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You're a medical student hoping to match into a highly competitive specialty,
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like dermatology, plastic surgery, neurosurgery, or something else highly sought after. The problem
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is that you didn't quite nail your USMLE Step 1. But don't worry, all hope is not lost.
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Dr. Jubbal, MedSchoolInsiders.com.
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Residencies are overrun with applicants, as we have too many freshly minted doctors
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graduating from medical school each year, but not enough residency positions for all of them.
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Confronted with over 100 applicants for a single residency seat,
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residency program directors need a way to narrow down the list.
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For this reason, they use a "standardized screening process", specific to each program,
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to reject approximately 50% of applicants. This includes USMLE scores among other factors.
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We often focus on USMLE scores as the end all in terms of residency competitiveness.
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But upon closer examination of the data, you'll see there were a handful of students matching into
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plastic surgery or dermatology or neurosurgery with USMLE scores below 230. What gives?
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If you've ever wondered how to get inside the mind of a residency program director
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to figure out what they care about, you're in luck. Every two years,
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the NRMP surveys program directors from all residencies and publishes the NRMP
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Program Director Survey, showing what factors are most important in selecting applicants to
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interview. And this is a big deal – after all, only 13% of applicants are offered an interview,
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making it one of the most challenging parts of the application process.
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USMLE Step 1 tops the list in the survey, with 94% of programs citing it as important
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with an average importance rating of 4.1. In other words, they care about it quite a bit.
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In fact, approximately 2/3 of all programs have a target score for Step 1.
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This cutoff score varies based on the specialty. On average, plastic surgery, orthopedic surgery,
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and dermatology programs will have a cutoff much higher, around 230 and sometimes even up to 240.
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On the other hand, programs like family medicine and neurology have cutoffs closer to 200.
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And if you really crush Step 1, there are threshold scores above
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which you're almost guaranteed an interview. For dermatology,
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that cutoff is on average 241, up to 251. For plastic surgery, it's on average 248,
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up to 256 — the highest of any specialty. For family medicine, it's 219, up to 223.
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But wait a minute - USMLE Step 1 is becoming pass/fail,
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therefore will this even matter? As I've [discussed on my personal
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channel](https://www.youtube.com/watch?v=LrJ5i9afqP8), this will largely shift the importance
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in applicant selection to other factors, like Step 2CK. And besides,
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this video isn't about telling you why crushing USMLE is important. You already know that. We want
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to know how else you can stand out and still match into that competitive specialty without a 260.
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If you take a step back, you'll find that the most important factors in screening applicants
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for interviews are largely high-level broader assessments. The top 5 most important factors are
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1. USMLE Step 1/COMLEX Level 1 score 2. Letters of recommendation in the specialty
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3. Medical Student Performance Evaluation (MSPE/Dean's Letter)
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4. USMLE Step 2CK/COMLEX Level 2CE score 5. Personal Statement
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Again, these are primarily summative assessments. Your board exam scores
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are proxies in assessing your mastery of preclinical and clinical content. Your MSPE,
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or Dean's letter, summarizes your performance as a student. At the end of the letter,
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they often use one of 4 keywords to indicate the class quartile in which the student ranked,
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even at supposed unranked programs. The letters of recommendation from physicians in that specialty
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summarize the opinions of experienced attendings who have worked closely with you. Are you a good
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"fit" for this field? And your personal statement reflects your story and motives.
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Without understanding the perspectives and priorities of residency program directors,
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most medical students poorly allocate their time and energy,
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placing too much emphasis on things that don't matter, and too little on areas with a higher ROI.
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Understand that applying to residency is a different beast than applying to medical school,
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and what matters to medical schools isn't necessarily the same as what matters to
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residency programs. Let's take extracurriculars for example. When applying to medical school,
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the depth of your extracurriculars are important — do you have clinical exposure? How about
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volunteering and leadership experience? Medical schools want to know you're well rounded, that
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you understand what medicine is about, and that you're going into the field for the right reasons.
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But when you're applying to residency, you're already well on your way to becoming a doctor.
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Now the priority is seeing if you'll be a good fit for that specialty and residency program.
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It's not a priority to them if you were part of X or Y
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student group. In fact, extracurriculars and volunteering ranked at #19 in the survey.
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I'm not saying to avoid interesting organizations,
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as they can offer value outside of your residency application. In fact, being a co-founder of the
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Future of Medicine student group at my medical school got the gears turning in my head,
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resulting in me founding the Blue LINC biomedical incubator that resulted in me falling in love with
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entrepreneurship and innovation. And that led me to starting Med School Insiders and
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Memm. But none of my residency interviewers cared about the Future of Medicine group.
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Similarly, many students obsess about their preclinical grades.
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Ask your school if the MSPE or dean's letter is reflective of your preclinical grades.
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If so, strive to be in the top quartile. And if your school has AOA, an honors society that
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is based on ranking, try to meet the cutoff. But if the letter doesn't reflect preclinical grades
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or you don't have an AOA chapter at your school, focus on just passing
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and spending extra time preparing for USMLE or building your research publication list.
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As a medical student, time is of the essence, and it's imperative to be mindful of the
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opportunity cost of any given activity. Don't be a robot, and don't forget to live your life.
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At the same time, understand that time spent with a student club
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means less time on other goals that will move the needle on your residency application.
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You already know it's important to do your best on USMLE Step 1, Step 2CK,
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and your clinical rotations. But how did those students with sub 230 scores
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match into plastics, derm, and neurosurgery?
