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  • You're a medical student hoping to match  into a highly competitive specialty,  

  • like dermatology, plastic surgery, neurosurgeryor something else highly sought after. The problem  

  • is that you didn't quite nail your USMLE Step  1. But don't worry, all hope is not lost.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Residencies are overrun with applicantsas we have too many freshly minted doctors  

  • graduating from medical school each year, but  not enough residency positions for all of them.

  • Confronted with over 100 applicants  for a single residency seat,  

  • residency program directors need  a way to narrow down the list.  

  • For this reason, they use a "standardized  screening process", specific to each program,  

  • to reject approximately 50% of applicantsThis includes USMLE scores among other factors.

  • We often focus on USMLE scores as the end  all in terms of residency competitiveness.  

  • But upon closer examination of the data, you'll  see there were a handful of students matching into  

  • plastic surgery or dermatology or neurosurgery  with USMLE scores below 230. What gives?

  • If you've ever wondered how to get inside  the mind of a residency program director  

  • to figure out what they care aboutyou're in luck. Every two years,  

  • the NRMP surveys program directors from  all residencies and publishes the NRMP  

  • Program Director Survey, showing what factors  are most important in selecting applicants to  

  • interview. And this is a big dealafter allonly 13% of applicants are offered an interview,  

  • making it one of the most challenging  parts of the application process.

  • USMLE Step 1 tops the list in the surveywith 94% of programs citing it as important  

  • with an average importance rating of 4.1. In  other words, they care about it quite a bit.  

  • In fact, approximately 2/3 of all  programs have a target score for Step 1.  

  • This cutoff score varies based on the specialtyOn average, plastic surgery, orthopedic surgery,  

  • and dermatology programs will have a cutoff much  higher, around 230 and sometimes even up to 240.  

  • On the other hand, programs like family medicine  and neurology have cutoffs closer to 200.

  • And if you really crush Step 1,  there are threshold scores above  

  • which you're almost guaranteed  an interview. For dermatology,  

  • that cutoff is on average 241, up to 251.  For plastic surgery, it's on average 248,  

  • up to 256 — the highest of any specialtyFor family medicine, it's 219, up to 223.

  • But wait a minute - USMLE  Step 1 is becoming pass/fail,  

  • therefore will this even matterAs I've [discussed on my personal  

  • channel](https://www.youtube.com/watch?v=LrJ5i9afqP8),  this will largely shift the importance  

  • in applicant selection to other  factors, like Step 2CK. And besides,  

  • this video isn't about telling you why crushing  USMLE is important. You already know that. We want  

  • to know how else you can stand out and still match  into that competitive specialty without a 260.

  • If you take a step back, you'll find that the  most important factors in screening applicants  

  • for interviews are largely high-level broader  assessments. The top 5 most important factors are

  • 1. USMLE Step 1/COMLEX Level 1 score 2. Letters of recommendation in the specialty 

  • 3. Medical Student Performance  Evaluation (MSPE/Dean's Letter

  • 4. USMLE Step 2CK/COMLEX Level 2CE score 5. Personal Statement

  • Again, these are primarily summative  assessments. Your board exam scores  

  • are proxies in assessing your mastery of  preclinical and clinical content. Your MSPE,  

  • or Dean's letter, summarizes your performance  as a student. At the end of the letter,  

  • they often use one of 4 keywords to indicate  the class quartile in which the student ranked,  

  • even at supposed unranked programs. The letters of  recommendation from physicians in that specialty  

  • summarize the opinions of experienced attendings  who have worked closely with you. Are you a good  

  • "fit" for this field? And your personal  statement reflects your story and motives.

  • Without understanding the perspectives and  priorities of residency program directors,  

  • most medical students poorly  allocate their time and energy,  

  • placing too much emphasis on things that don't  matter, and too little on areas with a higher ROI.

  • Understand that applying to residency isdifferent beast than applying to medical school,  

  • and what matters to medical schools isn't  necessarily the same as what matters to  

  • residency programs. Let's take extracurriculars  for example. When applying to medical school,  

  • the depth of your extracurriculars are important  — do you have clinical exposure? How about  

  • volunteering and leadership experience? Medical  schools want to know you're well rounded, that  

  • you understand what medicine is about, and that  you're going into the field for the right reasons.

