Letters of Intent

Medical school letters of intent (or what some applicants jokingly call "love letters") can be used for several types of applicants:

1) Those who have been wait listed
2) Those who have been interviewed but have not yet been accepted or rejected
3) Those who have not yet been invited to interview

When writing your letters of intent (LOIs), you should have the following principal goals:

1) Restating your interest in the institution
2) Positioning yourself as a distinctive candidate

The biggest error I see in LOIs is too much content about a specific institution's advantages. There is no reason to spend a paragraph or more telling medical school admissions members what makes their institution special. They already know! Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant.

For those of you interested in LOI assistance, please contact me. I do offer a popular LOI editing service.

AMSA Conference Update

Just an update that last week the American Medical Student Association (AMSA) secured the Honorable Kathleen Sebelius, the twenty-first Secretary of Health and Human Services, to give the AMSA National Conference's keynote address on Friday, March 9th from 1:00pm-1:50pm. Her speech will bump my talk - previously at 2:30pm - to 3pm.

I look forward to seeing many of you there.

NRMP Rank Order List Certification Deadline

Just a reminder that applicants and programs must certify their rank order lists before February 22 at 9pm EST.

Please see my previous blog entry on creating a rank list. Don't make the error of changing your rank order last minute based on panic! Your list should be a considered decision.

It Gets Better

In honor of the Dan Savage's "It Gets Better" campaign, I thought I would dedicate this blog entry to those who are in medical training and are struggling. (And who isn't?!)

Despite the relatively warm winter many of us are experiencing, this time of year can be particularly rough for medical students and residents trying to get through classes and rotations. As a practicing MD, I want to let you know that it gets better! For every medical student, resident or fellow who has heard an attending physician say, "If you think training is hard, wait until you're done," I say, "Don't believe that silly doctor!" Once you get through this tough time, you can look forward to more autonomy and a happier lifestyle.

I wish someone had told me all of this when I was going through training. It really gets better!

Making Your Match List

That time of year is quickly approaching, and I've already been asked how to optimally create a Match list. The algorithm for the Match is relatively simple; you can look at the details on this NRMP page.

The bottom line:

1. Rank programs so that they represent your true preferences. Your first choice should be first. Your second should be second and so on. Do not try to "outthink" the system, as it will only be to your disadvantage.

2. If you would rather not match than be at a specific program, then that program should not be on your Match list. Do think carefully, however, about the prospect of not matching, trying to scramble, and possibly having to reapply next year :(.

3. If you are applying to a competitive field, consider having many programs on your rank list to increase your chances of success. How many is many? See this excellent document for evidence-based assistance in how many programs you need, depending on your specialty choice.

Promises, Promises

As we approach the Match, I want to remind applicants that - although residency directors (RDs) are permitted to express strong interest in candidates - RDs' comments should not be interpreted as promises regarding rank.

Here is the NRMP's Statement of Professionalism that reviews violations and "misleading communications." The document is clearly written with examples of problematic interactions between RDs and applicants.

Pre-Match Offers

I received an urgent request from an applicant last week. He wanted to discuss a pre-match offer he had received that had a Friday deadline. The pre-match program was an academic institution, which was appealing, but the interview day had left the applicant underwhelmed for a number of reasons.

On the one hand, this offer was a sure thing. On the other, the applicant had noted what he considered to be red flags. He asked me what to do.

As usual, in life there is no right answer :). But here are a few suggestions if offered a pre-match:

1. Ask for more time. In the worst case scenario, the program director says no. Nothing lost.
2. Try to move up any interviews you have not yet attended.
3. Contact the other program directors and let them know you have a pre-match offer and give them the deadline date. They may offer you a pre-match in return. Or - on the contrary - they may let you know they are not interested. Either would be helpful in making your decision.
4. Speak to residents who are at the pre-match program. Trainees will often readily tell you the weaknesses of their institution :). This information will help you make an informed decision.
5. Assess a) your risk-taking comfort zone and b) the strength of your candidacy. This step is probably the hardest, yet most important.

In the end, the applicant did not accept the pre-match offer and is crossing his fingers he'll end up at another program he likes better. He is so relieved that - with the information he has now - the decision seems to have been the right one for him.

Outside of the Box

Now that the new year is here, many pre-meds, medical students and residents will be asked to finalize their schedules for the next year or more. Although it's easy to get wrapped up in it all, I wanted to put in a plug for something a bit unconventional - time away from the field entirely.

When I was in medical school, I took almost a year away to travel and explore journalism, a career that had always interested me. I obtained a small grant to conduct research in Mexico and then backpacked with some friends through Mexico and Guatemala. I also spent a month in Thailand. Additionally, I was awarded an American Association for the Advancement of Science Mass Media Fellowship in Science Writing, so I worked in Portland at the Oregonian writing articles for the paper.

Taking time away from medicine is not an option for everyone: Some institutions do not encourage it, and there is usually a financial opportunity cost. I will say, though, that being away from medicine made me appreciate it more and helped me improve several useful skills, including foreign language and writing.

If taking a scheduled break from the norm is a viable choice for you, I would strongly encourage it. The experiences I had have long-reaching effects that continue to help me as a physician today.

Step 2 CS Changes

In 2004, a team was created to initiate a multi-year, comprehensive review of the USMLE program. This team, called the Composite Committee, is comprised of the Federation of State Medical Boards (FSMB), the National Board of Medical Examiners (NBME), the Educational Commission for Foreign Medical Graduates (ECFMG) and the American public.

Last month this team announced some "enhancements" to Step 2 CS that are scheduled to start the middle of this year. Here is a summary of those changes. Updated practice materials for Step 2 CS will be posted to the USMLE website in March 2012.

An Excellent Question

I recently read a NYT piece called, "Why Would Anyone Choose to Become a Doctor?" by Dr. Danielle Ofri. It's a sweet essay written by a physician who describes being perplexed by the large number of medical school applicants yearly, considering her profession's numerous annoyances.

As the author considers alternatives to her career, however, she comes to the conclusion that her clinical encounters make it all worthwhile. The essay is a nice pick-me-up.

Interview Tips from an Entrepreneur

This article is currently at the top of the New York Times' most emailed list. It's written for those entering the work force, but it is very pertinent for applicants to medical school, residency, fellowship, and post bacc programs.

I hope everyone has a happy holiday season!

A Daring Journey Into Medical Anthropology

A few weeks ago, I recommended reading This is a Soul: The Mission of Rick Hodes, and today I want to highlight another must-read for the physician or doctor-to-be. The Spirit Catches you and You Fall Down was published in 1997 and promptly won the National Book Critics Circle Award for Nonfiction, among other accolades.

The book chronicles the U.S. medical experience of a Hmong family, showcasing the twisted miscommunications between the two groups. It's an excellent story and strong reminder to all medical caregivers as to how - although everyone may be aiming for the patient's best - cultural differences can spoil the doctor-patient relationship.

Happiness: Be All That You Can Be

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. 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 is 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.

This Is a Soul

I wanted to put in a plug for a book I'm reading called, "This is a Soul: The Mission of Rick Hodes" by Marilyn Berger. The book chronicles the work of Dr. Hodes, an American doctor who has lived in Ethiopia for over three decades assisting children with horribly severe - oftentimes lethal - spinal problems (frequently tuberculosis-related). Dr. Hodes himself has adopted several sick Ethiopian children.

