Talented Pre-Meds: Leverage your Money

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

Well, it’s worth a try.

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

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

You Can Lead the Witness: Letters of Recommendation Part 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Match Day and Financial Security

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

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

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

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

An Offer You Can't Refuse

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

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

Bias in Residency Evaluations

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

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

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

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

As you can imagine, the applicant was not hired.

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

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

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

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

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

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

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

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

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

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

Yes, Sleep is a Medical Necessity

I found this short piece, "A Call for Sleep" to be an interesting and honest read. Throughout my life, I've had non medical people tell me that I should be used to a lack of sleep because of my training and night shifts (which I, thankfully, no longer do). If someone has fasted before, that doesn't mean she doesn't get hungry when she doesn't eat!

For applicants, I'll again say that it's critical to consider lifestyle and priorities when choosing a specialty.

Read the Fine Print

A few years ago, a medical school applicant told me the following story:

This pre-med decided to write follow up notes to all the schools at which he had interviewed, usually a good idea. However, he was upset to receive a brusque note from one of the institutions telling him that a) he should have read their policies; they do not allow post-interview contact and b) he was rejected from the school.

I found the school's note pretty severe, and I strongly suspect the post-interview contact was not related to his rejection. (As an aside, he successfully and happily matriculated at another school.) But this story is a reminder that it's important to read institutions' policies about post-interview contact. Most places welcome written updates, but it's essential to confirm before you send.

No One Wants to be your Second Choice for High School Prom Date

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 at your institution," or " I’m confident I can make a positive contribution." 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 and have been busy with them this season. Let me know if you need assistance.

After Your Residency or Medical School Interview: Is there Value in a Second Look?

After interviews - if permitted by the institution - there are several ways you can communicate with a medical school or residency. My favorites are brief thank you notes and well-written letters of interest.

But what about the "second look?" I've had many mentees ask me if re-visiting a school or training program after the interview day is valuable. Unfortunately, there may not be a definitive answer to this question because how a second look is perceived varies by institution.

The cons of the second look are cost and time. And perhaps even worse, there is the risk that you are imposing on the school or program. You don't want your request for a second look to work against your candidacy. On the other hand, the pros of a second look are a demonstration of interest and enthusiasm that many schools and programs are seeking.

If you are a pre-med and are wait listed at a medical school, I would generally recommend a second look if you can swing it. After all, you have every right to visit the institution you may be attending. If you go for a second look in this scenario, make sure to do a formal visit: Let the admissions office or Dean's office know you would like to spend the day and ask if you might have an opportunity to meet with students and even an admissions officer to support your candidacy.

If you are a residency applicant, it's hard to say if a second look will help or not. A residency director friend of mine says that a visit from someone who travels from far away might improve a candidate's standing by a few slots on the rank list at her program. That sounds like a tepid endorsement at best... If you are considering a second-visit, make sure to speak to the program coordinator. S/he might advise you against it or, on the contrary, let you know it's appreciated by the residency director.

As we all know, the residency and medical school interview scene is already stressful and expensive, so unless you are a wait listed pre-med - with all other things being equal - I generally would not push yourself hard to do that second look.

Pre-Med? Avoid a Big Mistake

Several years ago I was hired by a re-applicant who wanted to better understand why she did not get into medical school the prior year. She had a 3.9 GPA and a 40 on her MCAT (100% percentile). Yet, she had been rejected from all medical schools.

I looked through her materials and discovered the problem. The applicant had no clinical work at all. She had never been in the room with a patient. Many of you know that I like the saying, "No one wants to hire a chef who hasn't been in the kitchen." She had fallen prey to exactly that adage.

We talked, and I advised her regarding options she had for obtaining clinical experience. Fast forward a year: The client completed a robust clinical activity and was readily accepted to medical school (and felt more confident about her career choice).

If you are a pre-med, note that robust clinical experience is critical. Working as an EMT, in a good clinical care extender program, formally as a scribe (where you can also make some money), or in a low-income clinic are just some ideas for obtaining excellent clinical exposure. (Although you might think free clinics would be thrilled to have a pre-med volunteer, many understandably require one-year commitments.) Shadowing is a mixed bag: Medical schools don't know whether you're second-assisting in the operating room or just standing in a corner being ignored. If you choose to shadow, make sure you highlight any true clinical experiences and skills gained in your written materials. Other popular options for clinical experience include international work (although the activity is usually short-lived, which makes it less robust) and working as a volunteer in a hospital (although it might be more clerical than clinical, depending on the position. Do your research before accepting a "clinical" job). I've also had advisees who became certified, practicing phlebotomists and others who worked in veterinarians' offices to obtain procedural skills.

