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Getting Into Medical School and Residency: Wish I Knew It Before I Blew It

We’ve all known or heard of medical school or residency applicants with great credentials who should have had their choice of programs. They had the marks, the winsome personality, and the composure that made their success seem inevitable. But something happened on the way to derail their plans, and, sadly, they never realized their full potential. What happened?
Being a former Harvard Assistant Residency Director and a professional medical admissions counselor has afforded me the opportunity to witness firsthand many cautionary tales of candidates who, inadvertently, were their own worst enemies. Drawing on the wisdom of those who went before, you can mitigate the liability of personal inexperience.
In this tradition, allow me to highlight several proverbs that offer the savvy applicant blueprints for success. I hope to help you recognize and avoid errors by learning from candidates who, unfortunately, failed to understand the consequences of their actions until it was too late. I’ll present these errors as composite case studies, with details altered sufficiently to ensure protection of the innocent and misguided.

The chess master’s proverb: Never underestimate your opponent.

After interviewing medical school applicants all morning, a female colleague reconvened with other faculty in her department to discuss candidates. She was pretty shocked by what had happened in one of her interviews and was interested to hear the stories others would tell about this candidate. When they got to the name of the man in question, the female faculty member was surprised to hear all of her colleagues, who were male, wax rhapsodic about this applicant. She listened intently and after they finished, she told them how – during her interview – the applicant had put his feet on her desk and – at the end of the session – winked at her. The applicant’s candidacy was summarily dismissed.
This story demonstrates the perils of extreme overconfidence, but more importantly, it is a reminder that throughout the application and interview process you should never underestimate anyone’s influence. Be professional and respectful with everyone – your letter of recommendation writers, the programs’ administrative assistants, and other applicants on the interview trail. If you are staying at a medical student’s or resident’s home during interviews, be the best guest you can be. Write thank you notes and treat people graciously.
The corollary to this lesson is that the person you perceive to have the least clout may in fact wield veto power over your candidacy. Many slick applicants who bent over backwards to ingratiate themselves to influential interviewers never found out that the administrative assistant they verbally abused by phone was empowered to provide negative feedback to these same faculty members.
By the way, these lessons need not apply only to medical school and residency. The director of a highly regarded Emergency Department (ED) in California, after vetting faculty references for candidates from a local residency program, made it a habit to call the senior ED tech at the program for a report on how this person treated co-workers in the ED. If the tech reported hubris or entitlement, the tech’s opinion was valued highly enough to undermine the candidate’s prospect for a job.

Seneca: Luck is what happens when preparation meets opportunity.

A well-meaning, competitive medical school applicant was fortunate enough to have been invited to several interviews. Understandably, she scheduled the ones that were in geographic proximity back-to-back to save time and money. She packed her bags and set off on her voyage only to have a major flight delay cause her to arrive very late the night before a big interview. She was exhausted and perturbed but was thrilled that all seemed salvageable until she realized that her checked baggage was not arriving off the carousel. Unfortunately, she had packed her interview clothes in that bag. Needless to say, she arrived at her important interview at 7:30 the next morning in jeans. Despite her explanations, she knew that her first impression was not a good one.
I’m an emergency physician, and, consequently, I have learned repeatedly the importance of planning for the worst. If things go well, you can always laugh at your excessive caution. If things go badly, you can laud yourself for your preparation. Throughout my time in admissions I have seen many avoidable mistakes – arriving late for an interview, having insufficient letters of recommendation because a faculty member did not follow through, nonacceptance into medical school or residency because of an excessively short list of targeted institutions, and poor performance in an interview because of lack of preparation, among others. Many of the errors I see are avertable with advanced thought, good mentorship, and foresight.
Start very early in the process, make a checklist, enlist experienced help, and anticipate obstacles so that you can avoid them gracefully.

The old residency director’s proverb: The resident who shows up last for orientation on the first day of internship will be the problem resident.