During his emergency medicine training, my husband worked with Dr. Hodes and was tremendously impressed with his dedication. Here is more information about Rick Hodes and the work he does.

Mocking Optimally

This time of year I'm commonly asked when the best time to set up a mock interview with me is.

I would recommend arranging your practice session(s) with me in the month prior to your first interview. Whether you complete the mock interview(s) weeks in advance or the day before depends on how you best retain information.

More important than when you practice is that you simply do. The NRMP Program Directors' Survey, my experience at Harvard, and my work with hundreds of Insider clients all reinforce the critical nature of the interview in assessing an applicant's candidacy.

If you are planning to hire me, please do so as soon as you get that first interview invitation. My slots go very quickly, and although I try to accommodate everyone I can, I am currently scheduling several weeks in advance because of high demand.

Here is a link to my services page.

Acceptances

It's early in the season, but some of my clients have already been accepted to

UCSD
University of Chicago
Vanderbilt
Case Western
USC (Keck)
Mayo
UCI
Rosalind Franklin and
Wake Forest!

Most medical school applicants are still early in the interview process. Consider hiring me for mock interviews to improve your chances of success.

Thank You Notes: A Plug for the US Postal Service

I was recently asked by a client about the best way to send post-interview thank you notes - email versus snail mail. This client said he had read conflicting advice online.

As a former Harvard admissions decision-maker who used to receive thank you notes, I can tell you that I strongly advise sending your thank you notes by good old USPS. The reasons are twofold:

1) Email may be viewed as lazy. Hand-written thank you notes take more time, which shows.
2) To put an email thank you note in your file, the receiver needs to take the time to print out your email. You don’t want any barriers between you and your good impression.

I do recommend getting those handwritten thank you notes in quickly. The night after you’ve completed your interview or the next day is a good time to write and send.

You Never Get a Second Chance to Blow a First Impression

I receive a lot of questions about interview attire; I have two rules to guide applicants:

1. Do not be noticed for your clothes. You want to be remembered for your accomplishments, not your attire. Years later, I still remember the applicant who arrived in a Bugs Bunny tie. (This might fly for a pediatrics interview, but even then, I wouldn't recommend it.) I also recall the applicant who arrived in jeans. (He packed his interview clothes, checked his luggage, his bags were lost, and he had nothing else to wear for his early morning interview.)

2. Be comfortable. No heels that are so high you are in too much pain to take the tour. No coat so light - but stylish! - that you can't walk out of the building.

What you wear is really much less important than how you present yourself in interviews. For help, contact me. I've recently added some mock interview slots to my online calendar because of high demand.

Being the Squeaky Wheel

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.

It was at this time when I met the applicant; we conducted a mock interview so he would be well-prepared.

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 (not aggressive!) in the medical school and residency admissions processes: Send an update letter, call institutions (politely) to inquire about your status (if they do not expressly prohibit phone calls), and be proactive during your interviews.

You need to advocate for yourself in order to be noticed.

Physician Dissatisfaction in the News

Those of you who have worked with me know that I am a realist. (That term may be a euphemism for a pessimist, but hey, I'm an emergency physician.)

It's worth reading this article in the NYT, "Young Doctors Worry About Career Choices." Although job prospects are good for new doctors, there is still a lot that makes the newbies worry.

Coaching and Mentorship

Here's an article worth reading: Personal Best by Atul Gawande, MD in the October 3 New Yorker. The piece reviews the advantages of using a coach to break down performances and improve outcomes. Gawande starts by pointing out the obvious utility of coaches for certain professionals, like athletes, and then asks why we don't use them more widely in other fields - like teaching and even medicine.

Facebook and Twitter

I have re-launched my social media networks to better share relevant information with applicants. Please stay connected with me on Facebook and Twitter!

Do Interviews Matter?

There's an interesting NYT's article from this past week called "Do College Admissions Interviews Matter?" Although the article makes a convincing argument that undergraduate interviews may not matter in many cases, it does point out that many graduate school interviews do. It also recommends doing mock interviews.

The NRMP Program Directors' Survey makes it quite clear that residency interviews matter a lot, which was also my experience as Assistant Residency Director at Harvard. I remember very robust conversations about even small comments that candidates had made in their interviews that adversely affected their ranking on our Match list.

NRMP Stats

The NRMP does a really great job of collecting and distributing useful statistics about the Match. Many of you know that a document I refer to often is the NRMP Program Directors' Survey. Recently, the NRMP has published several more documents, including "Charting Outcomes of the Match - Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2011 Main Residency Match." I know clever applicants who have used the data in this document to strategically apply to residency this year.

The NRMP comments as follows regarding their analysis:

"The data in this report support the following straightforward
advice one should give to an applicant.

- Rank all of the programs you really want, without regard to
your estimate of your chances with those programs.
-Include a mix of both highly competitive and less
competitive programs within your preferred specialty.
-Include all of the programs on your list where the program
has expressed an interest in you and where you would accept
a position.
-If you are applying to a competitive specialty and you would
want to have a residency position in the event you are
unsuccessful in matching to a program in your preferred
specialty, also rank your most preferred programs in an
alternate specialty.
-Include all of your qualifications in your application, but
know that you do not have to be AOA, to have the highest
USMLE scores, to have publications, or to have participated
in research projects to match successfully."

I Wish I Had Known...

I was recently speaking to a colleague who graduated with his MD from UCSF and his MPH from Harvard. He's a successful, practicing physician, and we were discussing some advice he had offered an undergraduate acquaintance who is pursuing medicine.

My colleague had advised the college student to ensure she gets to know faculty: During his undergraduate years at Stanford, my colleague had gotten acquainted with a few professors by inviting them to lunch. He had to call one or two several times before they met with him! But once they did, my colleague's opportunities really expanded. One of the professors in particular realized my colleague's potential and good nature and offered him a position on an honor committee and a strong medical school recommendation.

I wish someone had advised me early to get to know faculty. It turned out okay for me but not without having to do some hard thinking about whom I was going to ask for faculty recommendations. Acquainting yourself with faculty early in your academic career can afford you research and leadership opportunities. Of course, it can also help you with those much-needed letters of recommendation.

MD/MBAs

Here's a recent NYT article on joint MD/MBA programs. Currently 65 MD/MBA programs exist. I have several colleagues and friends who obtained their MBAs years after obtaining their medical degrees - another option for interested physicians.

ERAS: September 1

Just a reminder that today is the day applicants can start applying to ACGME-accredited programs through the AAMC’s MyERAS website.

There are several advantages to an early application: 1) You look organized, a good quality for a future resident. 2) Admissions readers may have more time to review your application thoroughly. Later in the season, the volume can get overwhelming.

ERAS Support Services at ECFMG to Start Live Chat Option

I have found the ERAS support services at ECFMG (Educational Commission for Foreign Medical Graduates) to be very helpful. The representatives respond to my questions quickly via email. On September 1 ERAS support services at ECFMG is launching a live chat option to answer questions about ERAS.

Representatives will be available to live chat M-F 8a-5p EST. You will be able to access the Live Chat service here. Starting September 1, you will find a link to the Live Chat service on every associated web page.

