Residency Applicants, Thinking about How to Create your Rank Order List? Check out this easy advice.

For those of you who are starting to think about your Match rank order list, please make sure you follow this (simple) strategy: Rank your first choice first, your second second, etc. The Match algorithm is mathematically quite complicated, but because the process always begins with an attempt to match an applicant to the program most preferred on the applicant's rank list, you do not want to try to "game" the system.

For example, I've had applicants tell me that they plan to rank a less preferred institution higher because that program has more residency slots. That's a no-no. The applicant will actually be harming him/herself with that strategy.

Here's a video the NRMP created last year to better explain the Match algorithm. Here's also a less-than-one-minute Guru on the Go© video "NRMP Ranking to Avoid a Spanking" to emphasize your optimal ranking strategy.

If You Don't Laugh...

I posted this piece on social media last week, but it's so clever that I wanted to showcase it in a blog.  "A lexicon for gender bias in academia and medicine" is hilarious (and sad) - definitely worth a read. While I do not know Dr. Esther Choo personally, I have heard from an emergency medicine colleague that she is a powerhouse. She clearly also has a great sense of humor.

Happy Medical Training: An Oxymoron?

Medical school and residency training usually decrease one's happiness for several reasons. Happiness researchers have demonstrated that a feeling of control and the amount of spare time one has both correlate with happiness. Both of those factors are limited during med school and residency. Relationships are also correlated with happiness, and those can be squashed during medical training as well.

I'm not trying to be a downer here! I want to encourage applicants to consider this happiness quotient when selecting an institution and training program. A lovely client recently emailed me to ask if he should consider medical schools' residency program director scores in deciding where to matriculate. (He had already gotten multiple acceptances!) I advised him to consider where he would be happiest instead. If you are able, maximizing your contentment by choosing an institution that fosters your greatest happiness is key. Geography; proximity to family, friends and community; and a location that provides an opportunity to enjoy hobbies during limited free time are significant.

Excellent training is important, but, in the end, many programs turn out equally qualified clinicians. At least consider your well-being as a factor in selecting where you might be for the next three plus years of your life.

Residency and Medical School Interview Questions: How to Answer that Icky Decade One

"Where do you see yourself in 10 years?" the interviewer asks you, and you squirm...

An influential physician-administrator once complained to me that whenever he asked potential new faculty hires where they saw themselves in a decade they always said they were interested in global health or teaching. "It sounds sexy," he remarked. "But many of them have nothing in their C.V.s to bolster their interest in either pursuit."

When asked where you see yourself in ten years, consider how your accomplishments thus far might demonstrate an evolution. The idea is to have a trajectory that you can back up, defend, and easily justify. This doesn't mean you're stuck with what you've done even if you didn't like it, though. You could point out that having tried myocardial bench research, you realize that your real interest is in clinical investigations of new cardiac markers.

Many medical school applicants say they don't know what field they want to go into. That's okay! And many residency applicants don't know if they want to do a fellowship. That's also to be expected. The point is to focus on your previous strengths and achievements and leverage them to demonstrate a logical path, going forward.

Specificity is Golden

I’ve been editing and mock interviewing up a storm recently, and I want to offer a tip: Avoid words like “various,” “numerous,” and “several.”

“I’ve been involved in various community service projects” can imply a lack of true substance or even an attempt at obfuscation. (Is it just two afternoon health fairs you’re talking about?) Worse still, your strong accomplishments are overlooked when you lack specificity. It may feel redundant to showcase an activity you highlighted in your application materials, but - as you’ve heard me say before - your reader/interviewer is likely reviewing scores of candidacies. Yours won’t stand out if you don’t make it.

Surgery Without Anesthesia

As we recover from our big Thanksgiving celebrations, I recommend this recent short NYT piece by A.J. Jacobs on gratitude. It’s fun and reflective - just what the doctor ordered.

Top 25!

While I've written before about my (and Malcom Gladwell's) hesitation with school rankings, I do reluctantly use them in listing where my clients have been accepted because they are more illustrative than alphabetic order. Please note that the top 25 schools are all represented on the Insider accepted list (plus many, many more). 