More important than getting into medical school (gasp), getting robust clinical experience will help you ensure you've made the right career choice. Simultaneously, you'll demonstrate to admissions officers that you can handle the heat.

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

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

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

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

A Novel Approach: Reading throughout your Rotations

I have a thoughtful advisee who told me about an interesting plan she made for herself: As she rotated through different specialties during medical school, she read a book appropriate to each field. For internal medicine, she read "Being Mortal," by Atul Gawande. For neruology, she read the classic "The Man who Mistook his Wife for a Hat," by Oliver Sacks. For surgery, she read "When Breath Becomes Air," a beautiful book by Paul Kalanithi. The list goes on.

I was impressed by this contemplative approach to third and fourth year. So many of us are understandably focused on Shelf Exams and letters of recommendation that we don't give ourselves a chance to comprehensively reflect on our subject matter and patients' experiences.

If you have a moment, please check out a few book recommendations I have for those in the medical field. Perhaps my advisee's stellar plan can be one that other medical students adopt.

Happiness: Part 2

Last week I posted about happiness. Unfortunately, I have recently spent a lot of time at an academic medical center with a sick family member. The hours I’ve spent there have made me think further about contentment in medical school and residency.

What I noticed about this highly academic hospital is that the care is outstanding, but the atmosphere is much more collegial than the setting in which I trained. The doctors and nurses are extremely bright and competent. They are also kind and approachable.

The institution at which I trained (and it may have changed in the 12 years since I left) did not have this culture. I experienced unchecked sexism, arrogance, and standoffishness. As I interacted with the physicians and nurses recently, I realized that I probably would have been much happier at an institution that better matched my personality. (Having said that, I met many of my dearest friends and my husband during medical school, residency, and as an attending, and I would not change any of that.)

Bottom line: Yes, reputation is a factor, but culture is really key. You can oftentimes train at an equally excellent place where you will happily fit in.

After all, we’re talking years of your life here. 

Happy Medical Training: An Oxymoron?

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

I'm not trying to be a downer here! I want to encourage applicants to consider this happiness quotient when selecting an institution and training program. 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.

Do-It-Yourself Exit Strategy: How I Stitched Together My Own Golden Parachute

Over a decade ago, I was seated in the emergency department with a colleague when I inquired about another one of our physician co-workers I'd not seen in a while. “Oh, she’s on the Mommy Track,” my colleague said and picked up another chart, without giving his words a second thought. To me, selecting a career path that sacrificed career advancement for more time to raise children was legitimate. My colleague’s pejorative “Mommy Track” made it clear that to him, it was not.

At that sad moment, I resolved to pursue a non-clinical supplement to my emergency department work, colloquially known as an “exit strategy.”

Read more on Student Doctor Network here...

DO vs. MD

Thinking about a medical school application for 2018, I’ve had a few industrious pre-meds ask me about DO school. There was an excellent article in the New York Times a few years ago about what doctors of osteopathy do and how their admissions criteria are different from allopathic schools’. It’s here and worth a read.

The topic of DO schools is an enormous one. A few quick points many candidates don’t know about DOs:

1. Many doctors of osteopathy practice medicine just like allopathic doctors do. I do per diem emergency shifts at Kaiser and work with many DOs. Candidly, I usually do not know which colleagues have osteopathic degrees and which have allopathic ones unless I see a prescription blank or a signed computer note.

2. If applying to osteopathic school, candidates are generally better off with at least one (strong) letter of recommendation from a DO supervisor.

3. Osteopaths currently take the COMLEX for their board tests, instead of the USMLE. If an osteopathic medical student wants to enter an allopathic residency, s/he may need to take the USMLE in addition to the COMLEX. On the other hand, there are many allopathic residencies that accept the COMLEX. Also, there is talk that in the future (when exactly is unclear, however) there may be just one board test that both groups take.

4. The osteopathic Match occurs before the NRMP Match, a fact that can be difficult for osteopaths applying to both types of residencies. If those applicants are successful in the osteopathic Match, they cannot enter an allopathic residency. If, on the other hand, they wait and enter the NRMP Match, they run the risk of simply not matching.

