Two Hundred New Residency Slots Open

For a long time there has existed a bottleneck in the physician training system with more medical students graduating than residency spots available. This phenomenon has been one of the contributors to the physician shortage in the United States. 

In an effort to begin to relieve the problem, in 2021 Congress passed the Consolidated Appropriations Act Section 126 to expand the number of Medicare-supported residency slots. 

Last month the Centers for Medicare and Medicaid Services announced a list of hospitals that were awarded 200 new residency positions under the Act. About seven in 10 of the positions are going to primary care and psychiatry training programs. 

You can read an American Association of Medical Colleges (AAMC) news article about the new slots here. 

Introducing NRMP's Rank Order List Lock Pilot

In October I wrote a blog entry about the benefits of virtual interviews. One issue that has come up is the concern that those who choose to do in-person interviews may have an advantage compared to candidates who interview virtually. The NRMP has noted this worry and is, consequently, instituting a voluntary Program Rank Order List Lock pilot for internal medicine, pediatrics, and vascular surgery for the 2026 Main Residency Match cycle.

The idea is that programs can choose to finalize their certified Rank Order Lists and then provide time for interviewed applicants to come in-person, thus reassuring candidates that visiting or not visiting will not affect their candidacies.

Here is a statement from NRMP regarding the voluntary pilot. It's an interesting idea, and I'm curious to see how it will play out.

Sleep As a Vital Sign

“Without enough sleep, we all become tall two-year-olds.” — JoJo Jensen, Dirt Farmer Wisdom

As a resident, I spent one horrible week on my surgical rotation clocking 138 hours in the hospital...and I slept only 6 1/2 of those. By the end of the week, I had decided to quit residency. Fortunately, a good night's sleep helped me turn that decision around.

I recently heard an interesting AMA Journal of Ethics podcast called "Sleep as a Vital Sign" with Dr. Lauren Hale from Stony Brook University. In her interview, she clarifies the distinction between sleep medicine and the study of sleep as a public health issue, the latter of which is her academic interest. She offers policy recommendations to decrease morbidity and mortality from sleep deprivation, like eliminating daylight savings time and making school start times later. She also touches on how the lack of sleep adversely affects medical professionals. 

The podcast episode is brief and interesting. Plus, you can get CME credit for listening :-).

Mistake or Needed Break: Should You Take a Gap Year?

Recently, I've advised several premeds who are trying to make decisions about the utility of a "gap year" – an elective, non-curricular period between college and medical school. There are important professional, financial, and personal consequences to consider before making the decision. Here's a piece I wrote for Wolters Kluwer that offers guidance. 

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. (Please do your research because a few schools forbid post-AMCAS/pre-interview contact.)
3. Medical school applicants who have been waitlisted.

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

1. Restating your strong enthusiasm for the institution.
2. Positioning yourself as a distinctive candidate who can contribute fully to the institution.

Errors to avoid in LOIs are:

1. Don't include generic 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 his/her institution special. ("Your faculty is strong and your trainees are collegial" or "You are a world-renowned institution.") Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant. Having said that, it is very reasonable to link a particular interest of yours with a specific opportunity at an institution. For example if you have done cancer research, make sure to mention how you will contribute to the renowned oncology program the institution is associated with.
2. Don't write about how the program or school will help you. ("I know your residency will make me into a great doctor.") The focus should, instead, be on how you will be a contributor to their institution. For example, you can detail how a specific leadership experience of yours has given you the skills to make you a future leader at this 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.

A Great Opportunity for College Students Interested in Medicine

Applications for the Summer Healthcare Professionals Education Program (SHPEP), a Robert Wood Johnson funded opportunity for college students interested in healthcare professions, are open. SHPEP specifically targets students from economically or educationally disadvantaged backgrounds and those with demonstrated interest in issues affecting underserved populations. The goal is to help college freshmen, sophomores, and juniors apply and matriculate successfully to health professions schools. SHPEP is housed at 11 universities across the country with different start dates – but all over the summer. Housing, meals, stipend, and travel expenses are all paid.

Take a look at the program in more detail here. The application deadline is February 5.