If you are a previous Insider medical school admissions client and you do not see all of the schools that accepted you on the list, email me. 

It’s Not Personal

When I was in my second year of medical school, a third-year student came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on on our clinical rotations, 99% of the time, it wasn't personal. He likened the situation to Boston traffic - how drivers lean on their horns for little cause because they are simply frustrated about their days. 

It's not personal, he said.

I am saying the same to my clients. I've had applicants complain that faculty interviewers mixed them up with other candidates or were wholly unprepared - reading their applications for the first time during the interview itself. Remember: It's not personal. This process is arduous and long, and most candidates, faculty, and program coordinators are tired and doing their best. When things are rough, give others the benefit of the doubt. It will help you get through this stressful process with your sanity intact. 

Clinical Medicine: Know What You're Getting Yourself Into

The article I'm about to recommend is not for the faint of heart. 

Alex Mohseni MD wrote a very pointed, compelling piece in a recent Emergency Medicine News called, "Why I Quit Emergency Medicine." It has created quite a buzz in emergency medicine circles.

It's painful, but a really great read. Here it is.

Early Acceptances

Great news!  Insider clients have already been accepted to Georgetown Medical School, Ohio State University College of Medicine, Virginia Tech Carillion, University of Cincinnati School of Medicine, University of Arizona-Tucson, and UMass Medical School. 

Current clients, please make sure to email me with your updates!

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

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 start contacting institutions to inquire about your status. After I offered that advice to some residency applicants I was advising this year, several recently emailed me to say they obtained interviews after sending emails. 

I've seen this 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. Surprisingly, 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.

An additional strong option is to send an effective update letter or letter of recommendation from an influential writer (alumus, for example. I do edit letters of update/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 many cases).

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

Residency and Medical School Interviews: Moving Past Impostor Syndrome

First described by psychologists Drs. Suzanne Imes and Pauline Rose Clance in the 1970s, impostor phenomenon occurs among high achievers who cannot easily internalize their successes. They often externally attribute their accomplishments to luck and worry that others will eventually realize they are frauds.

Recognize this phenomenon of self-doubt?

You are not alone. Although many people suffer in silence (as they do not want to be revealed for what they perceive to be major deficiencies), the syndrome is quite common, especially in medical school. According to one 2016 study, almost a quarter of male medical students and nearly half of female students surveyed suffered with impostor syndrome. The phenomenon can be associated with depression, burn out, and anxiety.

The American Psychological Association offers a few tips for overcoming impostor syndrome including speaking to mentors, recognizing what you excel at, and talking to a professional if necessary. Here is a fun piece in Emergency Medicine News for more information.

Check out My Interview on the Hippocratic Hustle

Thanks so much to Carrie Reynolds, MD who kindly interviewed me for the Hippocratic Hustle, her podcast about women physician entrepreneurs, career options for doctors, and financial independence. Check out my interview and show notes here. 

Register to Vote

I'm deviating from admissions topics today for a quick plug to encourage you to register to vote if you have not already. Many medical school and residency applicants have worked in other countries in clinical and teaching capacities and know how lucky we are to have the opportunity to advance our opinions here in the US. Enjoy this privilege. Here is information about how to register in your state; you can also confirm you are registered on the site.

Residency and Medical School Interviews: Evade the Fashion Police

I've been chatting with a few clients recently about what they should wear for their residency and medical school interviews. Check out this less-than-one-minute stop-motion animated Insider Medical Admissions Guru on the Go© video "Spiffy Tie for the Dull Guy" for some professional advice.

Apply Broadly. Nuff Said.

In their publication Impact of Length of Rank Order List on Main Residency Match Outcome:2002-2018, the NRMP reports that matched applicants consistently have longer rank order lists than unmatched applicants.

What that means to those approaching the residency application process is that candidates should throw a wide net in choosing programs at which to apply. Of course, there is a financial cost to this strategy, and that expense needs to be balanced. However, if you can afford it, starting out with more options usually will provide more opportunities to interview and thus, the ability to create a longer rank order list.

Preliminary Year: What do I do with my Personal Statement?

