is a little too restrictive when you’re talking about “top tier.” Outside of the true ivory towers like hopkins and Harvard, you’ll wind up with more or less equivalent training with more or less equivalent "prestige" associated with your training at 30-40+ institutions across the country.

A few HPs and lack of AOA are not going to be dealbreakers anywhere. Nobody can predict your chances at a specific program, but you'll get in somewhere good. You should apply to any program you're interested in.

 

[Heat45]

Top 15 is a little too restrictive when you’re talking about “top tier.” Outside of the true ivory towers like hopkins and Harvard, you’ll wind up with more or less equivalent training with more or less equivalent "prestige" associated with your training at 30-40+ institutions across the country.

A few HPs and lack of AOA are not going to be dealbreakers anywhere. Nobody can predict your chances at a specific program, but you'll get in somewhere good. You should apply to any program you're interested in.

Thanks I hope so

 

[Hzreio]

4 publications all first author
7 poster presentations all first presenter
1 podium presentation that was honorable mention at the competition

Seems like a good app to me. More research more honors is obviously good. I’ve heard AOA is more important for top tier IM, but Idk

 

[voxveritatisetlucis]

Totally depends on school tier imo.

If you go to Harvard, Hopkins, UCSF, obviously you’ll make “top” IM because you’ll match a home program (which are all top). They also cross pollinate such that Harvard’s IM list usually consists of MGH, BWH, JHU, UCSF, couple BIDMC. Not many others (a handful)

If you go to a T20, you’re a shoe in for T20 IM residencies. From what I’ve seen, mid to lower tier MDs need AOA to differentiate themselves for T20, but I’d say that lower mid university IM is your floor. Judging fellowship matches from these places, you’re in a good place.

 

[Heat45]

Seems like a good app to me. More research more honors is obviously good. I’ve heard AOA is more important for top tier IM, but Idk

I’ve certainly heard the same about AOA, tbh that was my bigger concern.

 

[Heat45]

Totally depends on school tier imo.

If you go to Harvard, Hopkins, UCSF, obviously you’ll make “top” IM because you’ll match a home program (which are all top). They also cross pollinate such that Harvard’s IM list usually consists of MGH, BWH, JHU, UCSF, couple BIDMC. Not many others (a handful)

If you go to a T20, you’re a shoe in for T20 IM residencies. From what I’ve seen, mid to lower tier MDs need AOA to differentiate themselves for T20, but I’d say that lower mid university IM is your floor. Judging fellowship matches from these places, you’re in a good place.

my program isn’t T20 but I have T20 programs in my city so I was hoping there would be relative regional preference when I apply.

 

[GoSpursGo]

Totally depends on school tier imo.

If you go to Harvard, Hopkins, UCSF, obviously you’ll make “top” IM because you’ll match a home program (which are all top). They also cross pollinate such that Harvard’s IM list usually consists of MGH, BWH, JHU, UCSF, couple BIDMC. Not many others (a handful)

If you go to a T20, you’re a shoe in for T20 IM residencies. From what I’ve seen, mid to lower tier MDs need AOA to differentiate themselves for T20, but I’d say that lower mid university IM is your floor. Judging fellowship matches from these places, you’re in a good place.

I think that's overstated for the OP's situation TBH. 257 + 4 first-author pubs + podium presentation is going to be significantly above the curve for IM applicants except maybe at top top programs. I would be exceedingly surprised if OP winds up at "lower-mid" university IM.

 

[Redpancreas]

Totally depends on school tier imo.

If you go to Harvard, Hopkins, UCSF, obviously you’ll make “top” IM because you’ll match a home program (which are all top). They also cross pollinate such that Harvard’s IM list usually consists of MGH, BWH, JHU, UCSF, couple BIDMC. Not many others (a handful)

If you go to a T20, you’re a shoe in for T20 IM residencies. From what I’ve seen, mid to lower tier MDs need AOA to differentiate themselves for T20, but I’d say that lower mid university IM is your floor. Judging fellowship matches from these places, you’re in a good place.

Agree with most of this. Echo above thought that I'd be surprised if OP ends up at "lower mid tier IM". Definitely a upper mid tier top 30-40 is my guess.

