Jessica Freedman, MD

By Jessica Freedman, MD
President of MedEdits

Your son or daughter wants to get into medical school. Of course, you want to help, but how? Many parents, including those who are physicians themselves, are overwhelmed by the medical school application process. They want to guide their young adult children but also want to allow their “kids” to work independently and don’t want to do too much hand holding.

So, what do you, as parents, need to know about the medical school admissions process to help your premedical student to succeed? This article reviews some basic material to help parents and their children make wise choices that will help them to gain acceptance to medical school.

Know the facts, but try not to add more pressure to the cooker

It is important for parents to know what is required of their children to gain admission to medical school. This means knowing the premedical prerequisites and the activities in which students should be involved. But it also means understanding how to help without adding more stress.

Achieving this balance often depends on the relationship between parent and child. It is essential, however, that parents understand that their children are young adults who will someday soon be required to make independent (and very important) decisions. Since a career in medicine requires maturity and independent thought and decision making, parents should encourage these qualities while remaining involved in their children’s lives.

Consider carefully what college to attend

Many premedical parents ask me where their child should attend college. The most common question is: “Should my child attend a prestigious college where ‘As’ are more difficult to earn or go to a college or university that is considered less prestigious but where high grades may be easier to earn?” The answer to this question is not easy.

What is most important with regard to medical school admissions is academics. A high GPA (3.9) and a strong MCAT score (above 30 with a good distribution) are the most important factors for an application to be considered for review by an admissions committee. I have seen people who went to outstanding colleges but earned 3.3s or so who had difficulty gaining admission to medical school. Thus, students with similar MCAT scores but with higher GPAs from less prestigious undergraduate colleges may receive more interviews (and thus more acceptances) than the student who went to a top ranked college but had a lower GPA.

Help your child choose best major and courses for them

The emphasis in medical school admissions now is diversity. So, beyond the basic premedical prerequisites, students should major in what interests them most. Majoring in something other than biology or chemistry would be looked upon favorably by admissions committee members. It is always wise, however, to take upper level science classes regardless of the student’s major to demonstrate academic excellence in the sciences. I also suggest that all premedical students take biochemistry and, if possible, statistics; Medical schools like to see these courses on transcripts.

Think about the activities in which your premedical student should participate

Just as with their courses, students should become involved in activities that motivate and interest them. While everyone knows that medical schools “like to see” research, community service, and teaching, first and foremost, all applicants must have clinical and shadowing experiences. Also important is that students do not become involved in extracurricular activities at the expense of their academic success and that they do not accumulate a list of activities just for the sake of doing so. In-depth involvement is preferred over a long list of superficial activities and will likely lead to stronger letters of reference.

Put together a good “team” to help your son/daughter gain admission to medical school

This team should consist of professors, mentors, extracurricular leaders and premedical advisors. Remember that you cannot be everything to your child and that having other people to provide support and guidance throughout this process is helpful. I find that many “kids” like to have other objective authority figures to help advise them.

Think seriously about some time away from formal academics

Many applicants now take a year away from formal academics before going to medical school and apply during the spring of the senior year rather than the spring of junior year.  Some parents are uncomfortable with this idea, but it can be difficult for students to get “all of their ducks in a row” in time to submit a successful application at the end of their junior year of college. Applying in the senior year also allows applicants to have an extra year of grades on their transcript, which can be important for many applicants whose grade point average (GPA) tends to trend upward from the freshman to senior year. I find that some applicants who are not successful the first time they apply often fail because they and their parents did not understand how much work and organization is required for a successful medical school application.

Understand that the medical school application process is long!

As parents, it is important to understand that the process of applying to medical school requires a tremendous amount of endurance and perseverance. Many parents of my clients who are physicians lament: “It wasn’t this complicated when I applied!” Indeed, as medical school admissions have become more competitive, the process has become more laborious and expensive.

The application season officially begins when the student starts thinking about composing and submitting his or her primary application in June. But, students must also take all required courses and the MCAT and request letters of reference and transcripts in addition to composing an excellent application. Then, after the primary application is submitted, students must fill out secondary application essays for many schools and go on interviews. Some applicants may not know what school they will attend until they “get off a waitlist” in August. Thus, the application season may last for more than a full year.

Medical school applicants tend to be a highly motivated group who hold themselves to high standards. Sometimes, in an effort to make sure their kids stay on track, parents ask questions constantly, do GPA calculations, plan curriculums and seek out summer activities that will bolster their child’s application. There is a fine line between helping and hovering, and I find that this added pressure can sometimes backfire.  The premedical race requires agility and careful judgment, and parents play an important role in helping premedical students to reach the finish line.

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

By Jessica Freedman, MD
President, MedEdits : Medical Admissions

With medical students starting to think about the upcoming residency match season, it’s a good time to review what residency applicants can do to improve their chances of matching. Many students think that how they write their residency personal statement is all that matters, but this simply is not true. As September looms, I want to focus on factors that are still (for the most part) within the residency applicant’s control.  This article should also be useful for anyone who may be entering the match in the future.

