The Ins and Outs of Choosing a Specialty: The Generalist vs. The Early Committer

For many third-year medical students, this is a challenging time of year: Contemplating an ERAS application can be daunting, but it's even worse if you don't know what specialty you want to practice. Here's a short piece I wrote with my colleague David Presser, MD, MPH called "Choosing a Specialty: The Generalist vs. The Early Committer," and here's a complementary (non-medical) New York Times article called "You Don't Want a Child Prodigy" that's a great follow-up piece.

An Oversupply of Emergency Physicians?

When I applied in emergency medicine (EM), I had only two other classmates submitting applications to the field. EM wasn't a very popular specialty, although that would change as the show ER became hotter. Although enthusiasm for the field has generally increased over my career, medical students' interest in EM has waxed and waned.

Recently an eight-organization consortium of EM groups analyzed the field's workforce, demonstrating an oversupply of emergency physicians likely to appear over the next decade. There are a number of reasons proposed, including the proliferation of EM residencies and inappropriate use of physician extenders. Take a look at this piece in ACEP Now for detailed information, especially if you see EM in your future.

AMCAS Opens for Submission on Thursday

The AMCAS open-for-submission date is this Thursday, May 27. While submitting on Thursday is to your advantage because of rolling admissions, getting that application in at 9:30am EST on May 27 is not worth losing your mind over, so if you simply can't, please don't kick yourself.

If you're wrapping up your work and have your written materials in a superior state, just keep moving and get your application submitted promptly. If you're behind the eight ball and don't feel that you can craft outstanding written materials speedily, consider waiting a year to apply. Every season I encounter re-applicants who, during the previous cycle, submitted their AMCASes in August or September...thus making them re-applicants :(. 

Expert Writing Tips

With AMCAS' submission open date fast approaching (on May 27), I thought I might lower the boiling point a little by offering an amusing group of writing tips based on the wit of the late author William Safire and copywriter Frank LaPosta Visco. Enjoy!

A writer must not shift your point of view.
Always pick on the correct idiom.
Analogies in writing are like feathers on a snake.
Always be sure to finish what
Avoid alliteration. Always.
Avoid archaeic spellings.
Avoid clichés like the plague. (They're old hat.)
Avoid trendy locutions that sound flaky.
Be more or less specific.
Comparisons are as bad as clichés.
Contractions aren't necessary.
Do not use hyperbole; not one in a million can do it effectively.
Don't indulge in sesquipedalian lexicological constructions.
Don't never use no double negatives.
Don't overuse exclamation marks!!
Don't repeat yourself, or say again what you have said before.
Don't use commas, that, are not, necessary.
Don't be redundant; don't use more words than necessary; it's highly superfluous.
Eliminate quotations. As Ralph Waldo Emerson once said, "I hate quotations. Tell me what you know."
Employ the vernacular.
Eschew ampersands & abbreviations, etc.
Eschew obfuscation.
Even if a mixed metaphor sings, it should be derailed.
Everyone should be careful to use a singular pronoun with singular nouns in their writing.
Exaggeration is a billion times worse than understatement.
Foreign words and phrases are not apropos.
Go around the barn at high noon to avoid colloquialisms.
Hopefully, you will use words correctly, irregardless of how others use them.
If any word is improper at the end of a sentence, a linking verb is.
If you reread your work, you can find on rereading a great deal of repetition can be avoided by rereading and editing.
It behooves you to avoid archaic expressions.
It is wrong to ever split an infinitive.
Never use a big word when a diminutive alternative would suffice.
No sentence fragments.
One should never generalize.
One-word sentences? Eliminate.
Parenthetical remarks (however relevant) are unnecessary.
Parenthetical words however must be enclosed in commas.
Place pronouns as close as possible, especially in long sentences, as of ten or more words, to their antecedents.
Placing a comma between subject and predicate, is not correct.
Proofread carefully to see if you any words out.
Prepositions are not words to end sentences with.
Profanity sucks.
Subject and verb always has to agree.
Take the bull by the hand and avoid mixing metaphors.
The adverb always follows the verb.
The passive voice is to be avoided.
Understatement is always best.
Use the apostrophe in it's proper place and omit it when its not needed.
Use youre spell chekker to avoid mispeling and to catch typograhpical errers.
Who needs rhetorical questions?
Writing carefully, dangling participles must be avoided.

