School of Medicine

General Guidance

Robert N Frank. M.D.
My approach to this question, when students come to me, is to write the best, and most unique, personal statement that they can. If possible, have a faculty adviser read it before it is sent out with the application. I've read a lot of personal statements over the years, and unfortunately, many are the same dreary, humdrum stuff: "Ever since I was 8 years old and my mother took me to the pediatrician/GP/ENTguy/ophthalmologist/dermatologist/whatever and I saw all those whitecoats and all of those fancy instruments, I knew that I wanted to be a (name your specialty)." Write, instead, about yourself: what's unique about you? Why should an interviewer see you as a person "not like all the rest of them," who would be a special asset in the residency program and a special addition, down the road, to the community of physicians?

Second, but this is obvious, choose the best personal references you can. It's best to choose attendings (or even basic scientists, if you've done a lot of work in a particular field) who know you well, and would be willing to say nice things about you.

Finally, don't make excuses for your shortcomings. If you missed time because of serious illness and this affected your grades, that can be mentioned in some way, but for the rest of it, there's no excuse. If it's too bad, as in a "lack of professionalism," the best solution is not to apply for PGY1 training this year. Take a job in a laboratory or in an educational fellowship or enroll in another type of postgraduate training program (such as an M.P.H. or M.B.A. program) so that you can get an extra degree, which is always helpful, and redeem yourself personally.

Mary Jean Schenk, M.D.
ERAS application: Your personal statement should complement your CV by bringing forward those experiences that influenced your decision to select a specific specialty and to provide a platform to present yourself as the physician you imagine you want to be. Read as much as you can at the specialty organization website to get a feel for what is important to your specialty and start thinking about how you will fit in as a professional (and express this in your statement). Also, I believe that if you have had any academic difficulties or personal issues that have removed you from your studies, consider using the personal statement to talk about how the experience strengthened you--make it positive-- Also, make an appointment with the Chair of the Department to discuss your goals and aspirations (and to request a letter). If you did not work directly with the Chair, then this is likely your "4th" letter as the other three are best from faculty who have worked directly with you.

Resources: I encourage you look at the "Data and Reports" sections on the NRMP web site--and ponder their meaning for you as you embark upon your finding your "match" and selecting your training pathway
http://www.nrmp.org/ and then for information about the characteristics of applicants who matched in their preferred specialty that is most interesting reading http://www.nrmp.org/data/chartingoutcomes2007.pdf

Interview: Come prepared--I know it seems like a no brainer but trust me--Year 4 gets hectic as you are running around interviewing. Check out the program website--do a drive by/walk through the hospital before if you can--Talk about how your particular set of knowledge,skills, and personal attributes will enhance the program. Do you have leadership experience and hope to be chief resident? Ask how the Chiefs are selected and think about what you might have to offer---Talk to the residents about the quality of the workplace, the faculty, the balance between work and life, etc... the intangibles that aren't on paper but ask a core group of similar questions at all the programs you visit and keep track of the answers--or it will be very confusing to you come February-- Oh--and they all love WSU grads so enjoy the accolades.

Follow-up: If you really like a program and are serious about it--send a "thank you for the interview note" to the Program Director and highlight those things that were interesting to you about the program and what they expressed as interesting to them about you. If you feel you need a second look to clarify some additional questions in your mind, request a second visit-but specify what you are hoping to achieve with this visit so that the right individuals are available to meet with you. The faculty advisors/mentors/ Chairs/Deans/Student Affairs: We are all here for you and want to assist you in any way possible to realize the best match result for you--so when February rolls around and you are contemplating your rank list-don't hesitate to touch base and talk it through with a faculty member. There are really no "tricks" but the cardinal rule is don't rank a place you don't want to be just so that you can say that you matched--seems like a no brainer--but trust me--it is easy to lose track of the what is really important and usually very difficult to come to terms with the fact that you may need a viable plan B --and yes--we are here to help you with that too.

Noreen Rossi, M.D., F.A.C.P., F.A.S.N.
"In choosing a field for residency, picture yourself in that field every day for some time to come (tho this may change in the fast changing world of medicine). The lines between different areas may become increasingly blurred as we drill down to more genomic and proteomic approaches. BUT one thing likely will stay and that is the patient contact. If you want to specialize, will the residency be strong enough to make me competitive for fellowship (fellowships are getting harder and harder to get into)?