Candidates who apply to certain fields - dermatology, ophthalmology, etc. - need a preliminary or transitional year of residency before initiating their specialty training. So does that mean those applicants need to toil over two personal statements?

No, thankfully. It's very appropriate (and strategic) to use the same essay with minor modifications. Ensure you explicitly address why a prelim year will advance the rest of your career and how you will contribute to the prelim training program as a future specialist.

When you use a very similar essay, you can be honest about what your professional goals are. After all, the reader knows you're applying for a one-year position.

Remember that many preliminary/transitional year programs are eager to match residents who are moving on to competitive fields. In general, those applicants will have strong USMLE scores, evaluations, and clinical skills.

NYU Medical School - Free

Many of you read the recent news that NYU Medical School will charge nothing for tuition going forward. Here's a great entry from the CrispyDoc blog that sums up the fact that this announcement is going to completely change medical education going forward  - and why. 

Check out this FeminEm Podcast

Want to get tips on professional happiness, autonomy and flexibility, entrepreneurship, how to choose a medical school and residency program, and how to nail an interview? Download my recent guest spot on the Feminem podcast - 2018 Summer Series. 

FeminEm (Females Working in Emergency Medicine) is an open access resource for women in emergency medicine. FeminEM offers a national conference (FIX18), an e-newsletter, a blog, and accessible mentorship. 

Come and Get It! The 2018 NRMP Program Director Survey is Out

Every two years the National Resident Matching Program® (NRMP) publishes a program director (PD) survey that focuses on two main questions: 1) What factors do PDs use in deciding whom to interview? 2) What factors do PDs use in deciding whom to rank? Results of the 2018 Program Director Survey are available here.

So, as you approach interviews, if you're wondering what PDs want - by specialty - here are your answers. This document is extremely valuable. 

Medical School and Residency Interviews - Power Posing

As medical school and residency interviews approach, I want to remind everyone about Amy Cuddy, the Harvard faculty member who speaks about the psychology of power, influence, and nonverbal communication. Her research shows that a "fake it until you make it" philosophy and "power posing" practices improve your performance in interviews. Cuddy's TED talk has been viewed over 48 million times.

Your Residency Application: Being Repetitive Again and Again

In writing their personal statements, many residency applicants ask me, "Isn't it regurgitating my CV if I highlight my accomplishments?" After all, they say, their achievements have already been noted in the application, dean’s letter, and letters of recommendation. Think of the residency admissions process as an onion. Your ERAS and letters serve as one layer of that onion, albeit a thin one. In other words, your accomplishments are conveyed simply and succinctly there. The personal statement is your opportunity to apply a thicker layer, one in which you flesh out your achievements, thus persuading the reader of your distinctiveness. Finally, the interview is your chance to add on the thickest peel. Discussing your accomplishments in detail can seal the interviewer’s positive impression of you.

So yes, you are going to be redundant throughout the residency application process, but each part serves a different and additive purpose. If you do not include your achievements in your personal statement, how will you be viewed as distinctive? Remember: Who you are is what you’ve done… and what traits and skills you’ve gained accordingly.

Applying in Two Specialties

Here are some clarifications about what ERAS offers that will help you apply in two specialties:

1) Different personal statements can be assigned to different programs. This means you can assign your ob/gyn essay to ob/gyn programs and your internal medicine (IM) statement to IM residencies.
2) Different letters of recommendation (LORs) can be assigned to different residency programs as well. (A maximum of four letters may be assigned to each program.)
3) You will have only one MyEras application. It will go to all of your programs. Note that if you list your membership in multiple ob/gyn organizations, that will be viewed by your IM readers as well (and might make them question your commitment to IM).

Quick Tip: Schedule Your Strategy Session and Mock Interview Now

Applicants, secondary to very high demand this summer, I am currently booking 2 to 3 weeks in advance for Strategy Sessions and Mock Interviews. If you are in need of an upcoming Strategy Session or Mock Interview, please make sure to hire me at your earliest convenience to secure a slot.

Secondary Essays: Why Do You Want to Attend Our School?

Secondary essay prompts vary, but there are a few that are standard fare. "Why do you want to attend our school?" is a common topic pre-meds will encounter.

