Many students don’t realize that residency match should be top of mind when choosing their medical school. Even though residency is several years away, your time spent as a medical student will determine the fate of your residency. This is because residency directors have various criteria that they look for in their future residents, and this criteria comes from specific factors acquired in medical school.
Therefore, when deciding which school is right for you, be sure to think about more than just location and class size. Do your research. Not all medical schools are designed the same, and some will prepare you for residency more than others.
Residency programs vary just like medical schools—each one with its own priority list of criteria for future residents. However, there are several factors that all residency directors focus on when starting the residency-match process.
Step 1 Scores
The NRMP’s report has shown year after year, the number one criteria has almost always been, and will likely remain, Step 1 score. Seek out a school that not only integrates Step 1 preparation into the curriculum, but that the curriculum itself is designed to help students succeed. Look closely at how the classes are scheduled, when shelf exams take place, and how the whole experience is structured. A great sign that a student is in a school that’s interested in their success is how that school evaluates student outcomes and adjusts accordingly to not only incorporate the latest, best practices, but to give them the best possible opportunity to absorb and apply the material.
Letters of Recommendation
So much of clinical rotations can be about performing under pressure and realizing that you are being evaluated at all times. At the same time, almost paradoxically, a major concern of medical students is whether or not their performance is being noticed at all, and how that will be reflected in letters of recommendation. A school with heavy, active clinical observation and experience as early as possible in your basic science terms, (shoot for weekly if you can) is an indicator that you won’t just get noticed, you’ll impress.
The MSPE or Dean’s Letter
Typically, an MSPE is a form letter compiled through grades and faculty evaluations. Some schools build these one piece at a time over the course of a student’s time at the school. In other cases, they’re written at the conclusion—both are valid. What matters here, though, as far as really moving the dial, is how well the dean will know you personally. Students at smaller schools, and students that rise to leadership positions are at an advantage. Being a face and not just a number on a spreadsheet is a cliché, but it can push a student’s letter from formulaic and pat to genuinely impactful.
Something often overlooked is whether or not a school has enough seats in their core rotations for every student without relying on heavy attrition. This will ensure that students can proceed upon passing Step 1 as soon as possible and maintain their momentum and avoid drastic changes in cost of living, loan repayment, etc. Another key priority should be looking for all of those rotations in the same city. Some schools spread their clinical years across states and even countries. This is intensely disruptive to student learning and should be avoided at all costs. Look for faculty that also works with students, even by providing career guidance on many other areas of professional development—not the least of which is residency selection strategy.
While a student’s personal statement is acknowledged as a critical element to success in The Match, what goes into properly shaping the person crafting that statement is frequently missed. Students should make sure their school has an active culture in and around medicine and volunteer opportunities. (Sorry, the benefits in this area don’t stop with undergrad. In fact, the NMRP report even breaks down, by specialty, how much was too much, what was enough, and where there was room for more). Continued experience helping others, especially in and around a future profession, only serves to enrich education with relevancy and shape students into the doctor they want to ultimately become. If medical students can manage to maintain a full, healthy life and keep up with their studies, they will be able to develop a personal statement that stands above the competition.
It’s All in the Experience
When it comes down to it, almost every factor in residency match success comes from the student: USMLE Step scores, attributes highlighted in letters of recommendation, and a dean’s letter that captures who they are, not just what they’ve done. These personal achievements come from the environment that shaped them, the faculty that taught them and the experiences that were made available. It’s on medical students to make the right choices for themselves, but at the same time, it’s on the medical school to make sure it offers the singular best opportunity it can for those students.
Medical students don’t thrive in a vacuum. They need a curriculum, faculty, support structure, living environment, extracurricular opportunities, even a student body that is shaped to help them succeed. It’s about providing the best context possible for medical students to absorb and learn to apply an enormous amount of information. A school shouldn’t just provide that information, it should help students develop on a personal level into the sort of physician a residency director wants on their team and, ultimately, caring for their community.