"Second look" visits

Sometimes you do get a second chance to make a great first impression. A "second look" visit to a residency program can be an amazing way to show just how interested you are. During a second visit, you will be more relaxed and comfortable, and the people you meet will sense that. Typically, it's a chance for the original interviewers to get to know you better in a less stressful setting. Sometimes other faculty members will be there who weren't available during your first interview. At some programs, you might even be able to join a team during rounds.

Not everyone gets invited for a second look; it's a sign that the program director liked you a lot. Remember that the interview process isn't just about you asking for a job; it's about the program trying to convince the right residents to match there. Adding an applicant to a rank list is taken seriously; it's a multi-year commitment, and the program director wants to find residents who will be great long-term additions to the team, both on and off the wards. Although a second interview visit is an added expense, you ought to think of it as an investment in your future, and accept all offers. Remember that even if you aren't invited for a second look, you can also ask to return for a second visit.

Even if you've only interviewed at one or two residency programs in total this year, the residency director doesn't need to know that. Remember, as much as you want to match anywhere, the interviewers will assume that you're evaluating multiple programs, and will try to convince you to rank that program first.

Second look visits are often a good time to ask residents about lifestyle issues (how good/bad is it really), official work hours versus unofficial expectations, would they choose this program all over again if they had the chance, what aspects of the program are their favorites, and all sorts of questions like that. You should ask where people live, how often they hang out outside of work, what kind of things they do in the area, etc. You can also ask about things like maternity leave policies, but that allows the program director to use that information when ranking you, so be very careful. Sometimes asking questions like "Do you have any relatives nearby" will let people tell stories about their own spouses and kids without you sharing information that you legally can't be asked about.

One of my clients was recently invited for a second look visit on a date when she already had a first interview scheduled somewhere else. I'll tell you the same thing that I told her: although second look visits are important, if you need to choose, you should keep your appointment for a first interview. Most of you can't afford to skip any first interviews; you want to visit as many programs as possible to increase your chances of matching. Plus, what reason would you give for rescheduling that first interview? Instead, you should see if there are any other dates available for that second look visit. You can honestly tell the program director that you want to honor the commitment you already made to another program (although you don't need to share specifically where else you are interviewing), but that coming back for a second visit is also a priority for you.

Good luck! Please contact me if I can provide any more information.

Your online identity

What does your Facebook profile tell the residency directors about you, and is it helping you or hurting you? What types of quotes, photos, and "likes" are on your page? Do you start the day by posting how much you had to drink the night before? Are your posts full of profanity, or do you constantly complain about your boss? Is there a photo of you smoking tobacco from a hookah that could be misinterpreted as smoking marijuana from a bong? These could all stop you from getting invited for an interview, and even if you do get invited, do you really want to waste time during the interview giving excuses about your online profile rather than talking about what a great resident you would be?

Let's say that a typical residency director gets 1000 applications, schedules 100 interviews, and can only match 10 people at that program. These people are looking for an excuse to narrow that list, either by not granting you an interview at all, or deciding not to put you on their NRMP rank lists after they interview you. Searching for information about you online happens more frequently than you think! There are many qualified applicants out there who have professional-looking online profiles, and they could very easily move ahead of you in the applicant pool. Don't get rejected because you insist that your Facebook page is a place to "be yourself." You're a doctor, and it's time to be professional. Take down the worst photos, and clean up your online presence. Privacy settings are not enough, especially since Facebook seems to change its format and settings every few months.

This is also a great time to create a professional profile for yourself. There are many sites out there, but I'll mention LinkedIn specifically since I've heard that some residency search committees search it. You've already done all of the work creating your Common Application Form in ERAS; why not create a professional resume on LinkedIn using the same descriptions from the CAF that you spent so much time editing? Give the residency directors something positive to find about you online.

Right now, residency directors are continuing to review the huge numbers of applications that they have received. After you get interviewed, the residency search committees will continue to seek out more information about you before making final rank list decisions. Yes, they will contact your letter writers, but it's very easy to go online to search for more information. Although residency directors have invited some applicants, they're still deciding what to do about the rest of you. Your MSPEs (formerly known as the "dean's letters") will be released on November 1, and many residency directors don't make final interview decisions until they read what your medical school dean has to say about you. There's still time to clean up your online profile, which will hopefully lead to more interviews and might enhance your chance of matching. What are you waiting for?

Spelling and grammar in ERAS

Spelling mistakes and grammatical errors can ruin your residency application. Even if you have great USMLE scores, strong letters of recommendation, and lots of U.S. clinical experience, the residency directors will read your personal statement and Common Application Form to learn what kind of person you are. If they see that you didn't take the time to spellcheck everything in ERAS, or if you use poor grammar in your personal statement, the residency directors might think that you're lazy or sloppy. Would you hire a lazy or sloppy doctor?