Medical school admissions officers want to be assured that you know their institution, are seriously considering it, and will fit in well there. In approaching the "why-our-school" question, do your research on the institution and link something specific about you with the school's philosophy, curriculum, surrounding patient population, and/or extracurricular programs.

For instance, if you were a teaching assistant for chemistry in college, you might link your use of the Socratic method with a school's tutorial-based learning. In that way, you demonstrate knowledge of the school, show that you connect well with it, and showcase your accomplishment.

ERAS Tips for Your Residency Application

I've been starting to edit ERASes already, so I thought I'd create a list of tips for those embarking on their descriptors:

1. Include relevant pre-professional accomplishments from college. If you conducted research, for example, list and describe it. Do not include high school achievements unless they were truly unique (worked at the White House, sang on Broadway ;)).

2. While you want to include many strong achievements, you do not want your ERAS to be so long that your reader is tempted to skim it. Be selective.

3. Keep your descriptors to approximately three to seven sentences. Fewer can look lazy and more can look self-indulgent.

4. Use full sentences. It’s a formal application, and you want to make your written materials as readable as possible.

5. Avoid abbreviations. Again, you want to be formal, and abbreviations you think are common might not be familiar to the reader.

6. Make sure you spell out your accomplishments clearly. If your reader doesn’t understand an activity, you will not get “full credit” for what you’ve done. Make no assumptions.

7. Write about yourself and your role – not an organization. For example, don’t use the space to discuss Physicians without Borders. Use it to discuss the specifics of your role at Physicians without Borders.

8. Use numbers to be persuasive. Saying that the conference you organized had 300 participants says it all.

9. Unless your PI won the Nobel, avoid using supervisors' and/or doctors' names in your descriptors as they will be meaningless to the majority of your readers.

10. Get help. Do not submit your residency application without having it reviewed. Don’t submit suboptimal materials for a process that is this important and competitive.

ERAS: How Important is it to Submit on the Early Side?

On July 5, DO applicants can start applying to AOA-accredited residency programs, so I've had a lot of clients ask me about the importance of getting their ERASes in now. This topic is relevant for MD candidates whose submission date is in early September. These are my thoughts:

1. Yes, getting your ERAS in early helps. At the beginning of the season there aren't as many ERASes to review so, as a former Assistant Residency Director, I recall giving more time and attention to the early applications. I was also impressed by students who could get their materials in promptly.

2. On the other hand, if your application is not in its best shape then submitting early is a mistake. Waiting a week or two is absolutely preferable to submitting a suboptimal ERAS that will be tossed into the "do not invite" pile. Importantly, all osteopathic residency applicants who apply between July 6 and the 14th will display with a July 15 applied date anyway! 

Don't Let ERAS Kick Y'ERAS

Just a reminder to residency applicants: MyERAS is open and available for you. Even if you aren't ready to start working on your application (and if you know what field you are applying in, there's no reason that you can't be ready right now), I'd recommend registering and taking a look at what will be required of you on the ERAS. Many applicants have never seen an ERAS and don't know much about what extras are required (like "other awards" and additional unexpected sections).

Don't be surprised by what's required of you later in the season... You really cannot start too soon.

Can a Medical School See the Names of the Other Medical Schools You Apply to?

Medical school applicants sometimes worry about adversely affecting their chances of admission because they might "offend" one school by applying to others. Good news: Schools will not know which other institutions or how many other institutions you applied to through AMCAS.

However, later in the season, medical schools at which you are accepted will be able to see at which other schools you are holding acceptances. But, of course, at that point, it's too late for that information to harm you.

So, rest assured, applying broadly will not adversely affect your chances at an individual school.

AMCAS is in the House

The AMCAS submission date came and went, and the question I'm getting now is: Should I be panicking if I haven't submitted my AMCAS yet?

The answer is no... and, depending on where you are in the process, yes. Submitting on Day 1 precisely is not worth losing your mind over, so if you didn't do so, please do not kick yourself. On the other hand, submitting very soon is to your advantage because of rolling admissions.

So, if you are wrapping up your work and have your written materials in a superior state, just keep moving and get your application submitted promptly. If you are behind the eight ball and don't feel that you can craft outstanding written materials speedily, consider waiting a year to apply. Every season I encounter re-applicants who submitted their AMCASes in August or September.

