How Residency Admissions Committees Choose Their Applicants and Do Boards Scores Matter?

[RadsGuy]

Preface: I am a radiology attending who has been on residency and medical school admission committees.

In short, Yes, boards scores matter. They 100% matter even though they shouldn’t matter as much as they do.

The scores are well known by admissions committees to not be reflective of who will do well and will do poorly as a resident. We do not believe that someone who scored a 250 on their Step 1 is that much smarter than someone who scored a 240 or even a 220. We use them because we have to, not because we want to.

Look at it from our perspective for Admission into Program A:

600 applications for 40 interview spots and 4 residency spots.

What has any of us really done that separates us from someone else by age ~25? Honestly, not much. We’ve all done some research, some volunteer work, and have something we think is unique that we’re passionate about. We all have some generic personal statement (I’m sorry, only about 1/1,000 are unique and even those who try to be unique often come off as too weird to waste an interview spot on) and good letters of recommendation.

So how do I decide?

Well roughly the top 200 and bottom 200 can be separated by boards scores and honors. Not a great screening test, but I have to start somewhere, right? The bottom 200 (step scores of below ~210 or so) are ditched. #Sad. I know. There are plenty of talented people in this group but I just cannot tell them apart from the rest and while Step 1 scores do not correlate with academic success, they do mildly correlate with who will pass their boards (which makes sense because if you’re a good test taker now, then you’ll be a good test taker later).

The top 200 are pushed through but the problem is that if I only interview people out of this group, chances are that my residency will go unfilled because many of these people are going to go to other programs and I am not #1 on their rank list. So, I pick a few applications from this group, let’s say 15/40.

I give 5 interviews to people who did audition rotations.

Now, I’m left with the middle 200 of which I have 20/40 interview spots to give out. How the hell do I figure out who is using me as their safety school and who genuinely wants to go here; who is going to be a great resident and who will go on academic probation?

So honestly, I look for any connection to my program (geography being huge) and then randomly select 20/200 to give interview spots to from a range of board scores.

It’s not fair and it’s not a great way of doing things, but honestly, it’s the only way we’ve got. Sometimes we pick some winners, and sometimes we pick total duds. It’s so hard to tell that middle 200 apart from each other. Can you do that based on a paper application? I don’t think so. Some have a little of this and a little less of that, but overall those 200 are roughly comparable. And so, it’s random. That’s the dirty little secret of admissions committees. They put on a big show of application review and have selection committee meetings to figure out rank list, but it’s mostly random. So if you’re a phenomenal applicant who didn’t get an interview to a mediocre program, they probably think you’re out of their league regardless of how bad you want to go there. Or if you’re a good applicant who got rejected from an average program, it’s probably just random. And if you’re a medicore applicant who got an interview you weren’t expecting, it’s also probably random.

Some radiology residencies have a cut off of 235 for their step scores. I think that’s crazy and that they are leaving out too many talented people.

This probably isn’t news to many of you, but there you have it. Another person confirming the crapshoot of the admissions process. Good luck! That’s a lot of it.

And if you want to know my opinion on what is the real deciding factor on which residents are studs and which ones are not? It’s not intelligence.

Hard Work! That’s the real difference between academic success and failure. Favorite quote (by me): “You can teach stupid, but you can’t fix lazy”. Stupid can work hard and be responsible and do what is asked of them and learn and be on time and not create issues and do well. Lazy will always cause problems. Bright and lazy – we don’t want it.

EDIT:
There are quite a few people trying to read between the lines and gain an advantage from this. The "What are my chances" or "How do I get an interview by doing this or that" type of questions. I think you're missing the point. The point is that you can do everything right or a lot of things wrong and random chance may tip the scales in one way or another. There's only so much you can control in the crapchute of medical admissions. Do everything you can to increase your odds, but just know that luck has a lot to do with it.

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[NGTY1991]

You said what gets a mediocre applicant into a reach program could be random? Is that to say that despite the IV, they are not going to be matched?

 

[RadsGuy]

You said what gets a mediocre applicant into a reach program could be random? Is that to say that despite the IV, they are not going to be matched?

I'm not sure what you're asking. All I'm saying is that hard work (scores, application, etc.) will take you very far, but if you're a medical student then chances are you are in a batch of people who are already hard workers. So in that group, all things being equal (i.e. everyone works hard and has comparable applications), random chance is the deciding factor.

