What are the latest trends in medical admissions? At the annual meeting of the Association of American Medical Colleges (AAMC), 3,800 medical education professionals from around the country addressed changes in the MCAT, criteria for evaluating applicants, predictors of success in medical school, what elements of the residency application are most important, and a wide variety of other subjects that may interest premedical and medical students and residents. Here are some of the meeting’s highlights.

MCAT Update

Quick facts:

• In 2009, there will be 28 test administrations and 18 score release dates.
• A March date for the MCAT was added to assist students who are on quarter systems with scheduling.
• Scores are delivered 30-35 days after the test is taken.
• A change for this year: since applicants can be registered for only one test date at a single time, they will be allowed to cancel their test after the deadline (and forfeit the fee), enabling them to register for a future test date.
• The MCAT administration plans to review and modify policies regarding testing accommodations in the near future.
• A new publication, The Official Guide to the MCAT Exam, which will include testing tips and strategies, is to be released shortly.

In preparation for the fifth comprehensive review of the MCAT, surveys were sent to 142 US medical schools to find out what factors are important for evaluating applicants. The response rate was 90%. Survey results showed that the undergraduate GPA and MCAT scores are used to determine academic capability and success in the basic sciences. The MCAT score is also used to predict the USMLE Step 1 performance

Personal characteristics and qualities that were identified as important for success in medical school and beyond are:

• Integrity
• Critical thinking skills
• Professionalism
• Motivation for medicine
• Reliability
• Ability to integrate information
• Logical reasoning
• Maturity
• Work ethic
• Team work
• Compassion
• Self discipline
• Oral communication skills
• Intellectual curiosity
• Scientific and verbal reasoning
• Resilience
• Altruism

The MCAT staff discussed how standardized tests do not assess these qualities and that the tools and testing modalities to evaluate them need to be developed. This is why written documents (personal statement, application, and letters of reference) and interviews are so vitally important because they offer admissions members an opportunity to evaluate personal attributes.

The Holistic Review of Medical School Applicants

The AAMC is trying to ensure that applicants “are evaluated by criteria that are institution specific, broad-based, mission driven, and that are applied equitably across the entire applicant pool.” In an effort to increase the overall diversity of physicians (without considering race and ethnicity), the definition of diversity must be multidimensional and to more accurately assess applicants, the entire record must be considered as a whole (the so-called holistic approach). The definition of diversity may also differ from institution to institution so applicants must consider the mission statement of each school. It is also important to understand that with a looming doctor shortage (especially of primary care physicians), the need to increase access to primary care for everyone, including underserved populations, needs to be addressed at the level of the medical school application. There is also evidence that the care provided to racially and ethnically diverse patients is often affected by provider bias and stereotyping, which is why today’s physicians must be culturally competent.  Medical school admissions committees must select not only the most capable students but also those who will make a valuable contribution to our society as a whole.

Predictors of Success in Medical School

There are few accurate predictors of future performance as a physician, though past academic performance and MCAT score predict future academic success and USMLE performance.  Because past behaviors are usually predictive of future behaviors, and this is all admission committees have to go on, it is best to give admission committees enough material to provide a clear and multifaceted view of who you are.  Interviews are important not only because they give the school a chance to really know you, but they give you an opportunity to show your warmth and provide a sense of how you will interact and communicate with patients. Remember, admissions officers aren’t out to get you. They are kind people who carry a tremendous responsibility and have a very important mission.

National Residency Matching Program (NRMP) Update

Quick facts for 2008:

• 25,066 residency positions were offered
• 23,674 positions were filled
• 883 US allopathic seniors didn’t match
• The number of IMG applicants has increased during the past 10 years

Many IMGs register for the NRMP just to get the list of unfilled programs for the scramble. About 13,000 people compete in the scramble to gain an unfilled position. With only 1,390 positions remaining unfilled on scramble day, many of which are preliminary programs, the odds of getting a spot through the scramble are not good. As the scramble now stands, schools and students find out if they didn’t match on Monday. On Tuesday at 11:30 AM, programs find out if they didn’t fill. The list of unmatched programs is released at noon on Tuesday and unmatched applicants begin contacting programs. In 2008, by 4 PM on Tuesday, 50% of the unfilled positions were filled. By Wednesday, 147 positions remained open. Clearly, the scramble is stressful and you should do everything in your power to avoid it. The NRMP website gets more than 5 million hits on the Tuesday of match week.  Because of many “for profit” companies that fax materials to programs for clients, faxes and phone lines are often jammed at programs that have unfilled positions.

The NRMP is proposing a possible change for the scramble but this likely will not be put into effect until 2011. The goal of this change would be to allow applicants and programs more time to interview applicants (by phone), create more time to make decisions, and decrease stress for everyone involved.  A scramble work group has been formed to address these issues and the pros and cons of the current system and to make suggestions for improvement.

Electronic Residency Application Service (ERAS) Update

While growth of allopathic medical school enrollments is projected, the greatest increase of applicants using ERAS is of osteopathic students and international medical graduates (IMGs). The number of IMG applicants to ACGME accredited programs has increased by 14% since 2001, and the number of US ECFMG certified applicants, most of whom are Caribbean students, recently has increased significantly as well.

US allopathic students increasingly are choosing specialties with “controllable lifestyles,” such as anesthesiology, emergency medicine, dermatology, radiology, and pathology. Fewer and fewer medical students are choosing family medicine and internal medicine (primary care). Fifty five percent of those who match in internal medicine choose to subspecialize. IMGs continue to fill the void for specialties that US graduates are not choosing. Interestingly, a survey done by the NRMP of physicians over 50 found that 47% of primary care physicians versus 44% of “controllable lifestyle” physicians felt that they had control of their lives. So, perhaps medical students should start to reevaluate what specialties offer the best work/life balance – primary care might be the answer.

Specialty Choice

What are the factors guiding medical students’ specialty choice?

