Tag: applicant

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A Common Radiology Applicant USMLE Step I Misconception

Ask The Residency Director Step I USMLE Question:

Good evening. My name is Susana, a 3rd-year medical student, very interested in your radiology residency program. I would like to know, if possible, what is the average Step I USMLE score of your PGY1, to know if mine qualifies for your program? Thank you.

Susana

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Answer To The USMLE Step I Question:

Thanks for the great question! It’s a common misconception about how USMLE Step I board scores are used to rank applicants in the match. The board scores are generally not about the average score, but rather the minimum cutoff. The point of using the board scores to help with the match ranking process is to make sure that the candidate can pass the written core exam taken at the end of the third year. And, that is really the only role of the board scores. Most programs such as ours take into much stronger consideration the Dean’s Letter, interviews, and extracurriculars once the applicant has met that specific cutoff.

At our institution we use a cutoff of 220 for the USMLE Step I. However, we have made multiple exceptions over time. First of all, if you perform poorly on the Step I Boards but do well on the Step II Boards, we will often ignore the Step I board scores or average out the two boards scores. Again, the point of the boards for us is the correlation with passing the core examination. A good step II score proves you can pass the boards. Also, if there are exceptional candidates that have other special activities, have had extenuating circumstances for not doing well on the boards, or have proven themselves already by completing a rotation with us, we will on occasion forgo using the cutoff. As an answer to your specific question, if I was to take the average USMLE Step I score over the past few years, it would probably be somewhere in the 230-240 range. But, again I think the average number is irrelevant.

Hope that answer helps!!! Again, thanks for the great question!

Yours truly,

Director1

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Radiology Personal Statement Mythbusters- Five Common Misconceptions About Radiologists

Since I started work on my radiology program’s admissions committee in 2009, every year, I notice a significant disconnect between the medical student impression of what radiologists do and the actual day to day work of the radiologist. The radiology personal statement is a shining example of this truth. In this post, I will debunk many of the myths espoused in the personal statement about what we do daily (Just like the real Mythbusters– this is going to be fun!!!). Let us begin…

Where’s Waldo?

Out of the thousands of personal statements I have reviewed, many use the Where’s Waldo analogy in one form or another. If I see another personal essay with a resemblance to Where’s Waldo?, I will scream very loudly!!! All kidding aside (I’m not kidding!): The Where’s Waldo analogy is one part of the radiology job that is not understood by many applicants.

So, what is it that a radiologist does? First and foremost- we read films and lots of them. Film reading heavily leans upon pattern recognition. And that is what we do. We use search patterns and compare our visual databank to the thousands upon thousands of images, we have already seen.

How does that differ from Where’s Waldo? In Where’s Waldo, the scenes typically change on each page, and you are expecting to find the same Waldo character in a sea of miscellaneous extraneous information. For the radiologist, the scene is usually the same, whether it is a chest x-ray or a CT scan or even a Brain MRI. And, the findings can vary widely in any given film. You may find a pneumothorax or a herniated bowel loop or an infarct. However, you are not looking for one specific thing. You are looking for everything. This general search for everything is very different from finding one Waldo, who is always going to have the same appearance. The analogy does not hold very well!

The One Fascinating Case

A personal statement will often talk about one fascinating case and how that led the applicant to the decision of choosing radiology as a career (I am sick of this conclusion!). Why does this point demonstrate so little insight into the day to day practice of radiology? Sure, every once in a while, something is fascinating- perhaps it is a bezoar or a sporadic tumor. And, sure, it is excellent to perseverate on that case. But in reality, although exciting, these cases take up less than .01 percent of the radiologist’s work. You have to expect to pick up thousands of normals, normal variants, and common findings before picking up one of these rare zebras. When I hear that an applicant is choosing radiology for the one fascinating case, it does not show a good understanding of our day to day work!

The Family Member Saved By A Radiology Finding

Sure, every once in a while, the radiologist is the hero. We discover an occult aneurysm, unexpected appendicitis, or early breast cancer. Maybe the radiologist has picked something up in your relative to save the day and has been credited. But in reality, how often does that occur? Not that often! In reality, it is pretty darn unusual. If you want to save lives daily and get the credit, go into trauma surgery!!!

In general, radiologists have to be pretty humble because rarely are we showcased as an example of the medical profession for all to see. Usually, the doctors on display are the surgeons, internists, ob/gynecologists, or almost every other medical specialty. Don’t go into radiology to expect the glory of saving patients. We are usually behind the scenes!!!

The Diagnostic Dilemma

Many personal statements will describe when a radiologist went through a case and came up with an incredible on-target well thought out differential diagnosis. And, the applicant will point out that they want to go into radiology to make incredible interpretations. In reality, I also love a well thought out differential diagnosis in a compelling case. Unfortunately, most studies are not in the category of the intriguing differential diagnosis. Final interpretations are usually mundane and limited. Don’t expect to go into radiology to become the next House, MD, every hour of every day!

The Isolated Radiologist

What is the last thing that we want to hear as radiologists? That we spend an excessive amount of time in an isolated dark room, not speaking to others for hours. Yet, many personal statements assume that we rarely come in contact with others and only plug away at the films. Although there are probably a few radiologists out there like that, it is usually the opposite. I can’t tell you how many days, there is a constant bombardment with technologist questions, physician consults, nursing issues, and more. Please get your facts straight before putting it in writing a personal statement!!!

Busting Myths And The Final Truth About The Personal Statement

The good news: After all these false assumptions in many of these personal statements and the thousands of personal essays that have come across my desk, very rarely does one spur me to change a radiology residency applicant’s disposition on the final rank list. I usually give these personal statements a pass because I understand it isn’t easy to comprehend what a radiologist does without stepping in our shoes.