1. Do away electives
   These “audition electives” can really help your chances of matching at a program. Some applicants with whom I speak are often fearful of doing away electives because they believe a less than perfect performance may actually hurt their chances of matching at the program where they rotate. Indeed, this is often not the case. As the associate director of a program, I often found that applicants who demonstrated a solid (or even mediocre) performance when rotating with us were ranked higher than other applicants with slightly better stats. Most program directors would rather take a student whom they know will be a solid, “no-problem” resident than take a risk on someone with whom they have not worked.
2. Get letters of reference from attendings in the specialty to which you are applying
   It is essential that you ask for letters from faculty within the specialty to which you are applying. I recommend getting at least two letters from faculty within that specialty. In general, the best letters are written by people with whom you worked and, ideally, they should be clerkship directors, program or associate program directors, chairs or other academic faculty. When I reviewed applications for an emergency medicine residency program, while I read all of the letters carefully, I paid special attention to those letters from emergency medicine faculty.
3. Demonstrate interest in your desired specialty
   Your interest in your specialty goes beyond doing well on your rotations. For most residencies, doing research is not essential, but, in general, the more involved you are in your specialty, the more committed to it you appear. Consider joining your specialty’s national organization or becoming a student member on a national committee.
4. Communicate your interest in your specialty through your residency personal statement
   It is most likely that the last personal statement you wrote was for medical school. The approach you should take for your residency personal statement is different; you must convince the reader of your commitment to the chosen specialty. Some creativity will help engage your reader, but, in general, this statement should be a less creative piece than was your medical school personal statement.  A well-written personal statement that piques the reader’s interest will increase the odds that you will be granted an interview. The Electronic Residency Application Service (ERAS) allows you to write more than one personal statement so consider writing different statements for different types of programs. For example, a community based program does not necessarily want an applicant who hopes to make research a major part of his or her residency training.  You can also write a statement targeted to a specific geographic area.
5. Do not skimp when writing about your work/volunteer/research/ experience in your ERAS application
   The written descriptions of your activities in your application are also key.  Make these entries interesting. Be sure your application entries and personal statement complement each other.
6. Practice for your residency interviews
   I find that many students are not comfortable talking about themselves so it is essential to practice interviewing. The interviewer is trying to assess your interest in, understanding of and commitment to the specialty. They want to discover if you have good interpersonal skills and if you will be a good fit for their program; they also want to make sure you do not have any major psychopathology. Most residency interviews are conversational and are conducted by a wide spectrum of people from senior residents to chairs. As a result, the experience and skill of your interviewers may vary tremendously.
7. Plan a strong fourth year curriculum
   Your candidacy does not have to end when you send in your application. I was always impressed when applicants still had some “real” rotations scheduled for the remainder of the fourth year and weren’t wasting a valuable part of their medical education by taking rotations or electives that were obviously fluff.  This told me they were serious, really interested in becoming great doctors and took advantage of their time and opportunities. When I asked interviewees what they had planned for the rest of the fourth year, the least impressive answers went something like this: “Well, I have only one requirement left, so I am going to travel around Europe and take it easy before I start internship.”
8. Be energetic, attentive, and personable and smile on your interview days
   All of your interactions on your interview day are important. Be kind and respectful to everyone you meet, including residents, nurses and staff. If, during an interview day, my residency coordinator had concerns about an applicant, I listened since I knew and trusted her judgment. Remember that everyone has influence in this process. One negative impression can cause your ranking to suffer– or worse, it may bump you off a list.
9. Be courteous throughout this process
   A recent survey of program directors by the National Residency Matching Program indicated that following up with programs and “second looks” were not important factors when ranking applicants. That said, I believe that thanking those who took time out of their day to meet you demonstrates that you are gracious and courteous, which are important qualities for a medical professional.
10. Do not be swayed by letters from programs
    I am amazed by some of the letters applicants receive from program directors to express the program’s interest in the applicant. While some of these letters may be sincere, I have found that many of them are not. While it surely isn’t a bad sign to receive these letters from programs, do not become too confident since often, it seems, these letters are sent to people who are not “sure to match.”
11. Seek out an advocate
    Before you even start interviewing, identify a faculty member whom you think would be a good advocate. Once you decide how you will rank programs, ask this person to call your top choice programs to put in a good word. You should also consider asking for additional letters of reference that can be sent individually to all of the programs where you interview or will rank.
    
12. Do not rank programs in which you are not interested
    It is Murphy’s Law. If you rank a program where you really don’t want to go, you will match there.  If you know, without a doubt, that you do not want to go to a program, then don’t rank it.

Think of all your written materials, such as letters of reference, application and personal statement, as your “ticket” to your interview. If the person reviewing your application is intrigued, they will invite you for an interview. Then, your interview day becomes the key to your success. I know that all of this may be overwhelming as you embark on the path to your residency match, but as you start interviewing, you will become less anxious and more comfortable.  Good luck to everyone and match well.