• Whether the specialty “personality” matches the applicant’s personality
• Mentors and exposure to the field
• Lifestyle
• Income/job market/debt
• Length of training

Getting Into Residency

What are the most important factors for getting into residency? The answer to this question depends on the specific program and the specific specialty. All programs consider the following factors important but not necessarily in the order presented:

• USMLE Step 1 score
• Grades (if not pass/fail), AOA, class rank
• Subinternship performance
• Letters of reference
• Personal statement
• Interview
• Medical School Performance Evaluation or MSPE (formerly known as the Dean’s letter). The usefulness of the MSPE and the timing of release is being evaluated. More to come on this.

Changes Ahead

With the election of Senator Barack Obama as our next president, the country is expected to undergo health care reform, making this a truly exciting time for the future generation of physicians to be a part of medical education.  While it is important to understand what it takes to “get in” to medical school and residency, you should also keep bigger issues in mind. For example, how will we improve the access to and quality of medical care for everyone? How will we decrease the income disparities among specialties so students will pursue the specialties where the need is greatest?

Dr. Freedman’s Bio:

Jessica Freedman, MD, is a former medical 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.

Authors of The Successful Match: 200 Rules to Succeed in the Residency Match and 250 Biggest Mistakes 3rd Year Medical Students Make And How To Avoid Them

“I saw his drunk photos on MySpace, and he just strikes me as immature. Do you think that matters?” “I don’t know, but we have 30 other great applicants here to choose from.”

“She’s a member of the Facebook group, ‘Medical Students Behaving Badly.’  I don’t think that’s someone we should bring in as a resident.”

Applying for residency, as every applicant knows, is a long, complex process, and understandably so. Residency selection committees use every tool at their disposal to compare applicants. Would programs use internet search engines and social networking sites, such as Facebook and MySpace, to screen applicants?

No studies examining this issue as it pertains to the residency application process have been published. However, there is data available from other fields. In the business world, employers are increasingly using social networking sites to learn more about potential hires:

• In a recent CareerBuilder.com survey of 3,169 hiring managers, 22% used social networking profiles to screen potential hires.¹
• Α Vault.com survey found that 44% of employers reported looking up potential hires on social networking sites.²
• According to the executive search firm ExecuNet, 77% of recruiters surveyed used the Web to screen applicants.³

How did the information discovered affect hiring decisions?  In the CareerBuilder.com survey, 34% of managers who used these sites in the screening process reported dropping candidates from consideration based on the content found.  Most concerning for these hiring managers were candidates posting information about alcohol or drug use, followed closely by posting of inappropriate photographs or information.  Less commonly cited, but still areas of concern, were poor communication skills and discriminatory comments related to race, religion, or gender.  Even an unprofessional screen name, while seemingly much more innocuous, raised concern for some managers.

In a recent study published in the Journal of General Internal Medicine, researchers at a major medical school in the Southeastern U.S. evaluated the Facebook profiles of all students at their institution.⁴ Of the 501 medical student participants in the study, 64.3% had Facebook accounts.  In an analysis of these profiles, the authors found the following:

•    Forty percent joined online groups.  While most groups were benign in nature, some groups raised concern, including those with the names “Party of important male physicians,” “Keep your f***ing hand down in lecture and shut the f*** up,” and “I should have gone to a blacker college.”
•    When a random subset of students was examined more closely, 70% were found to have photographs with alcohol, with a substantial number showing excessive drinking.
•    Some profiles contained unprofessional comments, involving foul language, overt sexuality, and patient privacy violations.

While students maintain that their personal profiles were never meant to be viewed by anyone other than their friends, the reality is that anything placed in a publicly available profile may be viewed by programs and used in the selection process.  As stated by the Student Affairs Office at the Drexel University College of Medicine, “programs/employers are increasingly gaining access to social networking sites such as Facebook and MySpace to see what they can learn about candidates…”⁵

Social networking sites often allow users to restrict access to their profiles.  While students often realize this, many users fail to activate these privacy features.  In the aforementioned study of medical students, 62.7% kept their Facebook account public.  Even when a profile is restricted, however, there are ways around privacy guards.  For example, a member of the residency selection committee who is a graduate of your college or medical school, can create a profile using an alumni email address.  In doing so, he can acquire access to current students at that institution.  In this way, he can circumvent the privacy guards in place at social networking sites such as Facebook.

Some students argue that their online personality is different from their professional personality.  Therefore, no conclusions or assumptions should be drawn from the content posted.  It is currently true that research examining the predictive value of posted content on social networking sites as it relates to on-the-job behavior or performance is not available. However, that’s not likely to stop a program director from making judgments about you based on your personal profile.

In selecting candidates, programs are searching for those who will succeed as residents and, later, as practicing physicians.  They also seek to avoid problem residents, defined as “trainees who demonstrate a significant enough problem that requires intervention by someone of authority, usually the program director or chief resident.”⁶ When Yao looked at reasons why certain residents were considered “problem residents,” among the deficiencies reported were inappropriate interaction with colleagues or staff, unsatisfactory humanistic behavior with patients, and unacceptable moral or unethical behaviors.⁷

Studies have shown that behavioral and noncognitive traits and skills have significant value in predicting resident performance.  However, programs are limited in how they can assess these skills.  The use of social networking sites may provide additional information about potential residents not found in traditional application components (i.e., curriculum vitae, letters of recommendation, MSPE, personal statement, transcript, interview).

In justifying their actions for use of this information, programs may maintain that unprofessionalism displayed at social networking sites may be a harbinger of future unprofessionalism during or after residency.  In a retrospective study done by Dr. Papadakis, associate dean of student affairs at the UCSF School of Medicine, researchers searched for warning signs during medical school associated with an increased risk for disciplinary action later as a physician.⁸ They found that “disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school.”