 

[voxveritatisetlucis]

I think that's overstated for the OP's situation TBH. 257 + 4 first-author pubs + podium presentation is going to be significantly above the curve for IM applicants except maybe at top top programs. I would be exceedingly surprised if OP winds up at "lower-mid" university IM.

Ya I don’t really see it happening either based on past IM WAMC/results threads but I guess it could be the “floor.” as in worst case scenario.

Also I think it depends how one breaks down mid into upper and lower mid. Would the following be considered lower mid: Loyola, UIC, MCW, Nebraska, Indiana etc. (that is what I assumed the floor would be but maybe these are upper mid and the upper mid I was thinking of are borderline top)

Either way, I think that you’re set for a place that should set you up for solid fellowships and exit opportunities so congrats!

 

[seeinghowitgoes]

Totally depends on school tier imo.

If you go to Harvard, Hopkins, UCSF, obviously you’ll make “top” IM because you’ll match a home program (which are all top). They also cross pollinate such that Harvard’s IM list usually consists of MGH, BWH, JHU, UCSF, couple BIDMC. Not many others (a handful)

If you go to a T20, you’re a shoe in for T20 IM residencies. From what I’ve seen, mid to lower tier MDs need AOA to differentiate themselves for T20, but I’d say that lower mid university IM is your floor. Judging fellowship matches from these places, you’re in a good place.

Like others have said, agree with this.

Of the big 4, chances at BWH will be lowest (look at their match list - they take from a pretty limited number of places and specifically look at MD/PhD folks). Of the other big 4 places, perhaps there is a small chance (a bit more accepting of non-top 20 med school applicants), but without AOA I think it’s probably a bit of a long shot.

For the other top 20ish IM programs, I think there is a good chance assuming the narrative is good and consistent (for example of the 4 pubs are research ones in your field of interest then I think it’s a good shot - if they’re like random case reports I think the chances become less).

I think the floor is probably a mid-tier program assuming no other red flags and such.

 

[expicept]

Hello all, going through my clerkship grades I have a few honors and the rest high passes. There are a couple left and I’m obviously hoping for the best, but in the case I finish with the rest high passes does that rule out high tier IM? I have a 257 on my step 1, solid research and expecting good LORs but most likely won’t be AOA.

Just wondering how the lack of all honors and AOA will impact my application. Thank you in advance!

Speaking as someone who matched at a t10 IM program, I can share with you some of my observations from this last application cycle (YMMV, of course). I bet you’ll get love from t20 IM programs with the combination of your step 1 score and research. Killing it on step 2 is a must, but I would imagine with that step 1, you’ll do well. In terms of being guessing which or how many of the top programs will interview you is anyones guess. However, I would imagine the ones in close geographic proximity to you and those your school has recent IM match’s are a safe bet. Because it seems that IM PDs are risk-averse and love to recruit from places they know.

While having few honors isn’t as great as having all honors, your IM clerkship grade (where getting honors unfortunately does seem to matter) and your SubI eval are what they’ll primarily look at. AOA (or top quartile), GHHS, t20 medical school, or connections help but seem to be mandatory for the big 4 programs.

I could go on with personal anecdotes , but there is a WAMC thread in the internal medicine forum that can provide you with some excellent advice. The people on there were very helpful in answering any questions I had when I was at your stage in the process. Otherwise feel pretty to PM me if you have any specific questions or if there’s anything I might be able to help with.

Edit: spelling

 

[Heat45]

Speaking as someone who matched at a t10 IM program, I can share with you some of my observations from this last application cycle (YMMV, of course). I would imagine that you’ll get some love from the t20 IM programs with the combination of your step 1 score and research. Killing it on step 2 is a must, but I would imagine with that step1, you’ll do well. In terms of being guessing which or how many of the top programs will interview you is anyones guess. However, I would imagine the one’s in close geographic proximity to you and those your school has recent IM match’s are a safer bet. Because it seems that IM PDs are risk-averse and love to recruit from places they know.

While having few honors isn’t as great as having all honors, your IM clerkship grade (where getting honors unfortunately does seem to matter) and your SubI eval are what they’ll primarily be looking at. AOA (or top quartile), GHHS, t20 medical school, or connections help but aren’t necessary but seem to be mandatory for the big 4 programs.