So... on your mark. Get set. Go!

Personal Statement Russian Roulette #2

Last week I showcased a personal statement mistake to avoid. Here's another common one simplified in a stop-motion Guru on the Go© video. This advice applies to residency applicants as well.
 

Personal Statement Russian Roulette

It's time (okay - not to freak you out - but actually late) to start working on your medical school personal statement. Check out this under-one-minute Guru on the Go© video on an important misstep to avoid when crafting your essay.

The AMCAS Most Meaningful Paragraphs: Three Mistakes to Avoid

In 2012, seemingly out of blue, a significant, new addition appeared on the AMCAS. Applicants were being asked to identify their most significant extracurricular experiences (up to three) and support their choices with more writing:

This is your opportunity to summarize why you have selected this experience as one of your most meaningful. In your remarks, you might consider the transformative nature of the experience, the impact you made while engaging in the experience and the personal growth you experienced as a result of your participation. 1325 max characters.

Now the "Most Meaningful" paragraphs are par for the course, but applicants routinely make a few avoidable errors in crafting them:

1) Don't merge the descriptors with the Most Meaningful paragraphs because they are separate sections: You can complete descriptors for up to 15 activities with up to 700 characters each, plus up to three most meaningful paragraphs of up to 1325 characters each. The fact that these are two different tasks might seem obvious, but every year, I get AMCAS drafts to edit that include this error.

2) Do not use patient anecdotes in your Most Meaningful paragraphs: Most medical school applicants have patient vignettes to share, which means that a patient story does not distinguish an applicant from the masses of other candidates. Also, these patient stories can sound trite or even condescending.

3) Don't repeat what you have written in your descriptor. The Most Meaningful is an opportunity to delve deeper into your achievement. Let's say you are showcasing your experience as a biochemistry teaching assistant. In the Most Meaningful paragraph, give concrete examples of what you taught, to whom, how often, using what techniques. If you were promoted to head TA or asked to come back the next semester, showcase teaching achievements that propelled you to get the position. Did you get excellent teaching reviews from students? Did you offer an unconventional way of learning the difficult material? If so, what was it? By delving deeper, you can truly demonstrate the "transformative nature of the experience, the impact you made while engaging in the experience and the personal growth you experienced as a result of your participation."


The Most Meaningful paragraphs are an opportunity for you to demonstrate your distinctiveness and worthiness for medical school. Don't waste this chance to further your candidacy.

Physician Burnout Report 2018

Medscape has published its 2018 Physician Burnout Report. (You may have to sign in to view.) Congratulations to my field of emergency medicine for moving down from #1 on the list of burnout specialties a few years back to #6 this year. (The rate of burnout was a scary 45% for emergency physicians. To find out why, check out this piece.) Among all physician respondents, 42% reported burnout.

The lowest rates of burnout were found in plastic surgeons (23%), dermatologists (32%) and pathologists (32%). Medscape attributes this fact to these specialists' decreased likelihood of working under emergent conditions. (The highest burnout was among critical care doctors at 48%.)

A higher level of burnout was reported in female physicians (48%) compared to male (38%). 

In a different approach to the question, those specialists who reported they were very to extremely happy at work were ophthalmologists (37%), orthopedists (35%), and plastic surgeons (35%). 

Paralympic-Medalist Physician Asks to be Recognized for her Tremendous Abilities, Not her Wheelchair

Check out this well-written New York Times piece by Dr. Cheri Blauwet, an American wheelchair racer (Paralympic and Olympic medal winner) and physician in PM&R. I'm sure Dr. Blauwet's assertions are true about bias among patients, colleagues, and admissions officers: In my career, I've met very few doctor colleagues with overt physical disabilities.

Tomorrow Belongs to Those Who Can Hear it Coming

That's right: Tomorrow, May 1 is the day before the official open date of AMCAS 2019. (Okay, I know that sounds confusing, but originally the AMCAS open date looked to be May 1 and is still posted as such in multiple locations. As it turns out, it is May 2.) So, at 9:30am EST on Wednesday, you can start inputting your data. 