Since programs are free to use whatever tools are at their disposal for the evaluation of residency applicants, we recommend that you view social networking sites as yet another tool.  Even with privacy guards in place, there are ways to circumvent restrictions.  Therefore, we recommend a preemptive stance or approach to keep your online persona clean.  We recommend the following:

•    Google yourself regularly to ensure that troublesome or offensive material does not appear online.
•    Employ whatever privacy guards or blocking tools are offered by your social networking site.
•    Closely review your posted materials (i.e., comments, photos, membership in groups) to ensure you are displaying the professionalism expected in a future resident and doctor.
•    As you examine your online persona, consider your audience.  You and your friends may feel that the content is relatively normal or harmless, but faculty members and program directors may have a completely different viewpoint.
•    Remove any material, including photographs and text, that may be considered inappropriate.
•    If you cannot remove the information, politely contact the company or person who owns the site and request its removal.
•    If the information cannot be removed, be prepared to discuss it should the issue be raised during an interview.
•    Consider creating profiles at professional networking sites such as LinkedIn.  Such sites tend to be ranked highly by internet search engines and profiles placed at these sites may be displayed first on an internet search of your name.

Finally, we agree with the recommendations of Brittany Warwick, in her SDN article “Keep Your Online Persona Clean.”⁹ She recommends using “your online presence to advertise your good qualities.  You can post information about your leadership, maturity, growth, and potential.”  An online persona conveying a professional image may solidify a program’s decision to interview or even rank you favorably.

References

1. Available at www.CareerBuilder.com
2. Available at www.Vault.com
3. Available at www.ExecuNet.com
4. Thompson, LA, Dawson K, Ferdig R, Black EW, Boyer J, CouttsJ, Black NP.  The intersection of online social networking with medical professionalism.  J Gen Intern Med 2008; 23 (7): 954 – 957.
5. http://webcampus.drexelmed.edu/osa/careeradvising/interview.asp
6. American Board of Internal Medicine.  In:  Materials from Association of Program Directors in Internal Medicine (APDIM)’s Chief Residents’ Workshop on Problem Residents; April 19, 1999; New Orleans, LA.
7. Yao DC, Wright SM.  National survey of internal medicine residency program directors regarding problem residents.  JAMA 2000; 284 (9): 1099 – 1104.
8. Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND.  Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board.  Teach Learn Med 2007; 79 (3): 244 – 249.
9. Warwick, B.  Keep your online persona clean.  Available at www.studentdoctor.net.

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.

Reprinted with Permission

Any transition, be it from college to the work world, or the common transitioning between jobs, can be difficult. But most transitions happen fairly quickly, in a matter of a couple months, compared to that of the medical transition. Transitioning in the medical profession is a way of life, whether it be from student to internship, internship to residency, or residency into a fellowship, specialty or private practice. The family of medicine is always there to support their physicians in training and make the transitions as smooth as possible.

Planning—The Key to Success

The first step in any transition is planning. How much time depends on each person and his or her priorities. For example, for Gary and Ashlie Schooler, physician and spouse started planning at different times. Gary Schooler, a fourth-year medical student at the University of Oklahoma, began planning on the first day of medical school. “I knew doing my best throughout my pre-clinical and clinical years would afford me the best opportunity to be successful in gaining access to the specialty that was best fit for me,” he said. But for his wife Ashlie, planning began in his second year of medical school. “This was the time to start budgeting…so we could afford for me to travel to most of the cities [we were considering for his new job and our relocation] with him,” said Ashlie. “I also saved my vacation through the year at my job to allow me to be gone. With this plan we were able to visit neat places together.”

For others, the planning process was approached in steps. For Dr. William and Gretchen Dupps, the first step was related to the program or job that was the best match for the physician. The second step was researching the areas that were being considered, including the school systems and culture of the region. “After we painstakingly went through lots of research and visits, we would make a list of pros and cons,” said Gretchen, whose husband Dr. William Dupps is two years out of fellowship. “Ultimately the most heavily weighted part of that list would be the job opportunity.”

With this transition process being one of the most challenging decisions of a physician’s life, research is very important. No one knows better about this transition than those who have gone through it. “I asked many questions of the residents who just recently were in my shoes,” said Adam Ostendorf, a fourth-year medical student at the University of Iowa starting his transition to a residency in pediatric neurology in St. Louis. “In addition, certain staff physicians have been extremely generous with advice regarding both transition to residency and the transition to a new city.”

And while some physicians are very open to the idea of moving to a different city, others want to stay close to their roots. “Getting back ‘home’ is most important to us,” said Darla McVay, spouse of Dr. Bryan McVay, a surgical resident in Pennsylvania.

Matchmaking

The “match” process can be stressful for the student and his or her family.

For some, the result can create an easier transition than for others. For the Hogrefe family, their transition takes them no farther than into a new home. Christopher Hogrefe, a fourth-year medical student at the University of Iowa, will be working in a residency in the same city he went to school in, and he will start working with his spouse, Amy Hogrefe, who is a nurse at the University of Iowa Hospitals and Clinics. “However, we laugh frequently because of all of our life changes that are occuring this spring and summer,” said Christopher. “To briefly recap, we [experienced] Match Day, bought a house, will graduate from our respective graduate programs at the University of Iowa, I am starting a new job and Amy is having a baby in July!”

The matching process can take longer for some than others. Gary Schooler was always under the impression after talking with other specialists that when the best specialty for him presented itself, he would just know it was meant to be right away, like a light bulb coming on. But his process was a drawn-out system of weighing likes and dislikes before coming to his conclusion.

Sometimes the conclusion isn’t thought of in great depth because the outcome is already assumed, as in the case of Brent Owen, a fourth-year medical student at the University of Iowa starting his residency at the Via Christi Family Medicine Residency in Kansas. “Originally we planned on [a] residency closer to home but really enjoyed the Via Christi program when we interviewed.” And while a lot of planning can be put into the transition, it can still be overwhelming. According to Adam Ostendorf, “Our lives are about to change in almost every aspect.”

Transitions happen to many people across the country on a daily basis, but most people only make major transitions couple times in their lives. The profession of medicine can make the lives of physicians and their families seem like a constant state of flux. “There are so many transitions throughout training that I felt we were in transition for our entire course of training,” said Gretchen Dupps. “I think we are just now feeling like we are getting settled. This is the first time in our 15 years of marriage that we have been in a location for an [extended] amount of time.”