On the other hand, if I had to give you one piece of advice as one of the leading players in the application process at our institution, make sure you are not one of the chosen few who write a personal statement that influences our final decision. These are the personal statements with bizarre and sometimes scary thought processes and conclusions. The outcome of these weird personal statements is not usually positive! (meaning DO NOT RANK) So, stay away from the impulse to write something too unusual/different. We typically use the personal statement to weed out potentially psychotic behavior, not as a tool to make the final rank list.

So, as long as you don’t write something overly bizarre, I wouldn’t worry about this part of the application too much. Just make sure to avoid the basic grammatical and spelling errors. And, most importantly, don’t try to rock the boat!!!

 

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The Post Interview Second Look – Is It Worth My Time?

second look

Every year after interview season ends, there is a brief interlude until the rank selection list is submitted. And now, during the life and times of covid, it may be more challenging to arrange a second look. However, with vaccines available to health care team members, students, and attendings alike, you may be able to schedule one. 

So, you may wonder at this time- Does it make sense to go back to a radiology program to take a second look? It may be a complicated decision and can depend on numerous factors. Therefore, I am going to take a look at this issue from a program director’s perspective. We will approach the problem by tackling a series of questions that will help you make this critical decision. Hopefully, it will be of some benefit to those of you that are involved in this process.

Who Is Most Likely To Benefit From a Second Look?

From a residency director’s perspective, the ideal candidate for a second look at a residency program is a student that has already interviewed, for which the admissions committee was unsure of its final disposition. For example, every once in a while, an application/prospective resident interview causes a stir among the committee. The interview may have gone well, but the application quality didn’t sync with the interview. Or, the application was excellent, but the applicant’s personality was questionable on interview day. Usually, it is some conflict in the committee evaluation process. These applicants can benefit the most from a second look because it may sway the admissions committee one way or another after the candidate returns.

Second, the marginal/below average candidate that has been ranked but did not have many interviews would also be an ideal candidate to return for a second look. Some programs will rank their returning applicants slightly higher for just showing interest by returning to the program. Usually, candidates don’t return unless they are earnest about a program. A slight increase in the rank list can make the difference between matching and not matching.

Finally, the other ideal candidate would be the interviewee who felt he/she didn’t get the best impression of a program and wants to make a more informed decision on the day he/she will submit the rank list. Maybe the program director was absent. Perhaps you have a spouse that wants to remain in the area, and you didn’t get the best impression on the interview, but the location would be ideal. Or, maybe you like the people you met, but you felt you didn’t meet the residency program’s key players on the day you interviewed. Whatever the case may be, the second look can help to reinforce that decision.

How Do You Know You Should Come For a Second Look?

Let’s first begin by stating: The worst situation for the residency applicant and the program is to have an applicant that has already been placed into the “Do Not Rank” pile return for a second look. It wastes the applicant’s time and money and the resources of the program director and staff. Also, it may not make sense for the individual applicant to return depending upon other applicant factors. So, here are some criteria that may help you to decide if you are in either of these situations:

  1. Did the interviewer suggest you come back for a second look? The program director will usually recommend to return for a second look if he/she is potentially interested in a candidate and think it may be of some benefit.
  2. Did you get the cold shoulder during the interview process? Some interviews don’t go well for multiple reasons. That will happen from time to time. Your instinct is probably correct if you feel that is the case. In this situation, it is perhaps not worthwhile to return for the second look.
  3. How far down is the program on your rank list? If the program is very low on the order of your rank list and you are a reliable candidate, it is probably not worth the effort to return for the second look.
  4. Is it reasonable to travel to the interview site? Some candidates live very far away from the prospective residency program. Suppose it will be disruptive to return to the program due to travel costs or significant inconvenience (maybe you are amid your medicine sub-internship and can’t miss a few days). In that case, it is probably not worth your effort.

 

How Should You Behave/Present Yourself On The Day Of The Second Look?

The program director or interviewer that asks you to return for a second look will often tell the candidate, “we would love to have you return for an informal second look.” It is important to remember that there is no such thing as an “informal” second look. A second look is a second interview day, and you need to treat it as such. Wear your best interview clothes as you would have worn for your first interview. Be on your best behavior and be friendly to all staff members, just as you would have done for the initial interview. Remember, you still have not been admitted to the program, and you are certainly not yet “one of the residents.”

What Should You Tell The Program Director Before You Leave?

Certain buzz words have significance to the program director when meeting at the end of the second look day. The program directors and admissions committees take these words very seriously. So, be careful what you say. If you say the wrong thing, it may cause a different result than intended.

If you are genuinely interested in the program, you can say, “I will rank the program first.” This phrase is specific and demonstrates your genuine intention to the interviewers. The program can verify this fact on match day when you either match the program or do not match it. So, your action will back up the facts. This truth will follow you from this point forward. If you ever decide you want to return to the community as an attending and you did not abide by your word, the program can blacklist you!!!

On the other hand, the phrase “I will rank your program highly” is a buzzword that means your program is nowhere near their first choice, and you will probably match elsewhere. Some applicants do not realize this. So, be careful!

If you are still not sure after the interview day, it is appropriate to say, “I really enjoyed my second look at the program, but I am still considering my decisions.” The program director/interviewer will usually understand. When/if you decide to rank the program first, you can always contact the program and let them know.

Final Thoughts About The Second Look

The second look can be an essential part of the residency interview process. It can provide a slight edge to your candidacy and may be worthwhile if approached the right way. On the other hand, it may not be the right move for all applicants. So, weigh the facts and make a final decision. The interview process will be over before you know it!!!