I could go on with personal anecdotes from this last years match, but there is a WAMC thread in the internal medicine forum that can provide you with some excellent advice. The people on there were very helpful in answering any questions I had when I was at your stage in the process. Otherwise feel pretty to PM me if you have any specific questions or if there’s anything I might be able to help with.

thanks for the reply, is there any way you can link the WAMC thread into a comment? I couldn't find it when looking through the IM threads.

 

[Deecee2DO]

A USMD with just shy of a 260 Step 1? Id say your floor is upper mid tier (CCF Brown Tufts UVA Dartmouth type schools). If you go to a T20 med school and score 260+ on CK I think your chances at T10 are pretty high tbh. No one can predict if youll match “big 4” since those programs are intensely competitive and many near perfect applicants dont always match there. Im not sure what youre considering “high tier” but if you mean T20 id say youd have a very high chance depending on your med school and Step 2 score

 

[voxveritatisetlucis]

A USMD with just shy of a 260 Step 1? Id say your floor is upper mid tier (CCF Brown Tufts UVA Dartmouth type schools). If you go to a T20 med school and score 260+ on CK I think your chances at T10 are pretty high tbh. No one can predict if youll match “big 4” since those programs are intensely competitive and many near perfect applicants dont always match there. Im not sure what youre considering “high tier” but if you mean T20 id say youd have a very high chance depending on your med school and Step 2 score

Isn’t UVA a significant step above the others? I thought it was borderline top 20 whereas the others were mid tier

 

[Deecee2DO]

Isn’t UVA a significant step above the others? I thought it was borderline top 20 whereas the others were mid tier

No UVA is upper midtier and nothing more. I can tell you with 100% confidence UVA is not T20 or even borderline-then you would be comparing it to NYU, Cornell, Vandy, BIDMC, Stanford which its not even close to in rep or tier. Brown Dartmouth CCF and UVA schools are all dead even tier wise they are solidly upper mid tier. UVA is only slightly better than Georgetown in my opinion but not by much. As far as breaking up tiers in the mid tier between upper mid and lower mid youre splitting hairs as it will differ from person to person. If we are talking DC/Virginia programs (UVA>GT>GW) in my opinion

 

[voxveritatisetlucis]

No UVA is upper midtier and nothing more. I can tell you with 100% confidence UVA is not T20 or even borderline-then you would be comparing it to NYU, Cornell, Vandy, BIDMC, Stanford which its not even close to in rep or tier. Brown Dartmouth CCF and UVA schools are all dead even tier wise they are solidly upper mid tier. UVA is only slightly better than Georgetown in my opinion but not by much. As far as breaking up tiers in the mid tier between upper mid and lower mid youre splitting hairs as it will differ from person to person. If we are talking DC/Virginia programs (UVA>GT>GW) in my opinion

Are brown, Dartmouth, Yale, UVA, CCF, Mayo hard to get at a low tier MD in your opinion

 

[Deecee2DO]

Are brown, Dartmouth, Yale, UVA, CCF, Mayo hard to get at a low tier MD in your opinion

Brown Dartmouth CCF and UVA are totally doable from any USMD program with above avg app and solid letters with at least some research activity but nothing crazy. Mayo and Yale id say half honors clerkships really solid letters and 250+ Step 2 but not necessarily needing AOA. For the Big 4 and T10 places (UCSF, JHU, MGH, BW, HUP, Duke, WUSTL, Columbia etc) youll need to be close to perfect on paper (all honors or mostly honors AOA 250s-260s Step) with some serious research output (first author pubs in HI journals).

 

[srirachamayonnaise]

Brown Dartmouth CCF and UVA are totally doable from any USMD program with above avg app and solid letters with at least some research activity but nothing crazy. Mayo and Yale id say half honors clerkships really solid letters and 250+ Step 2 but not necessarily needing AOA. For the Big 4 and T10 places (UCSF, JHU, MGH, BW, HUP, Duke, WUSTL, Columbia etc) youll need to be close to perfect on paper (all honors or mostly honors AOA 250s-260s Step) with some serious research output (first author pubs in HI journals).