Wondering How to Evaluate a Medical School or Residency Program? Consider Your Happiness and Trust Your Intuition.

Medical school and residency applicants routinely ask me how to evaluate institutions, especially since most interviews are virtual. This is a huge topic, but here are some thoughts:

• To me, geography is one of the most important factors – at least equal to the reputation of the institution. You want to make sure you are in a location that will make you happy – near community, family, friends and/ or the ability to enjoy your hobbies.
• Cost is sometimes a deal breaker when it comes to medical school. There can be significant differences – especially state versus private institutions – and scholarships can make a huge impact in your debt profile going forward.
• Of course, didactics and academic opportunities are critically important for both medical school and residency. However, many programs of similar caliber have equivalent curricula and offerings. You likely could be happy at many different institutions. With regard to residency specifically, it's important both to ensure you're getting a lot of hands-on experience and to look at what fellowships are available, with your interests in mind.
• Faculty is hard to assess because – like anything – there are good and bad ones. Also, faculty come and go. Having said that, if you are applying to residency, the program director is critical (understanding that he or she could leave at any time :-( ).
• With regard to residency, call schedule and overall work hours are important to consider. Certain programs within the same specialty require a lot more hours and scut work than others.

One of your best bets is to talk to current medical students or residents. Oftentimes they will be very honest about the pros and cons of their institution.

Once you've assessed all of the above - narrowing down your list by geography and quality - I would analyze the vibe you have. If this sounds too touchy-feely, remember that intuition is not a magical assessment; it's based on major and minor facts that you consciously and subconsciously analyze.

Remember: If you're a medical school applicant, consider yourself fortunate if you have more than one option to choose from. Earning admission to medical school is extremely challenging; it's a great problem if you have to struggle to decide among multiple schools!

Virtual Interviews Aren't Perfect but the Benefits Unquestionably Outweigh the Downsides

The AAMC recently published a piece about the post-pandemic persistence of residency virtual interviews. While some programs still encourage in-person interviews, most now standardly conduct online ones. The AAMC article points out important benefits including financial and environmental.

Something the AAMC article doesn't specifically touch on is that virtual interviews have likely softened the sting of systemic sexism in the application process. The potential (albeit remote) for a candidate to record an interview or even have another person listening in diminishes the risk of sexist questions. 

What happens in the room between an applicant and faculty member may no longer necessarily stay there. 

Check out the Doximity piece I wrote, "How Virtual Interviews Might Mitigate Systemic Sexism in Medicine." (Unfortunately, the story I tell at the beginning of the article is only one of several inappropriate questions I got from faculty interviewers when I was a student.) 

A Valuable Tool: AAMC Webinars

The AAMC offers a variety of recorded premed webinars on their website here, including current topics like "2025 MCAT Testing Year Update for Examinees," "Preparing for the MCAT Exam," and "Learn about the 2024 AAMC Fee Assistance Program." 

They also have comprehensive information about the Fee Assistance Program (FAP) here. Please remember that the AAMC recommends applying for an FAP waiver prior to taking the MCAT.

With regard to my services at Insider Medical Admissions, premed applicants demonstrating financial hardship through a current AAMC FAP grant may be considered for reduced rates. Please contact me for more information.

Taking the Fifth

The goal of every medical school, residency, and fellowship interview is to distinguish yourself from everyone else to demonstrate you're worthy of a competitive spot. So what happens when you get this (ugly) question:  

If there were one reason not to accept you, what would it be?

When a (salty) faculty member asks you this interview question, her motivation might be to determine whether there's a weakness in your application she's missing. Or she may be assessing how you manage stressful situations by posing a question that is unpleasant.

While you need to be honest throughout the entire application process, you do not need to volunteer information that might harm you. So, for a charged question like this one that conflicts with your goal, you might answer, “While no candidacy is perfect, I have a strong application, and I don't see a reason not to accept me." Then you can leverage the question as an opportunity to mention the strengths of your candidacy. Remember: You have a duty to further your application, not damage it.

Contact me for mock interview help. I still have some October slots open, as of this writing.