Choose the Right Category for your AMCAS Experiences

AMCAS provides 18 categories in which you can classify your experiences. They are:

Artistic Endeavors
Community Service/Volunteer – Not Medical/Clinical
Community Service/Volunteer – Medical/Clinical
Conferences Attended
Extracurricular Activities
Hobbies
Honors/Awards/Recognitions
Intercollegiate Athletics
Leadership – Not listed elsewhere
Military Service
Other
Paid Employment – Medical/Clinical
Paid Employment – Not Medical/Clinical
Physician Shadowing/Clinical Observation
Presentations/Posters
Publications
Research/Lab
Teaching/Tutoring/Teaching Assistant  

Sometimes an activity can match two categories. When that happens, lean on the clinical categories, if applicable. (For example, if your activity is both Leadership and Community Service - Medical/ Clinical, choose the latter.) If clinical is not relevant, then choose the category in which you have the fewest activities.

A client who came to me as a re-applicant a few years back told me that a school from which she was rejected indicated that they had not counted a clearly clinical activity as clinical because she had classified it differently. So be sure you consider the categories deliberately in crafting your AMCAS.  

How To Craft Stand-out Most Meaningful Paragraphs

Back in 2012, seemingly out of the blue, a new component appeared on AMCAS®. Applicants were being asked to identify up to three of their most significant extracurricular experiences and support their selections with more writing. The instructions stated:

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.

Now the Most Meaningful Paragraphs are par for the course, but applicants routinely make a few avoidable errors in crafting them. Here are tips to do your best work:

1) Don’t merge the descriptors with the Most Meaningful Paragraphs; they are separate sections: You can complete descriptors for up to 15 activities with a maximum of 700 characters each, plus up to three Most Meaningful Paragraphs with a maximum of 1325 characters each. The fact that these are two different tasks might seem clear to some, but every year, I receive AMCAS drafts to edit with merged descriptors and Most Meaningful Paragraphs. 

2) Don't use patient anecdotes in your Most Meaningful Paragraphs: Most medical school applicants have patient vignettes to share, which means that a patient story does not distinguish an applicant from the masses of other candidates. Also, these patient stories can sound trite or even inadvertently condescending. Talk about yourself instead. (See below.)

3) Don’t repeat what you've written in your descriptor. The Most Meaningful Paragraphs are an opportunity to delve deeper into your achievements. Let’s say you're showcasing your experience as a teaching assistant (TA) who was promoted to head TA or simply asked to return the next semester. Highlight teaching achievements that propelled you to get the lead position or the return invite. Did you offer an unconventional way of learning the difficult material? If so, what was it? Did you provide service that was above and beyond what was required? If so, what exactly did you do and how did it help your students? Did you get excellent teaching reviews? By delving deeper, you can truly demonstrate 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.” Make sure you address at least one of the three topics mentioned in the prompt - transformative nature, impact, and/or personal growth - in your Most Meaningful Paragraph. 

Bottom line: The Most Meaningful Paragraphs are an opportunity for you to demonstrate your distinctiveness and worthiness for medical school. Write substantively to make sure you don’t waste the opportunity to further your candidacy.

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

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

You Can't Be It If You Can't See It

I had the great opportunity to see the film Black Men in White Coats last week as part of an HMS alum event. The documentary follows several African American male doctors and, in particular, the founder of the Black Men in White Coats organization Dr. Dale Okorodudu, a pulmonary and critical care physician. Here's the trailer for the film. 