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 also the author of the MedEdits blog, a useful resource for applicants. (www.MedEdits.blogspot.com)

By Jessica Freedman, MD
President of MedEdits: Medical Admissions

Because the competition for admission to medical schools in the United States is extremely strong, many applicants consider attending medical school in the Caribbean. In fact, a great many bright and talented applicants are now opting to obtain their medical education in the Caribbean.

How can you decide what is the best choice for you? What must you consider in evaluating these schools? And will you be able to obtain a residency in the United States after you graduate? To help you decide if attending a Caribbean medical school is a good choice, this article provides a framework for evaluating these schools and the success of their graduates.

A Little Background

In the last four decades, the Caribbean has seen a steady increase in the number of medical schools on the islands as well as the size of their student bodies.  In the late 1970’s three Caribbean medical schools were established: American University of the Caribbean, originally located on the Island of Montserrat, Ross University on the Commonwealth of Dominica, and St. George’s University in Grenada.   Since their inception, these schools have educated many US citizens seeking a medical education outside the US,  and now about 60 medical schools in the Caribbean are listed in the Foundation for Advancement of International Medical Education and Research (FAIMERs) International Medical Education Directory (IMED).

The physicians who graduate from Caribbean medical schools play an increasingly important role in the US health care system by supplying residency programs with qualified applicants and helping to meet a well documented physician shortage, particularly in primary care medicine.  While accreditation, didactic studies (first and second years of medical school), and clinical rotations (third and fourth years of medical school) differ among institutions, requirements for graduate certification in the United States, as outlined by the Philadelphia based Educational Committee on Foreign Medical Graduates, are the same for all students graduating from all international schools, including the Caribbean.

Caribbean Medical School Accreditation

An article by van Zanten et al published in the June 2009 edition of Academic Medicine reviews some of the processes by which Caribbean medical schools undergo external quality assurance.  Accreditation for Caribbean medical schools is on several levels, including local Ministry of Health accreditation by some  individual Caribbean country’s government, regional accreditation by organizations such as The Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP). The World Health Organization (WHO) does not accredit medical schools but maintains a list of schools that are recognized by local governments. In the United States,  The National Committee on Foreign Medical Education and Accreditation of the US Department of Education (NCFMEA) of the United States Department of Education determines whether the process conducted by an accrediting organization is comparable to the Liaison Committee on Medical Education (LCME) process of accreditation. This is a voluntary process so not all schools undergo this evaluation. If a school’s accreditation is deemed comparable to the LCME process, then that country can apply for US federal loans for those students. Currently, only 3 schools in the Caribbean are eligible for these loans.

California, Florida, New Jersey, and New York require individual school review and approval for Caribbean students to do rotations in that state.   In California, not only must the individual school be approved for clinical clerkships but the student’s clerkship and course work must be approved by the state medical board to obtain residency and subsequent physician licensure.  Any deficiencies in clinical training, as determined by the state, may need to be remediated to practice in California.  Many other states defer to California’s approval for the purpose of licensure because most do not have their own approval process. Also of note, New York has the largest number of international medical graduates in residency training and about one third of residency programs in the US are located in the state of New York.

It is important to know which organizations have accredited any school you consider attending.  Knowing if the state in which you intend to practice recognizes your school is also important.  Caribbean medical schools proudly display these accreditations on their websites so if an accreditation is missing, be wary.

Quality of Medical Education in the Caribbean

Another recent study by van Zanten and Boulet published in Academic Medicine examines the quality of medical education in the Caribbean. The report finds tremendous variability in both the quality of undergraduate medical education and in students’ performance. The only way to evaluate the education Caribbean medical students received was to examine students’ scores on the United States Licensing Exam (USMLE) Step 1, which is taken after the second year of medical school. Investigators calculated the average USMLE Step 1 first time pass rate for each country in the Caribbean. In evaluating this data they also took into account that some islands have more than one medical school.  The countries with the highest percentage of students passing the (USMLE) Step 1 on the first attempt were Grenada (84.4 %) and Dominica (69.7%). Countries with the lowest pass rates were Saint Lucia (19.4%) and Antigua/Barbuda (22.9%).

Preclinical Years

Students typically spend the first four to five semesters of medical school in the Caribbean completing basic science courses before taking USMLE Step I.  Basic science curriculums in the Caribbean are similar to US curriculums.  Some schools offer a fifth semester, either in the Caribbean or in the US, to help students prepare for the USMLE Step 1 and transition to their clinical semesters.

Living in the Caribbean can present many challenges for those who have never lived outside the United States. For many students, it will be their first time away from the United States for a prolonged period of time. Many of the luxuries found in large US cities, such as restaurants, movie theaters, shopping malls, and commercial gyms, are not available on the islands, and friends, family, and religious support groups are thousands of miles away. On the plus side, many students form strong relationships with classmates and also enjoy learning about the history and culture of the local West Indian population. Former students also have fond memories of celebrating yearly holidays such as Carnival, the colorful, festive, and historical event celebrated annually throughout the Caribbean.

After successfully passing the USMLE Step 1, students proceed to their clinical rotations, which usually are outside of the Caribbean.  When evaluating schools, it is important to ask what percentage of students who initially enroll in each class actually take and pass the USMLE Step 1 and successfully proceed to clinical rotations.