Because of rolling admissions, submitting a complete application early in the cycle has distinct advantages at many schools.That doesn't mean you should submit suboptimal written materials; it means you should start early enough (now, at the latest!) that you are offering your best work.

Rolling admissions means that a school takes applications in the order in which they are received and makes decisions about interviews and then acceptances, accordingly. So, as times goes by, there are fewer interview and admissions offers remaining to be made.

If your application is not complete, your candidacy may not be evaluated early when there are more opportunities for interviews and admissions. So, if you have not already, get started immediately. It could make a huge difference in your available opportunities.

Making a List and Checking it Twice: The Fellowship Match Checklist

The 2018-9 Fellowship Match process is heating up. The NRMP recently posted a brief but useful fellowship match check list with links to important dates for all fellowship matches.

As many of you may know, the range of time frames varies tremendously among the different fields - from abdominal transplant surgery (now) to adolescent medicine (autumn) - so it's worth taking a look at this information even if you just matched for residency, believe it or not.

DNR

Recently, I was socializing with an old friend who reviews residency applications for his academic program. We were discussing personal statement errors (don't worry - we chatted about nonprofessional topics too), and he told me that he and his colleagues have a term for candidacies that are represented by bad written materials: DNR, or Do Not Rank.

Make sure your candidacy is not hamstrung by bad writing. Avoid common personal statement errors that can bomb your application. Good writing takes a lot of time, so make sure to start early. AMCAS is opening on May 1, so medical school applicants should be completing their essays and experience descriptors. Residency applicants should be starting an outline for their personal statements and a draft of their experiences.

Contact me (soon) for help.

Talented Pre-Meds: Leverage your Money

Recently I’ve heard from a few fortunate Insider medical school applicant clients who were not only accepted to several medical schools, but also were offered scholarship money to attend. They’ve asked me this: Is there a way to leverage the money I’ve been granted at one medical school to get funding at another?

Well, it’s worth a try.

As long as you’re diplomatic, contacting other medical schools, advising them of your scholarship, and requesting a match might help, although I’d suggest having low expectations. Still, if done politely, it cannot hurt.

In a different vein, a sometimes-successful technique I’ve encountered is to use the scholarship award as a means of obtaining an interview or trying to get off the wait list at another school.  Send a note to your wait listed schools to let them know of your promised funds. After all, if you’re competitive enough to earn a scholarship at one place, you should be competitive enough to be accepted at another.

You Can Lead the Witness: Letters of Recommendation Part 2

This is my second blog entry regarding actions you can take immediately to help you obtain strong letters of recommendation (LORs). The first entry describes two initial strategies for improving your medical school letter of recommendation process.

As a Harvard Assistant Residency Director, I bore witness to how weak – or even mediocre – LORs had the potential to bomb an otherwise competitive candidacy. Once you’ve followed directions and asked the right people (see my previous entry), it’s time to influence the content of your letters by making the job of letter writing easy:

Influencing the Content
When pre-meds, residents, nurses, and physician colleagues asked me to write them LORs when I was Assistant Residency Director, the first thing I requested was that they send me background information to make my letter robust…and my job easier. Accordingly, I strongly recommend you create a “LOR packet,” which can include the following:

1. A brief, well-written cover letter defining all of your important accomplishments
2. Your curriculum vitae (CV)
3. Your personal statement in its final form
4. Your transcripts.

With regard to the cover letter, keep it streamlined. No one will skip the beach or her two-year old’s birthday party to read your exhaustive biography, so you want to thank the writer and highlight your pre-professional achievements in one page. The point of the cover letter is to supplement a letter writer’s knowledge of your candidacy and offer flattering content for inclusion. A professor may know that you made the only A in an organic chemistry class, but her LOR will be more complete, and she will demonstrate a more intimate familiarity with you if she knows enough to write that you volunteer regularly at a homeless shelter.

With regard to the CV and personal statement, these make useful supplements to the LOR packet only if they are in professional and final form. Don’t include rough drafts, as poorly organized background information leaves your writer the impression that you are a disorganized person. Also, only include the transcript if it bolsters your candidacy, demonstrating academic achievement. Don’t shoot yourself in the foot if you have some bad grades or an incomplete you’d rather not showcase.