African American men represent only 2% of all physicians, and they are applying to medical school in lower numbers than decades ago. Dr. Okorodudu is trying to improve those numbers through his organization's efforts, including impressive outreach to kids.

If you have a chance to see the film, I highly recommend it. 

What Makes New Yorker Articles So Good?

I have a dear medical school friend who gifts my family the New Yorker every year at the holidays. The New Yorker is one of the best Chanukah presents we receive, and we get to appreciate it weekly, which makes it even better than the usual candy and fruit baskets. What makes New Yorker writing so good is that the journalists offer facts and then let the reader make his/her own assessments. A subject's own words or the description of his/her home office or clothes or even gait tells it all. There is no need for convincing.

Currently, as I'm editing medical school essays, I'm reminding my clients of the importance of that principle in writing a strong personal statement. To an admissions reader who hasn't yet met you, you are what you've done. It's the facts that matter. You need to use substantive examples of your achievements to demonstrate your worthiness for a potential medical school position. Evidence is persuasive; use it!

Tomorrow Belongs to Those Who Can Hear it Coming: AMCAS is Opening Next Month

This year's AMCAS application will open on May 3 at 9:30AM EST, and candidates will be able to submit their AMCAS applications beginning on May 27 at 9:30AM EST. 

Because of rolling admissions, submitting a complete application early in the cycle has distinct advantages at many schools. That doesn't mean you should submit suboptimal written materials on the twenty-seventh; it means you should start early enough that you are offering your best work.

Rolling admissions means that a school takes applications in the order in which they are received and makes decisions about interviews and then acceptances, accordingly. So, as times goes by, there are fewer interview and admissions offers remaining to be made. Think of an auditorium whose doors open to allow guests in. Those in the front of the line get the seats, and those who come later may not have a chair to sit in. 

If your application is not complete, your candidacy may not be evaluated early when there are more opportunities for interviews and admissions. So, if you have not already, get started immediately. It could make a huge difference in your available opportunities.

How to Use the MSAR to Your Advantage

The Medical School Admission Requirements (MSAR) is an online database that allows users to search, sort, and compare information about U.S. and Canadian medical schools. The 2021 MSAR is out, and if you are applying to medical school, I'd recommend purchasing it ($28 for one year and $36 for two) because it provides so much information about schools and their admissions statistics. The MSAR allows you to sort and compare schools by median MCAT scores, AMCAS GPAs, and other criteria.

You should use the MSAR to help determine which schools are in your range and which are "reach" schools. While it's fine to have a lot of reach schools  (if you can afford it), it's critical to ensure you are applying wisely to schools that match your numbers; in other words, do not apply to reach schools at the expense of those in your range. The advantage of the MSAR is that you can make evidence-based decisions. I've found some applicants have eye-opening experiences when they thoroughly review schools' statistics and either realize that their numbers are low and that they should apply accordingly or, happily, that they have numbers that match with top schools. Either way, reviewing the data is critical to good decision making.

 

White Coat Investor Podcast Interview

Two years ago this week (which may seem like a lifetime ago), I was honored to be the featured interviewee on the White Coat Investor (WCI) podcast. For those of you who aren't familiar with WCI, it's a website/blog/podcast founded by James Dahle MD, an emergency physician whose interest in personal finance and the FIRE (financial independence - retire early) movement has sparked a slew of physician devotees. My interview focused on how Insider Medical Admissions helped me create autonomy and flexibility while balancing a clinical career and a family. Check it out here or on your favorite podcast app. 

On Your Mark. Get Set. Go: It's Match Week.

At 11am EST today (8am here on the West Coast) applicant Match statuses becomes available and SOAP starts. If you're looking for a way to distract yourself with interesting material, take a listen to last week's wonderful Planet Money podcast on matching algorithms called "The Marriage Pact." The episode starts with a reference to my alma mater Stanford (go cardinal), reviews an innovative dating algorithm, and touches on the NRMP Match system. 

