By Laura Turner

Dr. Rajani Katta and Dr. Samir Desai, who provide “The Successful Match” column to the Student Doctor Network, have written a book called The Successful Match to aid students in their applications.  The book provides 200 rules and over 130 tips on how to prepare for all phases of the match process.

Katta and Desai have combed the research on medical education to provide evidence-based strategies for improving the odds.  Detailed and easy to understand steps teach students how to influence the content of letters of recommendation and the Dean’s Letter, draft better personal statements, and highlight their strengths during the interview and audition elective.

The Student Doctor Network spoke with Dr. Katta and Dr. Desai, who serve on the faculty of the Baylor College of Medicine, about The Successful Match.

Why did you want to write this book?

If the 2009 match is similar to previous matches, over 40% of U.S. senior medical students will fail to match with the program of their choice. In competitive specialties such as dermatology and plastic surgery, over 30% of U.S. senior students will fail to match at all. The numbers are significantly worse for international medical graduates.

A successful match – matching with the program and specialty of your choice – requires a well-thought-out strategy. Strategizing always begins with full knowledge of the process, followed by informed decisions. Our goal was to help applicants make informed decisions by offering highly specific, evidence-based advice and recommendations.

We wanted to highlight the wealth of impressive research that’s been done in the field of medical education, and in the field of the residency match in particular. Many researchers have asked questions about the factors that lead to match success, and have approached the study of these questions in a scientific manner. The results of these published studies provide the basis of our evidence-based recommendations. Studies such as these are continuously being added to the medical literature. In the last two months, two impressive and highly useful studies were published:

• One study, performed by the NRMP, surveyed directors of all programs in the 19 largest specialties that participated in the 2008 NRMP Match. The goal was to determine applicant factors which are important in the residency selection process.(1)
• In another survey of program directors in 21 specialties, Dr. Green and colleagues at the Feinberg School of Medicine (Northwestern University) sought to ascertain the relative importance of criteria used in the selection process.(2)

The results were published too recently to be utilized in our book, but we will be able to utilize these results to help those students whom we advise.

Which residency selection factors were found to be most important to orthopedic surgery residency program directors? How important is published medical school research to pathology residency programs? What degree of importance do plastic surgery residency program directors attach to the quality of questions asked by an applicant during the interview?

This is precisely the type of information necessary for a well-thought-out application strategy – one that will lead to a successful match.

What aspect or aspects of an application that are important to administrators are most often discounted or overlooked by students?

When it comes time to make interview and ranking decisions, residency programs will use all the available information. Therefore, applicants should use every component of the application – the common application form, letters of recommendation, personal statement, and interview – to capture the attention of program directors.

Program directors are understandably overwhelmed by the deluge of applications they receive. To stand out from the rest of the field, every component of your application has to demonstrate your unique strengths. What is that sets you apart from other candidates? It’s that message that needs to be consistently communicated throughout your application.

Far too often, candidates end up sounding the same. We devoted a chapter in our book to guide applicants on how to distinguish themselves from others in the most compelling manner possible.

What are the most common misconceptions that students have about the match? Which of these misconceptions is most dangerous or damaging to a student’s chances of successfully matching?

While applicants recognize the importance of recommendation letters, they often assume that letter writers know how to write the most compelling letter possible. However, that’s a dangerous assumption. In one analysis of recommendation letters, reviewers noted that 35% of letters had no information about an applicant’s clinical judgment, while 32% lacked information about interpersonal skills.(3) In our chapter on letters of recommendation, we describe the type of evidence that applicants can provide to the writer to increase their chances of having the most helpful letter written – one that includes information most useful to programs. Your letter writers want to write the best letter possible, and you can do much more than you realize to make this a reality.

Another common misconception has to do with minimizing the importance of the personal statement. It is true that individual specialties, residency programs, and application reviewers attach varying degrees of importance to the personal statement. However, you won’t know how the statement is used or viewed at each program. Therefore, you must create a well-written, high-quality statement that makes the application reviewer say, “This is definitely someone I want to meet face-to-face.” We believe that statements written by many candidates have a neutral effect, and that this represents a lost opportunity.

What are some of the key steps students should take to improve their chances of a successful match?

First, obtain detailed and specific information from your medical school. The right advisor can be invaluable, yet many applicants don’t have one.  In one study of third and fourth-year medical students, only 36% reported having a mentor or advisor.(4) Your specialty-specific advisor can share with you detailed information about how your school’s previous students fared in the residency selection process with respect to specific programs. How do their credentials stack up against your own? This type of information can help you more accurately assess the strengths and weaknesses of your application and target programs where you have the best chances.

Second, begin working on the application as early as possible. Often, applicants underestimate the time and effort required to produce a high-quality application. A late start leads to the inevitable last-minute rush.

Third, take interviews seriously. Multiple surveys of residency programs have shown the interview to be most important in the residency selection process. In one survey, 66% of applicants had either no change in their ranking or were ranked less favorably following the interview.(5) We believe that most applicants recognize the importance of the interview, but few go to the lengths required to become a good interviewee. In recognition of this fact, we devoted four chapters of the book to the interview process.

As an interviewer, what are the most common mistakes you see students make during the interview process?