Again, this topic is complicated and nuanced, but the DO option is a great one for some applicants.

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

One of the more frustrating aspects of the medical school and residency admissions processes is the lack of response from some institutions. There is no obligation for medical schools or residency programs to reply to a candidate, which leaves applicants in limbo.

If you have not heard back from medical schools or residency programs to which you've applied, I recommend that you contact (preferably call) the institutions to inquire about your status.

After I offered that advice to a residency applicant I was advising, she emailed me to say she obtained an interview in a competitive specialty with a phone call. Another said she received two preliminary interviews with simple emails. (I recommend calls over emails, however, because it's hard to ignore someone on the other end of a phone line. Still, if you simply can't bring yourself to call, an email can be effective.)

I've seen this phone call strategy work for medical school interviews as well: Several years ago I helped a strong applicant who had been rejected by a top medical school. He thought he was a very good fit for this particular institution, so he called the school to make his case. Surprisingly, after the applicant's phone call, the school granted him an interview, reversing their original rejection. Ultimately, after being initially rejected, this applicant was admitted to that top school. Of course, this is an exceedingly rare occurrence. But to me, the moral of this story is that it is worth being assertive in the application process.Now, if the school or program explicitly asks in written materials that you don't contact them about your status, then calling is not a good idea.

An additional strong option is to send an effective update letter or letter of recommendation from an influential writer (alumus, for example). I do edit letters of update/interest for medical school and residency applicants, but even if you choose not to use my services, I recommend sending a well-written, strategic note in addition to making a phone call.

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

Some People Have Real Problems

The residency and medical school application processes are anxiety-provoking, but in honor of Thanksgiving, I'm posting this guest blog from CrispyDoc David Presser about a truly stressful, heartbreaking choice a patient recently had to make...

Years ago, I bought an album because the title caught my eye: Some People Have Real Problems. I was browsing used CDs in a music store back when both of those existed, and I felt the universe trying to restore perspective to my personal pity party.

Fast forward a decade, and I had fallen off the wagon again into whining doctor mode: headed into my second weekend night shift in as many days. The first night had been a killer, where the spigot of patients opened to a steady gush around 1 A.M. and all four of the late shift docs stayed several hours past the end of their shift to flush the proverbial toilet that our waiting room had become.

 

Read more of this article...

So Easy for You to Do: Medical School and Residency Interview Thank You Notes

A few years ago a medical school applicant wrote me to say that the dean of the school at which she had recently interviewed called her to tell her that he was impressed with her candidacy and the hand-written thank you note she had sent. The client thanked me for my help and the thank you note tip I had given her. As you might have guessed, she was admitted to that medical school.

Writing a thank you note after a medical school or residency interview is so easy for you to do, and it can go a long way. 

Now, I get asked by clients what the best way to send post-interview thank you notes is - email or snail mail. I strongly advise sending your thank you note by good old USPS. The reasons are:

1) Email may be viewed as lazy. Handwritten notes demonstrate you've put some time into being appreciative.
2) Email can be deleted without much thought. Emotionally, it's harder to throw someone's handwritten note in the trash.

Get your 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.

Emergency Medicine: Queen, Rodney Dangerfield, and George Clooney All Rolled into One

Check out the below, a great post called "We Are the Champions?!" written by Crispydoc (Dr. David Presser) on burnout in emergency medicine, a field that towers over the others in burnout statistics:

It’s official: a study published in the Mayo Clinic Proceedings showed that as of 2014, Emergency Medicine (EM) took the top slot for physician burnout (59%).  Suck it, critical care (50%). In your face, OB/GYN (56%).  We’re #1, we’re # ...huh?

How did my beloved field of EM win the race to nowhere?  When I was in medical school, the pioneering faculty insisted that EM’s reputation for early burnout was based on the fact that those docs who’d burnt out had trained in another field, couldn’t hack it in their chosen specialties, and ended up woefully underprepared to spend their careers in EM.  As a medical student, I saw EM transform from Rodney Dangerfield disrespected to George Clooney sexy.  A full 13% of my class at UCSF matched in EM.  We smugly believed we knew what we were getting into, and we took for granted our ability to work as lifers.

Read more of this article (and see an awesome Queen video to boot)...

Your Residency Application: What Do Program Directors Really Want?