Along with the continuous state of transition that is unique to the medical field, there are many other factors that only seem to affect those in medicine. “There is certainly nothing like ‘the match’ in the regular working world,” said Adam Ostendorf. “What a stressful process! Then it is complicated by such a short amount of time to tie up loose ends in medical school and then move to your new home.”

Christopher Hogrefe points to another challenge, “Try getting your first job at 26!” Dr. Edward Hill, faculty at the North Mississippi Medical Center and former AMA President, concurs. “Perhaps there is some delay in the development of social skills outside of medicine as well as a lack of opportunity for a balanced lifestyle since being immersed in focused medical studies for seven to 12 years post-college. The physician completing training has non-medical college classmates that have been in the real world already for those seven to 12 years.”

A Life-Long Family Commitment

One other aspect of medical life is the need to continue to learn. Medical advancements are made every day, and physicians are expected to stay up-to-date on the latest and greatest ways of helping patients. “I believe the biggest difference [between medical student graduates and college graduates] is that after medical school a doctor’s education is just really starting to become fine-tuned toward their future career,” said Gary Schooler.

The transition not only affects the future career of the physician, but also that of their spouse in most cases. With moves being made to different cities and states, spouses often find themselves having to leave careers, family and friends behind. “After completion of my intern year, we will be moving to a new area of the country to begin my [residency] in radiology,” said Gary Schooler. “My wife will have to quit her current job and find a new one in our new location.”

Some families with children find this transition period the perfect opportunity to spend more time with them. With one parent being obligated so much outside of the home, the spouse decides to make sure that the children continue to get all the attention they are accustomed to, as is the case with Hilah Owen, wife of Brent Owen. “We are planning on Hilah staying home to take care of our son and future children since I plan on being busy, especially for my first year of residency,” said Brent. Still others find a way to continue their careers while always remembering to support their physician spouse. “Fortunately Amy will be able to keep her current job, while making a few adjustments,” said Adam Ostendorf. “It is certainly challenging to have to help me out so much while having her own career and I respect her immensely for it.”

Children can make the life changes even more difficult. Moving away from friends and family that can help with childcare, and taking children away from friends they have made can complicate matters greatly. “My children’s education, and our support system will be determined, in large part, by the nature of the community in which we find employment,” said Dr. Bryan McVay. Meeting fellow medical families with children is what helped Gretchen Dupps get through the difficult residency years. “One of my best friends from residency became a ‘co-parent’ with me,” she said. “She and I would trade off taking care of each other’s children and spent many afternoons and evenings together letting the kids play and enjoying some adult conversation.”

Support System

Friendship can help overcome the difficult times, but it is most important that all family members appreciate each other for their continued support. “My husband and I work as a team, and he has done an excellent job of giving me credit for all I do and for acknowledging the sacrifices we have made as a family throughout his training,” said Darla McVay. And struggling through these complicated times together can make the bond that much closer if it is handled correctly. “Amy and I have become intimately aware of the importance of confiding in one another,” said Christopher Hogrefe. “Such an approach aided us in gaining perspective and understanding how each of us independently views a situation, which is not always identical.”

The process of moving from one life stage to another can draw extended family closer. “We have been fortunate to live within 10 miles of both our parents while attending medical school,” said Brent Owen. “It has been nice to have them so close for support, baby-sitting and advice. The transition of us moving has been equally hard on them as [it has] for us.”

Dr. Hill repeats a quote he shares with the students he advises, “If you fail to plan, you are planning to fail.” He also instructs them to include the family completely in the planning if the transition is to be successful, stressing that a lot of support is vital. Support can come from many places. Young physicians and spouses should not fear asking for help and guidance.

Join the AMA Alliance nationwide medical family action network - click here.

Find Alliance children’s activity books and other resources – here.

Authors of The Successful Match: 200 Rules to Succeed in the Residency Match and 250 Biggest Mistakes 3rd Year Medical Students Make And How To Avoid Them

In researching our book, we asked applicants what they found most difficult about the residency application process. A number of applicants commented on the same issue. “There’s so much conflicting information out there. How do you know what to believe? Who should you listen to?”

Applicants with mentors have a decided advantage. A joint committee of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine described a mentor as “someone who takes a special interest in helping another person develop into a successful professional.”¹ In defining the term, the committee described a fundamental difference between mentoring and advising. “Mentoring is a personal, as well as, professional relationship. An adviser might or might not be a mentor, depending on the quality of the relationship.” While the two terms are not synonymous, for the purposes of this column, we will use them interchangeably.

Mentoring relationships are invaluable. Students benefit greatly when the wisdom, experience, and perspective of a knowledgeable faculty member are used to help them achieve a successful match. Having a mentor to guide you through the complex residency application process is recognized by students as an important factor in boosting the strength of their application. In a survey of third- and fourth-year medical students at UCSF, 96% of all participants rated mentors as important or very important.² Unfortunately, recognizing the value of a mentoring relationship is a far cry from developing such a relationship. Although 96% of the participants rated mentors as important, only 36% actually reported having a mentor.

The value of mentoring is recognized in all fields. The literature in the fields of business, education, and medicine all support its value. Comments made by medical school faculty emphasize the value of a mentoring relationship:

“I had a difficult time learning the rules of the game.”³

“Without a mentor…I had no idea really what to expect from academic medicine. I have been feeling my way through the tunnels because I don’t know where the roadblocks are. I just kind of deal with them when I get there.”³

These words resonated with us, as they mirror the type of comments we hear from applicants. It’s tough to learn the rules of the game when they’re not actually written down anywhere. “I didn’t know you could customize your personal statements for different programs.” “I didn’t know I should have sent an email thank you immediately after the interview, especially since I was planning to send a note later.” Particularly difficult is when you learn the rules of the game too late to make a difference. “I didn’t know that 93% of matched applicants to radiation oncology in the NRMP data from 2007 had reported one or more abstracts, publications, or presentations. I’m in my fourth year now, and it’s probably too late.”⁴

Medical schools have recognized the importance of mentoring and advising students, and have responded with the development of mentoring programs. As would be expected, these programs have differed widely in structure and scope. At schools such as Johns Hopkins and Columbia, highly organized programs have been developed.