Bottom line: An applicant who offered me a list of her accomplishments in a tidy, accessible package was more likely to get a strong, comprehensive letter that was submitted promptly. She also distinguished herself from the majority of candidates who requested letters without demonstrating a comparably sophisticated understanding of the demands this process made on my time. If you can make a letter writer's job easier, your forethought is likely to pay dividends in the letter you receive. This is not a court of law, so the savvy applicant can take subtle advantage of her ability to "lead the witness."

Medical School Applicants, Don't Mess Around with Your Letters of Recommendation

Today’s topic will be letters of recommendation (LORs), a part of your application you should get moving on immediately if you haven't already. Having read many LORs as a Harvard Assistant Residency Director, I can tell you that these letters matter much more than I originally thought when I was applying to medical school and residency myself.

I have a distinct memory from years ago of a colleague’s pointing out the word “shy” in an applicant’s LOR and asking me what I thought it meant. I didn’t make much of it, but my admissions colleague was worried about what the writer was trying to convey about the candidate. If one ambiguous word can make an admissions reader balk, you can imagine what a weak letter can do.

This brings me to one of the most important points about medical LORs: Mediocre letters (not to mention frankly bad ones) are a lost opportunity at best and a fast way to bomb your application at worst. It is critical that you get strong letters of recommendation…so let’s review how to do that.

Getting the best letters of recommendation for medical school, residency and fellowship is dependent on multiple factors:

1. Following Directions
2. Asking the right people
3. Influencing the content of your letter by making the job of letter-writing easy

Because there is so much advice to offer on these topics, today’s blog entry will cover #1 and #2, and I’ll focus on #3 in a follow up piece.

Following Directions
Different medical schools are seeking different sources of your letters. It’s worth checking online to ensure you meet the varied requirements of each institution.
Many medical schools require at least two science professors and one non-science professor to submit LORs on your behalf. Some also require a letter from your principal investigator (PI) if you’ve done research. Other medical schools may prefer a composite letter from a premedical advisor or committee. (For students attending schools that do not provide this service, individual letters from faculty members can be substituted.)

If you are currently attending graduate school, you may have a different set of letter writer requirements altogether, so it’s worth looking into this issue at each medical school before you apply. Furthermore, if you are employed in the workforce or on active duty in the military, some schools will require that you have a letter from an immediate supervisor. Also, some medical schools mandate "expiration dates" on their letters; they may require that no LORs be older than a year.

The reality is that medical schools are (generally) not malevolent institutions bent on creating confusion for their prospective applicants; being able to read and follow their directions is a basic and reasonable prerequisite for consideration as a candidate. If you can't be bothered to follow instructions as an applicant, how can they expect you to learn the nuances and complexities of caring for patients :)?

Asking the right people 
Now, beyond fulfilling a school’s requirements, you want to get the strongest letter you possibly can from the most influential writer. Choosing the right professors can be a challenge, and advisees often ask me what to look for in a letter writer. Here is my suggested wish list for potential letter-writers:

1. Senior faculty
2. Weighty academic titles
3. Well known in their field
4. Spent significant time with you
5. Experienced letter-writers
6. Explicitly state they will write you a strong LOR

Of course all of these qualifications are not possible for all letter-writers. But the more of these you can garner the better. With regard to #1-3, admissions officers are human just like the rest of us: Receiving a LOR from an accomplished, known colleague will be weighed much more heavily than one from someone deemed less successful and unfamiliar. If you are better connected to someone without a title, consider asking the professor (a more senior person who has a weightier title) if she would consider writing the LOR with significant input from your closer contact (i.e., the TA who taught your section, or the postdoctoral fellow who directly supervised your research project). That way you get a LOR that includes insight from someone who knows you, signed by a name that packs a punch.

With regard to #6, don’t be afraid to ask a potential letter-writer if she will write you "a very strong" LOR. It may seem awkward at the time you ask but, believe me, getting a wimpy letter will be much thornier. If the faculty member says no, hesitates, or tells you in May that she has to plan her Thanksgiving get-together, politely thank her and move on. Although disappointing, acknowledge that she has done you a huge favor. You are far better off avoiding her letter. You now have the advantage of substituting a stronger LOR written by someone who loves you.