Decision Fatigue

This recent NYC article ("Do you Suffer from Decision Fatigue?") is really interesting, especially when you think how decision fatigue might affect your medical school or residency application. It's worth having the insight this article provides as you make decisions that will affect your future (where to apply, where to send secondaries, where to interview, how you make your match list or decide what school to accept).

Being Repetitive… Again and Again and Again

In writing their personal statements, many applicants ask me if it’s okay to include their accomplishments. After all, they say, their achievements have already been noted in the application, dean’s letter, and letters of recommendation.

Think of the medical admissions process as an onion. Your application (AMCAS, ERAS, post bacc CV, AADSAS) 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 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 statement to internal medicine 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.

Thus, when you select a program to apply to, you will be able to choose which documents (personal statement, LORs) you would like send to that program. ERAS, in this way, allows you to keep your options open.

Ordering Your AMCAS Activities and ERAS Experiences

I've recently received a few questions about how best to order the AMCAS activities and the ERAS experiences. You do not have a choice in how you list your accomplishments. The computer will arrange them chronologically. This is one less thing to worry about!

Be a Minimalist

Just a reminder that AMCAS activities character limits are 700 (with up to 15 activities total) and ERAS experience character limits are 1020 (with a limitless number of activities). (The ERAS "reason for leaving" is 510.)

You do not need to write up to the character limit! In fact, brief, streamlined writing makes a much bigger impact. Your written materials are critical to your application; ensure you submit your best work.

Optional Secondary Essays: Are They Really Optional?

I've recently received several questions about optional secondary essays and their necessity. I would recommend completing these essays if you have something new or important to say. Writing these essays just to have more "stuff" on your application won't further your candidacy.

Another tip on secondaries: Start early. Although there is overlap among schools, you may have twenty to thirty of these to write, depending on the number of applications you send.

California Licensure for IMGs

Today I have a guest blogger. Daniel Louvet worked in my hospital's emergency department before he left to go to medical school. Daniel is super talented, smart and an all-around nice guy :).

Below is some very helpful and detailed information for IMGs interested in the requirements for California licensure.

As a native California resident and a recent IMG from Ross University
School of Medicine, I have often been asked by my fellow colleagues
about the process of becoming a licensed physician in the state of
California. The answer is as follows:

(A) First, the international medical school MUST be recognized by the
state of California and MUST be listed on their website PRIOR to starting medical school. NO EXCEPTIONS.

(B) Second, the student's United States clinical rotations MUST fulfill these requirements:

1) A total of 70 weeks of Accreditation Council for Graduate Medical Education (ACGME) clinical rotations MUST be completed by the time the application for licensure in California is submitted.

2) Of the 70 weeks of ACGME clinical rotations, 40 weeks of the 70 weeks MUST come from CORE rotations. The minimum number of weeks for each of the respective CORE rotations are as follows:

Internal medicine - 8 weeks
General surgery - 8 weeks
Ob/Gyn - 6 weeks
Pediatrics - 6 weeks
Family medicine - 4 weeks
Psychiatry - 4 weeks

While these CORE rotations only add up to a total of 36 weeks, an additional 4 weeks to complete the total of 40 weeks MUST come from any of the CORE rotations listed.

3) Of the 70 weeks of ACGME clinical rotations, 30 weeks of the 70 weeks MUST come from ELECTIVE rotations.

4) At the end of each ACGME clinical rotation, an L6 form must be completed PER clinical rotation as part of the application process for California licensure. The L6 form can be found here.

In the event that some of the requirements are not fulfilled by your medical school graduation date, it is highly recommended you complete these rotations after graduation and prior to starting residency, through your medical school.

If you happen to do a residency outside of California and have yet to fulfill all the requirements, it is possible to count the respective rotations done while in residency towards obtaining California licensure through a petition by contacting the California medical boards at (916) 263-2382. For instance, if you had a non-approved/non-ACGME Family Medicine rotation during medical school, and you matched into a Family Medicine residency, it is possible to count the Family Medicine rotation completed during residency to obtaining California licensure in the future.

IMGs: Your ERAS Tokens are Here

Just a quick note to International Medical Graduates: Residency Tokens for ERAS 2012 are now available. You can use the token to register with AAMC's MyERAS starting on July 1.

Visit the ECFMG ERAS Support Services website for instructions on how to get your token.

Formal Attire Required

In crafting your AMCAS or ERAS activity descriptors, make sure you write formally. By that I mean write in full sentences and avoid contractions and colloquialisms. The AMCAS and ERAS are important documents that deserve respect!

Also, ensure your descriptors - without going over the character limit - can stand alone from the activity title in case the reader skims through the latter. In other words, assume the reader has not read the organization and title before your prose.

Contact me for editing help.

Scribes

Here's a short Los Angeles Times article on scribes. The article points out what a good experience scribing is for pre-meds. (And it pays!)

Application Support for IMGs

Starting July 1 IMG residency applicants can reach ERAS Support Services through extended hours Monday through Thursday 8a-6p EST and Friday 8a-5p at 215-966-3520. Remember too that applicants can get some questions answered by e-mail at eras-support@ecfmg.org. I've emailed the ERAS Support Services before, and they respond relatively quickly. If they don't have your answers, they'll point you in the right direction.

That Foreigner Song

As soon as June 1 hits, I have a multitude of medical school candidates panicking about the urgency of their application submissions. Plan ahead! Good writing takes a long time.

Even if you have a super-fast editor like me on your side :), you should expect that you will revise your materials multiple times and that each revision will take you many days or weeks.

Residency applicants: Take note. Start working on your written materials now, as some of my organized clients have already done.

"You say it's urgent
Make it fast, make it urgent
Do it quick, do it urgent
Gotta rush, make it urgent
Want it quick
Urgent, urgent, emergency
Urgent, urgent, emergency
Urgent, urgent, emergency
Urgent, urgent, emergency
So urgent, emergency
Emer... emer... emer...
It's urgent" :)

New AMCAS Certification

I received an email recently from an applicant who was interested in hiring me and wanted to know my thoughts on AMCAS' new certification requirement. The phrasing is as follows:


“I certify that all written passages, such as the personal
statement, essays required from M.D./Ph.D. applicants, and
descriptions of work/activities, are my own and have not been written,
in part or in whole, by a third party. Quotations are permitted if the
source is cited.”


I want to remind applicants that I provide only editorial services; I do not generate content. This has been my policy since starting Insider, so the new certification is not a problem for me, my business or my clients.

Let me give you an example: In aggressively editing a personal statement, I will help with syntax, organization, etc., but I will not write any section for the applicant. I might make an explicit suggestion like "Another example of clinical work here that emphasizes your ability to communicate clearly will make this paragraph more robust. Can you think of something to add?" But I will not write a section for the applicant.

Throughout my website - home page, medical school applicant page, terms and conditions - I explicitly state that I do not generate content. I have turned down clients who have asked me to do so well before AMCAS required the new certification.

AMCAS 2012 Change

This year a significant new addition has appeared on the AMCAS. Applicants are being asked to identify their most significant extracurricular experiences (up to three) and support their choices.

Here's the prompt:

"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."

This new section will add to the prose a candidate must craft, so if you are hoping to apply early (beginning of June), make sure to plan accordingly.