 

[NGTY1991]

I'm not sure what you're asking. All I'm saying is that hard work (scores, application, etc.) will take you very far, but if you're a medical student then chances are you are in a batch of people who are already hard workers. So in that group, all things being equal (i.e. everyone works hard and has comparable applications), random chance is the deciding factor.

I guess what I meant to ask was that if the process was quite random, then are you saying even having a good interview for a mediocre applicant in a program they never thought they'd get, would not grant them the program because other aspects of app is still weighed after IV? Based on what ive heard all the PDs say, id have to disagree but what do i know. IV is the most important factor once youve been called i assume and the post is confusing to suggest that because the process is so random, people are just given an IV without the intention of being ranked which seems kinda off-putting for those of us applying this year

 

[Newyawk]

If step scores and grades correlate with hard work, isnt that a fair proxy for success? Why not? If not, what correlates better? Or are you saying its random?

 

[deleted938090]

The top 200 are pushed through but the problem is that if I only interview people out of this group, chances are that my residency will go unfilled because many of these people are going to go to other programs and I am not #1 on their rank list. So, I pick a few applications from this group, let’s say 15/40.

Now, I’m left with the middle 200 of which I have 20/40 interview spots to give out. How the hell do I figure out who is using me as their safety school and who genuinely wants to go here; who is going to be a great resident and who will go on academic probation?

They put on a big show of application review and have selection committee meetings to figure out rank list, but it’s mostly random. So if you’re a phenomenal applicant who didn’t get an interview to a mediocre program, they probably think you’re out of their league regardless of how bad you want to go there. Or if you’re a good applicant who got rejected from an average program, it’s probably just random. And if you’re a medicore applicant who got an interview you weren’t expecting, it’s also probably random.

I appreciate your honesty and openness in regards to this. Does this mean good applicants should only apply to places where they won't be dismissed as "not their first choice", and mediocre applicants should apply geographically?

 

[Goro]

Preface: I am a radiology attending who has been on residency and medical school admission committees.

In short, Yes, boards scores matter. They 100% matter even though they shouldn’t matter as much as they do.

The scores are well known by admissions committees to not be reflective of who will do well and will do poorly as a resident. We do not believe that someone who scored a 250 on their Step 1 is that much smarter than someone who scored a 240 or even a 220. We use them because we have to, not because we want to.

Look at it from our perspective for Admission into Program A:

600 applications for 40 interview spots and 4 residency spots.

What has any of us really done that separates us from someone else by age ~25? Honestly, not much. We’ve all done some research, some volunteer work, and have something we think is unique that we’re passionate about. We all have some generic personal statement (I’m sorry, only about 1/1,000 are unique and even those who try to be unique often come off as too weird to waste an interview spot on) and good letters of recommendation.

So how do I decide?

Well roughly the top 200 and bottom 200 can be separated by boards scores and honors. Not a great screening test, but I have to start somewhere, right? The bottom 200 (step scores of below ~210 or so) are ditched. #Sad. I know. There are plenty of talented people in this group but I just cannot tell them apart from the rest and while Step 1 scores do not correlate with academic success, they do mildly correlate with who will pass their boards (which makes sense because if you’re a good test taker now, then you’ll be a good test taker later).

The top 200 are pushed through but the problem is that if I only interview people out of this group, chances are that my residency will go unfilled because many of these people are going to go to other programs and I am not #1 on their rank list. So, I pick a few applications from this group, let’s say 15/40.

I give 5 interviews to people who did audition rotations.

Now, I’m left with the middle 200 of which I have 20/40 interview spots to give out. How the hell do I figure out who is using me as their safety school and who genuinely wants to go here; who is going to be a great resident and who will go on academic probation?

So honestly, I look for any connection to my program (geography being huge) and then randomly select 20/200 to give interview spots to from a range of board scores.

It’s not fair and it’s not a great way of doing things, but honestly, it’s the only way we’ve got. Sometimes we pick some winners, and sometimes we pick total duds. It’s so hard to tell that middle 200 apart from each other. Can you do that based on a paper application? I don’t think so. Some have a little of this and a little less of that, but overall those 200 are roughly comparable. And so, it’s random. That’s the dirty little secret of admissions committees. They put on a big show of application review and have selection committee meetings to figure out rank list, but it’s mostly random. So if you’re a phenomenal applicant who didn’t get an interview to a mediocre program, they probably think you’re out of their league regardless of how bad you want to go there. Or if you’re a good applicant who got rejected from an average program, it’s probably just random. And if you’re a medicore applicant who got an interview you weren’t expecting, it’s also probably random.