First author in HI journals?! You are kidding. I can tell you that no one in Big4 has published as a first author in a HI journal. Maybe if you are coming from a DO school. But I am sure Big 4 never interviews DO’s…

 

[Lawpy]

First author in HI journals?! You are kidding. I can tell you that no one in Big4 has published as a first author in a HI journal. Maybe if you are coming from a DO school. But I am sure Big 4 never interviews DO’s…

It’s hard to publish a first author paper in a high impact journal even coming from a top school unless you’re connected with a powerhouse PI early on. I’ll actually be surprised to see DO students having such papers given the differences in school resources and it’ll be a shame if Big 4 ignores them just because they’re a DO

 

[srirachamayonnaise]

It’s hard to publish a first author paper in a high impact journal even coming from a top school unless you’re connected with a powerhouse PI early on. I’ll actually be surprised to see DO students having such papers given the differences in school resources and it’ll be a shame if Big 4 ignores them just because they’re a DO

It’s so rare to publish in HI journals for even the best medical student in the world… I basically meant to point out how ridiculous this is when someone lists that as a condition to match at a Big4. clearly that person has no clue what they are talking about.

 

[Lawpy]

It’s so rare to publish in HI journals for even the best medical student in this world… I basically meant to point out how ridiculous this is when someone lists that as a condition to match at a Big4. clearly that person has no clue what they are talking about.

Oh i agree. But I still think it’d be a mistake for Big 4 to ignore a DO applicant with that paper

 

[srirachamayonnaise]

Oh i agree. But I still think it’d be a mistake for Big 4 to ignore a DO applicant with that paper

I agree. But it looks like Hopkins rather has IMG’s then DO’s.

 

[voxveritatisetlucis]

Those IMGs at Hopkins probably come from top med schools (ie. Oxford, Heidelberg) in their countries and have amazing research/stories etc.

 

[srirachamayonnaise]

Those IMGs at Hopkins probably come from top med schools (ie. Oxford, Heidelberg) in their countries and have amazing research/stories etc.

Doesn’t look like that at all. The truth is when it comes letters behind your name, top IM programs just don’t ever want any DO’s. They rather have MBBch’s. When you look at the list of interns of any reputable IM programs, if you see a DO, you basically always pause for a second and wonder how selective this program really is... it’s just the reality.

 

[voxveritatisetlucis]

Doesn’t look like that at all. The truth is when it comes letters behind your name, top IM programs just don’t ever want any DO’s. They rather have MBBch’s. When you look at the list of interns of any reputable IM programs, if you see a DO, you basically always pause for a second and wonder how selective this program really is... it’s just the reality.

Don’t people think the same when they see low tier MD though? It seems like the best thing for lower tier MDs is to select Midwest or southeast. The school I’ll be attending usually has at least a few people match IM at Umich, Barnes Jewish, Vanderbilt etc. but usually never UCLA, UCSF, Columbia, MGH etc.

Of course it probably doesn’t do any harm to apply to top programs if one is AOA and or has high steps, but it is lower yield on the coasts.

 

[srirachamayonnaise]

Don’t people think the same when they see low tier MD though? It seems like the best thing for lower tier MDs is to select Midwest or southeast. The school I’ll be attending usually has at least a few people match IM at Umich, Barnes Jewish, Vanderbilt etc. but usually never UCLA, UCSF, Columbia, MGH etc.

No, Big 4’s have plenty low-tier MD’s. People just think wow they must have done really well. However, if I saw a DO on the list, I would assume the program is not that selective immediately. Go check out different programs, as you go down the list, more IMG’s and DO’s are in their rosters.

 

[voxveritatisetlucis]

No, Big 4’s have plenty low-tier MD’s. People just think wow they must have done really well. However, if I saw a DO on the list, I would assume the program is not that selective immediately. Go check out different programs, as you go down the list, more IMG’s and DO’s are in their rosters.