  • But when you're applying to residency, you're  already well on your way to becoming a doctor.  

  • Now the priority is seeing if you'll be a good  fit for that specialty and residency program.  

  • It's not a priority to them  if you were part of X or Y  

  • student group. In fact, extracurriculars and  volunteering ranked at #19 in the survey.

  • I'm not saying to avoid interesting organizations,  

  • as they can offer value outside of your residency  application. In fact, being a co-founder of the  

  • Future of Medicine student group at my medical  school got the gears turning in my head,  

  • resulting in me founding the Blue LINC biomedical  incubator that resulted in me falling in love with  

  • entrepreneurship and innovation. And that  led me to starting Med School Insiders and  

  • Memm. But none of my residency interviewers  cared about the Future of Medicine group.

  • Similarly, many students obsess  about their preclinical grades.  

  • Ask your school if the MSPE or dean's letter  is reflective of your preclinical grades.  

  • If so, strive to be in the top quartile. And  if your school has AOA, an honors society that  

  • is based on ranking, try to meet the cutoff. But  if the letter doesn't reflect preclinical grades  

  • or you don't have an AOA chapter at  your school, focus on just passing  

  • and spending extra time preparing for USMLE  or building your research publication list.

  • As a medical student, time is of the essenceand it's imperative to be mindful of the  

  • opportunity cost of any given activity. Don't  be a robot, and don't forget to live your life.  

  • At the same time, understand that  time spent with a student club  

  • means less time on other goals that will move  the needle on your residency application.

  • You already know it's important to do  your best on USMLE Step 1, Step 2CK,  

  • and your clinical rotations. But how  did those students with sub 230 scores  

  • match into plastics, derm, and neurosurgery?  

  • It comes down to three areas that can override  score cutoffs and compensate for deficiencies.

  • First, it's a matter of who you know, and who is  in your corner. It's no surprise that students  

  • pursuing a competitive specialty have the highest  odds of matching into their home program. It's  

  • simple human psychology and risk assessment —  you'll have a higher degree of direct interaction  

  • with faculty and your program directorincluding the opportunity to rotate there.  

  • Assuming you exhibit strong performance and  impress them through clinical rotations,  

  • research, and perhaps supporting them  on their side projects or initiatives,  

  • chances are they'll take a strong  liking to you. Comparing two candidates,  

  • they'll favor the one who they know  personally and has a proven track record.

  • You can still do this with faculty  at other programs, too. This is most  

  • traditionally done through away rotationsIn 2020, that's going to be less common,  

  • but you can still make connections outside the  formal rotation setting. For example, say you find  

  • a faculty's clinical interests from their website  and reach out to them to assist with case reports  

  • or research articles remotely. If you're part of  a national organization committee, this is another  

  • worthwhile opportunity to interact with faculty  committee members and build a relationship.

  • Beyond that, having faculty in your corner who are  willing to bat for your at application time can  

  • massively influence your outcomes, particularly  if you're applying to a smaller specialty where  

  • most faculty more or less know one anotherWhen you apply, they'll reach out to their  

  • contacts in residency programs to specifically  vouch for you and help you secure an interview.

  • These faculty advocates are most impactful when  they have significant direct contact with you.  

  • After all, it's much more meaningful whenfaculty member has worked with you closely on  

  • research for 18 months and can speak to your  amazing skills and how any program would be  

  • lucky to have you. This isn't something you  can simply figure out at the last minute.  

  • Rather, you'll need to begin working  on this earlier during medical school.  

  • A great place to start is simply pursuing  research projects or interest groups in your  

  • particular specialty to find a faculty mentorYou can also ask medical students and residents  

  • who may offer more insight as to which faculty  members would be more receptive and helpful.

  • Next, it should be no surprise that being prolific  with research can transform your application.  

  • Looking at the NRMP official match data, you'll  find that for many competitive specialties,  

  • there is a large difference in the total number  

  • of research items between those  who matched and those who didn't.