Some radiology residencies have a cut off of 235 for their step scores. I think that’s crazy and that they are leaving out too many talented people.

This probably isn’t news to many of you, but there you have it. Another person confirming the crapshoot of the admissions process. Good luck! That’s a lot of it.

And if you want to know my opinion on what is the real deciding factor on which residents are studs and which ones are not? It’s not intelligence.

Hard Work! That’s the real difference between academic success and failure. Favorite quote (by me): “You can teach stupid, but you can’t fix lazy”. Stupid can work hard and be responsible and do what is asked of them and learn and be on time and not create issues and do well. Lazy will always cause problems. Bright and lazy – we don’t want it.

Damn, Rads, here's another one that needs to be stickied!!!

There's a large overlap with the problems you have and with med school admissions. My wily old Admissions also places an emphasis on proximity to us. Thanks for the insight!

 

[RadsGuy]

I guess what I meant to ask was that if the process was quite random, then are you saying even having a good interview for a mediocre applicant in a program they never thought they'd get, would not grant them the program because other aspects of app is still weighed after IV? Based on what ive heard all the PDs say, id have to disagree but what do i know. IV is the most important factor once youve been called i assume and the post is confusing to suggest that because the process is so random, people are just given an IV without the intention of being ranked which seems kinda off-putting for those of us applying this year

I said nothing about the post-interview process. The above only relates to getting the interview, which can be very random (so don't get discouraged if you don't get the interview that you thought you were a lock for). Once you receive an interview invite, the playing field is mostly leveled. At that point, it's up to you to walk through that door and prove that you deserve to be there.

 

[RadsGuy]

Damn, Rads, here's another one that needs to be stickied!!!

There's a large overlap with the problems you have and with med school admissions. My wily old Admissions also places an emphasis on proximity to us. Thanks for the insight!

Thanks. 100% applicable to receiving medical school interviews, except those committees have even less to differentiate applicants and in my opinion, are even more random.

 

[RadsGuy]

I appreciate your honesty and openness in regards to this. Does this mean good applicants should only apply to places where they won't be dismissed as "not their first choice", and mediocre applicants should apply geographically?

Honestly, I don't know if I have a good answer to that. Apply broadly with a good mix of all types of programs because chances are you will get some random interview invites from programs that you will have never expected. It sucks, it costs money, but there's just no good way around it. And yes, just by the numbers, you have a better chance of matching geographically. For example, small town liberal arts college in Minnesota has name recognition to a medical school in Nebraska, but no one in California will have ever heard of your school.

 

[NGTY1991]

I said nothing about the post-interview process. The above only relates to getting the interview, which can be very random (so don't get discouraged if you don't get the interview that you thought you were a lock for). Once you receive an interview invite, the playing field is mostly leveled. At that point, it's up to you to walk through that door and prove that you deserve to be there.

Got it! Thank you

 

[afib123]

I want to go into neurosurgery, have good stats but everyone keeps saying I need a ton of research. I am working on having 2-3 projects before interview season.
Any input on how important research is? I know radiology is different from neurosurg, but wondering if you have any inputs on that based on discussion with your colleagues

 

[afib123]

Also, sorry for the double post but how do third years strengthen their application to apply to competitive fields like radiology, or surgical subspecialties. My step 1 is in the 250s and have been trying to get honors/near honors for 3rd year grades. what else can i be doing/should i be doing come fourth year or even this year?

 

[RadsGuy]

If step scores and grades correlate with hard work, isnt that a fair proxy for success? Why not? If not, what correlates better? Or are you saying its random?

Just my opinion, but NO. Some people are good at taking tests, and others haven't figured out how to game those tests yet. Yes, it takes some work to do well on your Steps, but test taking is a skill. You can hone it. Honestly, if you do 10,000 practice questions, you'll do well on your Step, but what does that mean? Does that make you a good doctor? Will you be successful because of it? Probably not.