Do you think it will be possible for low tier MDs to match T20 IM with pass/fail step 1 if the school keeps AOA

 

[srirachamayonnaise]

Do you think it will be possible for low tier MDs to match T20 IM with pass/fail step 1 if the school keeps AOA

Absolutely. Just try to network with someone who can get you published and also find someone who might be a bigwig in an IM field at your school. Do well on Step 2 and honor everything if possible and get AOA. I think you have a solid chance at t20 programs.

 

[Deecee2DO]

First author in HI journals?! You are kidding. I can tell you that no one in Big4 has published as a first author in a HI journal. Maybe if you are coming from a DO school. But I am sure Big 4 never interviews DO’s…

Haha relax dawgg youre getting your little panties in a wad its only SDN! For the big 4 my point is you gotta be perfect on paper unless youre at a T10 med school. You know im right do you have any idea how hard it is to match big 4 not coming from JHU Columbia HUP UCSF or MGH tier schools without basically being perfect

 

[Deecee2DO]

It’s so rare to publish in HI journals for even the best medical student in the world… I basically meant to point out how ridiculous this is when someone lists that as a condition to match at a Big4. clearly that person has no clue what they are talking about.

Not really lmao I know many that have published first author in Lancet and BMJ and some others. Dead ass. Find a better PI lol

 

[Deecee2DO]

Do you think it will be possible for low tier MDs to match T20 IM with pass/fail step 1 if the school keeps AOA

T20? Yes without question. AOA and 250+ step 2 will certainly help. Not having AOA wont be a deal breaker though but your apps gotta be strong

 

[Deecee2DO]

No, Big 4’s have plenty low-tier MD’s. People just think wow they must have done really well. However, if I saw a DO on the list, I would assume the program is not that selective immediately. Go check out different programs, as you go down the list, more IMG’s and DO’s are in their rosters.

They dont have plenty of low tier MDs lol If there is a low tier MD on the list at a big 4 they most likely had 260s Steps tons of research a top PI all honors and stellar letters with AOA

 

[TelemarketingEnigma]

It’s so rare to publish in HI journals for even the best medical student in the world… I basically meant to point out how ridiculous this is when someone lists that as a condition to match at a Big4. clearly that person has no clue what they are talking about.

It is not completely impossible to have a first author paper in a high impact journal, but it’s also certainly not a requirement for all people at those programs

(Also probably depends how you define high impact - if you’re only thinking Nature/Cell/Science then sure, pretty unlikely. But if you include leading specialty journals, other general high impact factor journals, etc, not unreasonable at all. Does require hard work and luck, but it happens.)

 

[Deecee2DO]

It is not completely impossible to have a first author paper in a high impact journal, but it’s also certainly not a requirement for all people at those programs

(Also probably depends how you define high impact - if you’re only thinking Nature/Cell/Science then sure, pretty unlikely. But if you include leading specialty journals, other general high impact factor journals, etc, not unreasonable at all. Does require hard work and luck, but it happens.)

Yeah this kid is making it sound like its impossible. I know kids personally with them

 

[srirachamayonnaise]

They dont have plenty of low tier MDs lol If there is a low tier MD on the list at a big 4 they most likely had 260s Steps tons of research a top PI all honors and stellar letters with AOA

Just check their websites. About 20% come from non t20 schools.

 

[Lawpy]

It is not completely impossible to have a first author paper in a high impact journal, but it’s also certainly not a requirement for all people at those programs

(Also probably depends how you define high impact - if you’re only thinking Nature/Cell/Science then sure, pretty unlikely. But if you include leading specialty journals, other general high impact factor journals, etc, not unreasonable at all. Does require hard work and luck, but it happens.)

Yeah this kid is making it sound like its impossible. I know kids personally with them

You guys saw med students with first author NEJM/JAMA/Lancet papers? I think that’s the high impact journals being discussed here. Yes getting a paper into a leading specialty journal is great and impactful but it’s a completely different level to publish in one of those mentioned journals

 

[Deecee2DO]

Just check their websites. About 20% come from non t20 schools.