The Good News and The Bad News... and Then More Bad News

There is a clearly-written article by Jan Greene in the current issue of the Annals of Emergency Medicine about fifteen new, US medical schools that are currently being accredited and slated to open. The Association of American Medical Colleges (AAMC) estimates that this increase will lead to an additional seven thousand medical school graduates every year throughout the next decade.

Sounds great, right? More chances of getting into a US medical school!

Well, no so fast.

The idea behind opening these new schools was to preempt the impending doctor shortage, but, as Greene points out, the new medical school openings will not solve the scarcity because there are no plans to increase the number of residency spots. In fact, in fourteen years, the number of teaching hospital residency spots for which Medicare pays a share (about thirty percent) has not increased. With Medicare cuts in the works, it's unlikely residency positions will expand or that hospitals will have extra funds for unsupported spots.

Unfortunately, this means more competition for residency spots for everyone, especially International Medical Graduates. (The domestic graduates will likely be prioritized by residency directors.) And it means no solution to the doctor shortage. Unless funding for training programs increases, which seems unlikely, future doctors should expect a bottleneck at the post-graduate level. Bad news for doctors and the American medical system.

Featured Interview

I was recently featured on Medical MasterMind Community, a website for pre-medical professionals. Here's my twenty-minute interview with explicit essay-writing tips and techniques.

The Medical School Application Calendar

Don't forget that May 1 is the first day AMCAS 2012 is available on the AAMC website and that June 1 is the earliest date for submission of the AMCAS.

Submitting a strong application early is important for your candidacy, particularly with rolling-admissions schools. Your personal statement should be closing in on its final form now. For those of you who don't know where to start with your essay, consider my new Writer's Block Package.

Letters of Intent: Don't Forget Your Purpose

In editing letters of intent (LOI), I note that applicants often make the mistake of focusing on their desired institution's virtues. Remember that the goal of the LOI is twofold:

1) Affirm your strong interest in the institution.
2) Distinguish yourself with your accomplishments.

These programs already know their strengths; unfortunately, you won't further your candidacy by reiterating them.

See my editing pages for information on my LOI services.

Is It Kosher?

My advisees often have questions about the ethics of letters of recommendation (LOR).

First, some applicants tell me they feel guilty because - although they waived their right to see their LORs - their writers gave them their letters to read. If your letter writer crafts your LOR understanding that s/he has no obligation to let you read it yet chooses to offer you a copy, you have done nothing unethical. That decision is the letter writer's.

Furthermore, I've had applicants tell me they feel uncomfortable because faculty have told them to write their own recommendation letters after which the letter "writers" will edit and sign. Again, totally kosher. This topic was recently addressed here by the ethicist in the New York Times.

Remember to start early in asking faculty to write your recommendations. LORs almost always take longer than you think.

New "Getting Into Residency" CD-ROM Available

I don't usually refer readers of this blog to my other blog, but with the launch of my new "Getting Into Residency" CD-ROM, I thought that might be easier. Here is the information. The CD includes video, audio, printable slides and a transcript.

Getting to Know Faculty

When I conduct Strategy Sessions with medical and dental school applicants, I notice a recurring problem: It's hard to get very strong academic letters of recommendation, especially at colleges with large classes.

So I'm here to offer a piece of advice to those just starting their university studies: Get to know your profs. In addition to keeping your grades up from the beginning of your college career, acquainting yourself well with your teachers is one of the most important pieces of advice I can give to the new pre-med. Go to office hours, send an email invite for a lunch meeting or approach the faculty member about working in his or her laboratory.

In addition to being strategic, these relationships can fill a mentorship role that is invaluable.

Brevity is the Soul of Wit

Here's a NYT op-ed piece about learning to write concisely, an important skill in the admissions process.

Match!

Congratulations to so many clients who have written me about their Match successes. Here's a nice comment I received today:

"Hey Michelle, I wanted to thank you again for all of your advice in this year's Match, as I matched to my number one. I couldn't be happier and couldn't have been more prepared. You relieved a lot of the stress that accompanies such a demanding time. Thanks again!"

I would love to hear from all of you!

Being Classy

A client emailed me to say that after a recent interview, the medical school dean called her to say he was impressed with her candidacy and the hand-written thank you notes she had sent. The client thanked me for my help with her application and the thank you note tip. Needless to say, she was admitted.

Writing thank you notes is easy and goes a long way. Remember to hand-write the notes, keep them brief and send them immediately after your interview day.

AAMC Fee Assistance Program (FAP)

Just a reminder regarding the Association of American Medical Colleges' (AAMC) Fee Assistance Program (FAP). The FAP is designed to offer help to individuals with extreme financial limitations who cannot pay the MCAT registration or AMCAS application fees without financial support.

If you think you are eligible, it's worth applying for an FAP grant early: If an applicant submits his/her AMCAS prior to receiving a decision on his/her FAP application, that candidate will be ineligible to receive the FAP for the AMCAS. In other words, the candidate will not receive a refund.

For more information on the FAP, please click here. I offer reduced rates for applicants demonstrating financial hardship through the AAMC FAP grant. Once you have been granted the FAP, contact me for more information.

Learning to Doctor

Here's a NYT article about medical students at my alma mater. Frankly - as one of my friends and former classmates emailed me - it makes HMS students sound a bit socially inept. But this piece is written from a patient's perspective, and she should know best what does and does not make her feel comfortable.

It's a good lesson on doctoring well.

Getting Into Residency: An Insider's Tips

For those of you interested in my upcoming "Getting Into Residency" lecture who have written me saying you can't attend the AMSA national conference, I am currently working on an affordable CD-ROM with a version of the lecture, including video, audio, printable slides and a transcript.

I'll keep you posted as the project comes to fruition. Thanks for everyone's interest.

What Would your Mother Say?

I had a sweet client recently tell me that, although she will feel uncomfortable showcasing her accomplishments throughout her upcoming application process, she thinks her mom might be able to help her learn to speak about them fluidly.

If you have a supportive mother (father, grandparent), and you are having trouble highlighting your achievements in your personal statement, application, interview, even letter of intent, consider channeling your inner mother.

Remember: You must distinguish yourself from the other competitive candidates, and the best way to do that is with explicit examples of your accomplishments.

Ranking Schools

There’s an interesting Malcolm Gladwell article in the latest New Yorker on the pitfalls of U.S. News and World Report's college rankings. Gladwell's points regarding the deficiencies of a system that tries to be "comprehensive and heterogeneous" and the flimsiness of quality proxies can be applied to medical school rankings as well.

Despite their many shortcomings, however, I do use U.S. News and World Report's medical school rankings on my website because they are more descriptive than alphabetic order in listing where my clients have been accepted.

$105K Awards for Recently-Licensed California Physicians

The Medical Board of California recently sent me a notification about their Physician Corps Loan Repayment Program, a grant for California-licensed physicians who are willing to practice in underserved communities for three years. The goal of the program is to provide improved health care access to needy neighborhoods with the hope that doctors might remain where they are working after their three-year commitment.

The application deadline for this year is March 24, 2011. The application can be accessed here.

New International Medical School Options

Here's a short NYT article on three new Italian medical school programs that are being taught in English in part to attract foreigners. The advantages are lesser cost, nice geography and, apparently, lower admission requirements, although for at least one institution, the entrance exam includes questions on Italian current affairs.

