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.]