Away-electives etc.

[piggaloo]

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Dear all,

I'm a third-year medical student who wants to go into academic neurology. I've been reading posts on this forum for the past two days, hoping someone had already asked, and some other person had already answered, the kind of question I'm about to ask, but I've failed to find a thread that just fits the bill. I realize no one here has a crystal ball, but I've read so many insightful posts on so many salient questions that I thought I might at least ask for an educated guess regarding my particular question(s).

I'm an MD/PhD student. I did my PhD in neuroscience and was trained primarily as a protein biochemist during my time in the lab. I have a modest number of first-author papers, some in better journals than others. (Journal of Biological Chemistry, Nature Medicine, and PNAS are my best.) I graduated undergrad from an Ivy League school with an overall GPA of 3.96 and a science GPA of 4.00. I scored 235 on my Step 1. With the exception of a likely A in neurology (this particular grade won't be final until the end of the year), I've only made B's so far in all my third-year clerkships. (I still have pediatrics and family medicine left.) Based on everything I've heard, I'm sure the PhD will help my chances of getting into a decent academic program, but in the end none of this is truly spectacular, with or without a PhD. Who knows? Maybe it's not even good enough to get me an interview at some of the places I've been reading about, like Partners and Columbia.

Be that as it may, I'd be happy if that were all I had to worry about. Due to medical reasons that have since resolved (i.e. have been under better control), I also failed two MS1 courses (anatomy and genetics) and had to repeat part of my first year as a result. My condition has remained stable over the past 6-7 years, but its toll on my GPA has been heavy. It probably also makes me a potential risk, a likely problem resident, in the eyes of most program directors. So not only have my third-year grades been generally mediocre, but I also have two whopping F's on my transcript. (Some of you might say, who the hell cares what your undergrad GPA was. I only included that information to illustrate that I'm not altogether incapable of scholastic achievement, which may seem a distinct possibility to anyone who looks at my academic record in medical school.)

Given this history, I've decided that my only chance of getting into a good program is to do an away elective there in my fourth year. For family and personal reasons, I want to do my residency in the Northeast. Moreover, I'd really like to end up in one of those fabled top programs since I'm interested in a basic science type academic career. However, even with a stellar externship, I'm not sure I have the remotest chance of being offered an interview at some of these places.

The front end of my fourth-year schedule looks like this: stroke elective in July, medicine sub-I in August, FM in September (deferred from third year), and a month off in October to take both components of Step 2. This leaves me with November to do an away elective.

Questions:

1. Does this schedule make any sense? I plan on asking for letters from my attendings in my stroke and sub-I months and submitting my application by October 1. Is that too late to get interviews at competitive programs? Should I really shoot for early September to submit my application?

2. Is November too late for an externship at my top choice program? I'd be doing it not so much for a letter to send to other proprams, but to increase my chances of being offered an interview at my top choice.

3. With my history in mind, is it worth spending the time and resources on an externship at Harvard? How about Columbia? Or Cornell? If my goal is to tip the scales in my favor for an interview, where would I get the most bang for my buck? Even with a great away rotation at Harvard, is Partners totally out of my reach? Columbia? Cornell? UPENN? Since there is no guarantee that I will shine like a star on this rotation, is it worth taking the risk?

I'd greatly appreciate your opinions.

 

[typhoonegator]

Good questions. A couple thoughts:

1. Can you switch the Family Med clerkship to later in the year and do your away rotation earlier? November isn't too late to do an away rotation, but movement up or down the program's rank list may be a bit more restricted at that time. You have some good numbers, but given the few "black marks" on your record, a well-executed away rotation will be very helpful at washing away the concerns of program directors. In fact, it is probably more important than step2 for you, since your step1 score is decent. So you could also consider doing an away rotation during that block of time you set aside for step2 studying. Personally, I took step 2 long after my applications were submitted and interviews done, and then updated programs individually of my scores later.
2. I personally can't speak to the submission time since I did this whole thing a few years ago when neuro was still an early match. I would say that earlier submission of your application gives you more time to plan your interviews so you can consolidate trips to certain areas, etc.
3. Dude, you never know unless you try. From what you have provided, you seem to be fairly competitive. Speak candidly about your failed classes in M1 year in your application and interviews. Play up your interest in academic research work. Do an away rotation at the program(s) of your choice and work your ass off. The residents at the programs you mention aren't all super-geniuses with perfect board scores and first-author publications in Nature (although some are). Don't sell yourself short. You never know what might happen...