Match Week Starts Next Monday

Monday, March 15 starts Match Week 2021. For a comprehensive review of events, see the calendar here. Of note, SOAP starts at 11am EST and ends on March 18 at 3pm EST. On Friday, March 19 at noon EST, applicant Match results are available. 

SOAP is somewhat complicated, so if you have questions about the process, make sure you read about it. 

I'm wishing everyone good luck in the Match. If you are a current residency client, please email me with your results!

Implicit Bias in Medical School Admissions

I participated in a great Harvard Medical School webinar on implicit bias in medicine with cardiologist Dr. Quinn Capers IV, who is a dean at UT Southwestern Medical School. Dr. Capers has published work documenting racial and gender bias in medical school admissions, among other realms. He has also published recommendations on how clinicians and medical educators can mitigate implicit bias in patient care and candidate selection. 

In the webinar, Dr. Capers covered strategies to reduce or neutralize implicit bias, including 

1. Common identify formation - Ask interviewee questions about interests and activities that you share in common.

2. Perspective taking - Take the perspective of a member of the group against which you have unconscious bias.

3. Consider the opposite - When data seem to point to one conclusion, briefly look for information supporting the opposite conclusion before making a final decision.

4. Counter stereotypical exemplars - Spend time with or focus on individuals you admire from groups against which you have a bias.

Dr. Capers described providing an implicit bias "cheat sheet" that included these strategies to medical school interviewers at The Ohio State College of Medicine, where he previously worked. If you have a chance to hear a lecture by Dr. Capers, make sure to grab the opportunity. 

Administering COVID Vaccines is the Closest Thing I've Come to Attending a Party in a Year

As of this writing, I've administered 214 COVID vaccines. I've had the opportunity to vaccinate through a hospital in my area where health care workers and volunteers are eligible. The latter group includes some senior citizens who have been volunteering for decades at the hospital. 

I've vaccinated several people over 90; two people on supplemental oxygen - one who had just come from chemotherapy; one person who shared my birthday; multiple who are immigrants from Vietnam, Iran, and Mexico; one who had recently lost both her mother-in-law and mother to COVID; and someone who told me her only past allergic response had been to her husband.

If you have the opportunity and skill set, I highly recommend vaccinating. It is the most satisfying volunteer experience I've had. People are so grateful, and the mood is so celebratory. I've had my photo taken several times, and the hospital has music playing in the background. It feels like I'm at a bar mitzvah (without the food). 

Here's a piece on medical students who have joined the vaccination effort.

Your Match Rank Order List Should Be Completely Uncoupled from Institutional Feedback

I've recently received some email asking about how Match rank order lists should be affected by positive feedback applicants receive from interviewers and/or program directors. The answer is not at all. Because of the way the Match algorithm works, what programs think of you should have zero bearing on how you make your rank order list. See this recent blog that covers mistakes to avoid when making your list.

It's really impossible to know about the program's interest in you anyway. Even if a program tells you straight up that you will be ranked to Match, that isn't a promise. I've known applicants who were "promised" a ranking to Match that never happened. 

Bottom line: It doesn't matter what the programs think of you; it's all about what you want. Here's a good video about the Match algorithm if you'd like to understand the process more granularly. 

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

Imagine you're back in high school, planning to ask a fellow classmate out to the prom. You approach your potential date, "Would you be interested in going with me to the dance? You're one of my top choices."

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

Avoid that type of language. 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 can stay honest while not shooting yourself in the foot.

I edit letters of interest and have been busy with them of late. Let me know if you need assistance.

Be Honest about Your First Choice

A few applicants have asked me whether it's wise during the interview, in thank you notes, or in letters of interest to tell an institution that it's your first choice. My response: Yes, if it's true. It's not wise or ethical to tell all institutions that they're your first choice. I can assure you from experience that faculty across the country speak to one another. And you may see these selection committee members again.