This is a professional application for the most important step of your medical training so far. This is not Twitter; this is not Facebook; this is not a text message. Proper capitalization, spelling, punctuation, and grammar are extremely important from now through Match Day. That includes everything you send through ERAS, as well as all email correspondence and thank-you notes.

This is also true for your letters of recommendation. Sometimes your advisors and mentors will ask you to prepare a rough draft. Do you know what should be included in a letter of recommendation, and what should not be there? Are you able to write a proper and professional LOR? I can help you with that too.

If English is not your first language, or even if you've been speaking English your entire life but were too busy learning medicine to focus on the rules of grammar, you need to have your entire application reviewed. I am happy to offer you a free consultation; send me your CAF and personal statement, and I will share my preliminary thoughts with you at no charge.

July 15 is not the new ERAS deadline

If you log into ERAS this week, you will see a MyERAS Alert on the main page:

Applicants will not be able to certify their applications until July 15, 2011 when programs have the ability to download applications. Please use this time to begin the application process, and fill out the information requested within the MyERAS application.

What does it mean? The July 15 date only applies to people applying for fellowships, as well as to people applying to osteopathic programs. The vast majority of you don't need to be concerned about it; you'll still be applying to residency programs on or after September 1.

Personally, I think that the ERAS alert should have been phrased more clearly. There are actually a number of confusing things about ERAS, and it's always best to ask for help and advice. Please feel free to email me with your questions.

UPDATE: I originally posted this on July 4; since then, ERAS has updated the alert to make it a little clearer (new text in red):

Applicants will not be able to certify their applications until July 15, 2011 when July cycle programs have the ability to download applications. Please use this time to begin the application process, and fill out the information requested within the MyERAS application.

Choices

Everyone wants the strongest residency application, but it's often hard to tell what a program director is looking for. People often ask me to help them choose between two options for a variety of topics, and here are some of my thoughts that might help you. While there are certainly exceptions for specific situations, I strongly believe that the vast majority of you will benefit from this advice when applying to American residency programs:

• Participating in a hands-on externship is better than shadowing during an observership.
• A letter of recommendation from an externship is better than a letter from medical school.
• Recent clinical experience is very valuable! You will enhance your knowledge base and clinical skills during an externship, and that will show in your letters of recommendation.
• A letter of recommendation from your fourth year of medical school is better than a letter from your third year.
• The skills and confidence you develop during your fourth year will be reflected in your letters.
• United States clinical experience is better than international experience.
• Applying in mid-September with a complete application is better than applying on September 1 with an incomplete application.
• I really want to emphasize this point. Far too many people rush to send out their applications on September 1. If your application has spelling and grammatical mistakes, is missing key information, or is otherwise incomplete, you have wasted your chance and you have failed to impress the program director. Take the time to have your application reviewed by a professional.
• Describing your work, volunteer, and research experience in ERAS should be done using full sentences, not the bullet points that you would find on a regular CV.
• Explaining your non-medical experiences in ERAS is better than having large chronological gaps on your application.
• Leadership of an organization (such as a student club) is better than casual membership in that group.
• Primary care specialties (internal medicine, family medicine, pediatrics) are more receptive to applications from international graduates than non-primary care specialties are.
• Making presentations and/or publications of your research is better than participating in a research project with nothing to show for it.
• Honesty is always, always, always better than lying on your application.

Also, as you probably know, ERAS opens on July 1 to start the residency application season. If you'd like a free assessment of your residency application, I'd be happy to review what you've already prepared, such as your CV and a draft of your personal statement. I have been advising and supporting residency applicants like you for over ten years.

I didn't match! What should I do now?

Unfortunately, not every applicant matches into a residency program. As bad as this year's situation was with the delayed list of open programs on Scramble Day, you can't just blame the NRMP. And maybe some program directors gave you false hope during your interviews, but they never actually promised you a residency position. Think back. Did you get as many residency interviews as you had hoped for? Now is the time to assess your application and determine how to make it stronger to get those interviews you want:

1. What specialties did you apply in last time? Did you pin all of your hopes on a competitive specialty like orthopedic surgery? Or did you remember to apply in primary care fields like family and internal medicine, which often have more vacancies and are looking for qualified applicants?
2. Where did you apply last time? Did you focus your search on states like California and New York, perhaps because that's where you and your family live? Or did you apply to places like Idaho and Nebraska to increase your chances of getting interviewed, since programs there don't always fill during the Match?
3. What have you done since graduating? Have you been relying on the knowledge base and procedural skills you learned in medical school? Or have you continued to grow as a doctor through externships, medical volunteering, and relevant research?