Clinical Years

Core clinical rotations and third and fourth year curriculum in Caribbean schools resemble those of US medical schools. Caribbean schools that offer clinical training in the US have strict guidelines about the location and quality of students’ clinical training.  All core rotations and subinternships must be completed in hospitals with which the Caribbean medical school has an active, written affiliation agreement and which have appropriate clinical faculty members. Rotations must be approved by the Accreditation Council for Graduate Medical Education  (ACGME). In addition, it is preferable that hospitals have approved residency training programs (or their British equivalents) in the specialties through which students rotate.  Students also take both parts of USMLE Step 2 (clinical knowledge and clinical skills) after the third year.

Hospitals in which electives are taken should also have approved postgraduate programs in those specialties.  For example, it is best to do an anesthesia elective at a hospital that has an anesthesiology residency. Regardless of school affiliation, however, individual hospitals still reserve the right to screen individual students for elective clerkship acceptance. Some individual hospitals and departments do not accept international rotating students, which can limit the away electives in which students can participate. From a competitive perspective, it is always preferable to participate in clinical rotations located in hospitals that not only have ACGME accredited residency programs but are academic teaching hospitals rather than community hospitals.

If I Go To a Caribbean Medical School, Can I Get a Residency?

Graduates of Caribbean medical schools have tremendous success in obtaining residency positions, even in competitive specialties. It helps to attend a well-established Caribbean school, perform well on the USMLE Steps 1 and 2, and obtain strong letters of recommendations. (See my previous articles: Getting Into Residency Part 1 and Part 2 for more information.) Before applying for the residency match and early in medical school, students should strategically plan their clinical clerkships in the US, ideally arranging rotations in the settings where they prefer to match.  In recent years, Caribbean students with strong academic and clinical performances have been able to obtain competitive residency positions at an increasing rate.  However, the largest number of students pursue less competitive specialties, such as internal medicine or family practice.  Some students are also able to ”prematch” into residency positions outside of the National Resident Matching Program (NRMP).

When evaluating the success of a Caribbean medical school’s graduates, it is important to find out specifically where and in what specialties students match. Also determine what percentage of fourth year students match into categorical programs. This information may not be easy to obtain. While schools typically publish their match results, it is unclear if these lists are truly comprehensive.

After residency, Caribbean medical students, along with their domestic colleagues, will obtain board certification and must meet specific requirements for state licensure. The quality of one’s residency training usually carries more weight than the medical school attended, so obtaining the best possible residency and even fellowship can help Caribbean students overcome some of the bias foreign students face when competing for competitive attending positions.

Educational Commission for Foreign Medical Graduate (ECFMG) Certification and Graduate Medical Education Programs

To be eligible for ACGME accredited residency programs in the United States, and for licensure in many states, students who graduate from a Caribbean medical school must obtain an ECFMG certificate. Eligibility for this certificate includes graduating from a medical school listed in FAIMERs online International Medical Education Directory (IMED) and passing the USMLE Steps 1 and 2 (both clinical knowledge and clinical skills).  For more details, see the ECFMG website at www.ecfmg.org.

Questions to Ask

School History

• When was the school established?
• What percentage of students are US citizens?
• By whom is the school run and what are the credentials of the academic faculty?
• Has the school had any recent changes in leadership? Are any leadership changes expected?

Caribbean Medical School Accreditation

• By whom is the school accredited and is the school accredited by the states of California, Florida, New Jersey, and New York?  Is the school listed in FAIMER’s IMED?

Admissions, Medical Education and Curriculum

• The quality of your medical education begins with the advice you receive prior to attending a Caribbean medical school. Is your premed advisor well versed in the pros and cons of attending medical school in the Caribbean?
• If interviews are required, by whom are they conducted – alumni, administrative staff, faculty and/or current students?
• What are the mean overall and BCPM (biology, chemistry, physics and math) GPAs and MCATS of accepted students? Are MCATs required to submit an application?
• Does the school have more than one matriculating class annually and are admissions rolling? Unlike most US schools, Caribbean medical schools typically have two to three first year classes that begin at different times during the academic year.
• What is the average size of each entering class? Does the size vary depending on the start date?
• How many students enroll in each first year class? What percentage of students who enter as first year students start third year rotations as scheduled?  What percentage of first year students match into categorical residencies in the United States during their fourth year? What percentage of first year students graduate? (Understand that graduating does not necessarily mean matching, so both of these questions must be answered.)

Financial Concerns and Living Conditions

• Do most students fund their education using outside loans or scholarships? Are these loans backed by the US government or are they private loans? Does the school offer financial guidance to help students choose the best loans and make responsible financial decisions?
• Where do students live and what are the housing conditions? Does the school provide housing?

Clinical Studies

• Where do students do their clinical training? Can students choose where they do core rotations? Are the rotations ACGME accredited? Do students work alongside US medical students?
• Are students allowed to do elective rotations? How many? Can students do away electives at nonaffiliated hospitals? Does the administration or faculty help students obtain away electives?