Imagine that you're a program director (PD) going through scores of ERASes and interviews. What questions would you ask yourself as you assessed 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, 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 approach your interviews, consider how you can 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, extra curricular activities that demonstrate teamwork, and - if asked - hobbies and reading materials that demonstrate your personality. For the latter, highlight research projects in the specialty, sub-internships, and knowledge about the program and city.

Making sure the PD knows you are not going to cause him/her trouble is at least half the battle.

White Coat Investor Scholarship Winners Announced

For the past few years, the White Coat Investor has funded a scholarship for full-time professional students, including those in medical, osteopathic, dental, law, pharmacy, nurse practitioner, physician assistant, optometry, and podiatry schools. The goal is to both reduce the winning students' debt burden and spread "an important message of financial literacy throughout medical, dental, and other professional schools."

This year's first place winner's essay is here. It's great and worth a read. Second through fifth places can be found here. Keep your eye out for next year's contest. The financial support is significant. 

I Believe

I was recently speaking to a friend who is a law professor at a prominent institution. He teaches first-year law courses and thus, meets students when they are just entering their careers and not yet polished. He was telling me that he is taken aback by how many of his students use "I believe" before their statements in class. The preface "I believe" diminishes the student's point; my friend is looking for persuasive pronouncements, not thin opinions. 

Consider this issue when interviewing. Note the difference between "I'll make a strong medical student" and "I believe I'll make a strong medical student." The latter introduces that inkling of doubt you don't want to impart.

I have advisees who worry about saying "um" or "uh" during interviews. (I advised a pre-med who, in preparing for interviews, asked his girlfriend to gently slap his hand every time he said "um" so he'd experience negative consequences. Yikes!) As I tell my mentees, I'm not worried about an "um" or an "uh." (Note President Obama, well-known to be an excellent orator; he inadvertently uses vocal pauses when he speaks.) 

Instead, the key to a persuasive interview is to have confident responses that are bolstered by persuasive evidence. 

What Is the One Thing You've Learned...?

I was with my children at a four year-old's birthday party a few years ago when I met the grandfather of the birthday-boy. As it turned out, before retiring, the man had been on the admissions committee of a prestigious medical school for decades.

So, I asked him, "Looking back at all of those years of experience, what is the one thing you learned from interviewing medical students?"

The man chuckled and said, "They have no idea what they're getting themselves into."

In life, we never have any idea what we're getting ourselves into, but I think of this man every time I practice the question "What will you like least about being a doctor" or "...least about being a [insert your medical specialty here]" with my medical school and residency mentees, respectively. Saying you'll love everything about being a physician or psychiatrist or pediatrician or internist sounds disingenuous and naive. You need to show that you have some idea what you're getting yourself into.

Having said that, I would avoid tacky topics like money. And talking about how horrible night shifts are is not going to win you many points. But a sophisticated applicant can infer what the challenges will be in medicine or in her specialty and can express them with aplomb.

...As with everything, practice your answer in advance.

Accomplished, Not Lovely

Last week I went to hear the author Nicole Krauss speak about her recently-released novel Forest Dark. I am a big fan of Krauss' writing. The day I heard the author speak, she had published an opinion piece in the NYT Sunday Magazine called "Do Women Get to Write with Authority?" In the article, Krauss speaks about the lack of authority that women writers have compared to men, and specifically, how female artists' work is often characterized as "lovely," a word she describes as lacking in "independent power."

I must admit that I sometimes use the word "lovely" (both for women and men) when I like someone. But Krauss made me think about the word in the context of achievement - not personality - and her point is well-taken.

What does this have to do with medical school and residency admissions? When you interview, you want the faculty member to leave the table saying you were "accomplished," not "lovely." Many applicants miss this point: You don't want to simply be liked; you want to be seen as worthy. It's important that you focus on that important goal as you practice for interviews. 

As an aside, I have not gotten a hold of Forest Dark yet, but I would strongly recommend Krauss' Great House and History of Love.

Four Ways to Save $ in the Medical School and Residency Interview Processes

1. If you are ambivalent about an institution, schedule your interview later. By late-season you may decide not to interview there at all, saving you some money.

2. Group your interviews geographically. If you think this is impossible, consider this: There is nothing wrong with calling an institution you are waiting to hear from and politely letting the assistant know you have been invited to interview at a nearby school/program. Let him/her know you can only afford to fly out to the area once and ask if the admissions committee/ residency might be willing to let you know now if the institution will be offering you an interview. Believe it or not, this technique sometimes works.

