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You Just Might Be More Competitive Than You Think You Are!

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The time of year when fourth years need to decide where to apply for residency is coming up faster than you might think. This is often the point in time when applicants to the Match begin to wonder, “Is it possible for me to match in my dream residency? Am I competitive enough for the big names? What can I do to make myself look better on paper?” The bigger questions that arise include, “What exactly are the residency directors looking for? Do I meet the criteria specified?” In order to find the answers to these questions, I randomly queried internal medicine residency program directors from across the United States in the different types of residencies that exist, including Med-Peds, academic, community, primary care and categorical programs. I asked them two simple questions:

1. What qualities does the ideal applicant have?
2. If an applicant does not have all the ideal qualities, what can he or she do to be more competitive?

The first conclusions I came to were that every program is unique and every program director desires specific qualities, and as a result they assess applicants differently. The multitude and variety of responses I received astounded me. I also learned that the philosophy of programs can differ over time as their respective directors change. Keeping that in mind, I’ve summarized the comments from the different residency directors in the categories listed below. Hopefully, this will bring some clarity to the issues at hand.

1. Personal Qualities: I put this category first because, based on the responses, it seemed that most residency directors placed a substantial amount of importance on this category. The qualities that were suggested by a large percentage of residency directors were:

  • Well-rounded
  • Superb interpersonal skills
  • Positive attitude
  • Optimistic personality
  • Team player
  • Commitment to patients and quality health care
  • Intelligence
  • A passionate love for medicine
  • A strong work ethic
  • An affection for and appreciation for fellow human beings
  • A capacity for empathy
  • Evidence of high motivation
  • Enthusiasm to both learn and independently self-study but also to share knowledge with team members
  • Community service involvement and leadership, or another unique quality that distinguishes them from other medical students

These are all traits that a strong letter of reference can vouch for and are often cemented during the interview. It is important to remember that in the case of students who are not exceptional academic performers, outstanding research or unique volunteer work will go a long way, but do not always guarantee an interview. On a positive note, there were also program directors who blatantly stated that they did not care whether an applicant had all honors, stellar board scores and did research, as long as the student was able to demonstrate that he or she has the “right stuff.”

2. Academics: The consensus across the board from all the residency directors is that applicants with above average academic performances are more likely to be invited for an interview by their programs. Program directors weigh the individual components of the applicant’s performance differently. The majority of residency directors base the emphasis on performance in clerkships. One needs to do well in his or her clerkships and sub-internships; this is critical and usually will not be overlooked even if the individual was outstanding in the first two years. It is not a good sign if the candidate was required to repeat classes in the first two years of school without a plausible reason. All honors in medicine with less than stellar evaluations in other clerkships is also not well received. The ideal applicant should demonstrate clinical excellence in his or her clinical clerkship grades, sub-internship grades, Dean’s letter and letters of recommendation.

3. USMLE Scores: Once again the jury is out on the board score; however, the residency directors questioned said that they do not give very much importance to board scores. They contend that often board scores are better correlated with test-taking abilities rather than academic performance. However, when evaluating candidates for interviews, applicants who have failed either USMLE Step I or Step II Clinical Knowledge Examination receive a more in-depth screening before receiving an invitation to interview. Having said all that, keep in mind that programs with a large number of applicants will use USMLE scores to determine interview status as well as use them in ranking applicants.

4. Research: This category is clearly more highly regarded at the academic programs. Most programs agree that outstanding research will not compensate for mediocre grades. However, research may be a useful surrogate for those who have average grades early on in their medical school careers and then excelled in the medicine sub-internship and later clerkships. Earning graduate degrees as well as participating in other meaningful scholarly activity such as teaching and tutoring is looked upon favorably. Achievements in research, such as being published, are helpful but the residency directors state that the most important thing is that an applicant needs to be able to talk about his or her research fluently at an interview.

5. Competitiveness: One tool to be used to increase competitiveness at application time is to apply widely (many programs of different types) in order to increase the chances of getting interviews. Applicants who choose to apply widely should be prepared to visit more programs during the months of December and January. Keep in mind that a mediocre performance in a single clerkship should not be a reason to stress, as good grades and evaluations in the majority of clerkships plus good research and/or volunteerism will increase your desirability. Students should know that their extracurricular activities and research are only viewed as favorable as long as they do not affect academic performance. Applicants can become more competitive by getting involved as early as possible in leadership activities and/or research as this can help demonstrate academic potential and productivity. The letters of recommendation should be written by different types of evaluators, such as an attending physician from your sub-internship, someone who can provide useful insight regarding personal qualities, and a scholarly activity preceptor. It is definitely important and useful to have someone inside the program advocate for you if possible. Other ways to get your foot in the door consist of doing an elective at the program you are interested in and letting people know you are interested by either sending correspondence or going back for a second look. Finally, the way you present yourself at an interview should be honest, portray you in a positive yet realistic fashion and be consistent with your application, CV, and personal statement.

In conclusion, it seems that every residency director is looking for something different, so the best advice is just to be yourself and remember you are definitely more competitive than you think. Good luck with the Match!

Talia K. Ben-Jacob
Vice Chair, Council of Student Members
University of Vermont College of Medicine, 2007
e-mail: talia.ben-jacob@uvm.edu

Back to May 2006 Issue of IMpact

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