Suicide Rates are Significantly Higher for Female Physicians

The British Medical Journal published a meta-analysis last month by lead author Claudia Zimmermann looking at studies published between 1960 and March 2024 that found physicians were more likely to die by suicide than the general population and that female doctors suffered from a rate that was higher than their male counterparts. While male doctors had a suicide rate ratio of 1.05 across all studies, female physicians faced a rate ratio of 1.76. The findings suggest that female physicians have unique challenges and need targeted interventions.

A few months back I read about a nonprofit organization that offers free and confidential counseling for physicians and medical students, using volunteer psychiatrists. The organization is called Physician Support Line and their number is 1-888-409-0141.

Highly Recommended Paid Summer Opportunity

I was an American Association for the Advancement of Science (AAAS) Mass Media Science Fellow in 1995 (during medical school). The program was truly fantastic and life-altering.

Applications for this year's AAAS Mass Media Science and Engineering Fellowship will open on October 1 and will remain available through January 1, 2025. The scholarship is a 10-week summer program that places science, engineering, and math undergraduate and graduate students at media organizations across the nation - outlets like NPR, the Los Angeles Times, and WIRED. I worked at the Oregonian in Portland and had a tremendous time, learning how to write effectively and edit. I also gained an appreciation for the immense public health influence journalists can have. It's really an amazing program.

Here are the anticipated dates for this cycle:
Application window: October 1, 2024 - January 1, 2025
Fellowship: June 4, 2025 - August 19, 2025
Orientation in DC: June 4 - 6, 2025
Dates onsite: June 9 - August 15, 2025
Wrap-up in DC: August 18 - 19, 2025

Check Out the AAMC Virtual Medical School Fair

The AAMC (Association of American Medical Colleges) will be holding a live informational fair Wednesday, October 16 and Thursday, October 17. There will be sessions with staff from medical schools, postbac programs, and the AAMC. Registering also affords you 15% off a one- or two-year subscription to the Medical School Admissions Requirements (MSAR®) website.

You can register here. I offer individually-tailored, one-on-one assistance for pre-meds and candidates applying to postbaccalaureate programs, but there's no downside to hearing more general tips from the AAMC itself.

What Do Program Directors Really Want?

Imagine you're a program director (PD) reading hundreds of ERASes and conducting scores of interviews. What questions would you ask yourself as you assess each residency candidate to avoid big headaches?

1) Can this person do the job? Is s/he competent?

2) Will this person "play well with others" and not create complaints from patients, faculty, and/or other services.

3) Will this person stick with the program and not leave prematurely? A PD does not want to scurry around to fill an open call schedule/ residency slot.

As you finish crafting your ERAS and approach your interviews, consider how to demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extracurricular activities that demonstrate teamwork, and - if asked - hobbies and reading materials that demonstrate your winning personality. For the latter, highlight sub-internships, research projects in the specialty, and knowledge about the program and city it's in.

Making sure the PD knows you aren't going to cause him/her trouble is at least half the battle.

Let Your Medical School Interview Transform Liabilities into Assets

Despite more than 17 years in medical school admissions consulting, I still clearly recall one bright advisee: She had improved her grades considerably throughout her college career, but had, unfortunately, a less than stellar freshman transcript. After calculating her AMCAS GPA with me, she lamented, “I feel like my grades are a criminal record.” In a twisted way, she was right; she couldn’t erase the grades. But she could address her GPA weakness in her interviews.

Not every applicant has a 3.99 grade point average or a 522 on her MCAT. In fact, one of the benefits of my years in advising has been the opportunity to help some candidates get into medical school by both acknowledging deficiencies and providing persuasive evidence that they have successfully overcome obstacles. Being upfront about a major deficiency and demonstrating – with evidence from the remainder of your candidacy – that the weakness is not representative of your abilities is a good strategy.