  • Research is attractive because it  demonstrates initiative, work ethic,  

  • curiosity, and the pursuit of knowledge. Perhaps  more importantly, it helps programs look good  

  • when their residents and faculty publish  frequently, and it helps them secure funding.

  • Standing out in research is often  a key differentiating factor.  

  • I have 65 publications and abstracts primarily  in plastic surgery, and at every institution,  

  • interviewers loved talking about how I was  able to be prolific with research at such an  

  • unusual level. Some even told me they were  excited to have a future resident like me  

  • to help them push through various  projects they've been working on.

  • Ever since [the video on my personal  channel explaining my research  

  • experience](https://www.youtube.com/watch?v=H9aMenyBdkk),  I've had a large number of students asking  

  • for specifics on how they can do the same. There's  a great deal of complexity and nuance to it,  

  • much more than a single video can encompass, so  I'm considering making a course. To gauge interest  

  • and see if it's worthwhile, drop a comment below  if you'd like me to work on a research course.

  • Lastly, a highly compelling ERAS application and  personal statement can make a huge impact on your  

  • competitiveness. But this is much easier said than  done. Many applicants write a personal statement  

  • or have other components of their ERAS application  that holds them back in some way. Others write an  

  • application that doesn't hurt or help them muchAnd only a small minority are able to craft an  

  • ERAS application and personal statement that  truly serves as an asset to improve their chances.

  • Your application should make the reader want  to meet you, while also highlighting the  

  • aspects of your application that would  make you a great fit at their program.  

  • Depending on your experiences and the program's  priorities, this can be anything from specific  

  • research interests to advocacy workand anything between. We have some  

  • example personal statements on the Med School  Insiders website that show a range of essays.  

  • One was so strong that the applicant was  told their essay was the main reason they  

  • were offered an interview at MGH and a few other  elite programs, despite having weaker USMLE scores  

  • and minimal research. You can sign up at the  link in the description to receive your free  

  • copies of those essays, including commentary  explaining the essays' strengths and weaknesses.

  • Getting into your dream specialty can be  overwhelming - I was there not too long ago.  

  • But by intelligently approaching your application  and prioritizing your energy and efforts based on  

  • relative yield, you should be able to better  position yourself for a successful match.  

  • Keep in mind your stage in training too. In  your preclinical years, focus on optimizing  

  • for USMLE Step 1 performance and dip your toes  into research. In your third and fourth year,  

  • prioritize clerkship grades, because those matterand set yourself up for success on Step 2CK.

  • If you need help with any step of the  process, from USMLE and shelf tutoring  

  • to optimizing your research to fine tuning  your personal statement or interview skills,  

  • visit us on MedSchoolInsiders.com. Our Insiders  are superstars in their respective fields,  

  • representing almost every specialty, from  plastic surgery and neurosurgery to derm, ortho,  

  • anesthesia, radiology, psych, and much more. When  building out our services, we found a common issue  

  • plaguing other companies in the industrylack  of consistency and expertise. One student may  

  • get assigned a great advisor or tutor, and the  next may get unlucky. That's simply not fair.  

  • Just as I obsess about my personal systemswe obsessed over creating the best tutoring  

  • and advising experience for aspiring future  doctors. We've shaken things up, innovating  

  • with systems that offer a consistently  elevated and high quality experience,  

  • with results that speak for themselves. And unlike  others, we have the experience and expertise to  

  • back up our claims. These are the same systems  that helped me score in the high 260's on USMLE,  

  • secure 65 research publications, match into  plastic surgery in Southern California,  

  • while also starting multiple profitable  companies. We'll teach you the methods and  

  • help you achieve your version of successVisit MedSchoolInsiders.com to learn more.

  • If you enjoyed this video, check out my video  on securing 65 research items or this video  

  • comparing medical school and residencyMuch love, and I'll see you guys there.

You're a medical student hoping to match  into a highly competitive specialty,  

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How to Match into Residency with a Low USMLE Score (Competitive Specialty)

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    Summer posted on 2021/01/23
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