When you interview at a site, take time if possible, to walk around and see the teams making rounds or at morning report (not just with the escorts). Is the atmosphere is one of learning and teaching and enthusiasm or are the residents tired, complaining, frustrated. Keep your eyes and ears open for clues on the environment...not just what they tell you. I know this made the BIG difference for me and I followed my instinct and though it was a tough call schedule, I was very very happy and learned a lot.

Last thing...don't ever list a place you absolutely do not want to go to ...even if you don't match...the scramble is better than going to a place you know you will hate."

Hasan Shanawani, M.D.
When it comes to writing letters of recommendation for students…
"I like bullet points from my students reminding me about anecdotes of our time together that help shape the experience."
In this way, Dr Shanwani feels that he can write a more personal letter with higher impact.

Robert J. Sokol, M.D.
Candidates must have reviewed the program's website, so they're knowledgeable and appear knowledgeable about and interested in the program. You should be asking questions for clarification, not from lack of available information.

Murali Guthikonda, M.D.
It seems like more and more programs are looking for someone with high grades in undergraduate level. High USMLE scores. Research if possible during medical school years with one or two publications. You need great letters of recommendation: this seems where the difference shows up. It all depends on how well the student interacts with faculty and show their enthusiasm without looking overbearing and a "pain"...you know what I mean. Most importantly the interview process where the attitude makes a big difference.

Carl Christensen, M.D.
Probably the biggest barrier to completing an application is a missing Step 2 score. Most programs not only weigh it heavily, but won't even consider someone unless they know their score. Take it as soon as possible (BTW passing it also helps).

Michael Kavan, M.D.
HOW MANY APPLICATIONS TO SUBMIT

The number of applications is based upon how competitive you are and the competitiveness of the program
to which you are applying. Be objective and get input from your faculty advisor, senior students, and your counselor.
Consider submitting extra applications as a back-up. No one can put in just one or two applications and be successful.
If you are academically stellar and you're applying for less competitive programs, initially apply to 20 and see how many interviews you get. Apply to more
programs if you don't receive interview invitations from at least 10-12. For more competitive programs, increase the initial applications to 30 or so.
If you are academically marginal (course failures, low step 1 score, step 1 failure, etc.), you have to apply to far more programs. Get advice on this from your faculty advisor and counselor.

HOW CAN I AVOID GOING UNMATCHED? Failure to match is usually the result of:

1. DISTORTED APPRAISAL OF ONE'S OWN RECORD
   Students sometimes apply for areas in which their record is simply not competitive. Although you do not want to underestimate your
   potential, it is very important to have an accurate assessment of your abilities. To avoid problems in this area, go over your record with your faculty advisor and your counselor.
   
2. NOT APPLYING TO ENOUGH PROGRAMS: See above.
3. DISTORTED APPRAISAL OF THE COMPETITION FOR THE PROGRAMS TO WHICH YOU ARE APPLYING
   Ask faculty in the field for input on this. Ask house officers and Year IVs where they applied. During your interview try to get a feel for how you measure up. Apply to programs at varying levels of competitiveness and always include several "safe" programs.
4. NOT HAVING A BACKUP PLAN
   Scrambling is not a backup plan--it is a nightmare. In the case of highly competitive programs, a good backup plan might be applying to: (a) less competitive programs within that specialty, (b) programs in another less competitive specialty area, or (c) a preliminary year. "Remember -- scrambling for a match is only fun at a party when the lights are out."
5. POOR INTERVIEWING SKILLS
Once granted an interview, be fully prepared to shine. This is the program's chance to see you in action. Be prepared and positive. Portray a strong work ethic and ability to get along with everyone. Scores may get you in the door, but the interview gets you into the program."

Matthew Griffin, M.D., F.A.C.E.P, F.A.A.E.M.
One key element for a "successful match" in Emergency Medicine (best candidate for their best position) is your rotations in EM during the 4th year. Identify yourself early to the program leadership and your daily attending as an interested candidate, and tell everyone you want a letter at the end of the month.

Then: be yourself, work hard, be enthusiastic, and be very appropriate in interactions with patients, staff, and support staff. The months you work in the specialty in which you wish to match are not the times for extensive scheduling requirements, requests to leave shifts or the rotation early for other obligations, or for the time/energy consuming resolution of personal issues. Any absences should be clearly be addressed and unavoidable (life happens,we know).
Every PD in our specialty relies on the host sites' PDs to give an accurate evaluation. We are a very tight group nationwide, and no one of us wants our students to "under-perform" if they match elsewhere. "Problems" now are seen as predictors of future difficulty, and we would rather have a solid academic performer with a great attitude and work ethic, than an AOA student who can't get along with the team. Of course we all hope for the AOA student with a great personality and work ethic.

