Applying to Residency

Published - Written by Eduardo Hariton, MD, MBA and Neha Vapiwala, MD

Applying to residency can be an arduous process, both emotionally and financially. To best manage this complex endeavor, it is important to be systematic and thoughtful. Recently, NEJM Resident 360 hosted a discussion on applying to residency with a panel of experts who answered questions about the application process. In this post, we share some of the information from that discussion as well as our own advice on how to successfully navigate the residency application process.

Setting the Stage

Making the decision: Most of you probably have already made the decision to apply for a residency position, but residency is not always the best choice for everyone. Post-graduate clinical training is the traditional path, but some medical students discover that clinical medicine is not right for them. If you are, or suspect you might be, one of those students, talk to your advisors and support network. Many nonclinical career paths exist in healthcare and beyond where you can apply the skills and knowledge you spent four years acquiring.

On the other hand, if you have decided that residency training is for you, choosing the right specialty is important. Everyone comes to this decision differently.

Helpful questions to ask yourself about residency training:

  • What patient population do I enjoy caring for and feel intellectually stimulated by? Adult, pediatric, or both? Patients with acute or chronic conditions?
  • Which physicians do I admire and what specialization path did they pursue?
  • What do I want to pursue outside of clinical medicine and will my field of interest allow me to do that?

Prerequisites: Different specialties and residency programs have their own requirements that you must complete before applying. While most requirements are standard (e.g., step 1, third-year rotations, etc.), some may be unique to a program. Make sure you are familiar with all prerequisites for each program you apply to because remedying missing requirements is hard once the process has started, and you are unlikely to get your application fee refunded if you overlooked a prerequisite.

Extracurricular activities: Finding time to do anything other than studying can be challenging. Nonetheless, it is important to start or continue to be involved in nonacademic activities while in school. Whether you volunteer at a clinic for underserved patients, conduct basic science or clinical research, or pursue an activity of personal interest, it will go a long way in strengthening your application.

Quality over quantity is key with extracurricular activities. Although it may sound cliché, delving deeply into one thing is more meaningful than superficial involvement in many activities. Also, involvement in organizations early in your career can help you rise to leadership positions and develop stronger relationships with mentors and supervisors. Don’t worry if you change your career choice late in medical school and your activities don’t match your current career path.

Admissions committees look for a track record of dedication to service,
research, and academics, and most will not fault you if some
activities are related to a different field.

Advisors: Advisors play a critical role in the residency application process. Make sure to have at least one or two primary advisors — perhaps your medical school advisor and a faculty member from your clinical years. Mentors can help shepherd you through the application process, advocate for you, and give you valuable feedback on your application. If you haven't found one yet, make sure to do so!


The Application

Submit as early as you can! While the official application cycle may extend until winter, most programs begin reviewing applications in early fall. By mid-to-late October, most interview slots are gone. Hence, it is crucial to prepare everything that you need early so you don’t delay your final submission.

Submit as early as you can!
By mid-to-late October, most interview slots are gone.

Making the program list: Preparing a list of programs to apply to can be daunting. A good starting point is to review past match lists from your medical school and see where previous students matched. Supplement this list with recommendations from your advisors and faculty on the wards and by searching the internet for programs in a preferred geographical area. If you have a specific career interest, look up prominent leaders in the field and consider their programs. If your list is too long (the optimal number varies by specialty, applicant competitiveness, etc.), narrow your choices based on your preferences regarding location, setting (university vs. community hospital), and program size.

Preparing your personal statement: Often, the personal statement is the hardest part of the application. However, only in this statement can you bring a personal voice to your story and tie together the life experiences that have led you to this juncture.

Consider the following questions when

starting to think about your personal statement:

  • Why do you want to pursue this specialty?
  • What makes you a strong candidate?
  • Why would a particular program want you as a resident?
  • What experiences helped you make this decision?

Once you have answered these questions, try to elaborate briefly (1–2 page maximum); help the reader better understand you as a person and as a physician in training. Share your statement with friends and colleagues who know you well and a few who don’t. Incorporate their feedback and confirm that they understand the message you are trying to convey to better ensure that admissions readers will interpret it correctly as well.

Your CV: The Electronic Residency Application Service (ERAS) has specified slots for your education, academic projects, publications, educational activities, etc. Include all projects during medical school and any major activities that are pertinent to your story. However, anything in your application is fair game during interviews, so be prepared to talk about everything.

Requesting letters of recommendation (LORs): First, find out how many LORs are required for your specialty. If not specified, three or four should be enough. The purpose of LORs is to support your stated goals, provide some background and context for your experiences.

Faculty — not trainees — should write LORs; they should know
you well and address your character, integrity, academic achievements,
clinical acumen, and ability to work on teams.

The best time to ask for an LOR is when you are working with that person so that his or her memory is fresh. If that is not an option, a nice refresher email of your time together (such as a de-identified patient anecdote) can help that person recall your time working together.

If someone you ask seems ambivalent or hesitant, consider it a red flag
and offer him or her an “out” because
no letter is better than a lukewarm or negative one.

If your specialty requires a chairman letter, ask the faculty in your school’s advising office, clerkship directors, or your mentors how to obtain one. Some programs will have you meet briefly with the department chair before the letter is written, while others may have a faculty member who knows you co-write the letter with the chair.

Start requesting LORs early;
the more time you give your recommenders, the better.

If you do not receive an LOR as the deadline nears, send a gentle reminder a few weeks before it is due.

