A frank discussion

Guys and gals,

Now that we are in the thick of interview season, I'm sure many of us who are either applying or have gone through the process recently have thoughts on just how competitive this specialty can be and how the uncertainty can be difficult to deal with. I know that I would have appreciated threads like this as an occasional reader of this forum in M2 and M3 year, so I think it would be the least we can do to give back to the community.

It seems that the application process has gotten so out of hand that solid to stellar applicants (250s-260s) are applying to masses of programs (70-100) and getting relatively few invites (<10) and feel understandably uneasy. I know personally of multiple classmates and colleagues I met alone the away rotation trial who are going through a real battle trying to secure the magic number of interviews to feel that they will confidently match.

Here are some things that I have noticed seem to be very important but previously underlooked:

1. AOA - I believe that this is often used by programs to decide who to interview when there are multiple strong applicants from one school, or when evaluating applicants from less well known medical schools
2. Competition within your medical school class - got a record number of people applying from your med school? Unless you're at the top of the food chain, this will affect you
3. LORs - important in the sense that they evaluate you very bluntly and often in comparison with your classmates

I also think that programs will have to take a hard look at how many places people are applying and how they will weed out was is serious interest vs. just checking another box to somehow hit that 12 interviews you need to be in the 90+% match rate.

*Disclaimer: this may be a pointless discussion if interview waitlists start to move as more fortunate/competitive applicants begin to decline, but I personally do not think this is as big of a savior as others might think

Others feel free to chime in cause I think it'll help both our cohort of applicants this year as well as future generations

-MZ

I think this is a valid discussion.

As someone with not so stellar numbers ( sub 255 on step 1 and step 2, top quartile but no AOA), I think another overlooked point that's more difficult to take control of is connections. I have 5 interviews right now. 2 are from aways (one away which I was only able to secure after a mentor advocated for me), 1 from a program where a highly regarded resident vouched for me, and another in a place that a mentor made a personal call for me (received an interview the very next day). Chances are you can't rely on your school to just automatically make calls for you unless you have a personable chairman and active program director who also both happen to be heavily invested in medical students. Not the case at many programs.

The in-school competition is also legitimate. Though I don't think there's any merit to closing yourself off from those classmates during the application cycle. The more open the better. (the only way I'm tracking which programs I still have a chance at are through the postings of the good people on this forum and texts with my classmates). It's good to keep tabs on the interview dates available at certain programs so you can schedule quickly when the interviews do come in. There's also little to no overlap in where you and your classmates will interview (at least that's been the case at my school), so you might as well keep each other in the loop. Birds of a feather and all that.

Sub-Is are crucial. And one thing that I found to work out for me that I don't believe enough rotators are open to is to collaborate with your fellow rotators and don't step on each others toes needlessly. I believe residents notice this, and every rotation where I vibed with sub-Is was infinitely more pleasant.

I'm very hopeful that the waitlists will move and a second wave of interviews trickle out, but I also don't believe this will be a saving grace for many of us.

I agree with everything said already, but I think the importance of research cannot be understated. After programs filter for step scores and class rank, there are still more applicants than there are interview spots. Academic programs seem to like applicants who say they are interested in academics and have a CV to back it up. Anyone can be involved in research, but publishing in a journal that your orthopod reviewer reads will help distinguish yourself from other applicants. Research experiences can be random, and sometimes unfair, but you can say the same thing about 3rd year clinical evaluations. Start doing research during the first or second year of medical school, be proactive with your PI about publishing and submitting stuff, and something should pan out by the time ERAS rolls around.

If I'm a 3 or younger reading this thread, the thing to take away is that your application doesn't hinge on one thing: it's the total package. Everyone has numbers, and AOA probably does help, but you can be pristine on paper and still struggle for interviews if you come from a smaller school, especially one without a home program. Connections and who you know in this process can not be understated. Unfortunately, these are the things you can't really control to an extent.

I have to agree with a lot of what is being said here. And I'm sure this has been said a thousand times on this site, but I would like to emphasize how important excelling at away rotations is. I'm a PGY-1 who matched last year and now currently getting a chance to see what it's like on the other side. If you do a great job and can get the residents to advocate for you, I think it's a HUGE advantage for matching. I was actually quite surprised by how many rotators we had mess this up, either by being lazy, calling out residents, and even being too aggressive.

I still think that you need to strive to be the complete package with solid board scores, good grades, research, etc... but for a below average candidate I really think this could push them over the edge to get a spot.

I also know this doesn't really help those applying now, but future applicants should certainly know this. There are some good tips for aways either here or on SDN. Most of it is common sense, but you would definitely be surprised.

Good responses guys. Like I said, this forum feels like it's been quiet but there is a lot of good advice to be had here so I'm sure this class and future generations of applicants will greatly appreciate it.

In addition to what the above poster said about away rotations, I want to emphasize the importance of rotating within your means and doing your homework on places to rotate. For example, certain programs do not interview all rotators. This can be a trap for an applicant who busts their ass on a rotation but has too weak of a paper application to be seriously considered. This happened to several people I have met along the trail. As mentioned above, the opposite is true where a strong paper applicant can torpedo themselves with a subpar rotation (committing the sins of either: laziness, incompetence, or bad/weird/awkward attitude), which I have also seen. Also, be aware that going to a program that interviews everyone is not always a great thing. Certain programs invite all rotators back for an interview or interview you while you are there. This can be a pity interview without you knowing it so beware. Worst thing that can happen is that you think you did a stellar job and you wind up at the bottom of their rank list because of either your paper application or the fact that they didn't like you --> recipe for disappointment

I think the best advice is to do your homework and find places that favor rotators and where you actually have a strong chance of matching given your paper application, which I think cannot be understated. At the same time, make sure it's a program that you like because your best odds of matching are at places that you rotate!