Residency Match and Professional Guidance

• Does the school provide guidance to help with the match process? Do students have an assigned advisor to help them?
• Where and in what specialties did students in the most recent graduating classes match for residency, and what percentage of fourth year students matched into categorical residencies?
• What percentage of students do not match annually? What percentage of students must enter the “scramble”? For students who enter the scramble, does the school provide assistance to find an unfilled residency spot?

Alumni and Student Support

• Where do alumni practice geographically, in what specialty and in what type of practice (community or academic)?
• Will the school provide contact information for alumni and current students with whom to speak?

Medical School in the Caribbean

Going to medical school in the Caribbean can be a good option as long as you do your research and make an educated choice. The medical education you will receive in the Caribbean varies tremendously, and the success you will have after graduation depends on many factors. Attending a top Caribbean medical school is a great option for some students but, just as for US medical students, once in school you must “do the right thing” to secure an excellent residency, (See my article Getting Into Residency Part 1 and Part 2.) I have had several Caribbean medical student clients earn residencies in competitive specialties, including anesthesia, emergency medicine, and internal medicine so, yes, it can be done!

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

The author would like to thank Marta van Zanten for clarifying parts of this article.

References

1) van Zanten M, Boulet J R. Medical education in the Caribbean: variability in medical school programs and performance of students. Academic Medicine. 2008;83: s33-s36.

2) van Zanen M, Parkins LM, Karle H, et al.  Accreditation of undergraduate medical education in the Caribbean: report on the Caribbean accreditation authority for education in medicine and other health professions. Academic Medicine. 2009;84: 771-775.

By Jessica Freedman, MD

AMCAS 2010 opens in early May and the next wave of applicants is preparing to submit applications, so it seems apropos to summarize some key observations I have made while privately advising medical school applicants. Here is my list of some essentials for medical school applicants to improve their chances of acceptance.

1. Submit an early application
   Everything you read tells you that the #1 rule of medical school admissions is to apply early. But, I find that many applicants still ignore this advice. You should not only submit your application as early as possible but also make sure that your transcripts and letters of reference are sent in promptly.
2. Take your MCAT exam early
   Again, the key word here is “early.” Your application will not be reviewed until your pending MCAT scores are in so, if you have worked hard to submit your AMCAS application in June, don’t negate this effort by taking an August MCAT.
   
3. Don’t apply once for “a practice run”
   Yes, people do this. I suggest applying only when you are truly ready. While the stigma of being a reapplicant is declining, being a third-time applicant does trigger a negative bias, so it is best to try and make your application as perfect as possible the first time around. Take an honest inventory of your stats, experiences and accomplishments and decide if you are ready to apply or if you must do something to enhance your candidacy.
   
4. Apply broadly
   It may be your dream to attend a top 10 medical school, but be realistic. Too often, applicants apply to only a few schools initially and limit their chances. It is important to apply to a broad range of schools both in terms of geography and ranking. Around this time of year, I receive calls from applicants who say “Well, I didn’t get in last year but I applied only to five schools because I wanted to stay in California.” If you really want to increase your chances of being accepted, do not limit yourself.
   
5. Think about your story
   I encourage applicants to think about their unique story and path to medical school. What motivates you? What are the overarching themes in your background and experiences? Why do you want to be a physician? Really thinking about who you are, how you got there and what you hope to do in the future will set the stage for your entire application process. Think about this throughout your education. And, remember, nothing is set in stone. As you develop new interests, expertise and hobbies, your story will evolve and change. Just make sure that your story doesn’t have any major unaccounted gaps in time because admissions committee members often regard these gaps as “red flags.”
   
   
6. Make your application entries descriptive
   While some applicants write a bulleted and brief description for each AMCAS entry, my advice is always to give as much information as possible in your written activities descriptions. You have a 1325 character limit per entry so, unless you have nothing to say about your experiences (which would be a red flag in my book), use this space to your advantage. The person who wants to read less can opt to skim your entries but the person who wants more information won’t take the time to pick up the phone and inquire about your experiences. These descriptions present an opportunity to write about your insights, experiences, accomplishments and observations.
   
7. Do not regurgitate your application entries in your personal statement
   It is important to say something new, different and fresh in your personal statement that does not repeat your application entries. Interestingly, I find that many applicants shy away from the very topics and aspects of their backgrounds that make them unique. Applicants also lament that they don’t really have a story or anything special about them. Boloney. Every applicant has a compelling story, but sometimes you need an outsider to bring it into focus. Often applicants are self conscious about the very experiences that will make them more compassionate providers (and more attractive applicants), such as being an immigrant, growing up with few opportunities or having their own encounters with illness. Applicants often say, “I don’t want anyone to feel sorry for me and I don’t want to tell a sob story.” As long as you present your story in a matter- of- fact way and write about the positive direction of your path, you won’t be perceived as a whiner. It is often the most challenging times in our lives that are the most catalytic, and any experienced medical educator understands this.
   