At other schools, the mentoring process is much more informal. Students may be given a list of faculty members willing to serve as advisors, and then encouraged to cultivate relationships. As one student in a survey of UCSF students stated, “I create the relationship, and then I follow it. I sort of take the risk.”⁵ Not all students find it so easy. Some have blamed themselves for not being assertive enough to find a mentor. “I just didn’t know how to go about setting myself up for a good thing to happen.”⁵ Others maintained that the problem lies with the system, citing the short duration of courses and clerkships as impediments to developing relationships with faculty.

Finding a potential mentor and developing an effective relationship can be very difficult. Understandably, students often hesitate to burden faculty members who are already clearly very busy. However, while faculty members have many demands placed on their time, there are faculty at every medical school who find mentoring and advising students enjoyable and rewarding. While these individuals are sometimes recognized publicly for their work, it is more typical that they go about their work diligently but quietly. You should make every effort to identify these types of motivated, dedicated individuals. In one study, 28% of students met their mentors during inpatient clerkships, 19% through research activities, and 9% during outpatient clerkships.²

Some students won’t find a mentor through their randomly assigned clerkships and courses. Persistence, courage, and some degree of assertiveness may be necessary. The process may be very informal. You may hear from the residents or your colleagues that Drs. A, B, and C have helped advise many students applying to your field in past years. You may then request that faculty member for a clerkship assignment or research elective. Some may be open to meeting with you. On the other hand, you may be advised to start the process by setting up a meeting with the clerkship director, program director or chairman of the department. The intent of this meeting would be to state that you’re planning to apply to the field of …. From there, the meeting can go in several directions. You can ask for recommendations on potential advisors. You can ask for recommendations on the application process, given the strength of your credentials. You can seek opportunities to work on a case report, to work on a research project, or to arrange a research elective.

Some schools lack residency programs in certain specialties. That poses obvious difficulties for students applying to that specialty. One option would be to seek advisors elsewhere, such as during an audition elective. In addition, local or national organizations may provide assistance. The Society of Academic Emergency Medicine (SAEM) has a medical student virtual advisor program open to students at all institutions. Through this program, students can query experienced individuals about a variety of issues, including the EM residency application process. Recognizing the importance of mentorship, SDN has launched an innovative mentorship program as well.

Finding the right mentor can be difficult. Even when a formal system for assigning mentors exists, this doesn’t necessarily mean that the mentor will be the right fit for the student. Should this happen, you should seek guidance from other faculty members. Few mentors have the answers to every question, and it is often to your advantage to have several opinions on certain issues.

As you consider possible mentors, you should be aware of problems that can occur in the advisor-advisee relationship. Chief among these is the potential conflict of interest that can occur with a mentor who advises a student and also serves on the residency selection committee at a program affiliated with the student’s medical school. In a survey of 740 graduating medical students from 10 U.S. medical schools, Miller found that nearly half met with their advisors during or following the interview season.6 The results indicated that:

· 31.8% were encouraged to rank the advisor’s program highly.
· 10.3% were asked which programs they planned to rank highly.
· 4% were asked how they planned to rank the advisor’s program.

Not surprisingly, students reported varying degrees of discomfort from these queries. One respondent stated that “it felt very uncomfortable to talk to him about my own strengths and weaknesses and about which programs I preferred knowing that he would later be evaluating me in comparison with many other applicants and deciding whether or not to advocate for me to be accepted.” Faced with such dilemmas, some students felt pressured to make misleading statements. Miller went on to raise some important questions. “What is safe for applicants to tell their advisors? Can applicants be sure that their advisors will put their interests first in these situations?” You need to consider how you would respond to these types of queries, since you may be placed in a similar situation.

Studies on medical students, mentoring, and the match are sparse. However, our experience has clearly demonstrated that having an effective advisor is invaluable. Mentors can help students with career decisions, evaluate potential residency programs, review curriculum vitas and personal statements, write letters of recommendation, and conduct mock interviews. Since faculty members often sit on residency selection committees, many can offer the type of insight into the selection process that is not available elsewhere. By analyzing and comparing your credentials with previous years’ students who have matched, specialty-specific advisors can identify specific ways in which you can strengthen your application. They can work with you to develop an overall strategy for success. Applicants should work hard to identify potential mentors, since these relationships can be invaluable in ensuring a successful match.

References

¹Adviser, teacher, role model, friend. (http://stills.nap.edu/readingroom/books/mentor). Accessed 3/13/08. Washington, DC: National Academy Press; 1997.

²Aagaard EM, Hauer KE. A cross-sectional descriptive study of mentoring relationships formed by medical students. J Gen Intern Med 2003; 18: 298-302.

³Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui, T. “Having the right chemistry”: a qualitative study of mentoring in academic medicine. Acad Med 2003; 78(3): 328-334.

⁴Charting outcomes in the match: characteristics of applicants who matched to their preferred specialty in the 2007 NRMP main residency match. (www.nrmp.org/data/chartingoutcomes2007.pdf ). Accessed 3/20/08. Washington, DC: National Resident Matching Program; 2007.

⁵Hauer KE, Teherani A, Dechet A, Aagaard EM. Medical students’ perceptions of mentoring: a focus-group analysis. Med Teach 2005; 27(8): 732-734.

⁶Miller JB, Schaad DC, Crittenden RA, Oriol NE. The departmental advisor’s effect on medical students’ confidence when the advisor evaluates or recruits for their own program during the match. Teach Learn Med 2004; 16(3): 290-295.

Authors of The Successful Match: 200 Rules to Succeed in the Residency Match and 250 Biggest Mistakes 3rd Year Medical Students Make And How To Avoid Them

Every aspiring physician knows the importance of memorization, especially in the basic science years. As you advance in your career, however, communication skills come to the forefront. Physicians with poor communication skills are more likely to be sued. (Virshup) They are more likely to be disciplined by the medical board. They may not receive as many professional referrals from colleagues or word-of-mouth referrals from patients.