3. Check out travel web sites daily or better yet, set an alert on Kayak or Google flights. Occasionally, a low price is available only if you catch it quickly.

4. Consider staying with students/residents if the institution offers. Hotels can be expensive, and sometimes you can gather useful information about the school/program this way. Just beware that anything you do or say may be repeated to the admissions committee/residency. (Make sure to write a thank you note.) 

Don't Let Other People Freak You Out

I started Insider Medical Admissions over a decade ago, so I've been in admissions consulting for a while. I'm pretty good at spotting trends. Every year about now I start getting emails from clients saying they're worried about their lack of (or minimal number of) interview invitations. Yes, even as early as mid-September folks are concerned. They say they have a classmate who says he's gotten an interview invitation or they read online that others are being contacted with invites.

Sure, it's possible some people are getting very, very early interview invitations. But, it's rare and should not affect your confidence. After all, according to Amy Cuddy, whom I've referenced before, confidence is the name of the game when it comes to interviews. 

So, simply stop checking online and minimize conversations about interviews with others. If you are in the thick of the season and you still haven't gotten any interviews, then you'll need to reassess and act. But for now, put in ear plugs. This process is so very stressful; you certainly don't need to seek out more anxiety-provoking information (and who even knows if it's accurate anyway!). 

ERAS 2018 Timeline: Don't Lose the Forest for the Trees

As many of you well know, September 6 was the date that candidates could start applying to ACGME-accredited residency programs (and September 15 will be the date that ACGME-accredited residency programs start receiving applications). I am a big fan of getting your ERAS in on the early side: It demonstrates commitment, and when I was reviewing applications as an Assistant Residency Director, I found my workload was lighter earlier, allowing me more time to spend on those initial applications.

Having said that, do not over focus on an early application such that your written materials are suboptimal. Every year I encounter panicked candidates who want to submit their poorly written documents simply to get them in, shooting themselves in the proverbial foot. 

Find a balance. Yes, submitting early is wise, but not at the expense of your candidacy's success.

Medical School Interview Questions: How to Handle the Illegal Ones

In the United States, a professional interview is subject to basic legal rules. Specifically, admissions officers should refrain from asking medical school interview questions that are not relevant to the position the interviewee is seeking. Questions about race, religion, sexual orientation, and marital or family status fall into this category.

If you are asked these types of questions, you can simply answer - if it's not distasteful to you - or respond by addressing the intent of the question without revealing personal information. ("I think you're asking if my home life will affect my ability to carry out my medical school studies or my clinical duties. I can assure you it won't, and I’ll complete my full tenure here at your school.")

If you have the opportunity to give feedback to the institution about your medical school interview questions or experience, you can consider doing so after the interview. When I was interviewing for residency, I was asked by a faculty member if I had a boyfriend. After the interview day, I talked to a faculty mentor at my school who reported the situation to the other institution. The faculty member who asked me the illegal question was no longer permitted to interview.

Difficult Interview Questions: Learning to Hit a Curveball Out of the Park

You put your heart and soul into your compelling, charismatic personal statement; you showcased your accomplishments and drive to succeed in your activities section; and you demonstrated the endorsement of respected faculty allies in your letters of recommendation. Now your hard work has paid off and helped you get a foot in the door: You’ve been invited to interview at your dream medical school or residency program.

Like the ghost stories we told around a campfire as children, interview horror stories have a certain inexplicable staying power. I can still recall a friend’s recounting of an acquaintance’s experience in an Ivy League faculty member’s office: The acquaintance was asked to open the window, only to find (after sweating bullets for several minutes) that it was nailed shut. This trick was allegedly this professor’s cruel attempt to assess how the interviewee coped with adversity. Some weeks later, I recounted the tale to a mentor, who told me that the same story had made the rounds 20 years earlier. The power of this terrible tale faded once I recognized it for the myth it was. This ability to demystify the medical school or residency interview is crucial to framing it as an opportunity for showcasing your strengths. Read more...

Women, Make Sure you Practice Before Heading off to your Medical School and Residency Interviews

I found this article about the need for women to be seen as warm in order to be seen as confident troubling, but it's worth noting the facts so that you can strategize accordingly. Previously, these authors published data that women tended to rate their abilities accurately, while men tended to be overconfident about theirs. All of this is to say, that women (and men!) need to practice interview skills prior to the big day. Growth mindset and power posing are also important concepts to review before you interview. 