As the supply of doctors continues to be a problem, while admission to US schools is increasingly difficult, more international schools will likely pop up.

Applying Evidence-Based Medicine to Applications

In medicine, we're taught not to do a test unless it is going to change outcome. (You have a very high suspicion for a PE? Why do the ddimer? You're going to have to do a definitive test anyway.)

The same is true for applications. Asking friends and colleagues about their progress in the application process won't change how you proceed; you'll do your best at interviews whether your neighbor tells you he's already been called by ten institutions or not.

I would recommend avoiding asking others about their progress or checking websites in which applicants make claims about their successes. It's likely to make you nervous and won't change your management.

AMSA Lecture: Saturday, March 12, 10am EST

As we approach the date, I'm sending this reminder regarding my AMSA National Convention lecture, "Getting Into Residency: An Insider's Tips." For the second year in a row, I have been invited to be a featured speaker at AMSA's conference, which will be held in Washington, DC. I'm speaking on Saturday, March 12 at 10am EST and will be available to answer questions after the talk. In the past, the American Medical Student Association's national meetings have been the largest annual gatherings of medical students in the United States.

Freshmen and Sophomores: Become an Outlaw

This blog post refers to an insightful article written by David Z. Presser, MD, MPH regarding the need for pre-med freshmen and sophomores to distinguish themselves early in their college careers. David's point, first made in the Chicano Medical Student Bulletin, is that pre-med underclassmen need to distinguish their "brand of leadership" as club officers. Here's an excerpt:

When you find an activity that you enjoy, a natural desire to explore your interests will lead you to want to get involved in a leadership capacity. Lots of people become officers in their organizations. An officer is someone who is elected to a position of leadership and fulfills the duties required of the job - nothing more, nothing less.

STORY BREAK: When I was a child, I used to love Billy the Kid. (This was at the age before I learned he was a sociopath.) The reason I put Billy on a pedestal was because he was an outlaw. He played the game by his own rules. He never accepted the limits imposed by society or dictated by convention.

The leaders who have the greatest impact on their groups and who revolutionize the way things are done are outlaws, not officers. It would be to your benefit to think like an outlaw and apply your innovative style to the different tasks you undertake. Among those tasks you can personalize are leadership duties in different groups. Don't stop at the list of duties specified by your position; rather, fulfill the needs of your group that no position is meeting.

David's point is well-taken. Anyone can be president of the health career interest club. But not anyone can organize a campus-wide conference on how physicians are being mis-incentivized, a controversial topic. Work toward originality and high impact to catch admissions committees' attention and enjoy your accomplishments more.

No One Wants to be your Second Choice for the Prom

Imagine you're back in high school, planning to ask out a fellow classmate to the prom. You approach your potential date, "Would you be interested in going with me to the dance? You're my second or third choice!"

Not very compelling...The same is true for letters of intent: I've had several applicants ask me if it's okay to say that an institution is their "second or third choice" or "one of my top" picks.

That does not sound very flattering! Instead you can say something like "I would be thrilled to be here" or " I’m confident I can make a positive contribution to this program." In other words, you don't need to lie (which I never recommend); but you don't have to shoot yourself in the foot either.

I do edit letters of intent, so let me know if you need assistance.

What to do about Medical School Wait Lists and Deferrals

I've had a few applicants ask me if there is anything to do after being wait listed for medical school. I do recommend streamlined letters of intent that include what makes you a distinctive candidate and updated information regarding your candidacy. I edit these if you want help.

I've also heard of applicants sending letters of intent AND making an appointment to tour the school. A visit demonstrates further interest.

Hang in there. Remember that some people get off the wait list as late as the summer. (Not ideal but better than not getting in.)

An Effort to Rid NY Hospitals of Caribbean Medical Students

This NYT piece on the push to rid New York hospitals of Caribbean medical students is worth a read. I think it's unlikely that Caribbean schools will be forced out of New York hospitals, as the financial incentive to keep the schools' funding is way too strong. It's worth considering, however, the fate and reputation of Caribbean schools.

It's interesting to note, too, that New York schools that have relied on their prestige to secure rotation slots may now be worried that they can't compete with the millions of dollars that Caribbean schools are spending to do the same.

Does Going to a Fancy School Pay Off?

Here's an interesting NYT article on whether going to elite colleges pays off financially (and emotionally). The results are a bit weak, but do suggest that elite schools can make a difference in income and graduate school placement.

January Schedule

I apologize for the delay: My January schedule is available online through the Insider Medical Admissions website. Please schedule Mock Interviews and Strategy Sessions early, as the slots get grabbed up quickly!

Thank You Notes

An applicant recently asked me to whom he should be sending thank you notes after interviews. Use this as a general guideline: If, during the interview day, you have spent more than five minutes of one-on-one time with someone from the institution, that person deserves a thank you note.

See my other blog postings on thank you notes for more information, but the bottom line is that these short notes should be handwritten (no email) and sent promptly after the interview.

The Time Pressure of Pre-Match Offers

A few of my residency applicants have already been given pre-Match offers. Can anything be done to alleviate the time pressure often associated with these early acceptances?

First of all, I'm always impressed with pre-Match offers that do not require a rapidly-forced reply from the applicant. Better programs have the confidence to afford their applicants some time to think.

If you are made a pre-Match offer, there is no down side to requesting more time to make your decision. If the program says no, nothing is lost and if they say yes, you have a bit more time to think or interview at other institutions.

I've had applicants ask me if they should accept a pre-Match offer or take their chances with the Match. Of course, there's no simple answer. Factors to consider include the strength of an applicant's candidacy, the quality of the program and the applicant's risk tolerance.

Super Duper Creepy

Here's a disturbing article in the Chronicle of Higher Education about a man who writes papers for students. (Even he is troubled by his work.)

I want to point out that I do not generate materials, and I am not a "secret weapon" for my clients. On the contrary, I am thrilled when applicants are forthcoming about my assistance. One of my clients was asked during her interview day if she had obtained professional help with her residency candidacy. When she said yes, the interviewer congratulated her on her initiative.

Contact me now for mock interview assistance. I have only a few slots left in December.

Happy, Healthy Thanksgiving

Just a quick greeting to all of my American readers. And to my international friends, have a great end of November. I'll resume my comments after the holiday!

More Options for Those Interested in Emergency Medicine

For those of you considering a career in Emergency Medicine, the American Board of Medical Specialties recently approved Emergency Medical Services (EMS) as a subspecialty. It is the sixth subspecialty available to boarded Emergency Physicians, along with Hospice and Palliative Care, Undersea and Hyperbaric Medicine, Pediatric Emergency Medicine, Medical Toxicology, and Sports Medicine. The American Board of Emergency Medicine is the sole sponsor of the EMS subspecialty.

Going Home

Here's a quick tip regarding medical school clinical rotations:

A few third years have asked me if it's kosher to take a resident up on an offer to go home early.

Very few residents are trying to trick you or test you when they tell you to get out of the hospital. The one thing I would suggest - before you leave - would be to say, "Thank you. Is there anything I can do for you or for our patients before I go?" The comment will go a long way.

