Getting Into Residency: Part 1

Posted on 05 October 2008 Tags: applications, internship, match, residency You were able to get into medical school so you think it will be the same process all over again when you apply for residency. But every application process has nuances and the criteria for selection and how you will be evaluated during interviews is different for residency than it was for medical school. This two part series discusses the essential ingredients for success, including rotations, written documents, letters of reference, interviews and follow up. While this article focuses on residency admissions, portions of this piece might also be useful for medical school and fellowship applicants. Away Rotations and Structuring Your Fourth Year of Medical School As soon as you have chosen your specialty, you should schedule your away rotations since these slots fill up quickly, especially at top residencies. For programs in which you are especially interested, try to schedule rotations in the summer and early fall of your fourth year to make a good impression before interview season begins. Your objective for an away rotation is twofold: to impress the faculty and residents of the program where you are rotating and to be a desirable applicant so the program will recruit you. While an outstanding performance during an away rotation is optimal, it isnt always imperative to secure a decent ranking. When I was a residency admissions officer, a rotating student whose performance was merely average often was ranked to match. I would much rather take an applicant who had a predictable performance (and no psychopathology) than take a gamble on someone with whom I had not worked. Also ideal is to try and secure an additional letter of reference during your away rotation. This demonstrates that you are able to adapt and perform well away from your home environment. While there are specific recommendations for every specialty, here are a few general guidelines for performing well on your away electives: Be independent and try not to appear needy. If your resident or attending asks you to do something, get it done as efficiently as possible. Be pleasant, be personable and smile. Be kind and compassionate to your patients. Recognize when you dont know something or have made an error. Arrive early and stay late. Work hard. Follow up on all labs and diagnostic tests that you have ordered. Always offer a helping hand and ask what you can do to make your residents and attendings lives easier. Be respectful to everyone.

Participate in conferences and morning report. Read about your patients diseases and study topics that are likely to come up on rounds or in the operating room (depending on the specialty). Dont compare your away institution to your home institution. Never speak negatively about anything or anyone. Structure your fourth year so you have some substantive rotations later in the year. While filling the remainder of your fourth year with fluff is tempting, spending your fourth year doing rotations that demonstrate your interest in the specialty to which you are applying will impress the program. I also encourage applicants who are applying to competitive specialties and may not match to schedule spring electives or participate in research if they plan on reapplying the following year. The Application When writing your documents, consider this scenario: A very tired physician, who has just spent four hours working clinically and then two hours at resident conference, sits down in front of a computer with a large cup of coffee to review the 200 new applications that are waiting for review. What may catch his or her eye? Also consider how most people review applications. Typically, reviewers first look at your demographics and, after that, some may review your board scores while others may move straight to the personal statement. All of the different elements of your application are tabbed so reviewers can look at documents in whatever order they please. You therefore must write each piece of your application as though it is the make or break element. Your ERAS entries must be distinct from your personal statement and must explain your accomplishments in detail. Describe what you have done with each work, volunteer, teaching and research experience. What have you learned? How has this experience helped shape you, your outlook or your interests? Use simple language and do not be too technical. Reviewers always have the option to skim entries, but they wont pick up the phone to ask for more information if they want it. I find that man y people leave out activities and experiences that should be included in their application. Not every experience should be medically related. In fact, significant accomplishments outside of medicine illustrate that you pursue diverse activities and are interesting. Though you generally dont want to write about college and high school accomplishments, you can include those that were especially outstanding: Were you an All-American athlete? Were you valedictorian of your high school class? Were you an accomplished musician? You can also mix up the presentation of your entries. One entry might be straightforward, while another one relies on a vignette. The Personal Statement Everyone thinks the personal statement is the pivotal part of the application. For some reviewers it may indeed be primary, but I know some who save the personal statement for review last and, even then, skim it unless it is really worth reading. This is why it is essential to make your essay stand out so even the skeptics who think they have seen it all beforewill read on. This piece must be flawless. Make your personal statement intriguing and make sure it tells your story. Here are a few guidelines for writing a personal statement:

Start with something catchy to engage your reader. The first one or two sentences are pivotal. If the opening of your essay bores your reader, he or she may stop reading. End with a strong conclusion to leave a lasting impression. Do not use clich phrases such as I like internal medicine because I enjoy working with patients.

