The importance of medical school reputation

A persistent question among premeds is how much does it matter what medical school you go to. Many people, particularly those who attend strong undergraduate institutions and have drank the kool-aid, insist there is a significant advantage of coming from a big name institution. We infer from anecdotal experience on the interview trail that being from Harvard (or equivalent institution) instantly gives you the benefit of the doubt in the eyes of others. We infer from the strength of the medical schools that undergrads from one school get into that there’s must be an effect of school prestige. Similarly, the strength of the match lists from top med schools suggests that there’s an institutional effect.

How do you dissect the effect of the brand name from 1) geographical preference (people from one part of the country tend to stay in that part, particularly as they get older), 2) institutional inbreeding (25-40% of top med school grads match to a hospital affiliated with their med school), 3) individual self-selection (strong students get into top schools and match well, but it could be that they would do just as well at another school), 4) different academic characteristics (perhaps at one school, it is the norm to take more than 4 years to graduate, or a greater percentage of the class has PhDs)?

Here’s a look at some data that address the question.

In a 2006 survey of all residency program directors in the national resident match program, “medical school reputation” was ranked 9th in a list of 14 academic criteria for selecting residents. Reputation was statistically lower than the top six factors, including core clerkship grades, specialty elective grades, letters of recommendation, and step 1 and 2 scores. School reputation was on par with class rank, AOA membership, and other awards, and statistically higher than preclinical grades, research, and publications. (Source: Green et al. Acad Med 2009.)

Thus, it seems the name of the med school is of only modest importance to residency directors in general. However, the survey is a heterogeneous pool of different kinds of program. One could hypothesize that academic residencies care more about pedigree than community programs, or that small and competitive specialties care more about reputation.

To dissect this heterogeneity, I looked at the same study for the rank importance of medical school reputation in different specialties, grouped by competitiveness (% of  all spots filled).

Two interest points emerged. First, the most competitive specialties (plastics, ortho, ENT, optho, radiology, rad-onc, neurosurgery) rated medical school reputation with higher absolute importance (3.38, on a scale of 1-5, average weighted by number of surveys from each field) than the competitive specialties (3.26) and less competitive specialties (3.21). Second, the most competitive specialties rated reputation with lower relative importance (weighted average rank 12.04) than the competitive (11.85) and less competitive specialties (9.73).

I interpret this to mean that for highly competitive specialties, directors are looking to many more factors to differentiate applicants. Reputation is one of them, but is relatively less important than many things like AOA, class rank, and research.

Even though these specialties are generally very competitive, within each specialty there often exist a broad range of competitiveness between different programs. To investigate further whether reputation matters much at the most competitive levels, I looked at a survey of plastic surgery program directors.

Let me justify why I chose plastics as a proxy for ‘most competitive’ programs. Plastic surgery has the highest number applicants per available position offered (1.8) out of any specialty in the NRMP that offers more than 50 positions total. In 2011, of the 168 US seniors who ranked plastics as their top specialty, 55% did not match to a plastics program. This is the highest non-match rate of any specialty. Plastics has the highest USMLE step 1 average (249) of any specialty. A third of US applicants with a 260 step 1 score don’t match in plastics. Plastics matches have the second highest average of research experiences (3.8) and abstracts/presentations/publications (8.1), only slightly behind radiation oncology. Plastics matches have the second highest percentage of AOA members (46%), next to dermatology. Getting at our question of medical school name, plastics matches have the highest percentage coming from a top 40 medical school by NIH funding (53%). (Source: NRMP Charting Outcomes 2011.)

Where does medical school reputation stack up in a list of factors considered by plastics program directors? In the first step in the process, programs cut out roughly a third of all applications they receive without even giving them an in-depth review. The rest are considered for interview. 57% of programs cited ‘graduate of highly regarded US medical school’ as a factor in selecting applicants to interview. This is moderately high, but in comparison, 71% used step 1 scores, 79% considered letters of recommendation in plastics, 75% considered the dean’s letter (which summarizes your course/clerkship performance) in selecting interviews. (Source: NRMP Program Director Survey Results, 2010.)

After the interview, programs rank applicants. In this context, the factor ‘graduate of a highly regarded US medical school’ had an importance of 3.8 (scale of 1-5), which was less than step 1 score (4.1), letters of recommendation in plastics (4.7), plastics clerkship grade (4.1), class rank (4.2), research involvement (3.9), and almost all aspects of the interview (>4.1).

Again, reputation was modestly important but by far not in the group of most important factors.

Another survey of plastics residency directors showed the same pattern. The following chart shows objective/academic factors (green) and subjective/personal factors (orange) that program directors considered important (scale 1-5) for applicant selection. The thick lines demarcates clusters in which the highest ranked factor is not statistically significantly different from the lower ranked factor. The medical school that an applicant attends falls in the second cluster. It is less important than leadership, letters, AOA, step 1 score, and interest in academics, but it is on par with class rank, research experience, and extracurriculars. Depending on the way you look at it, the medical school you’re from is only as important, or even as important, as your overall appearance (i.e. how good you look on interview day). (Source: LaGrasso et al. Plast Reconstr Surg. 2008)

So the surveys show that program directors value the applicant’s medical school name only moderately. What do the match data show?

I took the latest integrated plastics match list and looked at eleven top programs (roughly top 10) and where the med students came from:

UCSF: Columbia, Stanford, Stony Brook
Johns Hopkins/UMD: Harvard, Maryland, Southern Illinois
Harvard: Penn, UChicago, Kentucky
NYU: Vanderbilt, NYU, VCU
UTSW: Vanderbilt, Dartmouth, GW, Hawaii
Wash U: Harvard, Vanderbilt, USF
Northwestern: Penn, Stony Brook
Pittsburgh: Duke, Pitt, Pitt
Baylor: Baylor, UT Houston, Mizzou
U Michigan: WashU, Michigan, Florida
Stanford:  Stanford, NYU, Wisconsin-Madison

In general, at least one out of three matched applicants at these programs came from a school that’s not in the top 25 research schools. I think these data show that match success at the most competitive levels does not have a tight correspondence with medical school reputation. In fact, matching well from a lesser-known school is a common occurrence.

Advertisements

7 thoughts on “The importance of medical school reputation

  1. there are also a lot more applicants from non top 10 schools. It would be interesting to see if the proportion of applicants from elite schools who match into very competitive specialties is higher than those from less heralded medical schools.

    • 1) Is the proportion of students at a top 10 school matching into a very competitive specialty higher than the proportion of students at, say, a bottom 60 school who match into one of those specialties? The answer is definitely yes. Even a superficial inspection of match lists should demonstrate this (http://forums.studentdoctor.net/showthread.php?t=897848).
      2) In the most competitive specialties, are there more graduates of top 10 schools than non-top 10 schools? That’s an interesting question. My guess is no. Even looking at the smallest of specialties, like plastics, across all 100 or so available spots, most are from schools not in the top 20 (http://206.82.221.135/showpost.php?p=12344375&postcount=172).

  2. Could you please link to the Green et al. Acad Med 2009 study? I can’t seem to find it when I search…. I only come up with the editorials on it. Thanks!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s