Student Doctor Network Article

Here is my recent contribution to Student Doctor Network regarding planned modifications for the Scramble:

Using “SOAP” to Clean Up the Scramble

In response to persistent concerns about the “Scramble,” the two-day process when unmatched residency applicants vie for unfilled residency positions, the National Residency Match Program (NRMP) and the Association of American Medical Colleges (AAMC) have announced significant Match Week changes to start in 2012, thus affecting next year’s residency applicants. The new system, called the Supplemental Offer and Acceptance Program (SOAP), is an attempt to improve the Scramble after repeated complaints about disorganization and lack of transparency. SOAP will overhaul the Match Week calendar, so all applicants – both unmatched and, indirectly, matched candidates – will be affected by the reforms.

Read the full story here.

AMSA Featured Speaker

For the second year in a row, I have been invited to be a featured speaker at AMSA's national convention. The AMSA 61st Annual Convention will to be held in Washington, DC this spring. I'm scheduled to speak on Saturday, March 12, 2010 at 10 am. In the past the American Medical Student Association's national meetings have been the largest annual gatherings of medical students in the United States. I'll be offering an interactive lecture called "Getting Into Residency: An Insider's Tips."

See you there.

Your Dream Medical School Advisor

Make a list of the qualities that you would want in an ideal medical school advisor:

1. Someone intimately familiar with your academic background and educational pedigree.
2. Someone with a strong grasp of the residency applicant pool against whom you’re competing and a knowledge of the qualifications needed for a successful match.
3. Someone who is familiar with the logistics of the Match process.
4. Someone capable of giving critical feedback (even/especially when it’s not what you want to hear).
5. Someone who has the time and attention to focus on you.
6. Someone who offers discretion when discussing failures or shortcomings in your candidacy.

Only a small fraction of medical students have a dream advisor. The majority of will need to identify an outside mentor who can offer what their medical school cannot.

Whether you pay for a professional consultant or pursue the counsel of a trusted acquaintance, seek excellence in the mentor whose services you retain: Hold out for someone experienced, accountable and available. This individual should advocate for you and should provide the sometimes-brutal honesty to enable you to get your foot in the door with a compelling application and then dazzle your dream program once you interview.

Although friends may not be willing to make you uncomfortable in a mock interview scenario, faculty may have no qualms about doing so during your actual interview. During a residency mock interview, the proper guide can show you how to strategically navigate treacherous interview topics and how to answer open-ended questions so that you distinguish yourself from the masses.

I encourage you to make a list of those people who might help you with your candidacy for a competitive residency. If personal contacts fall short, considering hiring a professional. Ask around, check with fellow students, and look for a service where you know what and whom you are paying for.

Depression Among Student Doctors

by Michelle A. Finkel, Insider Medical Admissions

This article in the NYT called "Medical Student Distress and the Risk of Physician Suicide" covers depression in student doctors, noting that pre-meds enter medical training with mental health profiles similar to those of their peers but end up experiencing depression at greater rates.

Training is generally awful. (Why would anyone want to spend the majority of his/her time working and not sleeping?) Now that I am past my training and have many friends and colleagues who also are, I have the perspective to say that it gets better.

Please consider talking to a physician-mentor at your institution if you are feeling blue. If you are depressed, seek mental health help. (I have heard students say they are worried this will show up on their academic records, which is not accurate.) Knowing that you are not alone and that there is a light at the end of the tunnel can make a big difference.

Mock Interview Scheduling

By Michelle A. Finkel MD, Insider Medical Admissions

My open November slots are now available on my online calendar. The slots tend to go quickly, so if you are planning to hire me for Mock Interviews please do so soon. The steps to hire me can be found here for residency applicants and here for medical school applicants.

Lacking a "Social Mission"

by Michelle A. Finkel, Insider Medical Admissions

Here's a NYT article focusing on NYU's new curriculum, but examining more closely criticisms of many medical schools - a lack of patient-centered coursework. NYU, Harvard, Florida State University and other institutions are reacting to critiques that students do not get in to see patients early enough in their medical school careers and that pathophysiology is emphasized over compassionate care.

Unfortunately, until incentives are aligned (= reimbursement), practicing physicians will be forced to continue to focus on disease, rather than patient well-being. Along those lines, I recommend Atul Gawande's New Yorker article, "Letting Go" about end-of-life care.

Interviews: What to Wear

by Michelle A. Finkel MD, Insider Medical Admissions

Applicants ask me whether they can wear this-or-that suit, and I've seen entire articles written on interview attire.

But this is an easy one: Don't be noticed for your clothes. Don't wear the cartoon tie (even if you are a pediatrics residency applicant), and don't wear the orange tights in honor of Halloween. You want to be noticed for your accomplishments, not your appearance.

Email me at insidermedical@gmail.com for mock interview help.

Compulsive Email Checking

by Michelle A. Finkel MD, Insider Medical Admissions

I don't usually recommend compulsive behavior, but it's worth checking your email once a day to see if you've received interview invitations. Out of courtesy, an invite should be responded to quickly, and the sooner you contact the institution, the more likely you are to get a slot that you want. Ensure your email account is reliable and that messages aren't going to spam. (I've heard some horror stories.)

Contact me for help with Mock Interviews.

Medical School Interview Tips

by Michelle A. Finkel, Insider Medical Admissions

Congrats to those who have already been invited for med school interviews.

Getting into medical school has gotten so competitive; the interview is critical. But what are medical schools looking for during the interview process?

First, they are seeking someone distinctive. Your goal is to distinguish yourself from all of the other applicants by showcasing your accomplishments. Anyone can say s/he wants to help people or is hard working. Fewer candidates can prove it.

Second, they want to ensure you are committed to medicine and that you have an idea of what you are getting yourself into. Medical school is tough; the institutions are not seeking someone who is ambivalent and might quit. Giving examples of your clinical experience can help.

Third, the schools want to ensure you are reasonable. They want to see that you don’t have a problem personality, aren’t going to harass your colleagues, aren’t going to cause them embarrassment or extra work.

Fourth, they want to hear that you are particularly interested in their institution. You can convince them of your interest by knowing specifics about the school and city.

One would never take the MCAT without practicing first and yet, countless applicants go to interviews without preparing. Consider working with me so that you don't unknowingly undermine your chances of success with poor interview skills. I do all of my own work - not outside, anonymous "consultants."

Contact me (insidermedical@gmail.com) for help.

Scheduling Mock Interviews

by Michelle A. Finkel MD, Insider Medical Admissions

For those of you interested in Mock Interviews, please contact me the day you receive your first invitation. I still have some availabilities in September but am already scheduling into October. I have opened up weekend and late evening sessions to accommodate everyone as best as I can.

I conduct all of my own Mock Interviews. I thoroughly review your background information before the session and provide an individualized feedback document after. Live face-to-face video is an option you can add to your sessions.

Contact me at insidermedical@gmail.com for help.

When Your Debts Affect Your Dates

by guest-blogger David Z. Presser, MD, MPH for Insider Medical Admissions

A recent article in the NY Times highlights how individual debt taken on as a student has the power to adversely affect one's subsequent relationships. You can link to the article here.

You are feeling less anxious and more comfortable with the whole medical school applications game. The interviews keep rolling in. Finally, you start to receive acceptance letters from multiple schools. Suddenly you find yourself in the enviable position of having a choice between a reputable state school, where tuition is relatively low, and a reputable private school, where you will go deeply into debt. You visit the private school and see stars: the buildings are made of marble, the admissions officials wear designer suits, and the alumni network, everyone assures you, will give you a leg up in residency applications. Should financial considerations play into your decision? Should you ignore finances and follow your heart, assuming that as a future physician you'll comfortably be able to pay off any educational debt?

