Residency interviews: Terminal velocity

In this post – my last post about medical school – I want to focus on how I approached residency applications and interviewing. Your school will have their advice and approach, but it’s important to put everything in perspective. It’s you applying, not your mentor or your school. You are personally responsible for your life and your match. Do your research and know your timelines from the original sources (e.g. NRMP, ERAS, ECFMG, etc.).

Electronic Residency Application Service

With that said, I think it’s paramount to put your best foot forward when prepping your application on ERAS. Step one requires some planning, but if you can, have all of your papers and exams and scores in before submission time. My CS and CK were both completed and scored before apps opened up. When you submit, you want as complete of an application as possible. Moreover, you want to submit on the first day possible. Just as programs may filter you out of their interview pool because you’re not from their state, they can filter you out for not being punctual enough to submit on day one. Obviously, this isn’t to say that you won’t match if you don’t do this, but it’s a small step that helps immensely in terms of getting interviews from my personal experience, and anecdotally as well.

With that, in the experiences section, it’s solid to have some sort of publication or research on your application. It serves two points – one: it shows you are capable of producing quality work, and two: it gives you something to talk about during interviews. Plan ahead; it may take 3-8 months to push something through a publication pipeline. Participate in poster sessions. Volunteer. Enter everything as directly as you can on ERAS, as it will likely be read and checked by the institutions you’re applying to and reviewed beforehand.

Another, more critical, item that requires some planning is securing good sources for letters of recommendation. There are many strategies to this, and it suffices to say that three unflinchingly strong letters at minimum are needed. Letters are a finicky topic, especially when you’re starting out clinicals and have no tangible value to the team. Here are some tips:

  • Ask for more than you need so you can have a backup letter or two.
  • Be aware of the specific program requirements; some programs require up to 2 dedicated letters from a certain specialty (e.g. surgery).
  • If you feel it’s appropriate, you may preface your time spent with your preceptor by stating your intentions – “I’m going into a certain specialty, and I intend to work hard and hopefully get a letter from my experience with you this month.”
  • Ask for a letter even if you don’t know how to get it uploaded. A fresh impression of you is much more important and will yield a better letter than a stale one.
  • Lastly, put yourself in the shoes of the letter writer. What would they expect to see from someone for whom they were writing a letter?
    • Hours and hours of time will always be rewarded – be well-read, always present, and always willing to do tasks.
    • As you progress through your rotations, you’ll be able to make an impact on the team you’re on as well as impress your mentors. I’m saying you’re more likely to get a good letter near the end of your third year rather than fresh after USMLE 1.

Next, the daunting personal statement. I would suggesting writing from the heart, and writing 2 or 3 versions. This is going to be a fair amount of work, especially if you’re not a very expressive writer. Once you have your multiple PSs ready, get ready to have your heart torn out. Send it to your friends and peers for editing, and always ask which one they like better. After a few rounds of this you’ll have something worth submitting. Write your story, write why, and know why you want this next phase of your life.

Those are the major components of your ERAS app – the scores, the letters, the personal statement, and the open-ended ‘experience’ section where I listed any publications, posters, volunteerism, or other stuff. Additionally, there’s a sort of nebulous ‘Hobbies’ section on ERAS. I’d recommend sounding colorful and not generic. It’s a small section that you might overlook, but adding a bit of spice to it goes far – it’s pretty much there so you can put stuff that might be too silly for the formal experience section like you’re into sumo wrestling or whatever.

Program selection

Simple principle here, with some caveats. A larger net catches more fish. Cast a wide net. The rule of thumb is for every 10 places you apply to, expect 1-2 interviews. I would say this held true for me. If you have a few specific geographic areas, you can focus on apps there rather than apply all over. It’s very specific to who you are and what you want – are you willing to live there for the next 3-7 years? I applied very broadly, which was costly. I felt it was needed in my case, though, because I applied to Radiology, which can be a mixed bag in terms of competitiveness.

The thought, which I discussed with my significant other, was that we’d rather go matching anywhere than go unmatched overall. I suspect most rational people have the same logic. Our preference was in the Midwest, where we had largely done our respective clinical years. I knew I did not want to go into any other specialty, so I committed and only applied to Rads.

Submission

Submit on day one, have everything in, and don’t forget to register for NRMP, which was (when I did the 2017 Match) separate. Additionally, don’t forget to update your NRMP ID in ERAS once you register.

Interviewing

Respond in a timely fashion to interview invites. They can go fast, and some places have the dubious practice of sending out more invitations than there are spots available, allowing for waitlisting for the people who check the invitation later. That being said, you’ll hopefully hear back with a steady flow in invitations. It is quite a feat to juggle travelling and scheduling all the dates and times and travel. The most I managed was 3 interviews/week in different cities. More than that and it would have been too tight.

  • Realize that there are only a finite amount of days and spots that you can travel to and interview, so if somewhere you want to go to more comes up, try and switch dates around, Programs are flexible when you call and ask in person.
  • Uber and Lyft are your lifelines.
  • If you can group together a geographical area, renting a car can save costs.

Perhaps one of the finer points I can make is that it’s critical to send out emails reiterating your interest in programs. I sent out over a hundred emails to program directors and GME offices. Again, this takes some time and effort, but it gives you the best shot at landing an interview short of rotating there or someone vouching for you.

There are plenty of resources on how to interview, so I’ll skip that bit, other than to say be natural and talkative – no one is going to hire the quiet, surly applicant.

Rank Lists and Match

Sometime in February, you’ll finalize your list of places. Go with your gut instinct as to where you fit best. It’s hard to find a metric otherwise. I suggest you check out the NRMP stats on your likelihood of matching based on the number of places you rank to give you a realistic sense of what will happen on match day. Certify your list and wait as the sands of time slowly seep and creep until Match Day arrives.

Hopefully on that Monday you’ll get some good news. You’ll then wait until Friday for the real results.

Closing thoughts

It’s an exhilarating process to go through, with such a candid mix of emotions you’ll feel. You will grow as a person after exploring the country on a quest to find a program you like, and you’ll see what the world has to offer. You’ll come away with stories and experiences of your own, to cherish and to laugh at. You will come to a crossroads and feel doubt. You will feel indecision. You will overcome this by the virtue of the process. And, with the weight of the culmination of toilsome years of medical education, you will rise and succeed: to smile and feel the warmth of tangible success in your chest at the end of it, and to continue your personal odyssey of self-realization and healing.

Perhaps in the world’s destruction it would be possible at last to see how it was made. Oceans, mountains. The ponderous counterspectacle of things ceasing to be. The sweeping waste, hydroptic and coldly secular. The silence.

The Road, CM