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.