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It comes down to three areas that can override score cutoffs and compensate for deficiencies.
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First, it's a matter of who you know, and who is in your corner. It's no surprise that students
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pursuing a competitive specialty have the highest odds of matching into their home program. It's
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simple human psychology and risk assessment — you'll have a higher degree of direct interaction
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with faculty and your program director, including the opportunity to rotate there.
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Assuming you exhibit strong performance and impress them through clinical rotations,
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research, and perhaps supporting them on their side projects or initiatives,
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chances are they'll take a strong liking to you. Comparing two candidates,
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they'll favor the one who they know personally and has a proven track record.
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You can still do this with faculty at other programs, too. This is most
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traditionally done through away rotations. In 2020, that's going to be less common,
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but you can still make connections outside the formal rotation setting. For example, say you find
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a faculty's clinical interests from their website and reach out to them to assist with case reports
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or research articles remotely. If you're part of a national organization committee, this is another
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worthwhile opportunity to interact with faculty committee members and build a relationship.
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Beyond that, having faculty in your corner who are willing to bat for your at application time can
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massively influence your outcomes, particularly if you're applying to a smaller specialty where
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most faculty more or less know one another. When you apply, they'll reach out to their
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contacts in residency programs to specifically vouch for you and help you secure an interview.
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These faculty advocates are most impactful when they have significant direct contact with you.
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After all, it's much more meaningful when a faculty member has worked with you closely on
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research for 18 months and can speak to your amazing skills and how any program would be
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lucky to have you. This isn't something you can simply figure out at the last minute.
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Rather, you'll need to begin working on this earlier during medical school.
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A great place to start is simply pursuing research projects or interest groups in your
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particular specialty to find a faculty mentor. You can also ask medical students and residents
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who may offer more insight as to which faculty members would be more receptive and helpful.
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Next, it should be no surprise that being prolific with research can transform your application.
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Looking at the NRMP official match data, you'll find that for many competitive specialties,
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there is a large difference in the total number
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of research items between those who matched and those who didn't.
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Research is attractive because it demonstrates initiative, work ethic,
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curiosity, and the pursuit of knowledge. Perhaps more importantly, it helps programs look good
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when their residents and faculty publish frequently, and it helps them secure funding.
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Standing out in research is often a key differentiating factor.
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I have 65 publications and abstracts primarily in plastic surgery, and at every institution,
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interviewers loved talking about how I was able to be prolific with research at such an
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unusual level. Some even told me they were excited to have a future resident like me
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to help them push through various projects they've been working on.
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Ever since [the video on my personal channel explaining my research
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experience](https://www.youtube.com/watch?v=H9aMenyBdkk), I've had a large number of students asking
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for specifics on how they can do the same. There's a great deal of complexity and nuance to it,
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much more than a single video can encompass, so I'm considering making a course. To gauge interest
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and see if it's worthwhile, drop a comment below if you'd like me to work on a research course.
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Lastly, a highly compelling ERAS application and personal statement can make a huge impact on your
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competitiveness. But this is much easier said than done. Many applicants write a personal statement
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or have other components of their ERAS application that holds them back in some way. Others write an
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application that doesn't hurt or help them much. And only a small minority are able to craft an
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ERAS application and personal statement that truly serves as an asset to improve their chances.
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Your application should make the reader want to meet you, while also highlighting the
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aspects of your application that would make you a great fit at their program.
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Depending on your experiences and the program's priorities, this can be anything from specific
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research interests to advocacy work, and anything between. We have some
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example personal statements on the Med School Insiders website that show a range of essays.
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One was so strong that the applicant was told their essay was the main reason they
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were offered an interview at MGH and a few other elite programs, despite having weaker USMLE scores
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and minimal research. You can sign up at the link in the description to receive your free
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copies of those essays, including commentary explaining the essays' strengths and weaknesses.
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Getting into your dream specialty can be overwhelming - I was there not too long ago.
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But by intelligently approaching your application and prioritizing your energy and efforts based on
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relative yield, you should be able to better position yourself for a successful match.
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Keep in mind your stage in training too. In your preclinical years, focus on optimizing
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for USMLE Step 1 performance and dip your toes into research. In your third and fourth year,
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prioritize clerkship grades, because those matter, and set yourself up for success on Step 2CK.
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If you need help with any step of the process, from USMLE and shelf tutoring
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to optimizing your research to fine tuning your personal statement or interview skills,
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visit us on MedSchoolInsiders.com. Our Insiders are superstars in their respective fields,
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representing almost every specialty, from plastic surgery and neurosurgery to derm, ortho,
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anesthesia, radiology, psych, and much more. When building out our services, we found a common issue
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plaguing other companies in the industry – lack of consistency and expertise. One student may
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get assigned a great advisor or tutor, and the next may get unlucky. That's simply not fair.
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Just as I obsess about my personal systems, we obsessed over creating the best tutoring
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and advising experience for aspiring future doctors. We've shaken things up, innovating
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with systems that offer a consistently elevated and high quality experience,
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with results that speak for themselves. And unlike others, we have the experience and expertise to
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back up our claims. These are the same systems that helped me score in the high 260's on USMLE,
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secure 65 research publications, match into plastic surgery in Southern California,
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while also starting multiple profitable companies. We'll teach you the methods and
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help you achieve your version of success. Visit MedSchoolInsiders.com to learn more.
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If you enjoyed this video, check out my video on securing 65 research items or this video
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comparing medical school and residency. Much love, and I'll see you guys there.