Submitting the application: You should aim to input your information into MyERAS in June and submit it as close as possible to the first available date, usually September 15th. After you have double-, triple-, and quadruple-checked your application for errors, it is time to hit the submit button.

Make sure to thank those who supported your application with
a nice note and an update once you have matched.


The Interview

Once you make it to the interviewing stage, you and the program faculty have the opportunity to get to know each other better. Many program graduates stay on as fellows or faculty, so interviewers may be considering you as a potential future colleague. Take your time to think about each program and decide whether its culture fits with yours and whether you identify with the residents in the program.

How to prepare: Know your application! Know your application! Know your application! We can’t emphasize enough how important it is to be able to discuss all aspects of your application in depth. Many schools offer mock interviews. If yours doesn’t, mentors or current residents might be willing to help you practice. Take every opportunity to practice and ask for feedback so you can improve.

Know your application! Know your application! Know your application!

Some common interview questions:

  • Why do you want to pursue this specialty? Be ready to explain how you came to your decision.
  • Why do you want to come specifically to our program? You should know why each program attracts you. Doing the research before interview day will demonstrate your interest.
  • Where do you see yourself in 10 years? This helps programs make sure that your future goals are a good fit with their program.

What to wear: Interviews are not the time to try the latest fashion. It is better to be safe and traditional than to be avant-garde. For male applicants, this means a suit (preferably black, blue, or gray) and tie. For women, rules of thumb are to avoid short skirts and deep cleavage tops and wear neutral tones and shoes that you can walk in comfortably.

Do’s and Don’ts of the Interview

Do:

  • Be engaged: Put your phone away and talk to people.
  • Prepare for each program: Be familiar with information on the program’s website and prepared to articulate why you chose to apply to this program.
  • Ask questions: Asking thoughtful questions will convey your interest and help you interact with current residents and faculty.

Don’t:

  • Be disrespectful: Even when you are not in a formal interview, your interactions may be discussed; keep this in mind when talking to administrative staff and other people you encounter, including other interviewees. You want to come across as a team player and some might also be your co-residents one day!
  • Be late: Do your best to be on time to every interaction. While travel delays are sometimes unavoidable, this is not the time to catch up on sleep. Be early!
  • Get drunk: The pre-interview dinner is a time to meet residents socially, but do not get too comfortable or drink too much. You are still being evaluated as a future co-resident.

Post Interview

Post-interview communication: The National Resident Matching Program (NRMP) officially discourages post-interview communication, and many programs will tell you not to send thank you notes. Although not necessary, notes may be appreciated in some specialties, as long as the NRMP match rules are not broken. If you choose to send a thank you note, do not expect a response and do not send a gift. However, if you have major updates to your application (big award, new publication, etc.), do let programs know as soon as possible.

Programs are explicitly prohibited from asking you if/how/where you are going to rank them, but some may contact you to inquire if you have any follow-up questions. If you have any concerns about an interaction with a program, talk to your advisor or school faculty members.

Creating the rank list: Creating your rank list is the final step. There is no standard way; it is very much a personal decision! Ask your friends and family for advice, but remember the program has to fit your needs. When in doubt, go with your gut; it will likely lead you to the program you want and where you will thrive. Try to submit the rank list 1 to 2 days before the deadline to avoid any last-minute stress and computer glitches.

Remember, it’s your future and the program has to fit your needs.
When in doubt, go with your gut; it will likely lead you to the
program you want and where you will thrive.

Congratulations! Now you can relax and enjoy the end of medical school as you get ready for match day!


Other Considerations

Applying to multiple specialties: The process for applying to multiple specialties is similar, yet busier, given the likely increased number of interviews. You will also need different LORs and personal statements for each specialty. The best advice we have is to be forthcoming with your decision and explain your rationale. The caveat is that you do not want it to appear that the less-competitive specialty programs are back-up options.

Taking time off: While taking time off can certainly be a positive and help strengthen your application, do not take so much time that programs are concerned that you were away from the clinical world for too long. Many applicants who return after years away from the clinical world (dual degrees, PhDs, leave of absences, etc.) do several rotations before applying, and often get at least one letter from that experience.

 

Dr. Eduardo Hariton is an obstetrics and gynecology resident at Massachusetts General Hospital and Brigham and Women’s Hospital in Boston. His clinical interests are in reproductive endocrinology and infertility. He is also interested in healthcare management and working at the intersection of business and medicine. He currently serves as the resident member of the Perinatal Welfare Committee at the Massachusetts Medical Society. Dr. Hariton holds a bachelor of science in biology and a minor in nutritional sciences from the University of Florida, a doctorate from Harvard Medical School and a master’s degree in business administration from Harvard Business School. His past experiences includes global health work in Rwanda, healthcare consulting with McKinsey and Company, medical education projects across the Harvard system, and clinical research in a variety of fields.

Neha Vapiwala, M.D. is an Associate Professor and Vice Chair of Education in the Department of Radiation Oncology and an Advisory Dean in the Perelman School of Medicine at University of Pennsylvania. She has published extensively on issues related to medical education and training, and received multiple teaching awards in recognition of her dedication to trainees. Dr. Vapiwala also holds leadership roles in several national committees; she was elected as President of the Association of Directors of Radiation Oncology Programs, and Vice Chair of her specialty’s Residency Review Committee of the Accreditation Council for Graduate Medical Education. She also serves on cancer education and examination committees in the American Society of Clinical Oncology, American Society for Radiation Oncology, American College of Radiology and American Board of Radiology.