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What causes med students to not match to their first choice discipline?

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After talking to few of my friends in the class ahead of me, I realized that several individuals did not match to their top choice specialty ( in mid competitive specialties) despite having outstanding ECs and some research... what factors play a role into matching to ur first choice specialty? Is it ur knowledge

level during electives? How to improve your chances of matching to ur top choice discipline?

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Can be a lot of things. Limiting your choices geographically, ranking specialty #2 programs ahead of your first choice specialty, doing poorly at the interview or social (especially for very small fields), or red flags on letters. I don’t know that it’s necessarily knowledge; people who are choosing residents are often very concerned about how well they fit into the clinical and educational culture of a program. How well they work, how well they engage with the team. 

Being smart but being an ass is less likely to get you into your preferred specialty than being not-a-superstar who has letters showing they’re a great team member who works hard and can be relied upon. 

all this IMO, of course. I only applied to one specialty. 

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Competitiveness of a specialty is one factor. If there are 80 people applying for 20 optho spots, there's gonna be at least 60 that don't get it. Most of those people likely are competitive so good candidates are just not good enough. 

Laziness or being annoying/rubbing someone the wrong way during elective. Sounds weird but surprisingly more common than one would expect.

Lack of fit in a specialty. Extremely important for small surgical specialties and surgical ones. You gotta have good insight to judge this. Thankfully the ideal fit is different depending on program but if you happen to get a bunch of electives at place you don't fit, you're shit out of luck. Having a mentor tell you which programs they think will be good for you is extremely helpful.

Knowledge is surprisingly not as important. Everyone gunning for a specialty usually knows enough about that specialty. That being said, if your knowledge level is well above your peers out bid you aren't obnoxious about it, it's gonna make you stand out. Teachability is key.

Basically there's a ton of factors that are out of your control. All you can do is work hard, load up the CV and perform on elective. In terms of performances, I personally believe that if you are doing well in rotations you aren't gunning for, it's a sign that you will perform well on elective.

The whole point of carms is to optimize everything you can control and then pray things work out. 

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