If you're planning to apply to residency programs again in the fall, you must seriously consider what you can do over the next few months to become a stronger applicant:

1. A hands-on externship is much more impressive than a simple observership. Admittedly, these opportunities can be hard to find. But if you're serious about improving your application, talk to the doctors in your community to find out about available externship opportunities. There are even companies you can pay to place you into an externship. While it's an expensive option, the knowledge you acquire and skills you practice during that externship will be extremely valuable, should lead to a strong letter of recommendation, and will be prized by the residency directors.
2. If you graduated from a foreign medical school, and you performed poorly on USMLE Step 1 or Step 2, you should consider taking Step 3 now. Remember that taking the exam is not enough; you need to have your passing score available before you submit your applications to residency programs. Applying with the phrase "awaiting results" in your ERAS Common Application Form is not going to help you; there are plenty of people who have already passed Step 3, and why should a program director look at your incomplete application? Of course, you want to do better than simply passing Step 3; you want to get a great score, so you should strongly consider paying a professional test prep organization to help you study. Additionally, your externship will be a great way to prepare, since there's nothing like real-life experience.
3. Did you have someone help you with your residency application? A well-written personal statement and detailed Common Application Form can make a huge difference when residency directors are deciding who to invite for an interview. I am happy to provide a free consultation, assessing your old residency application and suggesting some things you can do to improve it. I have over ten years' experience advising and supporting residency applicants like you.

How the residency Scramble works

March 15, 2011 at noon (Eastern time) is the first time you will be able to access the dynamic list of Scramble programs with open positions. (it's a dynamic list because as programs fill, the NRMP is supposed to take them off the list - roughly once per hour the list will be cut down, but they don't add new programs) These are only available as PDFs, so you will need Adobe Reader or a similar program to view them.

You and your advisor (having an advisor help you is crucial!) should log into the NRMP website, look through the list of programs, and decide who to contact first. For example, maybe your advisor was a classmate of a program director and chooses to call her first on your behalf. And you might decide that there's no way you would work in Kansas or Nebraska, so you cross those programs off the list. But basically you'll start by reviewing the programs and deciding who to call. This is a long process. It's hard to get through to a program director so you (or your advisor) will be leaving a lot of messages.

If you two do get someone on the phone, there's no single "right" way to proceed. Often the advisor will speak on your behalf, briefly advocating for you, describing your skills and why you'd be a great candidate. Then hopefully you'd be able to have a short phone interview with the program director, who would encourage you to send your application via ERAS. But maybe a program coordinator will answer the phone and say that a Scramble spot has already been filled (some open positions are filled almost instantly, even though the NRMP would still show it as being open until the database was finally updated). Or you might simply be told that the program will not take any international graduates during the Scramble, and you'll never be able to get on the phone to plead your case. Or they might not want to speak to your advisor at all and only want to talk to you. In the end, you'll follow up by transmitting your official application.

According to the program directors I've spoken to over the years, they really want to get your application via ERAS, not by fax or email. That means that paying a company to fax your application is usually a waste of money. But of course you should do whatever you think is best. You will be able to apply to a maximum of forty-five new programs through ERAS (specifically 30 on the first day of the Scramble, 10 on the second day, and 5 on the third day). You cannot pay ERAS to apply to more programs.

But since ERAS limits how many new programs you can send an application to, many people do not send out their applications through ERAS during the Scramble before talking to program directors or program coordinators. If there are more than forty-five open positions in Internal Medicine, you don't want to waste one of your applications by applying somewhere that's already full or a place that doesn't want an international graduate. Forming a personal connection first is crucial. The hope is that the mini phone interview will help them get to know you and want to know more about you by reading your entire application. Remember that during the phone conversation, they basically know nothing about you, so that's why your advisor introduces you, and then you briefly describe yourself and your strengths.

While it's true that some Scramble applicants will get match offers quickly, many others will send out their applications through ERAS and then wait to hear back. Since the program directors don't need to fill the positions blindly, some do take the time to read every page of every new application and then decide who should visit for an interview. Interviews sometimes occur throughout the spring before someone is offered a residency contract.

I wish you the best of luck during the Scramble. If you have trouble matching and need to reapply next year, please let me know if I can help.

Preparing for the NRMP Residency Match

Every year, the residency application and interview process culminates in the Match. Though you used ERAS to transmit your application materials to residency programs, the NRMP is the organization that administers the Match. In this process, you prepare a list of the programs you interviewed at, putting them in the precise order that you would prefer to go to them for residency training. Here are a few points that explain this confusing process:

1) You should rank every single program you interviewed at, unless you would rather be unmatched than go to a specific program.