 

[ChildNeuro]

Hi, I would estimate that you have a good shot at the top spots in the northeast i.e. Harvard, Columbia. I would recommend that in addition to the top spots that you also apply to whatever you consider to be your backup programs. I would say that your good showing on Step 1 erases any doubt about having a good foundation in basic sciences, and that you have recovered from whatever problem(s) you had in the basic science years. Right now just focus on what you can still change about your application, and have a good time doing electives during the fourth year. I would say that away electives would be helpful for your neurology residency application because then PDs can see for themselves that you are back on track and doing well in medical school.

I would heavily invest some time in researching the various research opportunities available at the neurology programs that you want to go to. It is easy for any student to want to go to Partners, Columbia, but if you ask them why, they may come up short other than saying that they are "prestigious". So, to set yourself apart, do your research to a certain school and really know why you want to go to Harvard versus middle of the road neurology residency. If I was a PD I would want someone like you who said that they are interested in working with Dr. Z during residency to investigate such and such neurological problem, than someone who just spouts generics about wanting the best neurology training that is why Harvard is for me. You should focus on networking, and learning more about life at the different residency programs.

Also, study hard for Step 2 and do well, this is one part of your application that you can still have some input about. Don't stress out about getting into Partners, Columbia or not, even if you go to a so-called middle-tiered residency program, if you do well there you could get a fellowship at Harvard or Columbia. If asked about what happened during the first two years in basic science I would tell them about the struggles you encountered, and how you prevailed and how you learned from your situation so it will not happen again. I would say that your research background i.e. MD/PhD will make you shine and that you have at least 50/50 chance of Columbia, UPenn, Partners, even at the top programs not everyone is doing academic neurology post-residency, although it is near 80% at some top programs, so this should be to your advantage. Don't get overly stressed out though, in the end you will get a neurology residency, and maybe quit happpy at a place that you did not initially consider your top choice.

 

[ChildNeuro]

1. I would definitely submit my application as early as possible. I think that you can submit your ERAS as early as September 1??? I am not quite uptodate on this. If you can get it the main electronic application finished and completed, the submit that by the earliest date, and then get your LORs in as fast as is reasonably possible, I think that at the end of October the Dean's letter is uploaded to the ERAS. I would definitely plan to do as well as possible on the Medicine SubI as possible, i.e. ask students who honored it how they did it, there are often hidden extras that you need to being doing that you don't know about until it is too late and you've been spending your time doing other things like patient care or reading instead of volunteering to do a presentation etc . . . If you could maybe move your Family Medicine rotation to Spring, say February when all your application is done you might want to consider doing this to do an extra away-elective. I honestly don't know though how it would look if you haven't completed one of your core rotations before the match, but I don't think it would hurt at all.

2. November is not too late as programs directors haven't made the rank lists yet, so I would guess that if you do an excellent job, and network well, then they might feel comfortable working with you.

3. I would do a away at Harvard, it is not as big a risk as you think as fourth year electives are better as you will be treated much better and it is now assumed that you want to be there because you signed up for the away elective. I would study well for the elective ahead of time, get the right books, and work very hard. Be a fun person to work with, as all else being equal that is what PDs care most about IMHO.

 

[Methyldopa]

away rotations can be a double edged sword. A former classmate did one; the program hate him so much that they didn't rank and even ended up with an unmatched spot (He didn't match either).

It all boils down to how good you are as a student and how much you're liked. You might end being matched up with someone completely different than you. And that might not work out too well.