Although medical school application deficiencies are, of course, not real scandals, allow me an analogy: An otherwise respected politician is identified in an old photo smoking marijuana at Coachella. She has two options: First, she can deny, await a media frenzy, and then (after the media has crafted its own interpretation of her behavior) focus on belated damage control. Alternatively, she can acknowledge the episode, remind the public of her robust record in office, and defuse a crisis. Interestingly, the latter not only averts a disaster, but also – by addressing the problem head-on - makes her look more responsible. Although an imperfect analogy, the same principle is true with deficiencies in your medical school candidacy. When describing a weakness during a medical school interview, you should execute a three-pronged approach:

First, make a true, strong, and convincing statement about your candidacy’s worth. You can start by noting that the deficiency in your application does not accurately characterize your academic abilities nor your professional potential. Simply said: “My C- in calculus is not representative of my intellectual capabilities nor my overall academic achievement.”

Next, you can briefly explain the circumstances that led to the problem. This part is tricky. Saying that your MCAT score does not correlate with the remainder of your strong candidacy because you aren’t a good test-taker will not fly with many interviewers. You’ll be taking countless tests in medical school, and you don’t want your faculty interviewer to worry about your ability to pass your USMLE or COMLEX exams. This is true for excuses about a course’s level of difficulty as well. In other words, explaining that Organic Chemistry 33 is the hardest class around is to your disadvantage. After all, you’ll have to manage a very tough curriculum in medical school. However, you can simply say that in retrospect, you realize you did not fully and adequately prepare for your MCAT or your organic chemistry assignments. Also, if you have a justifiable reason for your deficiency (concomitant family illness, a job you took to support yourself that limited your study time, etc.), explaining that background will be helpful. Be careful walking the fine line between providing a factual explanation and creating what your interviewer may perceive as an excuse. Your explanation should convey full accountability for your performance.

Finally, you need to give examples of the strengths of your candidacy to convince the interviewer that your deficiency is not an ill omen of your future medical school performance. Your MCAT score may be below the school’s average, but perhaps you can note that your GPA is above. Your freshman year may have been a bad time for you, but you can point out that you earned a 4.0 your sophomore and junior years. You may have been disorganized in college, but as a post-baccalaureate student, you were at the top of your class. Your primary role throughout the interview process is to convince medical schools that you deserve a slot at their institutions. The best way to persuade is with facts, so giving evidence of your accomplishments will help convince the faculty member that your deficiency is an anomaly.

Consider rehearsing your sales pitch (and make no mistake about it, you are selling yourself) with an experienced advisor who is able to skillfully play devil’s advocate. You should actively solicit feedback on which aspects of your pitch sound defensive or come across as flimsy excuses. Spend ample time reflecting on how the same information might be conveyed in ways that present you as a mature individual who has achieved redemption enough to warrant a slot in medical school.

If you can persuade your interviewer with the above strategic steps, then when your candidacy is discussed in medical school admissions committee meetings, Dr. Decision, the brilliant – but also imperfect – professor whose approval may well shape your professional future might just advocate for you, citing the examples you have given to establish the strength of your application to her colleagues. Note, too, that by demonstrating a willingness to confront and discuss mistakes you have learned from, you may be perceived as having greater maturity, humility, and integrity than other candidates who remain evasive or fail to own up to their shortcomings.

A version of this article was previously published on the Student Doctor Network website.

NRMP® Data Indicates Matched Residency Applicants had Longer Rank Order Lists than Unmatched Ones

Over the years, the NRMP has published data regarding the impact of length of rank order list (ROL) on success in the Match. I first noticed information on this topic in a document called the Impact of Length of Rank Order List on Main Residency Match Outcomes: 2002-2016. There, the NRMP reported that matched applicants consistently had longer ROLs than unmatched applicants. More recently, this information has been validated in the NRMP's Impact of Length of Rank Order List on Match Results: 2004-2023 Main Residency Match. 

Since the latter document assesses two decades of Matches, we can take it seriously. Those approaching the application process should consider a reasonably wide net in choosing residency programs at which to apply and then should include all programs on their ROLs that they would consider "acceptable," meaning an applicant would rather train there than not Match. Of course, there is a financial cost to applying broadly, and that expense needs to be balanced. However, according to this data, matched applicants and filled programs consistently have longer ROLs than unmatched applicants and unfilled programs. The NRMP reminds candidates that a longer ROL does not adversely affect the chances of matching to choices higher on the ROL. Here's a video that reinforces that fact. 