What will make you a "success" is if you're a good human being, with great social skills who can relate to patients, who won't screw over their colleagues for their own benefit, who will show up early and stay late, who can admit when they're wrong instead of lying to cover it up, who can be humble, who is introspective and sees the big picture rather than the hoops they must jump through to become an MD or DO. That is not contained in any Step Exam and I don't know if you can test for it. Just be well rounded. Yea you may not get into the best residency program of your choice by being well rounded, but 1yr into residency no one cares where you went to medical school and 1yr into attendinghood, no one cares where you went to residency. They care if you're fairly competent, personable (not a robot-bookworm), and not an A-hole, and Steps won't tell ya that.

I'll give you another example of why the hard work that goes into a great Step 1 score doesn't mean that much. IMGs study for 2yrs for their step 1 and get a 270. Some can't speak english well, have major personality flaws, and can't relate to their patients. Does that make them a success? I would guess no.

 

[Lawpy]

If step scores and grades correlate with hard work, isnt that a fair proxy for success? Why not? If not, what correlates better? Or are you saying its random?

Just my opinion, but NO. Some people are good at taking tests, and others haven't figured out how to game those tests yet. Yes, it takes some work to do well on your Steps, but test taking is a skill. You can hone it. Honestly, if you do 10,000 practice questions, you'll do well on your Step, but what does that mean? Does that make you a good doctor? Will you be successful because of it? Probably not.

What will make you a "success" is if you're a good human being, with great social skills who can relate to patients, who won't screw over their colleagues for their own benefit, who will show up early and stay late, who can admit when they're wrong instead of lying to cover it up, who can be humble, who is introspective and sees the big picture rather than the hoops they must jump through to become an MD or DO. That is not contained in any Step Exam and I don't know if you can test for it. Just be well rounded. Yea you may not get into the best residency program of your choice by being well rounded, but 1yr into residency no one cares where you went to medical school and 1yr into attendinghood, no one cares where you went to residency. They care if you're fairly competent, personable (not a robot-bookworm), and not an A-hole, and Steps won't tell ya that.

I'll give you another example of why the hard work that goes into a great Step 1 score doesn't mean that much. IMGs study for 2yrs for their step 1 and get a 270. Some can't speak english well, have major personality flaws, and can't relate to their patients. Does that make them a success? I would guess no.

So wait, do you think clinical grades correlate better than Step scores? Because clinical grades measure the interpersonal skills you're looking for through evals (as well as test taking skills through shelf exams).

 

[getdown]

I agree 100%. At some point the major determining factor of getting interviews is your STEP score and "likelihood of attending said program". I put this in quotes because it could be a lot of reasons but mainly if you have family there or have strong ties to the area. No program wants to go unfilled and there are only so many interview spots to give. Plus you can't rank those who don't interview and may not want to rank those that you do interview.

Spot on with what makes a good resident. We don't care what your board scores are once you're there. Board scores only correlate to passing the actual boards which every program wants. The day to day functioning and interactions mean awhole lot more. No one likes the lazy resident who pawns work on others or the angry resident who walks around with a bad attitude. The ones that go far are the ones that have a good personality. "You can't fix lazy" is definitely a very true statement. Someone who's not as intelligent but works hard is hands down way better than a smart lazy resident.

 

[RadsGuy]

So wait, do you think clinical grades correlate better than Step scores? Because clinical grades measure the interpersonal skills you're looking for through evals (as well as test taking skills through shelf exams).

Oh I guess I only answered half that question. The one relating to Step scores. Sorry.

Yes, I think clinical grades are a better predictor, but they're also flawed in a different way:

1. Shelf exams are still a test you can study for and if you have that skill or put in that work of taking all those practice questions, then you'll do great on that.
2. If you ace the clinical aspect of your rotation and get amazing reviews, I am reassured that you are not a weirdo and likely will be a good physician. That is actually reliable. If you get terrible reviews, then that's easy too. But then there's the rest of the ~80% of people who achieve good reviews and pass their rotations. How can you tell who's good and who's not in that group? I mean you really have to mess up hard to get a bad review. The vast majority of people (attendings and residents) will not write a bad review if you're a poor or less than average student. They just won't write anything great. So you end up with a ton of people with good reviews and some of them are on the high end and some of them are on the low end of their clinical and interpersonal skills. That is still a black box to me and it's the bulk of applicants... so I don't know. It's tough.

 

[MedicineZ0Z]

Oh I guess I only answered half that question. The one relating to Step scores. Sorry.