Renee Van Stavern, M.D.
Only obtain letters of recommendation from faculty that you are fairly certain will write a great letter for you. Don't ask the Chair or the Program Director to write a letter of recommendation if you didn't work with him or her, unless it is required for applications in your subspecialty. If you didn't work with him/ her, then the letter that is written will be very generic and probably won't really support your application in a positive way.

Don't mention ill family members in your personal statement unless it is an illness that you experienced personally or it is a first degree family member, and you were intimately involved in the care of that person. I see hundreds of statements that begin something like this: I committed my life to medicine after I saw my grandmother (or cousin) suffer with Alzheimers, diabetes, etc. Bringing personal experiences in to your statement is important, but these sorts of illustrations just seem generic and manipulative.

If you have a deficiency in your training or took a leave of absence, please mention it in your personal statement. Don't make it the subject of your entire statement, but do mention it briefly: Three sentences that describe what happened, what you did to address the problem, and why it is no longer an issue in your training/education. If the person reviewing your application stumbles across it in your Dean's Letter or transcript without an explanation or without it being mentioned during your interview, then it is a red flag. You can potentially defuse some of the negative connotation associated with such issues by being direct, honest, and concise.

Don't chew gum during your interview. I know that seems obvious, but a WSU applicant did that last year.

Be polite and nice to the secretaries and residents in the Department on your interview day and during any communication with them about the interviews. You never know who is watching you. Rude or arrogant behavior toward a secretary has torpedoed many an applicant.

Don't arrive late for your interview. WSU applicants to our program do this every year. It tells the program that this interview is not important to you. If it's not important, decline the invitation to interview, but don't arrive late.

Don't cancel your interview date with less than a week's notice unless you are seriously ill, there is a death in your family, or the birth of your child. You may not be rescheduled.

David Mehregan, M.D.
Dermatology is a very competitive specialty. I think many programs are very selective. First and foremost, you need to be realistic and make sure that you are competitive in the application process. School ranking, USMLE scores, publications and letters of recommendation are important. MANY medical school students desire to become a dermatologist, but with such limited spots, those with the above credentials will get selected first. So be realistic before applying and make sure you are competitive. If not, consider a dermatology research fellowship to "beef up" (sorry vegans) your curriculum vitae."

Ryan Fringer, MD
Senior medical students must be persistent with their letter writers. I don't even read an ERAS application until there are two letters from Emergency Medicine attendings. Also, they must ask if the attending physician can write a STRONG letter of recommendation. This is a reasonable question, but surprisingly I read many letters that are not so favorable.

Lawrence Schwartz, MD
I've had a number of students come into my office with unnecessary anxiety. Let me offer you a few words of encouragement and refer you to one of us one-on-one as needed. There is a list of advisors on the WSUSOM website if you search under advisors. We have a number of emergency physicians who would be happy to discuss your situation with you. More generally here is how applicants divide out on their competiveness for an EM residency position.

1. Honor students - these are the AOA students or close, with high USMLE scores > 230. They have been involved in other aspects of life simultaneously. These are the mighty and few. They excel academically, personally, everyone wants them.

2. The good solid student - these students are the majority of the applicants. They have an unblemished academic record; no failures of any kind and USMLE scores approaching or exceeding the mean. They do well in their EM clerkship, honors or S+. If they don't get honors in EM it's because they didn't honor the exam, not because they didn't come to conferences or that their clinical evaluations were mediocre. Their transcript has an array of Ss, S+s and hopefully an H or 2 or more. This student also has done something besides going to med school for 4 years. These students match. They need to submit an appropriate match list however, and may need some discussion as to what programs would be appropriate for their match list.

3. Students needing a plan B - these are students who have an academic blemish. They have a failure on their transcript. They had to repeat a course or exam in year 1 or 2. They failed a shelf exam in year 3. They had to repeat a clerkship. They failed USMLE. They failed the EM final and needed to repeat it. I have seen students with one of these problems match into EM. However, the smart thing here, depending on the degree of difficulty is to apply to EM selectively and to also apply for a preliminary or transitional year so that you don't have to scramble. Any student in this situation should definitely be speaking with one of us.

A leave of absence, unless it is for unprofessional behavior, is not an academic blemish. If a student had a good academic record before the leave and maintained the same performance upon return, the leave is a neutral act. People are understanding that sometimes life happens and things need to be dealt with.