In general, it is better to show through example or anecdote rather than tell. Instead of writing I am empathetic and hard working, illustrate with examples how you have demonstrated these qualities. With every paragraph, ask yourself if someone else could have written it and, if the answer is yes, go back and make the paragraph more distinctive. Do not regurgitate your CV or write about something that can be read elsewhere in your application. Do not repeat yourself. W ith each sentence, ask yourself, Have I already said that? If the answer is yes, hit delete. Use an active rather than a passive voice. Your essay should be authentic. No matter what advice you receive, your essay must be a reflection of you and must be, as the title suggests, personal. It is essential to illustrate your interest in the specialty to which you are applying. This is also the place to explain any red flags in your application, such as gaps in time, institutional actions, a board failure, etc. Also explain any obstacles you have overcome: Were you the first in your family to graduate from college? Were you an immigrant? Did you have limited financial resources and work through college? Many applicants tend to shy away from the very things that make them impressive because they are afraid of appearing to be looking for sympathy. As long as you explain how you have overcome adversity in a positive or creative way, your experience will be viewed as the tremendous accomplishment that it is. ERAS allows you to write multiple personal statements. I encourage applicants to write individual essays to express interest in a specific geographic area or for a specific type of program, such as a community versus an academic setting. The Picture Many people ask what kind of picture to submit. You do not need to have a photographer take your pictures. Look professional, look neat and smile. No one wants to work with someone who looks grouchy. The picture also serves as reminder of who you are after you have interviewed, so make sure it is current. If you just colored your hair blonde, dont submit a picture of yourself as a brunette The Bottom Line Use every space in your application to your advantage. Tell your story and explain what makes you unique. The key is to engage and keep your readers attention, pique their interest and motivate them to click the interview check box in ERAS. Jessica Freedman, MD is a former residency admissions officer and president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is the author of the MedEdits blog (www.mededits.blogspot.com). Dr. Freedman is also a practicing emergency physician 20 Questions: Harry Rosen, MD [Hospitalist, Author] Pharmaceutical Case Management

Getting Into Residency: Part 2

Posted on 09 February 2009 Tags: interview, interview advice, Jessica Freedman, match, residency

by Jessica Freedman, MD President of MedEdits: Medical Admissions As the current residency application cycle is winding down, the next wave of applicants is getting ready to apply for the 2009/2010 season. As you begin thinking about your residency application, you should consider who will be writing your letters of recommendation (LORs), how you will talk about your path to residency at your interview, and how you should contact programs and follow up with them (and if this really makes a difference in outcome). This article serves as a follow-up to the article, Getting Into Residency: Part 1, which was published on the Student Doctor Network in October 2008.

Letters of Recommendation I encourage medical students to treat every attending as though he or she will one day write them a letter. Why? I believe this helps the student perform well and also creates a safety net of sorts. Since you dont know whom you will meet in the future, it may well be that a good LOR could come from the internal medicine attending from your third year rotation or a preceptor from an introduction to medicine course during your first year. If you have identified someone with whom you have rapport and who thinks highly of you anytime during your medical education, dont wait to ask that person if he or she would be willing to write you a strong letter of reference in the future. Then be sure to keep in touch with the attending from time to time. Keep the attending updated on your progress and achievements so, when it comes time to write your letter, the attending wont have to play catch up, which will make the letter more sincere. While writing a letter of reference is extra work for an attendi ng, it is also flattering since it indicates that you respect and think well of that individual. Writing excellent letters for my stellar students that I knew would help them get to the next level of their education and training was one of my greatest joys in academic medicine. Which letters have the most impact when it comes to residency? It depends. If you are applying for orthopaedic surgery, for example, you dont want to have three letters from non -orthopaedic faculty. ERAS allows you to select four letters to be sent to each program so, for a very competitive specialty, you want at least two of these letters to be from attendings within the specialty to which you are applying.