Medical School and Residency Interviews - Power Posing

As medical school and residency interviews approach, I want to remind everyone about Amy Cuddy, the Harvard faculty member who speaks about the psychology of power, influence, and nonverbal communication. Her research shows that a "fake it until you make it" philosophy and "power posing" practices improve your performance in interviews. Cuddy's TED talk has been viewed over 42 million times.

NRMP® Data Suggests Residency Applicants Should Apply Broadly

In their publication Impact of Length of Rank Order List on Main Residency Match Outcome:2002-2016, the NRMP reports that matched applicants consistently have longer rank order lists than unmatched applicants.

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

Are you a Residency Candidate Applying in More than One Specialty? Read this.

If you're planning to apply in more than one field, you have a challenging road ahead of you, and you should strategize accordingly. Remember that, although your ERAS activities cannot be individualized to different residency programs, your personal statement and letters of recommendation can. Demonstrating commitment to each field through your essay and letters will be a challenge, so take time to write thoughtfully, and make sure you speak candidly to your faculty recommenders.
 
Above all: Ensure that you assign the correct specialty-specific documents to the correct programs!

Allopathic Residency Candidates, Check out this Super Useful AAMC Data

I recently found this AAMC website that provides USMLE Step 1 and Step 2 CK Scores of (2015-2016) first-year residents by specialty. You can look up your desired specialty and then cross check your Step 1 score with your Step 2 score. The chart tells you how many applicants (and what percentage) successfully matched with those Step numbers in your desired specialty - helpful for predicting application success in a chosen field. Check it out.

How to Draft a Strategic Residency Personal Statement

Each year residency applicants ask me if they need to showcase their accomplishments in their residency personal statements if they've already drafted strong ERAS activities sections. The simple answer is yes.

First, remember that you don't know at what part of your application the readers will be starting. If a residency director peruses your personal statement first and it's thin and boring, you'll have lost that reader from the beginning.

Also, note that the faculty members seeing your application are reading many more ERASes than just yours. If you only mention an important achievement once in your application, the program director might simply forget your accomplishment. After all, s/he is reading hundreds of similar applications. Your readers need to be reminded several times of your candidacy's strengths. (You'll mention those accomplishments again in your interviews.)

To a program director who hasn't yet met you, you are what you've done. You need to use substantive examples of your achievements to demonstrate your worthiness for a potential residency position. Evidence is persuasive; use it!

Looking for a Laugh?

Over a decade ago the American College of Emergency Physicians solicited its members to submit a true story to the television show "Untold Stories of the ER." Lo and behold, my story was chosen, and my husband and I were invited to act in a fictionalized rendition of my tale. If you're interested in seeing it, check out Netflix's "Untold Stories" episode 17.
Enjoy!

Be an Adult: Don't Accept Helicopter Parenting

Check out this hilarious (and sad) piece in the New York Times about helicopter parenting and note that two of the anecdotes are physician related. (Can you imagine interviewing for an attending position with your dad present?)

My policy at Insider is to work exclusively with applicants (not parents or spouses) to maintain confidentiality, avoid redundancy, and ensure candidates assume primary responsibility for their work. It's a winning strategy.

Reading this Article Could Make You Wealthier than Working Long Hospital Shifts

Work smarter, not harder. Read this funny, informative Student Doctor Network article by CrispyDoc on financial literacy for the newly minted physician. Have little idea what an "alternative asset class" really means? Don't know which is a bear- and which is a bull-market? This piece is for you. Learn that do-it-yourself investing is not that hard with the technological tools now at our finger tips and start saving so that you can gain financial independence early and avoid burnout.

Also, make sure to check out CrispyDoc's awesome blog for tips on financial independence and finding your mojo in and out of medicine.

Inaccuracies in Medical Student Grades Translate into Residency Application Strategy

Here's an interesting article by Dr. Pauline Chen on medical student grades. In reading the article, residency applicants should reflect on how important the content of their letters of recommendation is, especially in the setting of medical school grades that may be inflated or simply inaccurate. The 2016 NRMP Program Director Survey supports the importance of letters, as well, with statistics. Make sure your letters are very strong; remember that mediocre letters should not be a part of your residency package.

Writing Your Own Residency or Medical School Letter of Recommendation: Is it Ethical?