Remember that your letters have a big impact on your application, and a mediocre letter can bomb your candidacy. In a follow up blog entry I’ll review how to influence the content of your letter by making the job of letter-writing easy.

Match Day and Financial Security

First, congratulations to all of my residency applicant advisees: I am thrilled by the enormous success the Match brought to these candidates in a variety of fields. If you have not yet updated me, please send me an email.

Second, now that residency applicants have a professional plan for their next few years, they also need a financial plan. You could choose to work many fewer years, work in an environment you prefer, or go to part-time if you start to make good financial decisions right now.

CrispyDoc.com is a financial literacy blog for the newly minted physician. (Yes, you.) Here's a recent blog entry about how to simply start to manage your financial portfolio without a financial advisor (even if that portfolio is tiny or you have significant debt). You can use Dr. CrispyDoc's advice and call up Vanguard or Fidelity (I get no kickback from them) and tell them you need help setting up what you have read. Whala! You are already making good decisions that will earn you compound interest and give you more control as you move through your career.

Here are more posts from Crispy Doc on finances, early retirement for doctors, raising a family, career choice, hedge funds, Costco and more.

An Offer You Can't Refuse

I speak to a few lucky medical school and residency applicants who are asked to write their own letters of recommendation. If you have this opportunity, first, realize that it is not unethical to write your own letter if you're asked to do so. If you'd like to explore the scruples of this issue, take a look at this New York Times ethicist column about this topic.

The mistake I see candidates make in these situations is that applicants don't write strong enough letters for themselves because they feel awkward about showcasing their accomplishments fully. If you have the opportunity to write your own letter, craft a glowing one. Be effusive and full-throated in your remarks about yourself. Remember that the letter-writer can choose to tone down the recommendation if she doesn't agree. But if she does, you've utilized an opportunity fully and bolstered your candidacy tremendously.

Bias in Residency Evaluations

There's a scary, but important, recent article in the Journal of Graduate Medical Education by Mueller et al called "Gender Differences in Attending Physicians' Feedback to Residents: A Qualitative Analysis." As you might have guessed, male and female residents were given - on average - very different types of evaluations from faculty. Here's a link to the study and a podcast with an interview of the physician-authors.

Pre-Meds (and Others): Don't Make a Promise you Simply Cannot Keep

My mom told me an interesting story recently: She is a retired lawyer - not in medicine - but her anecdote resonated with me:

Years ago, a legal job applicant indicated on his resume that he spoke two languages, in addition to English. Unplanned, the interviewer to whom the candidate was assigned also spoke those languages and proceeded to speak to him in those languages during the interview, only to find that the candidate spoke both poorly at best.

As you can imagine, the applicant was not hired.

I frequently see applicants indicate on their curriculum vitae or their AMCASes that they speak languages fluently. If you do speak a language in addition to English, good for you and great for your candidacy. However, if you indicate that you are fluent, please be ready for your faculty interviewer to conduct your entire medical school interview in that language if s/he pleases.

The Rank Order List Deadline Is Imminently Approaching: Check Yourself Before You Wreck Yourself

This is an important reminder that Wednesday (February 21) at 9am EST is the rank order list certification deadline. I'd recommend submitting today or tomorrow morning to be safe. Waiting until the last minute and making impulsive changes to your list is not a great idea.

Please make sure to avoid simple missteps in creating your rank order list. Improving written materials and interview skills is important, but all of that work can go to waste if applicants do not understand basic strategies for the Match. In November or 2015 the NRMP published an article called, "Understanding the Interview and Ranking Behaviors of Unmatched International Medical Students and Graduates in the 2013 Main Residency Match" in the Journal of Graduate Medical Education. The data is especially important for IMGs who represented the majority of unmatched candidates.

Sadly, the authors found that some applicants made strategic errors including the below:

- Not attending all interviews, thus failing to capitalize on every opportunity to market themselves.

- Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.

- Misunderstanding the Match and ranking programs at which applicants did not interview.

- Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is an explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.