Successful communication requires establishing a connection and imparting a message. Successful patient care does not end with gathering data from your patient. It revolves around imparting that information to the entire team that is involved in patient care: your team members, the consulting physicians, the nurses, the patient and family members, and even the cafeteria, among others. (“The patient’s allergies include a history of anaphylaxis to shrimp.”)

Third year students, in the midst of early clinical rotations, quickly recognize the importance of communication. Memorization may be a crucial skill for those taking exams and receiving grades based on an objective test score. However, when receiving a subjective grade based on your ability to take care of patients, one’s ability to communicate with patients, to establish rapport with colleagues, and to impart medical information, become important indicators of communication skills.

How exactly do medical schools determine a student’s ability to provide excellent patient care? A student’s grade in core clinical rotations is determined by several factors, including subjective ratings and objective test scores. One study examined the evaluation techniques of 97 US medical schools. (Kassebaum) Faculty and resident ratings accounted for 50-70% of a student’s grade in core clinical rotations.

How do faculty and residents arrive at their subjective rating of a student’s abilities? Clerkship evaluation forms ask faculty to rate students on specific skills, such as a student’s ability to take a history and perform a physical examination. However, attending physicians rarely or infrequently observe students in these areas. In fact, in a survey of 322 University of Virginia medical students at the end of their third year, 51% reported never having a faculty member observe them while taking a history; 81% had never been observed performing a complete physical exam. (Howley) Therefore, many faculty draw conclusions about a student’s ability in these areas from the quality of the oral case presentation.

In a study of surgical faculty, Pulito found that it was rare for faculty members to directly observe a student taking a history or doing a physical examination. (Pulito) In fact, only one of nine faculty members surveyed had done so. Despite this, five of the nine faculty participants rated students in this area. They inferred the rating of this characteristic from other factors, particularly the oral case presentation. Pulito wrote that “in the clinic setting, for example, if a student presents a patient to an attending and is verbally facile, succinctly describing a focused history and physical examination, the inference may be drawn that the student expeditiously obtained the relevant history and performed an appropriate examination.”

In one study focusing on communication apprehension among medical students starting a surgery rotation, Lang wrote that “much of a student or resident’s evaluation is based on oral presentations.” (Lang) In another study assessing student performance on a pediatrics clerkship, Greenberg found “a highly significant relationship between students receiving a final grade of honors and an ‘A’ on their case grade.” (Greenberg)

In oral case presentations, students aim to effectively transfer important clinical information between team members. When done well, these presentations facilitate patient care, improve team efficiency, and become a valuable learning experience. Since they also serve an evaluative function, students hope to deliver high-quality presentations to prove their competence. While some students are inherently gifted in the area of making presentations, all would benefit from practice and the following suggestions:

• Expectations for the oral case presentation vary from clerkship to clerkship, attending to attending, and resident to resident. For this reason, always meet with your attending and resident on the first day or two of the clerkship to ascertain their expectations.

• Your goal is to leave this discussion knowing the attending or resident’s personal preferences (preferably before your first presentation). Ask specific questions about time limits, the order in which to present information, and so on. “Do you want me to report the entire physical exam or just pertinent positives?” “Which labs would you like to hear, or would you prefer to hear all of them?”

• What worked well with one attending or resident may not work well with another. You may have internalized a certain set of “presentation rules.” With the start of a new clerkship or arrival of a new attending, recognize that these rules may not meet their needs.

• Be aware of the context in which you are presenting. Your presentation to a resident with whom you evaluated the patient should be different than the presentation given to an attending who is hearing about the patient for the first time.

• Make your presentation flow like a story. Your goal, many times, is to make an argument for a particular condition. Put the details of the case together in such a way as to lead the listener to a diagnosis.

• As a novice clinician, your inexperience makes it difficult to decide what to include and what to leave out. The easy way out, and the route that many students take, is to simply read the written H & P word for word. However, the oral case presentation should be a carefully edited version of the written record. The key is to communicate only what’s relevant. For a new clerk, that can be very difficult. Don’t be afraid to ask for help in this area.

• Use residents as a resource. Residents are often familiar with attending preferences and can help polish your presentation before you have to deliver it to the attending.

• Seek feedback after each and every one of your presentations. The best feedback is that which is explicit and timely. Many attendings won’t automatically provide feedback; you may have to specifically ask for it. “Dr. So, do you have any suggestions on how I can improve my presentation?”

• Uncertainty is normal with oral case presentations. Because of the evaluative function of these presentations, it can be tempting to bluff or lie in an effort to look good. As hard as it can be to say “I don’t know,” honesty and accuracy in the transfer of clinical information is vital to patient care. In a survey of Johns Hopkins medical students, 13% to 24% admitted to cheating during the clinical years of medical school. (Dans) Examples included “recording tasks not performed” and “lying about having ordered tests.”

• Projecting confidence is important. Your choice of words, the manner in which you speak, and your body language are all factors that will be used to judge the quality of your presentation.

• It is rare to present a patient without any interruptions. In one study of emergency medicine faculty and students, the mean number of interruptions was 2.49 per oral case presentation. (Yang) Although students often view interruptions as a sign that their presentation is lacking, this is often not the case. Attendings find it difficult to balance the need to teach with the need to care for a service full of sick patients. In addition to interruptions due to time constraints, you may be asked to repeat information or clarify a certain point. Unfortunately, many students let interruptions derail their presentation, and find they can’t recover.

• Many students stop short of offering an assessment and plan, especially novice clinicians who don’t feel qualified to do so. Always offer your own assessment and plan. Attending physicians are impressed with students who take the initiative to do so.

• Read extensively about your patients’ problems using a variety of resources, including handbooks, specialty textbooks, and the recent literature. As you read, make it a habit to ask “why?” Why did we order this test? Why did we choose this particular antibiotic? Such questions further your understanding of the disease – not to mention prepare you for the attending questions that are sure to come during or following your presentation.