When applying to residency, titles matter; a letter from a community doctor will carry less weight than a letter from the chair at a major academic center. A survey sent to directors of all programs participating in the 2008 match by the National Residency Matching Program (NRMP) addressed this issue. Most important, the survey showed, are letters from clerkship directors, colleagues and chairs within the specialty. Letters from other faculty, while still important, have the least weight. Writing a good LOR takes skill and experience. Sometimes junior faculty dont know what cons titutes a good letter, another reason why it is sometimes safer to have letters written by more senior faculty. A more experienced faculty member, who has read and written hundreds of letters of reference, understands the essential elements and buzz words that make a great LOR. Keep in mind that the smaller the specialty, the more likely everyone is to know each other. When I reviewed residency applications, it was comforting to read a letter from someone whom I knew and trusted. At the same time, letter writers get reputations. I remember a clerkship director who wrote outstanding letters for every single applicant who rotated in her department. As a result, I questioned whether I could trust this individuals evaluation. As an applicant, you have no way of knowing who writes good letters and who doesnt, but it is important to understand that some attendings are talented in this area while others arent. How do you go about asking someone to write a letter? To some degree this depends on your relationship with the individual. If an attending offers to write a letter on your behalf and you have had an open dialogue about this, then simply ask him if he would like any supporting documentation. Otherwise, it is best to schedule an appointment to meet with the attending. It is fair to ask this person openly if she would be willing to write a strong letter on your behalf. You must hope that you will get an honest reply. Your job is to make the letter writers job as easy as possible. Arrive at the meeting with a folder in hand that has a copy of your CV, your personal statement (if you have already written it) and any information she may need, such as your AAMC number and where the letters should be sent. ERAS has downloadable cover letters that you can fill out for your letter writers for both US students and IMGs. Remember to give your letter writers plenty of time to write your letter (at least one month), and understand that you may need to nudge or remind them more than once. The Interview Your most recent interview probably was for medical school. The emphasis for residency interviews is different, so dont think that you will be telling the same story all over again. It is important to think about the path you have taken since you started medical school. What has motivated you, who has inspired you and what determined the choices you have made? Applicants are judged most on the following during the interview: Commitment to the specialty to which you applying Understanding of what it means to practice this specialty Interpersonal skills Interactions with faculty, residents and staff Professionalism Maturity Leadership ability

Overall fit with the program Red flags, explanation for gaps in time, psychopathology I encourage applicants to review their written applications before interviews so they can remember what they have written. Anything on your application is fair game for discussion so be prepared to discuss everything in detail. Dont be afraid to try and guide your interview. The interviewer isnt the only one in control here and you should try to make segues to topics that you would like to discuss. The ideal interview is an open conversation a back and forth dialogue. While everyone has their own interview style, most (skilled) interviewers know they will get the best idea of who you are if you are at ease and comfortable. In my experience, it is the less experienced interviewer who tends to shoot questions at you. And remember, you arent going to be tested on your medical knowledge. Non-US citizen IMGs are often asked to discuss an interesting case to make sure they can communicate effectively about medical issues, however. Also remember that feedback from current residents and support staff (such as the residency coordinator) plays a role in resident selection. Residency is intense and, especially for small residency programs, being a good fit for a program is important. This is why your behavior and interactions with the residency staff, during tours of the facilities and during dinners and lunches with the residents, is vitally important. When I was in residency leadership, if my residency coordinator identified someone as rude or disrespectful, I listened. Residency leadership teams are small and a negative interaction with one member of that team is likely to negatively affect your ranking. Along the same lines, if a resident thought highly of an applicant and believed she would mesh well with our program, I also listened. A few questions you should be prepared to respond to on residency interviews:

Tell me about yourself Why do you want to go into XXX? When did your interest in XXX begin? What strengths would you bring to the program? Tell me about your research Tell me about (any flaw in your application). How do you feel about moving to our city/town? Where do you see yourself in 10 years? Why do you want to attend our program? Do you have any questions for me? Follow up with Programs I always encourage applicants to contact the program directors where they interviewed early in the season. While some programs rank as the season moves along, others hold a ranking day in late January/early February when they rank applicants. From experience, I can tell you that it was very difficult to remember applicants who interviewed early in the season. That said, the research done on this topic indicates that the timing of your interview does not affect your ranking. Interestingly, the NRMP survey results indicate that program directors do not place much importance on second looks or visits or that postinterview contact affects ranking. Nonetheless, I believe that you should send a thank you note just to play it safe, and demonstrate respect and because doing so is just good manners. Also, sending a letter of intent to your first choice program is wise. The worst thing that can happen to a program is not to fill its positions, forcing the program to enter the scramble. It also looks

good for a program director to boast, We got our top three applicants! If a program knows you are ranking it #1 and it doesnt want to go too far down on their list, your letter of intent may influence your ranking. As match day approaches, good luck to everyone and match well. For 2009/2010 applicants, start thinking about your strategy for next season. While this article (and Part 1 of this series) addresses some of the concerns related to the residency match, keep in mind that many nuances affect the process and this varies from applicant to applicant. Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com). Meet Dr. Freedman at the American Medical Students Association Meeting in March in Arlington, Virginia. From Their Point of View (Interview Advice Column)