A whole whopping 20%? Thats not a lot lol most come from the most elite institutions in the country. These 20% most undoubtedly walk on water with perfect step scores, clinical grades AOA started a non-profit yada yada the classic rockstar applicant. You are right that not a single DO has ever matched at a big 4 place and I don't see DOs doing so anytime soon. Maybe in the distant future. Have I seen DOs get interviews and match at T10s (WashU) and T20s (Yale, Mayo, Emory etc)? yes but its not common at all

 

[srirachamayonnaise]

A whole whopping 20%? Thats not a lot lol most come from the most elite institutions in the country. These 20% most undoubtedly walk on water with perfect step scores, clinical grades AOA started a non-profit yada yada the classic rockstar applicant. You are right that not a single DO has ever matched at a big 4 place and I don't see DOs doing so anytime soon. Maybe in the distant future. Have I seen DOs get interviews and match at T10s (WashU) and T20s (Yale, Mayo, Emory etc)? yes but its not common at all

I am sure they are exceptional. But you tended to exaggerate a bit about those residents. I think they might have had a higher step score than their peers from t20, and maybe one or two more pubs, but I think they are far from walking on water.

 

[TelemarketingEnigma]

You guys saw med students with first author NEJM/JAMA/Lancet papers? I think that’s the high impact journals being discussed here. Yes getting a paper into a leading specialty journal is great and impactful but it’s a completely different level to publish in one of those mentioned journals

I’ve seen students published in those (albeit not super commonly, but it happens). But that’s why I specified a difference - there’s lots of leading specialty journals that command significant respect, have high impact factors, and it’s still quite impressive for med students to publish there, but definitely happen more often.

 

[voxveritatisetlucis]

From a mid or low tier, a lot of it may come down to looks/charisma/likability. Unfortunately, I’ve seen this at work a fair amount. Somebody with fewer qualifications gets the job because it’s impossible to not like him/her in interviews. Granted this is less common in medicine than finance but it probably still happens quite often:

Of course these applicants likely still need high step, AOA, some research. But if they’re funny or just pleasant to be around, they’ll get it

 

[Deecee2DO]

I am sure they are exceptional. But you tended to exaggerate a bit about those residents. I think they might have had a higher step score than their peers from t20, and maybe one or two more pubs, but I think they are far from walking on water.

My point is if you arent from a top tier med school you gotta have a lot of wow factor to match at the big 4. Do you have any clue how hard it is/compettive to match big 4 IM? kids who match there from schools outside top tier have Derm/Plastics apps

 

[GoSpursGo]

Not really lmao I know many that have published first author in Lancet and BMJ and some others. Dead ass. Find a better PI lol

Unless these were MD/PhDs or at least had a research year, I am calling BS. “Many?” 5 PMIDs or it didn’t happen.

 

[srirachamayonnaise]

My point is if you arent from a top tier med school you gotta have a lot of wow factor to match at the big 4. Do you have any clue how hard it is/compettive to match big 4 IM? kids who match there from schools outside top tier have Derm/Plastics apps

I know it’s harder but I don’t think it’s improbable for most USMD’s.

 

[expicept]

My point is if you arent from a top tier med school you gotta have a lot of wow factor to match at the big 4. Do you have any clue how hard it is/compettive to match big 4 IM? kids who match there from schools outside top tier have Derm/Plastics apps

+1 to the bolded. It can't be stated enough that those programs are really tough to get interviews from let alone match. There's really no secret to assuring a match at any of them unless you went there for medical school.

Unless these were MD/PhDs or at least had a research year, I am calling BS. “Many?” 5 PMIDs or it didn’t happen.

I had a few classmates (IM and non-IM applicants) with first author publications in NEJM and the like. Granted most were MD/PHD's and one in particular had a very productive research year but there were some people who got connected with the right mentor and managed to pull it off. However, I doubt that makes up the majority of IM applicants, let alone those at t20 programs.

 

[GoSpursGo]

I had a few classmates (IM and non-IM applicants) with first author publications in NEJM and the like. Granted most were MD/PHD's and one in particular had a very productive research year but there were some people who got connected with the right mentor and managed to pull it off. However, I doubt that makes up the majority of IM applicants, let alone those at t20 programs.

and that’s sort of my point—yes, we can all agree research and high quality research is important. But some of the research activity being discussed here would be an outlier even at top programs. And beyond that, for most students there is little reason to aim for a “top” program anyways.