Getting Into Medical School and Residency: Wish I Knew It Before I Blew It

We’ve all known or heard of medical school or residency applicants with excellent credentials who should have had their choice of programs. They had the marks, the winsome personality, and the composure that made their success seem inevitable. But something happened on the way to derail their plans, and, sadly, they never realized their full potential. What mistake prevented them from getting in?

Being a former Harvard Assistant Residency Director and a professional medical admissions counselor has allowed me to witness firsthand many cautionary tales of candidates who, inadvertently, were their own worst enemies. Drawing on the wisdom of those who went before, you can mitigate the liability of personal inexperience.

In this tradition, allow me to highlight several proverbs that offer the savvy applicant blueprints for success. Then, I hope to help you recognize and avoid errors by learning from candidates who failed to understand the consequences of their actions until it was too late. Finally, I’ll present these errors as composite case studies, with details altered sufficiently to protect the innocent and misguided.

The chess master’s proverb: Never underestimate your opponent.

After interviewing medical school applicants all morning, a female colleague reconvened with other faculty in her department to discuss candidates. She was shocked by what had happened in one of her interviews and was interested in hearing the stories others would tell about this candidate. When they got to the name of the man in question, the female faculty member was surprised to hear all of her colleagues, who were male, wax rhapsodic about this applicant. She listened intently. After they finished, she told them how, during HER interview, the applicant had put his feet on her desk and, at the end of the session, had winked at her. The panel summarily dismissed the applicant’s candidacy.

This story demonstrates the perils of extreme overconfidence, but more importantly, it is a reminder that you should never underestimate anyone’s influence throughout the application and interview process. Be professional and respectful with everyone – your letter of recommendation writers, the programs’ administrative assistants, and other applicants on the interview trail. If you stay at a medical student’s or resident’s home during interviews, be the best guest possible. Write thank-you notes and treat people graciously.

The corollary to this lesson is that the person you perceive to have the least clout may wield veto power over your candidacy. Many slick applicants bent over backward to ingratiate themselves to influential interviewers but realized that the administrative assistant they verbally abused by phone was empowered to provide negative feedback to these same faculty members.

By the way, these lessons need not apply only to medical school and residency. For example, the director of a highly regarded Emergency Department (ED) in California, after vetting faculty references for candidates from a local residency program, made it a habit to call the senior ED tech at the program for a report on how this person treated co-workers in the ED. If the tech reported hubris or entitlement, the tech’s opinion was valued highly enough to undermine the candidate’s prospect for a job.

Seneca: Luck is what happens when preparation meets opportunity.

A well-meaning, competitive medical school applicant was fortunate enough to have been invited to several interviews. Understandably, she scheduled the ones in geographic proximity back-to-back to save time and money. She packed her bags and set off on her voyage, only to have a significant flight delay cause her to arrive very late the night before a big interview. She was exhausted and perturbed but was thrilled that all seemed salvageable until she realized that her checked baggage was not arriving off the carousel. Unfortunately, she had packed her interview clothes in that bag. Needless to say, she arrived at her important interview at 7:30 the next morning in jeans. Despite her explanations, she knew that her first impression was not a good one.

I’m an emergency physician, and, consequently, I have repeatedly learned the importance of planning for the worst. If things go well, you can always laugh at your excessive caution. If things go badly, you can laud yourself for your preparation. Throughout my time in admissions, I have seen many avoidable mistakes. Arriving late for an interview, having insufficient letters of recommendation because a faculty member did not follow through, not being accepted into medical school or residency because of an excessively short list of targeted institutions, and poor performance in an interview because of a lack of preparation, among others, can sabotage your efforts. Many of the errors I see are avertable with advanced thought, good mentorship, and foresight.

Start very early in the process, make a checklist, enlist experienced help, and anticipate obstacles so that you can avoid them gracefully.

The old residency director’s proverb: The resident who shows up last for orientation on the first day of the internship will be the problem resident.

An experienced residency director once told me that adage, and it has proven true. Years ago, as residency orientation was starting – at the last moment – a new intern ran into the room after everyone else was already seated and ready to go. The intern looked harried, and he fumbled into his seat, late for the session. Yes, he ended up causing many problems and leaving the program early with a stain on his reputation.