NRMP's Charting Outcomes™ in the Match 2024 is Out

The NRMP just published their Charting Outcomes information for 2024, data I keep bookmarked and which I would recommend medical students review. There are separate reports for US MDs, DOs, and IMGs, and results are further broken down into specialties. Charting Outcomes includes extremely helpful information, including what the mean board scores, number of contiguous ranks, and number of research experiences were for those who successfully matched - and those who did not.

It's important to make sure you are in the range for your intended field. Also, make sure to compare the competitiveness of different specialties if you are seeking to apply in two fields.

Here is the link.

Get y'ERAS in Gear

On September 4 (two plus weeks from today) at 9 am EST residency applicants may begin submitting MyERAS® applications to programs. Residency candidates often ask me about the timing of ERAS submissions. These are my thoughts:

1. Yes, getting your ERAS in early helps. As one of my program director friends wrote to me, since the residency application is arguably one of the biggest steps in one's medical career, getting the application in as early as possible should be a given.

2. On the other hand, if your application is not in its best shape, waiting a few days is preferable to submitting a suboptimal ERAS that will be tossed into the "do not invite" pile. Having said that, you still have 16 days to get your written materials in tip top shape, so there's no need to plan for a late submission :).

Contact me ASAP for help with your residency application.

The Number One Strategy for Crushing Medical School Interviews

Google had a problem. As a 2012 New York Times article described it, Google executives were growing increasingly aware that they were not hiring enough women. Worse still, they were attracting negative attention about it. So, Google did what Google does best: They amassed data and mined it.

In their analysis, among other findings, Google concluded that the company was overlooking women who tended to be more modest than comparable male applicants during interviews. The interviewers inappropriately perceived the women applicants to be less accomplished, and the candidates were not offered jobs. (Once they understood the problem, Google reported that they altered their internal hiring policies, accordingly.) 

This story is instructive in understanding the importance of how to approach your medical school interview: I call it, Let Your Story Show Your Glory.

Let’s start with this overarching strategy, one that can be gleaned from the Google story: The interview process is a persuasive one. Your role is to convince medical schools you deserve a slot at their institutions. The best way to persuade is with facts, just like a lawyer does when s/he is trying a case in front of a judge. Saying you are compassionate or hardworking is not convincing, and it doesn’t distinguish you from the scores of other candidates the interviewer is meeting. You need to prove your worth by highlighting your academic, clinical, research, community service, leadership, international, and teaching achievements.

When mentoring applicants, I hear them ask: Michelle, if I showcase my accomplishments in my interview, doesn’t that mean I’m being redundant? My answer: Absolutely! Think of the medical admissions process like building a house. Your AMCAS® and letters serve as one layer of that house – like scaffolding. 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 (plumbing, pipes, electrical). Finally, the interview is your chance to add on the thickest peel (exterior, roof).

Discussing your accomplishments in detail can seal the interviewer’s positive impression of you. 
If you still feel shy about drawing attention to your achievements, I can assure you that occasionally, interviewers do not leave adequate time to review materials for the candidates they will ultimately judge, or they are asked to interview such a large number of applicants that they might understandably get candidates confused. If you treat every interview as though it were a “blind” one, you address these obstacles. Determine in advance how you want your interviewers to remember you when they represent you to the committee, and tailor your interview to leave that impression. At the end of the week, when your interviewer asks what others thought of the "young woman who volunteered with Mother Teresa while doing malaria research and competitive hammer-throwing," all the other admissions officers will know immediately she is referring to you.
Remember: You can say you are smart or caring or that you want to heal the world, but to admissions committees (who don’t know you like your grandmother does), who you are is what you’ve done...and what traits and skills you’ve gained accordingly.

[A version of this blog was previously published on the Varsity Tutors website, where I was part of their Admissions Expert Series.]

Medical Student and Resident Mistreatment is Pervasive

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) 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 our clinical rotations, 99% of the time, it wasn't something we were truly being targeted for: 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.

