Part 1: Laying the Foundation
There are few days in a doctor’s life that are met with more stress and anxiety than that day in mid-March when you are matched with the program that will shape your professional life. There is also no other singular day you put more time and effort into for an intended outcome. Far too often, however, efforts are heavy in the standard areas of test prep, research and CV padding, and not enough effort is focussed on defining specific residency and career goals and interview preparation. In this series of articles, I will help guide you through the key components of having a successful match.
- Part 1: Laying the Foundation
- Part 2: Know Thyself, Market Thyself
- Part 3: Do Your Homework
- Part 4: Nail the Interview
- Part 5: Trust Your Gut
Most students are mentored in a traditional fashion. “Work hard. Study hard. Be on time and dress well. You will do fine.” These are all appropriate pointers, but really fail to offer detailed guidance. The field of candidates is among the best of the best. Everyone applying to residency has proven intelligent, diligent and of a work ethic above the average, even if attending physicians still like to question that on the wards (I know few places call them wards anymore, but it sounds doctor-y).
For some reason, the medical field has decided to ignore the process and concepts that the rest of the free market system has embraced in recruiting top talent. We are even worse when it comes to choosing a job after residency (more to come on this later). The truth is, however, people behave in very predictable ways when it comes to choosing others for a position, whether it is a partner in love or in work. We are drawn to people with similar interests and we are attracted to those who have an aura of success and power. We are also relate to stories, and successful applicants are able to create a consistent story of success, even if it wasn’t deliberately created. Understanding these points can really help you lay down the foundation to be a very attractive applicant.
Well before you get to the application and interview, you must be laying the foundation to be “attractive” to residency programs. Even if you are struggling in M1-3 to choose a field (see ttps://thedocmentor.com/howdoichoosefield/) there are some basic components of being a strong applicant you should consider. Fortunately, these are similar components to being a strong physician, which indeed is actually the ultimate goal for any of us. This advice is to help get you there and not a goal in and of itself. Matching is the first part of a long process.
So here are some areas to work on early in medical school and/or tighten up prior to submitting your application. These are the things that will be considered by programs to get your foot in the door, i.e. offer you an interview. I’ve heard many PD’s claim in some form that what they are really looking for at the end of the day is “grit and fit.” These may be tough to define but the concept is that you need to fit well with the field and program and you need to have the grit (work ethic, common sense, emotional intelligence) to get things done. Your life’s work or curriculum vitae should then reflect your grit and fit.
- First and Foremost, Be a Good Person. I can’t overstate this. The most important foundational piece of being a good applicant and subsequently a good doctor, is being a good person. To again quote one my mentors, Dr. Richard H. Pearl, “we can’t teach em what their mamma didn’t teach them.” Your life before medicine is indeed important. Being a good physician requires more than book smarts. On any given day, street smarts may serve you better than book smarts. People skills, work ethic and experience, open mindedness and resolve are all things we can’t teach you in medical school or residency. Don’t be afraid to pull from your life experience as you put your application together. Things like jobs held, sports, music and instruments, scouting and leadership positions all hint at your abilities to work with others and take on leadership. They also highlight that you are well rounded and more than just a number.
- Test Scores. There’s no way around this one. Although we all want to believe we are more than just a number, to programs you are a score of some sort. When interviewing 50, 100, or more applicants, program directors (PD) need some guidance on how to select applicants out of a pool that is often 500 to 1000 or more. As such, a common way to do this is list applications by score and start from the top down. The program used for selecting applicants allows PD’s to do this with a few clicks. It also allows PD’s to customize filters. Some programs exclude FMG’s or DO’s immediately. Not all do, but the option is available for a number of criteria. In addition, standardized test score averages are on the rise. USMLE will likely adjust the test with time based on this, but regardless, expect to study hard and put great effort into Step 1 especially. All parts are important to pass, though. In competitive fields like Ortho and Surgery, taking Step 2 prior to the submitting the application and proving you can perform consistently well will make you a more attractive candidate than someone with a similar Step 1 score who has not taken Step 2, even if there is a good reason. It’s kind of like running from a bear. You just need to be faster than the next person. Anything you can do to move you up on the match list, even by one spot, can have a great impact on your match. (Don’t be a d*#% though. No tripping or selling out your colleagues. All things with integrity and respect). Taking a review course is up to you. They can be expensive. If you traditionally are average to poor on standardized exams, then you should really consider it. The money will be well spent. If you routinely test in the top percentiles, then just do what you do. That said, after you get an interview, many programs will then take into consideration other factors. So getting a weak score is not a death sentence. Failing makes it pretty rough though.
- Grades. Just like having good test scores, having solid grades in medical school helps. M1 and M2 scores are less likely to be interrogated, but failures may hurt you. These scores can help you stand out, for example, if you are awarded AOA status. Most important is the clerkship that is relevant to your field. The highest score possible (Outstanding, Honors, etc.) is what you should shoot for. Every school does this differently but then provides a graph of how many students get each score. You can’t control if everyone gets an Outstanding. It’s still better to get one. As is the case elsewhere, a heavily weighted component of that score is the clerkship exam. So once again, study hard, work hard, and it should work out. As far as your clinical grade, I see too many students try to get by on personality rather than substance. Show up prepared. Be attentive. Don’t try to stand out too much. Be helpful. Pick up on social cues. Often there are longstanding relationships between the doctors and residents on the team. Don’t show up and expect to be “in the in crowd” right away. You are a visitor in their world. Be respectful and patient. The best students are usually well read, punctual and bring enthusiasm and energy to their work. If you don’t try and don’t care, expect the same in return when it’s time to offer you an interview.
