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We Need to Decrease the Stress and Inefficiencies Associated with the Residency Application Process

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Inefficiencies in the residency application system have been a problem for many years. While the AAMC and NRMP have made efforts to improve the process, including the move from the Scramble to SOAP a few years back, the lack of adequate slots for a large number of candidates leads to a tremendous amount of unnecessary stress and waste. With the introduction of virtual interviews, hoarding became a new problem.

To their credit, the AAMC is considering some reforms to the system. Allowing applicants to identify favored residency programs, called “preference signaling” through the supplemental ERAS, for example, has improved candidates’ abilities to get interviews at chosen programs. Additionally, some specialties – with AAMC’s support – have implemented a common interview invitation release date and a minimum response time for invitees. In the latter case, for example, most surgery programs provide candidates a minimum of 48 hours to accept or reject an invitation, such that applicants don’t need to sleep with one eye open, jumping to respond to an invitation to avoid the wait list. There has even been a consideration of capping the number of interviews each applicant can have to avoid interview hoarding.

I recommend reading this piece on proposed reforms to the system. Having gone through the stressful process myself, I wholly support strategies that would increase transparency and decrease unnecessary anxiety. 

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Five ERAS Platform Quirks to Heed

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On September 7th, ERAS will open for submission, so it’s time to get moving on your written materials. Let’s briefly cover five quirks of the ERAS platform to help you get through the drafting process. The ERAS platform…

1) Does not support italics. While journal articles and some phrases (e.g. “summa cum laude”) should be italicized, don’t be surprised when you can’t.
2) Prompts you for a supervisor for each activity. In some cases, you simply may not have one, but whenever you can, name someone. A name validates the experience.
3) Prompts you for average hours per week for each activity. It can be difficult to calculate this number for certain experiences, especially those that are intermittent, but it’s worth making your best estimate rather than leaving the question blank.
4) Offers space to include a “reason for leaving” for each activity. Don’t skip this section, but keep your answers brief.
5) Limits you to 1020 characters for experiences, 510 for the interruption in the medical training section, and 510 for each of the awards sections. Be aware of these limits as you write, so you are not furiously cutting later.  

For tips on how to craft your ERAS, check out these 15 ERAS tips.

Contact me for help with this weird, wild process.

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The NRMP is Considering a Two-phase Residency Match

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Recently the NRMP requested public comment on the concept of a two-phase residency Match. In part, the plan would mitigate weaknesses in the Supplemental Offer and Acceptance Program (SOAP), which provides the opportunity of unfilled positions to eligible unmatched residency candidates. SOAP replaced the Scramble, an inferior system from years ago. SOAP still has its weaknesses, however, including an expedited timeline for decision-making by candidates and programs.

See a full description of the proposed two-phase residency Match here. Of note, the first Match Day, which would be analogous to the current Match Day, would occur a month earlier in February. Accordingly, interview season would be shorter. 

The plan has many benefits, but it would require some adjustments in candidates’ and residency directors’ calendars and thinking.

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Love Letters and Janet Jackson

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Letters of interest (LOI) – or what some applicants jokingly call “love letters” – can be used in several types of situations:

1) Residency and medical school applicants who want to make an impression post-interview before decisions are made about their candidacies.
2) Medical school and residency applicants who have not yet been invited to interview.
3) Medical school applicants who have been waitlisted.

When writing your letters of interest, you should have the following goals:

1) Restating your strong interest in the institution
2) Positioning yourself as a distinctive candidate who can contribute fully to the institution

The biggest errors I see in LOIs are:

1) Too much content about a specific institution’s advantages. There is no reason to spend a paragraph or more telling a PD or medical school admissions member what makes their institutions special. Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant.

2) Writing about how the program or school will help you. The focus should be on how you will be a contributor to their institution. (It’s the “What have you done for me lately?” Janet Jackson principle.)

Finally, let me say that I find the term “letter of interest” to be better than “letter of intent” because, generally, I don’t recommend you let institutions know what your intent is (since it might change). Note that with a letter of interest you can create one general letter that you modify and send to different institutions with different goals (i.e. requesting an interview or demonstrating your interest post-interview). You can also modify the letter and send it to your top choices because, if you are not making commitments, then you can honestly use it for multiple institutions. 

For those of you interested in LOI assistance for medical school or residency applicants, please contact me.

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Haven’t Heard Back from a Medical School or Residency Program? Here’s What to Do.

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One of the more frustrating aspects of the medical school and residency admissions processes is the lack of response from some institutions. There is no obligation for medical schools or residency programs to reply to a candidate, which leaves applicants in limbo.

If you have not heard back from medical schools or residency programs to which you’ve applied, I recommend that you contact (preferably call) the institutions to inquire about your status.

After I offered that advice to a residency applicant I was advising, she emailed me to say she obtained an interview in a competitive specialty with a phone call. Another said she received two preliminary interviews with simple emails. A third recently told me that, after calling in the morning, he was offered an interview by the afternoon. (Generally, I recommend calls over emails because it’s hard to ignore someone on the other end of a phone line. Still, if you simply can’t bring yourself to call, an email can be effective.)

I’ve seen this phone call strategy work for medical school interviews as well: Several years ago I helped a strong applicant who had been rejected by a top medical school. He thought he was a very good fit for this particular institution, so he called the school to make his case. Shockingly, after the applicant’s phone call, the school granted him an interview, reversing their original rejection. Ultimately, after being initially rejected, this applicant was admitted to that top school. Of course, this is an exceedingly rare occurrence. But to me, the moral of this story is that it is worth being assertive in the application process.Now, if the school or program explicitly asks in written materials that you don’t contact them about your status, then calling is not a good idea, of course.

An additional strong option is to send an effective update letter or letter of recommendation from an influential writer (alumnus, for example). I do edit letters of interest for medical school and residency applicants, but even if you choose not to use my services, I recommend sending a well-written, strategic note in addition to making a phone call.

This process is an uncertain one, but asserting some small bit of control can be useful (and comforting).

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About Dr. Michelle Finkel

Dr. Michelle Finkel

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. Read more

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