Yes, I think clinical grades are a better predictor, but they're also flawed in a different way:

1. Shelf exams are still a test you can study for and if you have that skill or put in that work of taking all those practice questions, then you'll do great on that.
2. If you ace the clinical aspect of your rotation and get amazing reviews, I am reassured that you are not a weirdo and likely will be a good physician. That is actually reliable. If you get terrible reviews, then that's easy too. But then there's the rest of the ~80% of people who achieve good reviews and pass their rotations. How can you tell who's good and who's not in that group? I mean you really have to mess up hard to get a bad review. The vast majority of people (attendings and residents) will not write a bad review if you're a poor or less than average student. They just won't write anything great. So you end up with a ton of people with good reviews and some of them are on the high end and some of them are on the low end of their clinical and interpersonal skills. That is still a black box to me and it's the bulk of applicants... so I don't know. It's tough.

Maybe *some* places they're accurate but clinical grades are the most random thing ever. You can use it to weed out lower quality applicants via them having poor grades/bad reviews. But separating 2 honors vs. 5 honors is impossible. Some places will give honor to the top 5%. Many places will give it either just for showing up or being somewhat easy to work with. It's very likely that a student wasn't quite top 5% but very close and still doesn't get honors.

 

[NVO]

How would I show geographic ties without doing an away rotation in that state or being from that state? (my SO is from a certain state and we want to go back to that state)

If its in my PS, would you even reach that part of my app before discarding it

 

[getdown]

How would I show geographic ties without doing an away rotation in that state or being from that state? (my SO is from a certain state and we want to go back to that state)

If its in my PS, would you even reach that part of my app before discarding it

They won't know unless you tell them. Chances are if they see all of your family and education are on the east coast with no family ties to their state, they won't send you an interview invite. What you can do is email the program coordinator and tell them that your SO is from that state and there for you have them high on your list since you plan on moving back there. Many programs will often send you an invite as long as your grades meet their minimum cutoffs.

 

[Dr.Bruh]

At what point, if at all, does degree factor in to who gets an interview for your program? As in are DOs automatically at the bottoms? IMGs? Both?

 

[aafisahar]

At what point, if at all, does degree factor in to who gets an interview for your program? As in are DOs automatically at the bottoms? IMGs? Both?

School reputation is a major part of the application process.

 

[Psai]

Why do you keep making these threads

 

[hushhush88]

Why do you keep making these threads

I actually think this thread is helpful.


Sent from my iPhone using Tapatalk

 

[Angus Avagadro]

I believe audition rotations are important. Rads is a little different as so eleloquently stated above. In my specialty, residents have a great deal of interaction with patients, other faculty, and hospital staff. I remember when there was much giddiness when we hired a resident,(over my objection), and without an interview from one of the Ivys. He was such a pain in my a$$, daily a Dr, nurse, or other staff member would hurry to tell me about the latest escapades of MY resident! I would much rather accept a middle of the road applicant who auditioned, everyone liked, had a great work ethic and made it known we were his dream program. This is someone I can teach. If they have not auditioned, I am watching their interpersonal skills very closely during their interview. Having a LOR from someone known to our program is also a big help. Just my 2 cents.

 

[Psai]

I actually think this thread is helpful.


Sent from my iPhone using Tapatalk

It's not that I don't think they're helpful, I'm just wondering why he came out of nowhere to make all these threads

 

[MedicineZ0Z]

I believe audition rotations are important. Rads is a little different as so eleloquently stated above. In my specialty, residents have a great deal of interaction with patients, other faculty, and hospital staff. I remember when there was much giddiness when we hired a resident,(over my objection), and without an interview from one of the Ivys. He was such a pain in my a$$, daily a Dr, nurse, or other staff member would hurry to tell me about the latest escapades of MY resident! I would much rather accept a middle of the road applicant who auditioned, everyone liked, had a great work ethic and made it known we were his dream program. This is someone I can teach. If they have not auditioned, I am watching their interpersonal skills very closely during their interview. Having a LOR from someone known to our program is also a big help. Just my 2 cents.

1. Well liked and easy to work with makes sense.

2. How do you assess work ethic? Anything specific you look for? Anything you don't care about?

3. What sort of knowledge level do you really like to see? So it's a subI and you can place orders. You want to see almost zero errors in those orders? Perfect H&Ps? Perfect progress notes? Procedural competence?
Basically how do you really standout?