- Away Rotations. In no way is rotating at another institution mandatory or a key component in choosing a resident. The value in doing an away is getting more perspective on how things work elsewhere. Some things will be similar and others different. This knowledge is valuable when you later go to interrogate residencies on the interview trail. Also valuable is the opportunity to get a letter of recommendation from someone respected in your field. Caution, however. If you plan to use the away as an interview, be careful. It doesn’t always work out that way. Doctors are hard to impress because we have big egos. You have to be better than your best every day on an away for them to remember you and want to train you. That is certainly a possibility, and if you are really passionate about a program, you need to bust your ass on that rotation. Make the appointment to meet with the PD and Chair when you arrive. Do this early in the month because they will be busy and you may miss out if you schedule too late. Be prepared to be in interview mode all month. Otherwise expect that you will eventually fade into the mix of adequate and pleasant students in their memory. You will lose the freshness and sexiness of the unknown when they look into your application. The curiosity of the relationship yet to happen will disappear. In competitive fields you will be ranked in the middle, or even not at all. There is no rule that obligates a program to extend interviews to outside rotators. If you are poor applicant on paper, rotating there won’t get you an interview necessarily. In less competitive fields the away can actually work in your favor quite a bit. Be sure to work with a mentor in your field to guide you on the do’s and don’ts of away rotations.
- Research. This is quite the topic and a tricky one at that. There are those that clearly have a background and interest in research and it shows in their CV. Then there is just about everyone else. I can’t tell you how many times I’ve heard this conversation: “So, are you interested in research?” “Well I am not interested in bench research but I do like teaching and being in an academic environment.” Regardless of your career goals, recognize that all residency programs have an obligation to be involved in scholarly activity. Research, including posters and publications, is the largest component of that. Quality Improvement projects can fall in this category also, for those who want more of a patient focussed experience. Even community based programs have to prove engagement. So programs want to know that you can get things done. Getting published indicates that you can take on a project, put in the work, and execute to completion. Far too many applicants wait until late in M3 and have a nauseating list of “volunteer projects” that are research projects not completed but in progress. These never get done. Any unpublished work is listed as “other” or “volunteer projects” in the online system. Try to engage something early in medical school and get it done. You don’t have to cure cancer in the lab to be a good applicant. Those with no research on their CV just leave gaps open for another applicant to outshine them. Research is part of being a scientist. Even those going into community practice need to understand the science of research enough to be able to sift through the volume of evidence they will need to interrogate in their careers to make appropriate care decisions for their patients.
- Leadership/Teamwork/Committees/Volunteerism. This component covers a broad spectrum of things that can help highlight the qualities that make you more than just a number. Here, quality is more important than quantity. PD’s can see right through the person who has an elected position in every interest group and has volunteered at 12 different places for a half hour each. This shows a lack of commitment and efforts that are not goal driven. Find something you are passionate about or at least more interested in. It may not be directly linked to your field of interest, but often will help guide you in that direction. It’s ok if you change course in life. With a good explanation a well thought out applicant is still better than the journeyman mentioned above. It’s more likely that a longterm commitment to one or two efforts will better depict the traits a program is looking for than many superficial things. Remember that residency is a multi-year commitment to one organization with a narrow focus. You also don’t have to start a clinic for HIV patients in a third world nation to stand out. While these types of missions and service to those in need are wonderful and represent great qualities, don’t worry if you haven’t had those experiences. Of course, some students have limited opportunity to do much else except focus on their studies. Medical school isn’t easy. You may not have time for anything else, especially if you already have a family with kids, but being able to handle multi-tasking and showing that you in some way can put others before yourself will reflect better as PD’s look through your application.
- Find a Mentor. I couldn’t get very far without a shoutout to my mentors again. Dr. Jan Rakinic highlighted that we are trained to live in 4 -5 year increments from the time we start 1st grade. In each interval there is typically someone helping guide you. That’s a mentor. It may be hard to find a mentor in M3 as you rotate through so many services. It’s ok to reach out to doctors in M1 and M2 and start building a relationship. This also creates an opportunity to get involved in research at an earlier point. If you’re not sure where to start, try the Department Chair, PD, Associate or Assistant PD, Clerkship Director and/or Chair of Research. Don’t make important decisions in isolation. Bouncing your plans off someone with experience and wisdom is always a good idea. Case in point, I’ve seen several students with Step 1 scores above 250 fail to match because they thought they had it all figured out. There’s no room for that level of arrogance here. In our profession, there is always someone smarter and better than you. Relying on others is not a weakness, rather, it gives you strength. Have someone look over your CV and review the list of programs you intend to apply to. They can help strengthen your efforts and ensure success.
Once this foundation is laid, you are ready to put your CV together. It’s very helpful to keep track of things as they happen in some format rather than scramble in M4 to try and remember. Model your CV after a mentors. It doesn’t matter what format you use because you will ultimately enter each detail online to the application service where a templated format is used. So it will be hard to embellish. In fact, never embellish. Never lie. Be sure everything in your application is accurate and reflective of who you are.
In the next part, I will help guide you in creating your story and how to market that. After looking at part 2, you can come back to part 1 and be sure they are in alignment. If not, you may need to consider leaving parts out or adding things back in.