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Letters of Intent

Medical school letters of intent (or what some applicants jokingly call “love letters”) can be used for several types of applicants:

1) Those who have been wait listed
2) Those who have been interviewed but have not yet been accepted or rejected
3) Those who have not yet been invited to interview

When writing your letters of intent (LOIs), you should have the following principal goals:

1) Restating your interest in the institution
2) Positioning yourself as a distinctive candidate

The biggest error I see in LOIs is too much content about a specific institution’s advantages. There is no reason to spend a paragraph or more telling medical school admissions members what makes their institution special. They already know! Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant.

For those of you interested in LOI assistance, please contact me. I do offer a popular LOI editing service.

AMSA Conference Update

Just an update that last week the American Medical Student Association (AMSA) secured the Honorable Kathleen Sebelius, the twenty-first Secretary of Health and Human Services, to give the AMSA National Conference’s keynote address on Friday, March 9th from 1:00pm-1:50pm. Her speech will bump my talk – previously at 2:30pm – to 3pm.

I look forward to seeing many of you there.

NRMP Rank Order List Certification Deadline

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 minute based on panic! Your list should be a considered decision.

It Gets Better

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!

Making Your Match List

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.

Promises, Promises

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.

Pre-Match Offers

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.

Outside of the Box

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.

Step 2 CS Changes

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.

An Excellent Question

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.