 

[Angus Avagadro]

1. Well liked and easy to work with makes sense.

2. How do you assess work ethic? Anything specific you look for? Anything you don't care about?

3. What sort of knowledge level do you really like to see? So it's a subI and you can place orders. You want to see almost zero errors in those orders? Perfect H&Ps? Perfect progress notes? Procedural competence?
Basically how do you really standout?

Show up early, stay late, accept scutwork with poise, ask for assignments if none are given, offer to give a presentation, accept criticism with grace.
Knowledge level? Digest assigned reading and give presentations when asked. Having a good degree of intellectual curiosity and a commitment to excellence. Not afraid to ask questions rather than blundering forward. So yes to all the examples you give. I dont like students who cannot say I dont know, and try to BS their way through the question I just asked.
Procedural competence, is nice, but most students dont get enough chances to become competent.
Hope this helps a little. Good luck and best wishes!

 

[getdown]

I believe audition rotations are important. Rads is a little different as so eleloquently stated above. In my specialty, residents have a great deal of interaction with patients, other faculty, and hospital staff. I remember when there was much giddiness when we hired a resident,(over my objection), and without an interview from one of the Ivys. He was such a pain in my a$$, daily a Dr, nurse, or other staff member would hurry to tell me about the latest escapades of MY resident! I would much rather accept a middle of the road applicant who auditioned, everyone liked, had a great work ethic and made it known we were his dream program. This is someone I can teach. If they have not auditioned, I am watching their interpersonal skills very closely during their interview. Having a LOR from someone known to our program is also a big help. Just my 2 cents.

Had something similar at my residency program. Socially awkward kid from THE ivy medical school. Apparently had a lot of red flags as in relatively poor reviews during his clinical rotations but compelling story. Nearly everyone who interacted with him during the interview felt he was awkward and wouldn't fit well at the program. He was still ranked and matched despite numerous objections from the residents because of his school name. Was overall a poor resident clinically and somewhat slow but he was a hard worker and didn't complain much. Ultimately washed out and switched to psych. Didn't really have the personality or mindset for Anesthesia.

 

[watermelon master]

Preface: I am a radiology attending who has been on residency and medical school admission committees.

In short, Yes, boards scores matter. They 100% matter even though they shouldn’t matter as much as they do.

The scores are well known by admissions committees to not be reflective of who will do well and will do poorly as a resident. We do not believe that someone who scored a 250 on their Step 1 is that much smarter than someone who scored a 240 or even a 220. We use them because we have to, not because we want to.

Look at it from our perspective for Admission into Program A:

600 applications for 40 interview spots and 4 residency spots.

What has any of us really done that separates us from someone else by age ~25? Honestly, not much. We’ve all done some research, some volunteer work, and have something we think is unique that we’re passionate about. We all have some generic personal statement (I’m sorry, only about 1/1,000 are unique and even those who try to be unique often come off as too weird to waste an interview spot on) and good letters of recommendation.

So how do I decide?

Well roughly the top 200 and bottom 200 can be separated by boards scores and honors. Not a great screening test, but I have to start somewhere, right? The bottom 200 (step scores of below ~210 or so) are ditched. #Sad. I know. There are plenty of talented people in this group but I just cannot tell them apart from the rest and while Step 1 scores do not correlate with academic success, they do mildly correlate with who will pass their boards (which makes sense because if you’re a good test taker now, then you’ll be a good test taker later).

The top 200 are pushed through but the problem is that if I only interview people out of this group, chances are that my residency will go unfilled because many of these people are going to go to other programs and I am not #1 on their rank list. So, I pick a few applications from this group, let’s say 15/40.

I give 5 interviews to people who did audition rotations.

Now, I’m left with the middle 200 of which I have 20/40 interview spots to give out. How the hell do I figure out who is using me as their safety school and who genuinely wants to go here; who is going to be a great resident and who will go on academic probation?

So honestly, I look for any connection to my program (geography being huge) and then randomly select 20/200 to give interview spots to from a range of board scores.

