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.
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.