It's not infrequent that an applicant tells me that a letter of recommendation (LOR) writer has asked the candidate to draft his/her own letter because the writer is "too busy." I notice that medical school and residency applicants are a bit sheepish as they tell me about this arrangement. Have no fear: You are not doing anything unethical. (Here is an old piece by the New York Times ethicist Ariel Kaminer regarding this exact topic.)

If a faculty member asks you to write your own letter, not only should you do it, but you should do it with zeal. Make sure you showcase the accomplishments that distinguish you from other candidates and highlight traits that are important for your future career path. Use honest - but bold - adjectives to describe your best qualities.

Remember that the letter writer has final say, so even a busy faculty member might modify the letter. Keeping this fact in mind might alleviate your (unnecessary) guilt and should encourage you to write the strongest letter you can. (It's harder to go from outstanding to mediocre than from outstanding to excellent.)

Medical School Help: What are the Next Steps Once the AMCAS is Submitted?

Once your AMCAS is in, what can you do next to best prepare for what's to come in the medical school admissions process?

Here are a few tips:

1. Start to draft secondary essays. Even if you haven't yet received the prompts, you can begin to craft responses to common themes like "how would you add diversity to our school?" and "describe an extracurricular activity that might be of interest to the committee." Good writing takes time, but if you wait for the onslaught of secondary applications, you won't be able to impart your essays with your highest quality effort.

2. Get a head start on preparing for the medical school interview. Practice, practice, practice. Start mocking up answers to interview questions so that you distinguish yourself.

3. Consider what you want. Do some soul searching to determine what you are really seeking geographically, philosophically, and educationally. You want to make considered decisions when the time comes.

A Book that Will Break your Heart and Renew your Commitment to Medicine

This is a stressful time for medical school applicants and residency candidates alike. I recently wrote a piece for Student Doctor Network with five suggested books for training doctors, reads that might relax you a bit while you learn something about your future career. I want to add another recommendation: Paul Kalanithi's When Breath Becomes Air. Get ready to cry your eyes out, while appreciating beautiful prose and insightful content. Paul Kalanithi was diagnosed with metastatic lung cancer when he was a senior neurosurgery resident at Stanford. He chronicles his short life in a book that's hard to put down. 

Insider Medical Admissions Searchable Blogs

Have a specific medical school or residency admissions question? Don't want to rifle through blog entries individually?

I've been writing my blog since 2008 and have a wealth of answers to your questions - all free.  But many folks do not know what I have two platforms on which my blog is published.

The first is on my website here. The entries are all tagged, so you can pick a topic and search using that tag.

The second is on Blogger here. This one allows you to search any phrase in the right margin (about a third of the way down the page).

Either way, feel free to use the blogs to get your questions answered easily and quickly.

Ten AMCAS Mistakes You Absolutely Want to Avoid

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

1. Don't write to write, and don't fill to the maximum character count unless necessary. While you want to include many strong achievements, you do not want your AMCAS to be so wordy that your reader is tempted to skim.

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

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

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

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

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

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

8. Don't merge the descriptors with the most meaningful paragraphs because they are separate sections: You can complete descriptors for up to 15 activities with up to 700 characters each plus up to three most meaningful paragraphs of up to 1325 characters each.

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

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

Be A Dirtbag Millionaire

For many of us, medical training means taking on significant debt and learning to manage complex personal finances. Many financial advisors "specialize" in physicians (like wolves who specialize in sheep?), and young doctors have a reputation as easy targets. 

How can you defend yourself against financial predators, kill your debt early, and learn to manage your own portfolio? (And where can you even learn what a portfolio is?) Crispy Doc offers a blog dedicated to financial literacy for the newly minted physician with an emphasis on early financial independence for doctors.  

Check out his blog, and learn from Crispy Doc's recent Student Doctor Network article. 

Brevity

I've started editing a lot of medical school essays of late, and I want to give a shout out to the importance of brevity. I focus on a work count of 700 or fewer for my advisees for a few reasons: First, I've found that that number is just the right balance of content and streamlining. Under 700 words for an admissions essay leads to a lack of substance, and more lends itself to meandering writing.

Second, your reader is likely stuck reviewing tens or even scores of applications in a short period of time. S/he is looking to spend as little time as possible on your written materials, while still getting a good flavor for your candidacy. Don't burden your reader with verbiage.

Here's a helpful trick: Imagine AMCAS or ERAS is charging you $10 per word. How would you keep costs down?