Competitive Specialties

Which specialties are considered competitive?

  • dermatology
  • urology
  • neurosurgery
  • plastic surgery
  • orthopedic surgery
  • otolaryngology (ENT)
  • radiation oncology
  • ophthalmology
  • but even less-competitive specialties have competitive programs/locations.

What are the most important factors to consider when choosing a competitive specialty?

  • USMLE Step 1 scores - usually of 240 or higher, but there can be differences between specialties

  • Clerkship grades that are majority of Honors

  • AOA status - preferred, but may not be "required"

Year 1

A strong academic performance in Year 1 of medical school lays the foundation for a strong USMLE Step 1 performance. Take advantage of all resources offered by medical school, your instructors, and administration.

Plan to do research for at least part of your summer between Year 1 and 2. The experience will be a benefit for you no matter what specialty you decide to pursue. For many competitive specialties, programs will use research experience to help separate medical student applicants.  

Explore at least one of the specialties for a few weeks of your summer between Year 1 and 2. This will be the last big chunk of time available to you until Year 3. Use it to your advantage. Contacts made in these specialties may be a source of future research opportunities or a letter of recommendation. These weeks of exploration may also help you with your final decision on your specialty choice.  

Find a clinical mentor in the specialty you are interested in and begin to gather information about the specialty and how you need to prepare.  

Be in contact with Student Affairs. We are here to field your questions, assist in making connections and provide guidance in making decisions.

Year 2

  • Continued strong academic performance to build foundational knowledge in preparation for Step 2
  • Continued contact with your clinical mentor and Student Affairs
  • Continue extracurricular activities

Year 3

Focus on achieving high clerkship grades. Getting Honors in a clerkship requires:

  • Excellent clinical skills, outstanding work ethic, and teamwork
  • Strong preparation for the clerkship shelf exam
  • Going above and beyond the minimum expectations in the syllabus
  • Close communication with the clerkship director and coordinator

Explore specialty interests with Selectives

All year 3 students begin an intensive advising process in mid-Year 3 to prepare for fourth year. Attend the Specialty Advising Workshops held in Jan/Feb of your third year. These will help in planning your fourth year schedule and strategy for away rotations. Plan to make your final specialty decision by April-June of your third year.

Check in with Student Affairs to get the latest information on Match trends for your specialty and contact information for recent graduates.

Year 4

Be in close communication with your clinical advisor and clinical mentor to set up your Year 4 schedule.

Plan a home school sub-internship in your specialty choice early in Year 4.

Timing of USMLE Step 2:

  • Most students should plan to take Step 2 early in year 4. You are most prepared for the content at the end of Year 3.
  • If your Step 1 score was above 250, students can postpone USMLE Step 2 until later in the fall. You won't need it to get interview invitations. Remember, programs must have this exam score well before ranking lists are determined. Time your test so your score is reported no later than January 1. USMLE Step 2 scores usually are reported within three weeks of your test date, but are not guaranteed to be reported in this time.
  • Talk with your clinical advisor and Student Affairs for more information and advising based upon your academic record.

Away electives are required for competitive specialties. Plan two away electives, possibly three, depending upon your competitiveness for your chosen specialty.

Prioritize programs for your away applications.

  • Strength of program
  • Faculty/alumni connections
  • Academic versus community based
  • Geographic considerations:  Students applying to competitive specialties will need to apply nationally. Geographic bias can impact students. Plan at least one away elective outside of the Western region to show programs you are serious about relocation.
  • Make sure you'll have exposure to chief resident or program director at your away
  • Call or email program to make sure you meet with elective screening criteria - usually USMLE Step 1 scores.
  • Be confident in your preparation from UNR Med. Most UNR Med students "shine" and perform very well while on away electives, which is why our Match looks so good each year!

Remain in constant contact with Student Affairs regarding your application strategy, interview preparation, rank order lists and parallel planning. When applying to a competitive specialty, it is imperative that you are aware of your match risk and are open to discussions regarding a parallel plan.

Strategies for Success

  • Metrics aligned with specialty
  • Interview preparation
  • Proactive communication with advisors and Student Affairs
  • High level of professionalism
  • Leadership
  • Open to feedback
  • Seeks out feedback
  • Seeks information and diverse viewpoints