8. Fill out your secondary essays in timely fashion
   Here is that theme again. Early, early, early.   For schools that have secondaries, your application won’t be screened until the secondaries are in.
   
   
9. Practice Interviewing
   Many applicants think interviewing is easy and, for some, it is, but everyone needs practice. Even if you are a great public speaker, sitting down and talking about yourself one on one with a person in a position of authority does not usually come naturally. Also remember that you can guide your interview and highlight what you think is most important about you. Most medical school interviews are fairly low stress and conversational, so enter your interview knowing which experiences and thoughts you want to discuss and emphasize. When I do mock interviews with clients, I am often surprised at how many people, including those with a long list of impressive achievements, are not able to present their stories cohesively and comprehensively.
   
   
10. Make every interview count
    Every interview is an opportunity for an acceptance. Be sure to smile, be positive and be personable on your interview day. Regardless of “scoring systems” or “rankings,” there is a huge subjective component when evaluating an interviewee. This “halo effect” works both ways; if someone perceives you positively, this will likely carry over to everything about you and your candidacy, whereas if someone perceives you negatively, the opposite is true. I have several clients who received only one interview invitation which resulted in an acceptance. So, approach every interview, literally, as if it is the only one.
    
    
11. Get good advice
    This isn’t as easy as it sounds. Seek out individuals who are knowledgeable about medical school admissions and provide sound guidance. When I used to evaluate applicants as an admissions officer, it was often obvious when an applicant received bad guidance because they did not have the best mix of experiences, had poorly written documents or weak interview skills.
    
    
12. Stay objective and be honest with yourself about your chances
    If it is late in the season and you have not received any interviews or only have wait list offers, consider what went wrong and correct your mistakes. If you plan on reapplying, you must, once again, do so early. If you reapply in August after you realize you won’t get off a wait list, you may again be unsuccessful. Inevitably it is the waitlisted applicant who reapplies in June who gets off a waitlist in August just before classes start.

Learn from my collective experience working with medical school applicants and try to make the most of your candidacy. What I have learned from my clients, most of all, is that the new generation of physicians is a motivated, well-intentioned and inspiring group with a positive outlook.  Apply well because our patients need you. Good luck!

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

The scramble. Just these words make applicants and program directors anxious. So, what exactly is the scramble, why is it so competitive, and how is it likely to be changed?

The annual “Match Week” is March 16th – 19th 2009, and though I hope no one reading this article will ever need to put the information below to practical use, it seems an ideal time for a brief overview of the scramble — just in case.

A Little Background

The national residency matching program (NRMP) was established in 1952 to create uniformity and a schedule for postgraduate medical education assignments. Every March, the NRMP conducts a residency match to optimize the chances that both programs and applicants match with their most highly ranked choices.

Keep in mind that the NRMP is not an application service; applications are submitted via the electronic residency application service (ERAS). The NRMP is the mechanism for connecting programs and applicants.

After interviewing, applicants submit rank order lists (ROLs) of programs based on their preference, and programs do the same for applicants they have interviewed. Since 1998, the NRMP has used a matching algorithm designed to ensure that both applicants and programs “match” with their most desired choices.

For those applicants that did not match, the scramble is a period of time after the match when these applicants attempt to find, or “scramble”, to try and obtain one of the remaining unfilled positions.

The Numbers

Why is the scramble so competitive and stressful? The numbers tell the story.

In 2008, 4,214 programs participated in the match and a total of 25,066 positions were offered: total applicants were 35,956, 15,692 of whom were from accredited US schools and 20,264 who were independent. How’s that for fierce competition for a match? Of the almost 36,000 applicants, 28,737 submitted rank lists, of whom 20,940 matched.

What happened to the applicants who did not submit rank lists? Some applicants “pre-match” at programs and sign contracts before the match.  Others enter the match just to have a list of unfilled positions to enter the scramble. Since some applicants who pre-match do not withdraw their applications, data for the number of applicants who pre-match are not available.

The NRMP estimates that roughly 13,000 applicants, many of whom are non-US citizen international medical graduates (IMGs), registered for the sole goal of competing in the scramble. These applicants competed for only 1,388 unfilled PGY1 and PGY2 positions. Clearly, entering the scramble is not a wise gamble and should be avoided.

What is the Match Week Schedule?

March 16th: At 12 noon EST applicants find out if they matched.

March 17th (Scramble Day!): At 11:30 AM EST individual programs find out if they have filled their positions.

March 17th (Scramble Day!): The race begins. At 12 noon EST the locations of unfilled positions are released, and individuals may start contacting programs to obtain these positions.

March 19th: MATCH DAY! For those who matched, results are posted at 1 PM EST.

How Quickly Do the Unfilled Spots Fill?

The unfilled positions are filled very quickly during the scramble. By 4 PM on scramble day in 2008, more than half of the 1,388 PGY1 and PGY2 open positions were filled. By 6 PM the day after the scramble, only 179 positions remained open.

At many US schools deans are available to help students on scramble day; though this is helpful, the chances of obtaining a spot via the scramble still are slim.