It’s not fair and it’s not a great way of doing things, but honestly, it’s the only way we’ve got. Sometimes we pick some winners, and sometimes we pick total duds. It’s so hard to tell that middle 200 apart from each other. Can you do that based on a paper application? I don’t think so. Some have a little of this and a little less of that, but overall those 200 are roughly comparable. And so, it’s random. That’s the dirty little secret of admissions committees. They put on a big show of application review and have selection committee meetings to figure out rank list, but it’s mostly random. So if you’re a phenomenal applicant who didn’t get an interview to a mediocre program, they probably think you’re out of their league regardless of how bad you want to go there. Or if you’re a good applicant who got rejected from an average program, it’s probably just random. And if you’re a medicore applicant who got an interview you weren’t expecting, it’s also probably random.

Some radiology residencies have a cut off of 235 for their step scores. I think that’s crazy and that they are leaving out too many talented people.

This probably isn’t news to many of you, but there you have it. Another person confirming the crapshoot of the admissions process. Good luck! That’s a lot of it.

And if you want to know my opinion on what is the real deciding factor on which residents are studs and which ones are not? It’s not intelligence.

Hard Work! That’s the real difference between academic success and failure. Favorite quote (by me): “You can teach stupid, but you can’t fix lazy”. Stupid can work hard and be responsible and do what is asked of them and learn and be on time and not create issues and do well. Lazy will always cause problems. Bright and lazy – we don’t want it.

So what can an applicant do in order to increase their chances of being picked for an interview?

Let's say that most program directors use your strategy. Throw out the bottom 3rd. If I predict that I would be in the top 1/3, then I apparently only have a 15/200 chance of being chosen. If I'm going to be in this pile, can I do anything to increase my chances?

What if I'm in the middle of the pile and I haven't done an away rotation. Is there anything that I could say in an email to you that would increase my chances of an interview? How many people in the middle category send letters of interest? Surely that would make you more likely to choose them than just another face in that same pile?

Thank you!

 

[RadsGuy]

Why do you keep making these threads

Fair question. Because I had a spare Sunday and these are things I've been talking about to medical students, residents, and other attendings for years. Didn't just come up with them on the fly and honestly don't really know how many more original, helpful posts I have in me. Probably not many.

Definitely don't want to do as academia does and publish just to publish to advance my SDN career because of misaligned incentives rewarding quantity over quality leading to inaccurate medical school/residency/hospital rankings and muddying the waters for people trying to find helpful information/high quality research....oooh, that's another post right there.

 

[Lawpy]

Fair question. Because I had a spare Sunday and these are things I've been talking about to medical students, residents, and other attendings for years. Didn't just come up with them on the fly and honestly don't really know how many more original, helpful posts I have in me. Probably not many.

Definitely don't want to do as academia does and publish just to publish to advance my SDN career because of misaligned incentives rewarding quantity over quality leading to inaccurate medical school/residency/hospital rankings and muddying the waters for people trying to find helpful information/high quality research....oooh, that's another post right there.

Please make more of these threads, since they are invaluable

 

[kelminak]

@RadsGuy How does your program look at MD vs. DO applicants?

 

[RadsGuy]

@RadsGuy How does your program look at MD vs. DO applicants?

Unfavorably.

It's not fair, but it's even worse for IMGs. There are brilliant DOs and IMGs and some not so smart MDs out there. And before you blame the admissions committees, think about this: Let's say you can can quantitatively fill your entire program with DOs and IMGs who are all studs on every level. And you continue to do that and your program is full of rockstars. 4 cycles later, an applicant is looking at your program and so they visit the Resident/Program's page and see a bunch of IMGs and DOs. Do you think they'd give the DOs and IMGs all the benefit of the doubt or would that applicant wonder, "man what happened to xxxx program? I thought they used to be good." That's the irrational fear of taking many, if any, DOs or IMGs. All the program directors talk to each other at conferences every year and they'd be thinking that same thing, "what happened to xxxx program?"

 

[Angus Avagadro]

Unfavorably.

It's not fair, but it's even worse for IMGs. There are brilliant DOs and IMGs and some not so smart MDs out there. And before you blame the admissions committees, think about this: Let's say you can can quantitatively fill your entire program with DOs and IMGs who are all studs on every level. And you continue to do that and your program is full of rockstars. 4 cycles later, an applicant is looking at your program and so they visit the Resident/Program's page and see a bunch of IMGs and DOs. Do you think they'd give the DOs and IMGs all the benefit of the doubt or would that applicant wonder, "man what happened to xxxx program? I thought they used to be good." That's the irrational fear of taking many, if any, DOs or IMGs. All the program directors talk to each other at conferences every year and they'd be thinking that same thing, "what happened to xxxx program?"