An experienced residency director once told me that adage, and it has proven true. Years ago, as residency orientation was starting – at the last moment – a new intern ran into the room after everyone else was already seated and ready to go. The intern looked harried, and he fumbled into his seat, late for the session…And yes, he ended up causing a lot of problems and leaving the program early with a stain on his reputation.
There is an important admissions-related point to be made here: Being late may be a prognostic indicator for a “problem” medical student or resident because it might indicate that the individual is ambivalent about his/her career trajectory. If you notice that you are dragging your feet throughout the application process – for example, submitting your AMCAS® or ERAS® very late in the season – that might be a sign that you are “just not that into” what you see as your professional path. I see this with some of my clients. Those who approach the application process very late often turn out to have major qualms about their careers or specialty choices when I ask them directly. Acknowledge this possibility and consider what it means for your professional goals and future happiness. Identify the issue now – not unhappily 40 years later.
Another point – less admissions-related and more career-guiding in nature – is that you are being evaluated routinely throughout your medical education and training. Arrive early, complain at home, and be professional at every turn. Of course, being perpetually at your crackerjack best is difficult when you are physically exhausted, but it’s worth keeping as a goal when you face interpersonal conflicts, difficult patient cases, and unfair practices in medical school and residency.

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The psychic’s proverb: The person who expects to have his/her mind read should tip very well.

I remember a talented applicant I advised a few years ago who – in her residency application/ERAS® – showcased an award she had won. She listed the name of the honor, but didn’t explain what it was. If I had been a typical admissions reader, I would have just passed by the information without a second thought. But because I was advising her, I stopped to wonder what this award was. When I asked her, she told me the award was an academic honor given to only the top one percent of students out of several thousand. She had been awarded this prestigious prize because of an extremely high standardized test score. As you can imagine, I was very impressed and strongly advised her to clearly explain the award in her application. Had she not rewritten the section, her admissions readers wouldn’t have given her an ounce of credit for that extraordinary accomplishment.
Bottom line: Don’t make the mistake of obscurely referring to a crowning, distinguishing achievement without explaining it. This mistake is a lost opportunity and a dangerous oversight.
Along these lines, don’t expect a reader to understand something in your personal statement because it’s explained in your ERAS® or AMCAS® activities section. Different admissions readers will approach the application in different ways, so – to get “full credit” for your accomplishments – you need to assume that your reader could be starting with any section of your written materials. Ensure each part of your application can stand alone and doesn’t rely on another for clarification.

The politician’s proverb: Be discreet.

One day years ago as a Harvard faculty member, I was again spending the morning interviewing applicants for our emergency medicine residency program. Over lunch, we discussed each candidate, and one in particular stood out. He was impressive in every way – academics, extracurriculars, commitment to the field. He seemed like the total package. Each of my colleagues who had interviewed him (I had not) spoke very highly of him until we had gone around the room to the last faculty member. This physician paused and then – rather unexpectedly and emphatically – said that he would not recommend ranking the applicant favorably on our Match list.
This statement seemed quite odd, considering the previous rave reviews, and there was a bit of a rumble in the room. The physician continued, explaining that the applicant was from California and had said that he loved California and wished he could stay there. “Why should we rank him highly if he isn’t interested in us?” the faculty member asked.
Little did the applicant know that with that one stray remark, he had completely ruined his chances at a Harvard slot (although perhaps – from his remarks – he didn’t really want one anyway).
As I tell my clients, you must be honest in interviews, but you do not need to incriminate yourself. There is no reason to volunteer to an East Coast institution that you’d rather not leave the warm West Coast weather, no advantage to mentioning a spouse who is averse to a program, and absolutely no logic to explicitly answering the question, “What would keep you from coming to our institution?” during your interview day. Along those lines, do not feel obliged to readily answer, “What is the one reason we should not accept you?”
And with regard to being discrete, be aware of what you say to medical students, residents, and others during the admissions process. Your remarks may be inadvertently or intentionally repeated.

Santayana: Those Who Cannot Remember the Past Are Condemned to Repeat It

In conclusion, the savviest applicants seek out those with relevant experience and learn from them. This means finding valuable, trustworthy mentorship that will help you draft a road map to your goals. This also means speaking with students or residents a couple of years ahead of you to pick their brains for application do’s and don’ts while such anecdotes are still fresh enough that you can learn from their experiences.
Michelle Finkel, formerly an Assistant Residency Director and faculty member at Harvard Medical School, founded Insider Medical Admissions to level the admissions playing field by offering elite advising services for residency, medical school, fellowship, post-baccalaureate, and dental schools applicants. Check out Dr. Finkel’s under-one-minute, stop motion Guru on the Go© videos on her Youtube site and join her on Facebook and Twitter.