While many individuals send applications to unfilled programs via ERAS, others hire for-profit commercial companies who “fax” materials and email programs on behalf of clients. Jammed fax machines and lines of communication make this process challenging. Only 8,700 individuals submitted applications via ERAS during the 2008 scramble, suggesting that all of the other applicants used commercial services. Some applicants even hire companies and send applications via ERAS.

What Changes Are Ahead?

Recognizing that applicants and programs are forced to make important decisions quickly and that the scramble is disorganized and lacks leadership, the NRMP, together with the Association of American Medical Colleges, is forming a scramble task force to propose changes. The earliest these changes would be implemented is for the 2011 match. Here are some of the major changes being proposed, based on a five-day match week.

• NRMP releases unmatched applicant and unfilled program information simultaneously on the Monday of Match Week.
• Programs may not make offers for 48 hours after this information is released, giving them time to review applications and conduct (phone) interviews.
• Programs submit applicant preference lists on Wednesday (after the 48 hour period).
• The NRMP system emails applicants with offers from Wednesday to Friday; applicants can receive multiple offers.
• Applicants have two hours to consider an offer, after which the offer expires. Offers are sent out every two hours until 6 PM each day (valid until 8 PM).
• Applicants are required to submit only applications via ERAS.
• Programs are required to accept only applications via ERAS.
• Until Friday, program directors can add candidates to their preference list until positions are filled.
• Match Day is moved to Friday.
• This ERAS “scramble mode” ends at 6 PM Friday and remaining unfilled positions are posted.

Managing the Scramble

In an ideal world, avoiding the scramble is the best strategy. But if this is impossible, try to have a leader at your school who can advocate for you and help you through this stressful day.

Every year holds “surprises,” with some great programs not filling that must enter the scramble. Some applicants who thought they didn’t have a shot for a spot at a competitive program or within a competitive specialty may therefore end up with a really desirable position through the scramble. Such good luck is the exception, however.

Match Day

Match Day is not only a rite of passage but a tremendous accomplishment for everyone in medicine. Every Match Day is accompanied by some tears but more often by happy screams. If your school has a Match Day ceremony, I encourage you to participate.

In my day, we received the news in an envelope and didn’t have the option of finding out our “match” alone, via the internet. Even if you don’t get your number one match, this is a momentous day in which you should participate as a member of your class. Good luck and match well!

For more information on the match and the scramble visit the NRMP website.

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits Medical Admissions (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. If you want to decrease your chances of having to enter the scramble next year, visit: www.MedEdits.com. Dr. Freedman is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

Meet Dr. Freedman at the American Medical Student’s Association Meeting in Arlington, Virginia, March 12th- 14th, 2009. Visit us at booth #3 and pick up a free SDN lapel pin and pen.

As the current residency application cycle is winding down, the next wave of applicants is getting ready to apply for the 2009/2010 season.  As you begin thinking about your residency application, you should consider who will be writing your letters of recommendation (LORs), how you will talk about your path to residency at your interview, and how you should contact programs and follow up with them (and if this really makes a difference in outcome).

This article serves as a follow-up to the article, “Getting Into Residency: Part 1,” which was published on the Student Doctor Network in October 2008.

Letters of Recommendation

I encourage medical students to treat every attending as though he or she will one day write them a letter. Why? I believe this helps the student perform well and also creates a safety net of sorts. Since you don’t know whom you will meet in the future, it may well be that a good LOR could come from the internal medicine attending from your third year rotation or a preceptor from an introduction to medicine course during your first year.

If you have identified someone with whom you have rapport and who thinks highly of you anytime during your medical education, don’t wait to ask that person if he or she would be willing to write you a strong letter of reference in the future. Then be sure to keep in touch with the attending from time to time. Keep the attending updated on your progress and achievements so, when it comes time to write your letter, the attending won’t have to play catch up, which will make the letter more sincere.

While writing a letter of reference is extra “work” for an attending, it is also flattering since it indicates that you respect and think well of that individual. Writing excellent letters for my stellar students that I knew would help them get to the next level of their education and training was one of my greatest joys in academic medicine.

Which letters have the most impact when it comes to residency? It depends. If you are applying for orthopaedic surgery, for example, you don’t want to have three letters from non-orthopaedic faculty. ERAS allows you to select four letters to be sent to each program so, for a very competitive specialty, you want at least two of these letters to be from attendings within the specialty to which you are applying. When applying to residency, titles matter; a letter from a community doctor will carry less weight than a letter from the chair at a major academic center.

A survey sent to directors of all programs participating in the 2008 match by the National Residency Matching Program (NRMP) addressed this issue. Most important, the survey showed, are letters from clerkship directors, colleagues and chairs within the specialty. Letters from “other faculty,” while still important, have the least weight.

Writing a good LOR takes skill and experience. Sometimes junior faculty don’t know what constitutes a good letter, another reason why it is sometimes “safer” to have letters written by more senior faculty. A more experienced faculty member, who has read and written hundreds of letters of reference, understands the essential elements and “buzz words” that make a great LOR.