There is a critical admissions-related point to be made here: Being late may be a prognostic indicator for a “problem” medical student or resident because it might indicate that the individual is ambivalent about their career trajectory. If you notice that you are dragging your feet throughout the application process – for example, submitting your AMCAS® or ERAS® very late in the season – that might be a sign that you are “just not that into” what you see as your professional path. I see this with some of my clients. Those who approach the application process very late often have significant qualms about their careers or specialty choices when I ask them directly. Acknowledge this possibility and consider what it means for your professional goals and future happiness. Identify the issue now – not unhappily 40 years later.

Another point that is less admissions-related and more career-guiding is that you are being evaluated routinely throughout your medical education and training. So arrive early, complain at home, and be professional. Of course, being perpetually at your crackerjack best is difficult when you are physically exhausted. Still, it’s worth keeping it as a goal when facing interpersonal conflicts, difficult patient cases, and unfair practices in medical school and residency.

The psychic’s proverb: The person who expects to have their mind read should tip very well.

I remember a talented applicant I advised a few years ago who – in her residency application/ERAS® – showcased an award she had won. She listed the name of the honor but didn’t explain what it was. If I had been a typical admissions reader, I would have just passed by the information without a second thought. But because I was advising her, I stopped to wonder what this award was. When I asked her, she told me the award was an academic honor given to only the top one percent of students out of several thousand. She had been awarded this prestigious prize because of an extremely high standardized test score. As you can imagine, I was very impressed and strongly advised her to explain the award in her application clearly. Had she not rewritten the section, her admissions readers wouldn’t have given her an ounce of credit for that extraordinary accomplishment.

Bottom line: Don’t make the mistake of obscurely referring to a crowning, distinguishing achievement without explaining it. This mistake is a lost opportunity and a dangerous oversight.

Don’t expect a reader to understand something in your personal statement because it’s explained in your ERAS® or AMCAS® activities section. Different admissions readers will approach the application in different ways, so – to get “full credit” for your accomplishments – you need to assume that your reader could be starting with any section of your written materials. Therefore, ensure each part of your application can stand alone and doesn’t rely on another for clarification.

The politician’s proverb: Be discreet.

One day years ago, as a Harvard faculty member, I spent the morning interviewing applicants for our emergency medicine residency program again. Over lunch, we discussed each candidate, and one, in particular, stood out. He was impressive in every way – academics, extracurriculars, commitment to the field. He seemed like the total package. Each of my colleagues who had interviewed him (I had not) spoke very highly of him until we had gone around the room to the last faculty member. This physician paused and then – rather unexpectedly and emphatically – said that he would not recommend ranking the applicant favorably on our Match list.

Considering the previous rave reviews, this statement seemed quite odd, and there was a bit of a rumble in the room. Nevertheless, the physician continued, explaining that the applicant was from California and had said that he loved California and wished he could stay there. “Why should we rank him highly if he isn’t interested in us?” the faculty member asked.

Little did the applicant know that with that one stray remark, he had utterly ruined his chances at a Harvard slot (although perhaps – from his comments – he didn’t want one anyway).

You must be honest in interviews, but you do not need to incriminate yourself as I tell my clients. There is no reason to volunteer to an East Coast institution that you’d rather not leave the warm West Coast weather, no advantage to mentioning a spouse who is opposed to a program, and absolutely no logic to explicitly answering the question, “What would keep you from coming to our institution?” during your interview day. Do not feel obliged to readily answer, “What is the one reason we should not accept you?”

And concerning being discreet, be aware of what you say to medical students, residents, and others during the admissions process. Your remarks may be inadvertently or intentionally repeated.

Santayana: Those Who Cannot Remember the Past Are Condemned to Repeat It

In conclusion, the savviest applicants seek out those with relevant experience and learn from them. This means finding valuable, trustworthy mentorship that will help you draft a road map to your goals. This also means speaking with students or residents a couple of years ahead of you to pick their brains for application do’s and don’ts while such anecdotes are still fresh enough that you can learn from their experiences.