I hope this will ease some of the anxiety out there. Please take advantage of the list of advisors.

From a variety of sources (on letters of recommendation):

The persons you ask to write your letters should

• know you well
• know you long enough to write with authority
• know your work
• describe your work positively
• have a high opinion of you
• know where you are applying
• know your educational and career goals
• be able to favorably compare you with your peers
• be able to write well and to write a good letter

Four questions asked directly of proposed recommenders (preferably in person or possibly in a personal letter or telephone call) may help them to provide a good recommendation:

• "Would you be willing to write a letter of recommendation for me?"
• "Do you feel it can be a strong, supportive letter?"
• "May I make an appointment to come talk with you and review my qualifications?"
• "I'd like you to mention (fill in the blank) in my letter. Do you feel you could do that? (The decision rests with the writer.)

If the answer to these questions is not an enthusiastic "yes," you may indicate that you want to do further thinking before proceeding, or you may simply say, "No thank you, I'll try to find another recommender."

Material to Provide for Recommenders:

1. A vita or resume, including all relevant research, volunteer, and work experience. Please be specific about exactly what you did/are doing in each position (e.g., for research experience, did you collect questionnaire data, enter data, conduct interviews?).
2. A copy of your personal statement or at least a paragraph about your educational goals and interests.
3. A note about anything in particular this professor might be able to highlight about you in her/his letter.
4. Though certainly not required, you should consider signing the waiver of your right to see your letters (if you don't waive this right, people sometimes think it is because you have something to hide).
5. Please remember that the person writing letters for you is probably also writing letters for several other students at the same time. So the easier you make it for the professor, the better the chances of everything running smoothly and all your materials getting in by the deadlines.

From the www.medscape.com:

To develop a good curriculum vitae (CV), it is important to realize the function it will have in the residency application process. Namely, your CV is a tool for acquiring interviews and guiding the conversation during those interviews. Understanding this functionality makes it imperative to focus not only on the content, but also on a format that attracts and facilitates interviews.

Bear in mind that the audience reading your CV will be reviewing dozens, if not hundreds, of other CVs. A bleary-eyed, busy physician may not give your CV the time it deserves if it is not easy to read. You want to leave the reader wanting more, not less. Ideally, the potential interviewer will want to know more about an experience listed on your CV, prompting them to invite you for an interview.

How is this done? Well, even though this may seem counterintuitive, the page should have more blank space than text. Wall-to-wall print is overwhelming and difficult to read. If you have a lot of accomplishments, that's great. But be sure that the ones you are trying to highlight are not lost in a big list. Don't include anything on your CV that you would not want to become the main focus of an interview. This may mean removing some smaller endeavors to emphasize more important achievements, which should pop off the page and grab the reader's attention. Use bold, underlined, and italic lettering in appropriate areas. Think of your CV as a list of talking points for your interview.

Curriculum vitaes are submitted online through the Electronic Residency Application Service (ERAS). This means that you must format your CV within the confines of the ERAS format. You can familiarize yourself with this format by using the My ERAS Application Worksheet or by asking someone who has recently completed an ERAS application to share it with you. The ERAS application is divided into these categories: Education, Experience (Work, Research, or Volunteer), Publications, Languages, Hobbies and Interests, Awards, Accomplishments, and Memberships in Honorary or Professional Societies.

Imagine a program director going through this thought process:

• Education: Does the applicant's medical school have a history of producing residents who have done well in our department or hospital?
• Experience: Has the applicant engaged in activities that will have prepared him or her to be a diligent resident?
• Publications, awards, and accomplishments: Has the applicant shown a commitment to success among his or her peers or a dedication to improving the medical literature? Might he or she bring national attention to my program or become a leader in our field?
• Languages: Many of our patients speak language "X", and the applicant speaks it, too; this will be very useful in the clinical setting.
• Hobbies and interests: Does the applicant have any interests in common with my faculty, my residents, or myself? (This could easily become a main topic of conversation in the interview.)
• Memberships in honorary or professional societies: This applicant clearly has an appreciation for the professional community within which they will be practicing.

Finally, these tips may help with the nuts and bolts of developing a good CV:

• Update it regularly to avoid forgetting important accomplishments, and to save time when you finally start the application process;
• Ask several people to review your CV for typos, spelling, and grammatical errors. Such errors can be detrimental to an otherwise strong application; and
• Use Getting into a Residency: A Guide for Medical Students as an additional resource, both for CV development and for the residency application process in general.