Because of the complexity of the oral case presentation and the varied needs and expectations of residents and attendings, delivering high-quality presentations can be difficult. Is it worth the effort? Absolutely. First, presentation quality is a major factor used in the evaluation of students. Second, the development and acquisition of communication skills is important for your future career as a physician. That’s precisely why, in recent years, organizations such as the Association of American Medical Colleges (AAMC), Clerkship Directors of Internal Medicine (CDIM), and the Accreditation Council for Graduate Medical Education (ACGME) have emphasized its importance. In fact, the AAMC considers the development and acquisition of communication skills a core learning objective for medical students.

Communication skills remain important at every stage of your career. For fourth year students, currently in the process of submitting applications and awaiting invitations to interview, communication skills take on renewed importance. A successful interview requires establishing a connection with the interviewer and imparting a message about your strengths and abilities, a topic we will review in our next column.

REFERENCES

Virshup BB, Oppenberg AA, Coleman MM. Strategic risk management: reducing malpractice claims through more effective patient-doctor communication. Am J Med Qual 1999; 14(4): 153-9.

Kassebaum DG, Eaglen RH. Shortcomings in the evaluation of students’ clinical skills and behaviors in medical school. Acad Med 1999; 74(7): 942-9.

Howley LD, Wilson LG. Direct observation of students during clerkship rotations: a multiyear descriptive study. Acad Med 2004; 79 (3): 276-280.

Pulito AR, Donnelly MB, Plymale M, Mentzer RM Jr. What do faculty observe of medical students’ clinical performance. Teach Learn Med 2006; 18(2): 99-104.

Lang NP, Rowland-Morin PA, Coe N. Identification of communication apprehension in medical students starting a surgery rotation. Am J Surg 1998; 176 (1): 41-45.

Greenberg LW, Getson PR. Assessing student performance on a pediatric clerkship. Arch Pediatr Adolesc Med 1996; 150 (11): 1209-1212.

Dans P. Self-reported cheating by students at one medical school. Acad Med 1996; 71 (1 Suppl): 70-72.

Yang G, Chin R. Assessment of teacher interruptions on learners during oral case presentations. Acad Emerg Med 2007; 14 (6): 521-525.

• For ACGME residency and fellowship programs, use the American Medical Association’s Fellowship and Residency Electronic Interactive Database (FRIEDA):
  
  http://www.ama-assn.org/ama/pub/category/2997.html

AOA Programs:

• For American Osteopathic Association residency and fellowship programs, use the AOA Opportunities Database:
  
  http://opportunities.osteopathic.org/

Independent Resources:

• SDN’s Residency Interview Feedback, visit our resource at:
  
  http://more.studentdoctor.net/residency.php
  

• Also available is Scutwork.com. They have a list of reviews for many programs.   Be warned however, many students note that the site is out of date and contains old reviews and often incorrect information.
  
  http://www.scutwork.com

Authors of The Successful Match: 200 Rules to Succeed in the Residency Match and 250 Biggest Mistakes 3rd Year Medical Students Make And How To Avoid Them

Which of the following is the most important academic criterion used by program directors to select residents?

A) USMLE step 1 score
B) USMLE step 2 CK score
C) Pre-clinical course grades
D) Third-year clerkship grades
E) Membership in Alpha Omega Alpha (AOA)

In our own surveys, we have found that students almost always answer this question incorrectly. Students generally base their answer on information gathered from classmates, upperclassmen, residents, and discussion forums, among others. These are all useful sources of information. The ideal way to answer this question, though, would be to discuss it with those individuals directly involved in the residency selection process—in particular, program directors in your chosen field. Ideally, this should be done early in your medical school education. With this knowledge in hand, you can make the most of your opportunities, placing yourself in a position to succeed and match with the specialty or program of your choice.

Fortunately, others have done this work and published their findings. A survey of approximately 800 program directors was performed by Dr. Wagoner, the former dean of students at the University of Chicago Pritzker School of Medicine. These program directors represented 14 specialties, and were surveyed about the importance of various academic criteria used in the selection of residents.¹ Dr. Wagoner and her colleagues learned that grades in required clerkships are the most important academic criteria used to select residents.

At most schools, required or core clerkships include internal medicine, pediatrics, psychiatry, surgery, obstetrics/gynecology, and family medicine.Most medical students are surprised to learn that grades in required clerkships are ranked higher in importance than USMLE scores. In our inaugural column, we presented data from a survey showing that 44% of students from three U.S. medical schools perceived required third-year clerkship grades as moderately, mildly, or not at all important in the residency selection process.²

While many reasons exist for this disconnect between the perceived and actual importance of clerkship grades, we know that this can impact students’ efforts and attitudes during rotations.

As this article goes to press, we recognize that thousands of students across the country have begun, or are about to begin, their third year of medical school. Put simply, your performance this academic year can make or break your chances of a successful match.

• Grades in required clerkships are the most important academic criteria used to select residents.
• “Number of honors clerkship grades” was the second most important academic criteria used to select residents in the most competitive specialties.
• Clerkship grades are the major determinant of class rank. The most competitive specialties rate class rank among the three most important selection criteria.
• Clerkship grades are a major factor used by schools in electing students to the Alpha Omega Alpha Honor Medical Society (AOA). Election to AOA is highly valued by many competitive specialties. In some programs, and in some specialties such as dermatology, membership in AOA is used as a screening tool to determine which applicants are even considered for interviews.
• Comments made by attending physicians on the clerkship evaluation form find their way, often verbatim, into the Medical Student Performance Evaluation (MSPE). The MSPE, formerly known as the Dean’s letter, is often scrutinized closely by residency programs.
• Clerkship performance and grades are important in securing strong letters of recommendation. In competitive residencies where many applicants have excelled academically, letters of recommendation take on additional importance.

We present one final question: Which of the following is the most important academic criterion used by ophthalmology program directors to select residents?

A) USMLE step 1 score
B) Alpha Omega Alpha
C) USMLE step 2 CK score
D) Grades in required third-year clerkships
E) Grades in the ophthalmology clerkship

If you selected choice D, congratulations. The correct answer is indeed “grades in required third-year clerkships.” In the Wagoner study, 46 ophthalmology program directors were surveyed. Grades in required clerkships and the number of honors grades were ranked higher in importance than grades from ophthalmology electives.

