Just a reminder that applicants and programs must certify their rank order lists before February 22 at 9pm EST.
Please see my previous blog entry on creating a rank list. Don’t make the error of changing your rank order last last minute based on panic! Your list should be a considered decision.
In honor of the Dan Savage’s “It Gets Better” campaign, I thought I would dedicate this blog entry to those who are in medical training and are struggling. (And who isn’t?!)
Despite the relatively warm winter many of us are experiencing, this time of year can be particularly rough for medical students and residents trying to get through classes and rotations. As a practicing MD, I want to let you know that it gets better! For every medical student, resident or fellow who has heard an attending physician say, “If you think training is hard, wait until you’re done,” I say, “Don’t believe that silly doctor!” Once you get through this tough time, you can look forward to more autonomy and a happier lifestyle.
I wish someone had told me all of this when I was going through training. It really gets better!
That time of year is quickly approaching, and I’ve already been asked how to optimally create a Match list. The algorithm for the Match is relatively simple; you can look at the details on this NRMP page.
The bottom line:
1. Rank programs so that they represent your true preferences. Your first choice should be first. Your second should be second and so on. Do not try to “outthink” the system, as it will only be to your disadvantage.
2. If you would rather not match than be at a specific program, then that program should not be on your Match list. Do think carefully, however, about the prospect of not matching, trying to scramble, and possibly having to reapply next year 
.
3. If you are applying to a competitive field, consider having many programs on your rank list to increase your chances of success. How many is many? See this excellent document for evidence-based assistance in how many programs you need, depending on your specialty choice.
As we approach the Match, I want to remind applicants that – although residency directors (RDs) are permitted to express strong interest in candidates – RDs’ comments should not be interpreted as promises regarding rank.
Here is the NRMP’s Statement of Professionalism that reviews violations and “misleading communications.” The document is clearly written with examples of problematic interactions between RDs and applicants.
I received an urgent request from an applicant last week. He wanted to discuss a pre-match offer he had received that had a Friday deadline. The pre-match program was an academic institution, which was appealing, but the interview day had left the applicant underwhelmed for a number of reasons.
On the one hand, this offer was a sure thing. On the other, the applicant had noted what he considered to be red flags. He asked me what to do.
As usual, in life there is no right answer. But here are a few suggestions if offered a pre-match:
1. Ask for more time. In the worst case scenario, the program director says no. Nothing lost.
2. Try to move up any interviews you have not yet attended.
3. Contact the other program directors and let them know you have a pre-match offer and give them the deadline date. They may offer you a pre-match in return. Or – on the contrary – they may let you know they are not interested. Either would be helpful in making your decision.
4. Speak to residents who are at the pre-match program. Trainees will often readily tell you the weaknesses of their institution 
. This information will help you make an informed decision.
5. Assess a) your risk-taking comfort zone and b) the strength of your candidacy. This step is probably the hardest, yet most important.
In the end, the applicant did not accept the pre-match offer and is crossing his fingers he’ll end up at another program he likes better. He is so relieved that – with the information he has now – the decision seems to have been the right one for him.
Now that the new year is here, many pre-meds, medical students and residents will be asked to finalize their schedules for the next year or more. Although it’s easy to get wrapped up in it all, I wanted to put in a plug for something a bit unconventional – time away from the field entirely.
When I was in medical school, I took almost a year away to travel and explore journalism, a career that had always interested me. I obtained a small grant to conduct research in Mexico and then backpacked with some friends through Mexico and Guatemala. I also spent a month in Thailand. Additionally, I was awarded an American Association for the Advancement of Science Mass Media Fellowship in Science Writing, so I worked in Portland at the Oregonian writing articles for the paper.
Taking time away from medicine is not an option for everyone: Some institutions do not encourage it, and there is usually a financial opportunity cost. I will say, though, that being away from medicine made me appreciate it more and helped me improve several useful skills, including foreign language and writing.
If taking a scheduled break from the norm is a viable choice for you, I would strongly encourage it. The experiences I had have long-reaching effects that continue to help me as a physician today.
In 2004, a team was created to initiate a multi-year, comprehensive review of the USMLE program. This team, called the Composite Committee, is comprised of the Federation of State Medical Boards (FSMB), the National Board of Medical Examiners (NBME), the Educational Commission for Foreign Medical Graduates (ECFMG) and the American public.
Last month this team announced some “enhancements” to Step 2 CS that are scheduled to start the middle of this year. Here is a summary of those changes. Updated practice materials for Step 2 CS will be posted to the USMLE website in March 2012.
I recently read a NYT piece called, “Why Would Anyone Choose to Become a Doctor?” by Dr. Danielle Ofri. It’s a sweet essay written by a physician who describes being perplexed by the large number of medical school applicants yearly, considering her profession’s numerous annoyances.
As the author considers alternatives to her career, however, she comes to the conclusion that her clinical encounters make it all worthwhile. The essay is a nice pick-me-up.
This article is currently at the top of the New York Times’ most emailed list. It’s written for those entering the work force, but it is very pertinent for applicants to medical school, residency, fellowship, and post bacc programs.
I hope everyone has a happy holiday season!
A few weeks ago, I recommended reading This is a Soul: The Mission of Rick Hodes, and today I want to highlight another must-read for the physician or doctor-to-be. The Spirit Catches you and You Fall Down was published in 1997 and promptly won the National Book Critics Circle Award for Nonfiction, among other accolades.
The book chronicles the U.S. medical experience of a Hmong family, showcasing the twisted miscommunications between the two groups. It’s an excellent story and strong reminder to all medical caregivers as to how – although everyone may be aiming for the patient’s best – cultural differences can spoil the doctor-patient relationship.
Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital. She was appointed to the Assistant Residency Director position for the Harvard Affiliated Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes.
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Dr. Michelle Finkel, a former Harvard residency admissions officer, uses her expertise to provide individually-tailored advice to candidates applying to medical school, residency, fellowship, post baccalaureate and dental school programs. Years of candidate selection at Harvard taught Dr. Finkel what characteristics comprise a desirable applicant and how even bright candidates make mistakes that undermine their admissions success. Dr. Finkel is a practicing Emergency Physician with nine years of experience training medical students, residents and fellows. Read more
