The Residency and Medical School Application Process: 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, burnout, 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's a fun article on imposter syndrome by Joelle Borhart MD, the Associate Program Director at Georgetown University. I also recommend Amy Cuddy's TED talk with over 63 million views. 

Perils of the Virtual Match

I've written before about the benefits of virtual interviews - both with regard to finances and equity. However, the ability to easily hoard residency interviews now has led to an unintended consequence of online access: An increase in qualified applicants who don't match. Thomas Cook MD, an emergency medicine program director in South Carolina, covers this topic in his piece "The Virtual Match is Like the Toilet Paper Rush." In it, he points out that when superior candidates accept a very large number of interviews, there are serious negative consequences for their peers. Cook has a suggestion for a potential remedy based on transparency. The piece is worth a read. 

Love Letters and Janet Jackson

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.

Happiness

As you interview now for medical school, dental school, residency, or fellowship, it's important to think about what will make you happy in the next phase of your career.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad advice. I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. Where you live for your training is as important as the quality of your training program. The reasons are several-fold:

1. Training is time-consuming, and you want to be in a city you can enjoy fully when you’re able to blow off steam. 

2. Training is stressful, and you want to be in a city where you have social support.

3. Training is not completed in a vacuum. Your personal life continues. If you’re single, you may meet someone and end up staying in the city where you've trained for the rest of your life. If you’re in a long-term relationship, you may decide to have children (or already have them); down the road you might not want to relocate your family.

Not everyone gets the opportunity to train at an institution in a city s/he likes. But prioritizing your contentment will increase your opportunity for well-being and career longevity.

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 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).