One important mistake is inadequate preparation. Begin by thoroughly researching the program. Spend time on the program’s web site, talk with professors and residents at your school who are knowledgeable about the program you will be visiting, and so on.  Don’t stop there.  Take the knowledge that you acquire and use it during your interview visit. In fact, being knowledgeable about the program is one of the easiest ways to demonstrate your interest. It’s also a great way to impress interviewers.

Another common mistake is not offering the interviewer enough information about those qualities that set you apart from other candidates or that make you particularly attractive to a particular specialty. For example, we discuss the importance of leadership qualities. In a survey of emergency medicine residency program directors, having a “distinctive factor” such as being a medical school officer was one of three factors most predictive of residency success.(6) If, however, you leave an interview without discussing this experience, you’ve lost out on a valuable opportunity to highlight this strength. Our general rule of thumb is that if your answer to a question could be easily given by another applicant, your response is probably not as good as it could be. This is such a common mistake that we devoted an entire chapter to interview questions, and provide detailed information on how to answer commonly asked questions.

The end of an interview can be just as important as the beginning. Almost all interviewers will end with the question, “Do you have any questions for me?”  At some programs, and with many interviewers, the quality of questions asked by an applicant is a factor used in evaluating interview performance. In talking with interviewers across the country, most applicants ask basic questions that fail to impress. That’s why we outlined the questions to avoid, and provided multiple examples of thoughtful, insightful questions.

The book has a lot of great details on the competitiveness of different specialties. How can students assess if they are competitive for one of these popular specialties or for a highly sought after program?

Chapter 2, “Specialty-specific Information,” explains what programs in different specialties seek in their applicants. Reading that chapter will give you a reasonable idea of what your own strengths and weaknesses are. Once you recognize where you stand, take this one step further by approaching your specialty-specific advisor. Ask him or her how you compare to previous graduates who did or did not match into your chosen specialty. With this information, you should be aware of what a program director is likely to see as your strengths and weaknesses.

Take this information and together, with your advisor, develop a strategy. How can you make your application stronger in the time that you have remaining? What’s the best way to highlight your strengths? What can you do to turn your weaknesses into strengths? Or if that’s not possible, what can you do minimize them? The book specifically addresses how to add an extra competitive edge to your application.

What steps can students take to proactively address any weaknesses in their application?

First, you must have a clear understanding of the strengths and weaknesses in your application. Again, your specialty-specific advisor can help you.  Individuals are not always the best judges of the strength of their own candidacy.

Once you have identified areas of weakness, take action to overcome or minimize them. Seek out opportunities, responsibilities, or experiences that would enhance your application. Do you need to take the USMLE step 2 CK before you apply? Do you need to have a letter written by a particular faculty member in your school’s department? Should you begin a research project?

Do you need to do an audition elective? Don’t underestimate the power of an audition elective. For applicants with shortcomings in their application, an outstanding performance during an audition elective can lead to a match at that particular program. Personal knowledge of your skills, qualities, and work ethic can provide a huge boost to your application.

Do the matching statistics cited for osteopathic graduates in Chapter 1 take the osteopathic match into account?

The matching statistics that we present in chapter 1 relate to the NRMP Match alone. In recent years, approximately 30% of osteopathic applicants participating in the NRMP match failed to match. Some of these applicants, who failed to match into ACGME-accredited programs through the NRMP Match, then scrambled and were able to find positions in AOA-approved programs.

If you are an osteopathic student or graduate interested in securing a position in the NRMP Match, our book will show you how to strengthen your application and make it more competitive for allopathic residency programs. If you are participating in the osteopathic match, you’ll find that many of our recommendations are applicable to you as well.  Although there are fewer studies and surveys done of the osteopathic residency selection process, we do present this information in our book.

What recommendations do you have for international medical graduates?

Over 200,000 physicians in the United States are international medical graduates. These physicians have made valuable contributions to patient care, research, and medical education. If you speak to these physicians, you will hear about the difficulties and challenges they experienced in their efforts to secure a residency position in the U.S.

The process is difficult, and our experience working with international medical graduates has shown us that they frequently overestimate or underestimate certain residency application criteria. These misperceptions may result in a failure to match. In our chapter on international medical graduates, we provide information from those individuals directly involved in the residency selection process – program directors and other members of the residency selection committee. International medical graduates can use this information to develop a strategy for success.

References

(1) 2008 NRMP Program Director Survey. Available at www.nrmp.org.

(2) Green M, Jones P, Thomas JX Jr. Selection criteria for residency: results of a national program directors survey. Acad Med 2009; 84(3): 362-7.

(3) O’Halloran CM, Altmaier EM, Smith WL, Franken EA. Evaluation of resident applicants by letters of recommendation: a comparison of traditional and behavioral-based formats. Invest Radiol 1993; 28: 274-7.

(4) Aagaard EM, Hauer KE. A cross-sectional descriptive study of mentoring relationships formed by medical students. J Gen Intern Med 2003; 18: 298-302.

(5) Gong H, Parker NH, Apgar FA, Shank C. Influence of the interview on ranking in the residency selection process. Med Educ 1984; 18(5): 366-9.

(6) Hayden SR, Hayden M, Gamst A. What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident. Acad Emerg Med 2005; 12(3): 20