These are important questions. Let's look at a few numbers, accessed online on 9/7/10:

Average (2008) loan debt of a Georgetown Medical Student on graduation: $167,000

Average (2007) loan debt of a UCLA Medical Student on graduation: $98,677

Note that each of these numbers do not include debts accrued from undergraduate education. What you owe from college, you owe in addition to this.

Now let's add a touch of romance to the mix. You fall madly in love with another med student, who took out loans to attend a private undergraduate university (s/he owes $100k for that) and you both went to private medical schools ($150k each). Let's give you a pass and say your parents generously paid for all of your undergraduate education, so you personally only assumed debt for your medical education. The wedding after graduation is followed by the shocking realization that you collectively owe $400k. This does not account for the fact that your residency salaries are insufficient to let you pay off significant debt.

Were you both planning on a career in primary care? Think again - your earning potential would adversely affect your ability to pay off your loans. Compare the following starting salaries based on a 2009 American Medical Group Ass'n Survey:

Family Medicine $144,990

Urology $300,000

Anesthesiology $325,000

Internal Medicine $146,251


What if one of you has a high interest loan on a credit card because of poor financial discipline in the years before you met? What if one of you is a saver and the other is a spender? What if the medical student you marry is a U.S. citizen International Medical Graduate (IMG), where only 47.3% obtain a residency position through the match? If your partner cannot get a residency position, there is a real possibility that $250k in loans may not realistically be paid back. Despite the promise of a comfortable life as a two-physician household, your joint credit ratings may never permit you to get a home loan.

These are sobering possibilities that need to be realistically appraised early on. The debts you assume in your youth will have far-reaching consequences. So consider your choice of medical school carefully, because your debts will ultimately affect your dates.

The Role of Patient Anecdotes in the Personal Statement

by Michelle A. Finkel MD, Insider Medical Admissions


Here's another good one by guest-blogger David Presser, MD, MPH:

The temptation is great to include patient anecdotes in the personal statement. When written well, these stories can capture a sense of common human experience that transcends economic and cultural barriers and demonstrates the empathy of the author-applicant and her sincere motives for pursuing a medical career. This can only help the applicant, right? The answer (as with most situations in life) is: it depends.

The vast majority of applicants have anecdotes to share. Writing too extensively about moving patient experiences can be an opportunity cost. You are given a page to make the case for your entry into a medical training program. Does the anecdote distinguish you in some way from the masses? For example, a story that highlights your specific language abilities as an interpreter at a free clinic may be a wiser use of space than a story simply showing your general devotion to the needy. Does the vignette highlight specific strengths in your application? The experience working with Mother Theresa is more powerful when it transitions naturally into the public health degree you pursued and the parasitology research you published.

The key to judicious use of patient anecdotes in the personal statement is that they must be very concise (every excess sentence is a missed opportunity to make the case for why you are a good candidate), distinguish you from others, and concretely illustrate your attributes. If your patient anecdotes do not make the case that you are a uniquely talented applicant whom programs don't want to pass up, they may better serve you as fodder for your future novel than components of your personal statement.

Is Your Personal Statement a Little Too Personal?

by Michelle A Finkel MD, Insider Medical Admissions

I have a guest blogger today - my first ever. Dr. David Presser graduated from UCSF Medical School, completed his Emergency Medicine residency at UCLA/Olive View and his MPH at Harvard. He wrote an excellent primer on getting into an Emergency Medicine residency. Here's today's blog written by him:


Picture, if you will, a residency admissions committee member beneath a halo of light reading applicant essays in her office at midnight. Caffeine on her breath, crumpled white coat next to her desk chair, she is making steady progress on the never-ending stack of applicant files until she picks up a residency personal statement that begins, “I first became interested in Internal Medicine when Grandma was diagnosed with cancer…” Pulling out her hair by the fistful, she tosses the file into the trash. That cancer may not have killed your grandma, but it just might have killed your application.

Many students devote a significant portion of their ERAS essays to describing a universal experience that may have piqued their initial interest in a specialty. A residency admissions committee member does look for evidence of how your fundamental connection to humanity will make you an empathetic and skilled physician. The problem comes when an applicant starts to make the reader feel like s/he is providing counseling to the applicant, that is, when the candidate uses language that could strike the wrong reader as inappropriate for a professional application. The admissions committee can handle empathetic writing; however, if they suspect you mistook your essay for the journal under your pillow, they may not be forgiving.

Think carefully about the topics you choose. With all due respect to each of us who has had a family medical catastrophe, you can estimate the prevalence of cancer among the elderly and conclude that starting an essay with the description of a grandparent’s battle with cancer is not going to catch the reader’s attention. Unfortunately, just because it is genuine, it may not be compelling reading or a useful means to distinguish you from the hundreds of residency applicants whose essays share similar themes.

There are exceptions. You can be forgiven for including a common topic if it directly ties into highlighting a unique personal accomplishment. Perhaps grandpa’s prostate cancer diagnosis led you to seek out a research position with a faculty member at your local university lab where you were directly involved in sequencing a promising new molecular marker for prostate cancer. Give the generic topic a brief mention and transition rapidly into how it demonstrated that you are a mover and shaker who took a universal experience and, by virtue of your work ethic and intellectual curiosity, turned it into a contribution to science.

You get a pass on writing about universal experiences if you can pull off a convincing reason to keep the midnight reader going; otherwise, keep your essay distinctive and befitting the professional you hope to become.

Couples' Match

by Michelle A. Finkel MD, Insider Medical Admissions

I've received a few questions about the couples' match. Here is the information that the NRMP sends to applicants who inquire about it:

(Note the syntax mistakes are not mine :).)

Any two applicants may participate as a couple and may choose to link their individual rank order lists in the NRMP system so that corresponding pairs of programs may be considered together during the matching process.

Couples do not participate in a separate match. Each applicant register separately in the NRMP R3 System and then each partner must link themselves to the other partner in the “Update My Profile” Couples option, any time prior to entering their rank order lists. The rank order list function opens on January 15.

Programs consider, interview, and rank each applicant separately based on their individual merit or qualifications and not based on the fact that one is part of a couple in the Match. The NRMP does not indicate to the programs that applicants plan to enter their rank order lists as a couple.

Both applicants may rank the same or different specialties and programs. However, partners that rank the exact same program MAY possibly end up competing for the same positions in the program in this scenario.

Programs may be located at the same or different hospitals. The programs may be in any location preferred, such as the same city, neighboring cities, neighboring states or any other location of the applicants’ choice.

Prospective partners should determine early in their application process, as many acceptable locations of programs to apply to, so that they will have more workable combinations to rank (subject to interviews).

Couples have two unique options available to them in creating rank order lists:

· The same program of one partner may be ranked multiple times in combination with different programs of the other partner, increasing the possibility of one partner matching to a particularly desired program.

· After all combinations have been exhausted, one partner may also choose to go unmatched in order for the other to match to a program. The partner who is willing to go unmatched enters 999999999 opposite the corresponding program choices of the other partner. The partner who is unmatched will try to find a position through the “Scramble” for unfilled positions.