When I got to my clerkships, I was dismayed to find that I had underestimated how often I would experience the mistreatment the well-meaning third-year had warned us about. As a medical student, I was berated on numerous occasions for absolutely no logical reason. Residency was worse. The sexism and cruelty was hard to manage, and yet, I had little recourse. 

In a recent piece, AAMC staff writer Stacy Weiner highlighted that, in 2023, at least 38% of US medical students reported having suffered mistreatment and that residents described similar rates. According to the piece, 75% of students and residents don't report their mistreatment, at least in part because of concerns about retribution. 

The good news is that there are some institutions that are implementing systems to decrease mistreatment, including the University of Colorado School of Medicine and Penn State College of Medicine in Hershey. To its credit, Icahn School of Medicine at Mount Sinai created an online form to report mistreatment with access from every hospital computer.

Here is the AAMC article with more details about this ubiquitous, critical issue.

If You're an IMG, Make Sure to Review this Page

If you're an international medical graduate (IMG) applying for residency this year, I'd recommend you take a look at the Educational Commission for Foreign Medical Graduates® (ECFMG) ERAS Support for Residency main page. There, you can find eligibility requirements, an overview of the IMG application process, a timeline, and details regarding which documents ECFMG ERAS Support Services will upload for candidates and what your obligation is regarding those documents.

There's also technical guidance for your letter of recommendation writers, so you can direct them to online instructions through the Support for Residency main page.

Check out the NRMP Program Directory for Main Residency Match Applicants

The NRMP® recently launched a directory of residency programs that showcases over 6000 Match-participating PGY-1 and PGY-2 programs. It's a searchable database that includes locations, program type, and NRMP program codes.

I fiddled with the directory a bit, and I found it most helpful in 1) narrowing down programs by specialty and geography and 2) providing residency director names and program website links.

The NRMP says it will continue to update the database so it remains current.

"Optional" Secondary Essays: Are They Really?

I've recently received several questions about optional secondary essays. How to approach these depends on two things – the prompt itself and your candidacy.

The beauty of a generic "additional comments" section is that it is intentionally vague. It's your chance to provide details, context, or qualifications that the structure of the application didn't allow you to present. 

For that reason, if you have a candidacy without any red flags, I lean toward using the "additional comments" space to both highlight who you are and any exceptional aspects of your candidacy that you'd want a reader to know before making an interview decision. One good option in this circumstance is to pick something completely nonmedical that distinguishes you and is nowhere else to be found in your application. Since an interview isn't guaranteed, don't save your best material for an in-person meeting. (On the other hand, if you have a large weakness in your candidacy, you usually want to use an optional, generic prompt or a more focused one to gingerly address the issue. See the next paragraph for guidance.)

Sometimes an optional essay is more pointed. An applicant recently forwarded me this prompt: Please describe any extenuating circumstances that may have affected your medical or non-medical service experiences, including any circumstances that impacted your engagement in activities, academics, and MCAT that would have helped to prepare you for medical school. If you have no major deficiencies in your candidacy, there's no need to write this essay. On the other hand, you should draft a response to this prompt if there's a big elephant in the room. While, in general, I tell applicants to avoid highlighting standard weaknesses, sometimes someone has a big problem that's important to address head on. It's better that you write your own story than let someone else do it.

Bottom line: Optional essays are frequently worth completing because this process is so competitive. And, if you have a big weakness, you should leverage an optional prompt to explain extenuating circumstances. 

Secondary Essays: The Diversity Prompt

In considering your strategy and content for the medical school secondary diversity prompt, I’d recommend you ask yourself the following question:

What ethnic, religious, racial, gender, language, socioeconomic, or sexual orientation aspects of me, my family, or my experience make me distinctive?

Please note that experience is part of the question I have posed. An applicant I mentored a few years back wrote to me concerned that she did not fit into a minority category and thus, could not answer the prompt effectively. I suggested she consider an experience that targeted the prompt’s theme, and she wrote a strong essay about her successful efforts to increase diversity during sorority rush, which she spearheaded. When I applied to medical school, I crafted one of my secondary essays on my experience hearing Spike Lee speak on my college campus. Don’t be afraid to think outside the box.

If you haven't already, check out my Doximity piece on shortcomings of the medical school admissions process, especially the secondary applications (a moneymaker for institutions).