2) You should rank the programs in the order that you hope to match to each one. The NRMP algorithm is skewed in the applicant's favor; it will not hurt you to list your favorite program first, even if you think you have no chance of matching there.

3) The rank list you certify with the NRMP is a legally binding commitment. If you match to a program on your list, that's where you will be going.

4) The deadline for certifying your rank list with the NRMP is 9:00 PM Eastern time on February 23, 2011. However, I strongly suggest that you certify your list well in advance of that deadline. I've heard horror stories in the past about power failures and bad Internet connections, and if you don't meet that deadline there is nothing that anyone can do for you.

Additionally, it can be difficult to decide what criteria to use when ranking these programs. Here is an incomplete list of factors to consider when preparing your rank order list:

• salary and benefit options
• geographical location (which part of the United States, as well as urban versus rural areas)
• population dynamics of the community
• the program's accreditation standing
• the PGY-3 pass rate
• support for professional development (such as attending conferences)
• the program's academic strengths
• long-term connections with that program (do you see yourself doing a fellowship there? how many residents become attendings?)
• opposed/unopposed programs
• the number of rotations done away from the hospital (which might separate you from your family for lengths of time)
• the program's individual values
• your prior contacts within the program (such as medical school alumni)
• how this move would affect your family

Of course, you need to decide how important each factor is for you. Some might not be important at all, and there might be other considerations specific to your situation that aren't listed here.

I wish you the best of luck during the Match! Please contact me if you don't match successfully, and I will give you a free consultation to help you prepare for next year.

Join a committee

One great way to strengthen your candidacy for residency is to join a medical school committee. Typically, there are a variety of committees chaired by a dean or faculty member that meet regularly to discuss campus issues, such as ways to improve the curriculum, improve student life, adjudicate legal matters, or prepare for an upcoming re-accreditation process.

There are strong potential benefits to joining a campus committee. You'll learn a lot about how your medical school works, making you better informed and more well-rounded during your interviews. Also, many residency directors assess both the short-term and long-term benefits of your ERAS application. Short term, of course they want to know that you have the knowledge base and patient skills to be a great resident. But long-term, they might hope that you would stay at the hospital after your training and help guide the next version of the residency curriculum. Your committee experience could be an important factor in the residency director's decision.

Committee involvement could help your application in other ways. Your dean would include it in your MSPE, hopefully praising you for your dedication to the medical school community. Additionally, the chair of the committee could be the source of a strong letter of recommendation, especially if you two also worked together in a clinical or research capacity.

However, your academic transcript and USMLE scores need to be a priority! Don't join a committee if you can't balance your life. Many student committee members join in the pre-clerkship years, and leave when they start clinical rotations, and that might be the right plan for you too. There are also certain committees that would greatly benefit from the perspective of a third-year or fourth-year student. So if you're interested in getting more involved, talk to your dean at any time about opportunities.

I'm here to help you

Are you applying to residency programs? Maybe you feel like you're not getting the personal attention you want from your medical school dean, or you've already failed to match on your own and realize that you need more help this year? Perhaps you were trained abroad and now want to practice medicine in the United States, but the process of applying as a foreign graduate seems incredibly complicated? Or you're an osteopath who doesn't know how to present your training to an allopathic residency program? I'm here to help all of you.

In January 2001, I started supporting medical students at the University of California, San Francisco. It was a privilege to develop my advising skills and knowledge of the residency application process while ghostwriting the Medical Student Performance Evaluations ("dean's letters"), organizing workshops on personal statements and using ERAS, and helping to develop a new component of the medical school curriculum. After earning the respect of my colleagues and a major award from the students, I left UCSF in 2007, and since then I've been sharing my skills with people from all over the world.

It's been ten years since I started helping medical students. In that time, I've learned a great deal and have helped a number of people successfully write personal statements, edit Common Application Forms, solicit the right letters of recommendation, share documents with the ECFMG, prepare for interviews, and use the NRMP to match into great programs. Now, I want to help you answer the question, "How do I get into residency?" I plan to use this blog to explore a variety of topics, sharing some of what you need to know to improve your chances of matching.

Of course, this isn't just my passion, but it's also my career. I run http://www.residencysupport.com/ - currently, my clients and advisees are medical students and graduates from all over the world (plus a handful of undergrads getting a head start on their futures who want to know "How do I get into medical school?"). I've helped people from all over the United States, as well as graduates from medical schools in locales including Mexico, South Korea, Iran, and throughout the Caribbean. This year my clients were trained in many of the same locations, plus Canada, India, Egypt, China, Armenia, and more! If you want a personal consultation at any time, please visit my website for more information; I look forward to hearing from you.