Is this finding surprising? In our experience, all students recognize the importance of grades in their chosen specialty. However, fewer understand the overall importance of grades in required clerkships. A review of various discussion forums reinforces this finding.

In our next column, we’ll discuss the transition between the basic science and clinical years of medical school: what makes the transition such a challenge, and can be done to excel?

References

1. Wagoner NE, Suriano JR. Program directors’ responses to a survey on variables used to select residents in a time of change. Acad Med 1999; 74(1):51-8.

2. Brandenburg S, Kruzick T, Lin CT, Robinson A, and Adams LJ. Residency selection criteria: what medical students perceive as important. Med Educ Online 2005; 10:17.

The discussion thread for this article may be found here: http://forums.studentdoctor.net/showthread.php?p=5328043

Authors of The Successful Match: 200 Rules to Succeed in the Residency Match and 250 Biggest Mistakes 3rd Year Medical Students Make And How To Avoid Them

“Where was the career guidance I needed for the past three years? No one sat me down in my first year and told me what it would take to get the career of my choice. Had I been handed a residency application form in my first year, I would have made many decisions differently. I cannot help thinking that my medical school has let me down. I am not going to shine on my residency application, as I had hoped.”

- S. Ellen Morch (Morch SE. Students unprepared for residency applications. CMAJ 1994; 151(9): 1237-8)

Thirteen years have passed since these words were written by a fourth-year medical student, and yet we continue to counsel students who find themselves in the same position. “If only I knew then what I know now” is sadly a common refrain among residency applicants.

As faculty advisors, we have had the opportunity to advise students through all facets of the residency application process. Unfortunately, misperceptions about the criteria involved in this process are shockingly common among students. Conversations with students confirm this fact. Conversations with faculty highlight this issue. Even a review of posted comments on message boards confirms the confusion among students as to what it takes to have a successful match.

This fact was highlighted several years ago when researchers surveyed medical students at the University of Colorado, University of Utah, and Vanderbilt University (Brandenburg S, Kruzick T, Lin CT, Robinson A, and Adams LJ. Residency selection criteria: what medical students perceive as important. Med Educ Online 2005; 10: 17). The aim of the survey was to discern which criteria students felt were important in the residency selection process. Students were asked to rate the importance of various criteria, including clerkship grades, USMLE scores, AOA membership, class rank, letters of recommendation, and published research.

• Although 55.9% of students considered grades in required 3rd year clerkships to be extremely important, 44% felt that these grades were moderately, mildly, or not important at all. In a recent survey of program directors representing the most competitive specialties, grades in required clerkships consistently received the top ranking (Wagoner NE, Suriano JR. Program directors’ responses to a survey on variables used to select residents in a time of change. Acad Med 1999; 74(1): 51-8).
• Only 14.7% of students rated the number of honors grades as extremely important. Program directors considered the total number of honors grades to be one of the three most important factors in considering a candidate.
• 49.3% of students felt that class rank was mildly important or not important at all. However, program directors rated class rank high in importance, following only clerkship grades and the total number of honors grades.

Clearly, there are significant differences in the degree of importance students and program directors attach to these different criteria. These misperceptions have the potential to affect a student’s chances of matching into a particular specialty or residency program.

From our own experiences as students, and in the process of counseling students, we know how difficult, anxiety-provoking, and mysterious the residency selection process is. Combining evidence-based advice from our review of the literature on medical education, along with our own years of experience and discussions with hundreds of students, residents, and faculty colleagues, we hope to clear up these misperceptions. Our goal is to make you a well-informed applicant. A better understanding of the residency selection process can help you develop an approach that maximizes your chances of a successful match into the specialty or residency program of your choice.

We invite you to join us regularly here at sdn for our column – The Successful Match. In our next column, we address the importance of the third year of medical school, specifically clerkship grades.

Samir P. Desai, M.D.

Dr. Samir Desai is a faculty member in the Department of Medicine at the Baylor College of Medicine. He has educated and mentored medical students and residents, work for which he has received teaching awards. As a member of several committees, including the internal medicine residency selection committee and the medical school admissions committee, he has gained considerable insight into the obstacles that prevent students from reaching their academic and professional goals.

His experience and insight led him to write a series of books to help students tackle the challenges of medical school. He is now the author and editor of ten books that together have sold over 80,000 copies worldwide. Most recently, he coauthored the 250 Biggest Mistakes 3rd Year Medical Students Make, a book developed to help students successfully transition into and excel during the third year. Among the other titles he has written are the popular The Residency Match: 101 Biggest Mistakes and the Clinician’s Guide to Laboratory Medicine.

In 2002, he founded md2b.net, a website committed to helping today’s medical student become tomorrow’s doctor. At the site, a variety of resources, including survival guides for each core clerkship, are available to help students tackle the challenges of these rotations.

After completing his residency training in internal medicine at Northwestern University in Chicago, Dr. Desai had the opportunity of serving as chief resident. He received his M.D. degree from Wayne State University School of Medicine in Detroit, graduating first in his class.

Rajani Katta, M.D.

Dr. Rajani Katta is an Associate Professor in the Department of Dermatology at Baylor College of Medicine. She has authored over thirty articles published in scientific journals, and lectured extensively both nationally and locally on dermatology and contact dermatitis to students, residents, and physicians.

She serves as the course director for dermatology in the basic science years, and has served as the clerkship director for the dermatology rotation. She has seen firsthand the difficulties of matching into a competitive specialty such as dermatology, and has witnessed over the past nine years the increasingly difficult match process for dermatology applicants. Most recently, she coauthored the 250 Biggest Mistakes 3rd Year Medical Students Make, a book developed to help students successfully transition into and excel during the third year.

After graduating with honors from Baylor College of Medicine and completing her internship in internal medicine, she completed her dermatology residency at the Northwestern University School of Medicine.

Authors of: 250 Biggest Mistakes 3rd Year Medical Students Make And How to Avoid Them