15 ERAS Tips to Boost your Residency Candidacy

Over the years, I've cultivated many tips for crafting the best ERAS Experience Section. I've included 15 important ones below:

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, published in Nature ;)).

2. As of last year, you have only 10 slots, so avoid minor activities (like an afternoon health fair). 

3. Write in a streamlined fashion. Avoid verbiage. Of note, as of last year, you can choose three most meaningful activities, but you only have 300 characters for each. So while you want to explain why the activity was impactful, you'll need to keep your writing here especially tight.

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

5. Avoid most abbreviations. Ones you think are common might not be familiar to the reader.

6. Avoid contractions; they are too informal for an ERAS. 

7. Make sure you spell out your accomplishments clearly. If your reader doesn’t understand an activity, you won't get “full credit” for what you’ve done. Make no assumptions - not even that the reader has reviewed the experience's introductory information (position title, location). 

8. 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.

9. Use numbers to be persuasive. Saying that the conference you organized had 500 participants says a lot.

10. 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.

11. Do your best not to leave the "Medical School Awards" section blank. Even if you have to simply include clerkships in which you obtained honors (or high honors), fill that section out.

12. If you have not already, consider joining your specialty's national organization and listing it under the "Membership in Honorary/Professional Societies" section. If you are applying in two fields, take this advice, though. 

13. Try to end your entries with a sentence about how the experience you just described will help you as a future specialist. Making that connection for the reader furthers your candidacy. 

14. As with all good writing, avoid redundant language. Having the word "research" three times in two lines is distracting and demonstrates a lack of originality. 

15. Get help. Don't submit your residency application without having it reviewed by someone with a lot of experience. (I started Insider Medical Admissions in 2007.) You do not want to put forward suboptimal materials for a process that is this important and competitive.

(Please note that there are a few changes to this year's ERAS. For more information, see this AAMC page.)

Getting Started with the "Why Our School" Secondary Essay Prompt

Secondary essay prompts vary, but there are a few that are standard fare like "Why do you want to attend our school?" Here, medical school admissions officers want to be assured you know their institution, are seriously considering it, and will fit in well. 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, patient population, and/or extracurricular programs.

For example, if you were a physics teaching assistant 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 you connect well with it, and showcase your distinctive accomplishment.  

The paradox here is that - although you are focusing your essay on one school - because so many institutions have overlapping philosophies, curricula, programs, and objectives - you can oftentimes use the same framework for many different institutions. That's one strategic way to cut down the overwhelming workload that secondary applications present.  As you craft your essay, it's key, however, to know and leverage the names of institution-specific programs like student-run clinics, summer travel scholarships, and/or primary care tracks, for example.

Great Things About Being a Physician

Years ago my physician dad told me that it was important to select a specialty whose bread-and-butter you could still enjoy. For orthopedists, it's back pain. Interestingly, it's probably back pain for us emergency physicians as well!

Along those lines, I devote a reasonable fraction of my blog entries to the downsides of being a physician because I want to ensure that those who are considering a career in medicine understand and can tolerate the more mundane – even negative – aspects of their planned profession before they can't turn back.

I'm very happy, then, in contrast, to use today's blog entry to showcase Medscape's Best Things About Being a Doctor piece. It's interesting how many of the physicians interviewed mention having a "tangible" effect on their patients' lives.

White Coat Investor Scholarship 2024 Applications are Open

Each year the White Coat Investor (WCI) offers a scholarship opportunity to students enrolled in full-time US professional schools for the 2024-5 year. Students must be in good academic standing in eligible professional schools, including medical, dental, law, podiatry, pharmacy, physician assistant, nurse practitioner, and veterinarian, among others. The stated goal of the scholarship is to reduce winning students' indebtedness and to promote financial literacy in professional schools.

The lion's share of the application is an 800 to 1200 word essay in one of two topics: Inspiring Stories or Financial. The deadline is August 31.

For more information please check out this web page.

After You Get In

The AAMC recently published a piece called "Congratulations, you got into medical school! Now what?" in which staff writer Bridget Balch lists seven tips for rising first-year medical students. You can see the article here.