Keep in mind that the smaller the specialty, the more likely everyone is to know each other. When I reviewed residency applications, it was comforting to read a letter from someone whom I knew and trusted. At the same time, letter writers get “reputations.” I remember a clerkship director who wrote outstanding letters for every single applicant who rotated in her department. As a result, I questioned whether I could trust this individual’s evaluation. As an applicant, you have no way of knowing who writes good letters and who doesn’t, but it is important to understand that some attendings are talented in this area while others aren’t.

How do you go about asking someone to write a letter? To some degree this depends on your relationship with the individual.  If an attending offers to write a letter on your behalf and you have had an open dialogue about this, then simply ask him if he would like any supporting documentation.

Otherwise, it is best to schedule an appointment to meet with the attending.  It is fair to ask this person openly if she would be willing to write a strong letter on your behalf. You must hope that you will get an honest reply.

Your job is to make the letter writer’s job as easy as possible. Arrive at the meeting with a folder in hand that has a copy of your CV, your personal statement (if you have already written it) and any information she may need, such as your AAMC number and where the letters should be sent. ERAS has downloadable cover letters that you can fill out for your letter writers for both US students and IMGs. Remember to give your letter writers plenty of time to write your letter (at least one month), and understand that you may need to “nudge” or remind them more than once.

The Interview

Your most recent interview probably was for medical school. The emphasis for residency interviews is different, so don’t think that you will be telling the same story all over again. It is important to think about the path you have taken since you started medical school. What has motivated you, who has inspired you and what determined the choices you have made?  Applicants are judged most on the following during the interview:

• Commitment to the specialty to which you applying
• Understanding of what it means to practice this specialty
• Interpersonal skills
• Interactions with faculty, residents and staff
• Professionalism
• Maturity
• Leadership ability
• Overall “fit” with the program
• Red flags, explanation for gaps in time, psychopathology

I encourage applicants to review their written applications before interviews so they can remember what they have written. Anything on your application is “fair game” for discussion so be prepared to discuss everything in detail.  Don’t be afraid to try and guide your interview. The interviewer isn’t the only one in control here and you should try to make segues to topics that you would like to discuss.

The ideal interview is an open conversation – a back and forth dialogue. While everyone has their own interview style, most (skilled) interviewers know they will get the best idea of who you are if you are at ease and comfortable. In my experience, it is the less experienced interviewer who tends to “shoot questions” at you.  And remember, you aren’t going to be tested on your medical knowledge. Non-US citizen IMGs are often asked to discuss an interesting case to make sure they can communicate effectively about medical issues, however.

Also remember that feedback from current residents and support staff (such as the residency coordinator) plays a role in resident selection. Residency is intense and, especially for small residency programs, being a good “fit” for a program is important. This is why your behavior and interactions with the residency staff, during tours of the facilities and during dinners and lunches with the residents, is vitally important.

When I was in residency leadership, if my residency coordinator identified someone as rude or disrespectful, I listened. Residency leadership teams are small and a negative interaction with one member of that team is likely to negatively affect your ranking. Along the same lines, if a resident thought highly of an applicant and believed she would mesh well with our program, I also listened.

A few questions you should be prepared to respond to on residency interviews:

• Tell me about yourself
• Why do you want to go into XXX?
• When did your interest in XXX begin?
• What strengths would you bring to the program?
• Tell me about your research
• Tell me about (any flaw in your application).
• How do you feel about moving to our city/town?
• Where do you see yourself in 10 years?
• Why do you want to attend our program?
• Do you have any questions for me?

Follow up with Programs

I always encourage applicants to contact the program directors where they interviewed early in the season. While some programs rank as the season moves along, others hold a “ranking day” in late January/early February when they rank applicants. From experience, I can tell you that it was very difficult to remember applicants who interviewed early in the season. That said, the research done on this topic indicates that the timing of your interview does not affect your ranking.

Interestingly, the NRMP survey results indicate that program directors do not place much importance on second looks or visits or that postinterview contact affects ranking. Nonetheless, I believe that you should send a thank you note just “to play it safe,” and demonstrate respect and because doing so is just good manners. Also, sending a letter of intent to your first choice program is wise. The worst thing that can happen to a program is not to fill its positions, forcing the program to enter the scramble. It also “looks good” for a program director to boast, “We got our top three applicants!” If a program knows you are ranking it #1 and it doesn’t want to “go too far down on their list,” your letter of intent may influence your ranking.

As match day approaches, good luck to everyone and match well. For 2009/2010 applicants, start thinking about your strategy for next season.

While this article (and Part 1 of this series) addresses some of the concerns related to the residency match, keep in mind that many nuances affect the process and this varies from applicant to applicant.

Jessica Freedman, MD, a former medical admissions officer, is president of MedEdits (www.MedEdits.com), a medical school, residency and fellowship admissions consulting firm. She is also the author of the MedEdits blog, a useful resource for applicants: (www.MedEdits.blogspot.com).

Meet Dr. Freedman at the American Medical Student’s Association Meeting in March in Arlington, Virginia.

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.

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.