Getting Into Residency: Part 1

Last Updated on June 27, 2022 by Laura Turner

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 isn’t 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 don’t 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).
• Don’t 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 won’t pick up the phone to ask for more information if they want it. I find that many 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 don’t 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 before–will 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 cliché 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. With 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, don’t 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 reader’s 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

This is part one of a two part article, read the continuation of the article here.