The R3 System tries to match your first choice and the partner’s first choice, your second and the partner’s second etc. until a match occurs or the entire rank order list is exhausted. Please note: The R3 System will only match you as a couple under this process. If it cannot match you as a couple, it will not try to match you as individuals. The coupling function is only done on the primary rank order lists of the two partners so any supplemental lists will be considered individually without regard for the coupling link.

Each partner of a couple will be billed $15.00. Additionally, for each program over 30 different unique program codes listed per each partner’s primary list, there is charge of $30.00 per additional program. For purposes of billing, even if the same unique program code number is used on one partner’s list more than one time in multiple combinations with different programs on the other partner’s list, it would count only as one code toward the 30 programs per list (no additional charge) limit.

Supplemental list fees per person are $30.00 per each unique program code over 30 programs ranked on all supplemental lists combined.

Please visit our website at www.nrmp.org under Residency Match and then click on the left menu on your applicant type and then on Couples to read further about the process.

Applying to Multiple Specialties

by Michelle A. Finkel MD, Insider Medical Admissions

Just a clarification for those medical students applying in multiple specialties: The program directors cannot see your ERAS Document Submission Form and will not be aware of the other programs to which you will be applying. I know this has been a question that has come up many times.

Contact me for ERAS and personal statement help.

NRMP Program Director Survey

by Michelle A. Finkel MD, Insider Medical Admissions

The results of the 2010 NRMP Program Director Survey are out. (The last survey was done in 2008.) This document is tremendously helpful, documenting what percentage of residencies (separated by specialty) use specific factors (personal statement, perceived commitment to the field, etc.) in interviewing and matching applicants. You can use this evidence to make a strategic plan for your candidacy. (Warning: The PDF is large, and the download may take a while.)

Please contact me now for help with your residency application. You want to submit as early as possible.

Double Vision

by Michelle A. Finkel MD, Insider Medical Admissions

I've had a couple of clients this season tell me that they had other professional editors revise their personal statements but that they want me to do a re-edit because they need my expertise. Instead of double paying for a second look, please come to me directly. I do outstanding work and expedite your edits. Here is my testimonials page. The number and caliber of remarks about my work says it all!

Why an Early ERAS Submission Will Help You

by Michelle A. Finkel MD, Insider Medical Admissions

When I was an Assistant Residency Director evaluating ERAS, I was impressed with residency applicants who submitted their materials early. I figured those were the people who were on-the-ball and would make reliable residents. Also, early in the season, when I had only a few applications to assess, I was able to spend extra time on each ERAS. Later in the season, when I was flooded with applications, I could only give each one its allotted time.

For those two reasons, I strong recommend submitting your ERAS on September 1. Please contact me now so that you can achieve that goal.

IMG Study

Here's an interesting article regarding a study published in Health Affairs that supports foreign-born IMGs' clinical work.

Interestingly, the research results also demonstrate concern over US-citizen IMGs' capabilities. It's worth a read.

Secondary Essays

by Michelle A. Finkel MD, Insider Medical Admissions

I've received several emails asking how to best answer the secondary essay question, "Why do you want to attend our school?"

Medical schools want to be assured that you know their institution, are seriously considering it and will fit in well there. I recommend doing your research on the school and linking something specific about you with the institution.

For example, if you tutored high school students in math, you might link your use of the Socratic method with the school's tutorial-based learning. In that way, you demonstrate a knowledge of the school, show that you connect with it and showcase an accomplishment.

Contact me for secondary essay help.

IMG Observership Letters of Recommendation

IMGs, be aware that working in a physician's office getting hands-on experience may be viewed as illegal. The Medical Board of California July newsletter has an interesting article on page five warning physicians that allowing IMGs to work in offices treating patients is "only lawful if the scope of the work is no more than a medical assistant would perform."

The article goes on to focus on letters of recommendation for residency written by physicians who work with IMGs. "While the Board understands the desire to assist the international graduate, letters written by physicians that indicate they have allowed the unlicensed international graduate to perform examinations and assist with patient care activities in their offices can result in a charge of aiding and abetting the unlicensed practice of medicine."

The article never explicitly defines a "medical assistant" but refers to the fact that this role only requires a high school diploma.

Plagiarism

by Michelle A. Finkel MD, InsiderMedicalAdmissions.com

In a recent study published in the Annals of Internal Medicine, investigators report finding “evidence of plagiarism” in personal statements in 5.2% of residency applicants to Brigham and Women’s anesthesiology, general surgery, internal medicine, OB-GYN and emergency medicine residency programs between Sept. 2005 and March 2007.

Applicants should be aware of this type of scrutiny. (I hope that candidates won't consider plagiarizing material for obvious ethical reasons!)

ECFMG ERAS Tutorials

by Michelle A. Finkel MD, InsiderMedicalAdmissions.com

The Educational Commission for Foreign Medical Graduates (ECFMG) has developed four tutorials to assist international medical graduates (IMGs) with the ERAS 2011 application process. Topics covered include

a) requesting a 2011 ERAS Token,
b) uploading a digital photograph,
c) completing an on-line Document Submission Form and
d) re-using letters of recommendation for Repeat Applicants.

You can access the tutorials here.
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MSAR Update

by Michelle A Finkel MD, InsiderMedicalAdmissions.com

I've been searching for a more updated summary of the MSAR; I still regularly use the one noted in this blog entry, but it is not this year's version. I have a summary that's more current but less clear; email me (insidermedical@gmail.com) if you're interested in it.

Bottom line: The numbers are virtually the same - only a bit higher, meaning it's gotten a little harder to get into medical school (no surprise).

Contact me for secondary essay editing.

Good Writing Means Never Having to Say, "I Want to be a Doctor"

by Michelle A. Finkel MD, Insider Medical Admissions

It's important to express to medical school admissions officers why you want to be a physician, but the key - as always - is to show, rather than tell. The content of your accomplishments and the skills and insight you have gained from them are compelling. Stating that you really, really want to be a doctor is not. (This is true for post bacc, residency and fellowship applicants too.)

Contact me for help with your medical school personal statement and secondary essays. Unlike other consultants, I do all of my own work - while maintaining quick turn around times. Here are copious testimonials about my work.

Clarifying Your Honors

By Michelle A. Finkel MD, InsiderMedicalAdmissions.com

A word to the wise: Be explicit about the honors you have earned. Although you may be aware that a position you garnered was competitive, the reader may not. For example, you could write

As an intern at the American Nonexistent Foundation, I completed two research projects.

Or you could write

Out of a pool of ninety applicants, I was awarded the selective American Nonexistent Foundation’s annual internship, where I completed two research projects.

See the difference?

Contact me for AMCAS and ERAS help. I do all of my own work (no outside, anonymous editors) and expedite my clients’ edits.

New ACGME Recommendations for Work Hours

By Michelle A. Finkel MD, InsiderMedicalAdmissions.com

The New England Journal of Medicine released last week the Accreditation Council for Graduate Medical Education (ACGME)'s latest duty hour recommendations. They are more stringent, providing more compassionate training for doctors and, hopefully, better care for patients. This table may be an easier way to visualize the changes.

I recall very clearly the week I worked one hundred and thirty-eight hours during my surgical rotation. I am still recovering :(.