After 4 cycles, they would gave a program full of DO and IMG rock stars. So the problems is??? IMGs are very often rock stars by their own right. Great DO applicants are stl great applicants

 

[RadsGuy]

After 4 cycles, they would gave a program full of DO and IMG rock stars. So the problems is??? IMGs are very often rock stars by their own right. Great DO applicants are stl great applicants

The problem is perception. You can be internally great at something, but that's not how you're judged. A program's job is to be good AND to attract good candidates. If a program takes all their residents from India as IMGs, I think they'll probably be fine internally, but you have to admit that they will be judged harshly by other MD and DO candidates. That's the point. It's not a question of good vs bad or smart vs not. It's all about perception. That's why I said it's unfair.

 

[Goro]

Unfavorably.

It's not fair, but it's even worse for IMGs. There are brilliant DOs and IMGs and some not so smart MDs out there. And before you blame the admissions committees, think about this: Let's say you can can quantitatively fill your entire program with DOs and IMGs who are all studs on every level. And you continue to do that and your program is full of rockstars. 4 cycles later, an applicant is looking at your program and so they visit the Resident/Program's page and see a bunch of IMGs and DOs. Do you think they'd give the DOs and IMGs all the benefit of the doubt or would that applicant wonder, "man what happened to xxxx program? I thought they used to be good." That's the irrational fear of taking many, if any, DOs or IMGs. All the program directors talk to each other at conferences every year and they'd be thinking that same thing, "what happened to xxxx program?"

So the elitism and unfounded prejudices of applicants is enough to turn away good candidates?

 

[Black Coffee 24/7]

Oh I guess I only answered half that question. The one relating to Step scores. Sorry.

Yes, I think clinical grades are a better predictor, but they're also flawed in a different way:

1. Shelf exams are still a test you can study for and if you have that skill or put in that work of taking all those practice questions, then you'll do great on that.
2. If you ace the clinical aspect of your rotation and get amazing reviews, I am reassured that you are not a weirdo and likely will be a good physician. That is actually reliable. If you get terrible reviews, then that's easy too. But then there's the rest of the ~80% of people who achieve good reviews and pass their rotations. How can you tell who's good and who's not in that group? I mean you really have to mess up hard to get a bad review. The vast majority of people (attendings and residents) will not write a bad review if you're a poor or less than average student. They just won't write anything great. So you end up with a ton of people with good reviews and some of them are on the high end and some of them are on the low end of their clinical and interpersonal skills. That is still a black box to me and it's the bulk of applicants... so I don't know. It's tough.

As for clinical grades, how damaging is a Low Pass outside of the specialty of interest especially if the candidate has competitive stats, High Pass and Honor in the 8 other clinical rotations with great to excellent comments? What’s your assessment of that person?

 

[lagbydesign]

So the elitism and unfounded prejudices of applicants is enough to turn away good candidates?

Maybe. The perception is really that the program sucks/is malignant if it's full of IMGs/DOs. There are no MDs there, so there must be something wrong with the program. That's the thought process.

EDIT: It's really a shortcut for evaluating a program. It's obviously better to do your due diligence on each individual program no matter what, but it's potentially pretty time consuming to do a full investigation and to separate the hearsay from the truth on every single program.

 

[tealeafexplorer]

This thread is gold. Commenting in it so i can dig it up in a couple years

 

[Angus Avagadro]

The problem is perception. You can be internally great at something, but that's not how you're judged. A program's job is to be good AND to attract good candidates. If a program takes all their residents from India as IMGs, I think they'll probably be fine internally, but you have to admit that they will be judged harshly by other MD and DO candidates. That's the point. It's not a question of good vs bad or smart vs not. It's all about perception. That's why I said it's unfair.

Agree totally with perception. This is why DOs and IMGs have to work harder to get good training. As for perception, if you had DO and IMG rockstars, make the avg boards scores and publications for the current 1st years available to the applicants. The word gets out, then competition brings good applicants. I was one of the first DOs on staff at my university hospital and believe me, I received some scrutiny. But, excellence is the best deterrence to prejudice. I was always treated well and with collegiality. I would like to thank you for your insight and honesty. I always look forward to reading your thoughtful posts. Please continue