The author makes several suggestions, including leveraging the orientation and embracing the academic challenge, but I would highlight her recommendations to find mentors and prioritize your health.

Identifying strong mentors not only affords you the potential for good letters of recommendation and little-known opportunities, but also doing so can support you when medical school is a terrible grind. Mentors can be especially important role models for women and those in traditionally underrepresented groups. The key is to assert yourself and overcome feelings of insignificance. Many faculty are eager to meet and guide students.

With regard to physical and emotional health, I've written recently and many times in the past about clinician burnout and depression. Medical school can be a time of significant contraction in your life. Make sure to care for yourself physically and seek mental help when needed.

In the meantime, before school starts, take a well-deserved break!

Aim for All Stuff and No Fluff

The goal of your written materials (and your interview) is to distinguish yourself from everyone else to demonstrate that you are worthy of a competitive medical school or residency slot.

Therefore, it's critical that you avoid flowery or trite language, as using it does the opposite of making you distinctive. Recently, I read a piece by Lisa Miller called, "When Did Everything Become a 'Journey'" about the overuse of the word. Miller cites Northern Arizona University linguistics professor Jesse Egbert who notes that "journey," as a noun, has almost doubled in American English since 1990. 

In her piece, Miller also includes a wry quote from a Los Angeles clinical psychologist who describes the word "journey" as "eye-rollingly cheapened." In editing personal statements, I see the word used frequently – maybe once in every four essays I revise.

Good writing takes a lot of time - brainstorming, outlining, and many drafts. Make sure your written materials are the best they can be by being diligent about your process (and by getting professional help).

Avoid These Ten Common AMCAS Mistakes

Here's a brief list of AMCAS Work and Activities section errors to avoid at all costs:

1. Don't write to write. While you want to include many strong achievements, you do not want your AMCAS to be so wordy that your reader is tempted to skim.

2. While you need to be brief, don't write in phrases; use full sentences. It’s a formal application, and you want to make your written materials as readable as possible.

3. Don't assume your reader will carefully study the "header" section (including the title of the activity, hours, etc.). Make sure your descriptor could stand alone: Instead of "As an assistant, I conducted experiments..." use "As a research assistant at a Stanford Medical School neuroscience lab, I conducted experiments..."

4. Don't be vague, dramatic, or trite. Make sure you spell out your accomplishments clearly and substantively. If your reader doesn’t understand an activity, you will not get “full credit” for what you’ve done. Make no assumptions.

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

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

7. Avoid generalities and consider using numbers to be persuasive. Saying that the conference you organized had 300 participants says it all.

8. 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.

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. Choose the right category for each activity, so you get "full credit."

Bonus: Get help. Do not submit your medical school application without having it reviewed by someone with experience. You do not want to showcase suboptimal materials for a process that is this important and competitive.

How to Avoid AMCAS Verification Delays

The AAMC recently posted a piece with tips on how to avoid delays in the AMCAS verification process. The link to the article is below, but I've created an outline of their recommendations here:

1) Submit all of your official transcripts – including college courses taken during high school. The AAMC notes that transcript issues are the most common cause of verification delays.

2) When completing your application, include alternate names that appear on your official transcripts so AMCAS verifiers can readily match your transcripts with your application.

3) While this is not a requirement, the AAMC recommends you use the Transcript Request Form (TRF) to match paper transcripts to your application. The TRF can be found in the application's Schools Attended section.

4) When requesting e-transcripts, ensure you provide your accurate AAMC ID and Transcript IDs to avoid problems matching your transcripts with your application.

5) Make sure to fill out your coursework exactly as it is printed on your official transcripts (including abbreviations, grades, and symbols) and in chronological order. Include all courses - even ones you took more than once, you withdrew from, and/or you did not excel in. The AAMC recommends you order a personal copy of your official transcript early so you can complete the coursework section accurately.

6) If you are reapplying, resubmit all of your transcripts and your letters of evaluation, even if nothing has changed since your last application.

7) Proofread your AMCAS(!), as there are limited changes you can make once your application is submitted.

Here is the AAMC article.