I remember an applicant who told our institution that we were his first choice. He was ranked to match but didn't because he had ranked another residency over us. After that, my colleagues were pretty clear that they wouldn't forget this deceptive behavior if they interacted with him professionally in the future (seeking a job, seeking a national committee position). (I felt less frustrated: It's possible he simply changed his mind at the last minute!)

Medicine is a small world; make sure to demonstrate integrity and collegiality.

Read the Fine Print

Several 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 very 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.

The Rank Order List Access Opening Soon: Check Yourself Before You Wreck Yourself

On February 1 at 12 noon EST, Rank Order List (ROL) access opens, meaning applicants and programs may begin entering their rank lists at this time. Start now to think about your priorities and specifically, where you will be happiest. 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 down the drain if applicants do not understand basic strategies for the Match. In November 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.

Here is a video 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.

It’s Not Personal

When I was in my second year of medical school, a third-year student came to speak to our class about being on the wards. (The student is now a vice chair in emergency medicine here in California.) He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn't personal; they were just experiencing stress associated with patient care. He likened the situation to Boston traffic - how drivers lean on their horns for little cause because they are simply frustrated about their days.

It's not personal, he said. What great advice.

I say the same to my clients. I've had applicants complain that faculty were wholly unprepared - reading their applications for the first time during the interview itself. Remember: It's not personal. This process is arduous, and most candidates, faculty, deans, and program coordinators are tired and doing their best, especially in a pandemic. When things are rough, give others the benefit of the doubt. It will help you get through this anxiety-producing process with your sanity intact.

New Year's Resolution: Ten Ways for Pre-Meds to Improve their Medical School Applications

It's the beginning of the year and, therefore, a great time for pre-meds to redouble their efforts toward their medical school goals. This year applications to medical school increased 18%, so the process has gotten even more competitive.

As always, I recommend a very focused approach that allows you to do more of what you want and less of what you don't. Think research will help your candidacy but don't like being in the lab? Consider public health or clinical investigations. Think volunteerism will bolster your application but don't like being one of a crowd in a group project? Start your own social justice initiative.

There are definitely necessary elements to any robust medical school candidacy (clinical experience, strong grades), but being a pre-med can also be fun, mind-broadening, and career-affirming.

Here are ten ways to improve your medical school application that will give you direction but also leeway to be a happy applicant - not just a strong one.

Crossing Fingers for a Happier 2021

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.

Especially considering how difficult 2020 has been, 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 medical schools and residency programs turn out equally qualified clinicians. Prioritize your well-being as a factor in selecting where you might be for the next several years of your life.  

Your Residency Application: What to Do if You Receive No or Few Interview Invitations?

1. Don't panic.

2. Try contacting - in a professional manner - all institutions to which you have sent your ERAS. You can send an email and call. When you call, be calm, respectful, and enthusiastic. Do not demand to speak to the program director! Let the person who answers the phone know that you are very interested in the program and would appreciate the opportunity to interview. Offer to be on an interview wait list if necessary.

3. Ask faculty to make calls or send emails on your behalf. This strategy is especially helpful if the faculty member has a tie to the institution and/or has a weighty title. (Yes, the system is broken in many ways.) 

4. Prepare for the Supplemental Offer and Acceptance Program (SOAP). Note that SOAP is not a separate program from the residency Match. So a) your main residency Match user status must be active and b) your credentials must be verified by the Rank Order List Deadline in order to participate in SOAP. Here is more information on SOAP.

5. Make a plan for what you will do if the Match and SOAP don't work out for you. What will you do next year? How will you improve your written materials, interview skills, and overall candidacy? Consider getting comprehensive help and an honest assessment from me or a faculty member who is highly experienced in residency admissions - the sooner the better to improve a candidacy and prepare for a re-application. Also, as sad as this sounds, if this is not your first defeat in the Match/SOAP process, it might be time to consider other career options like research or industry. Sometimes it's simply recognizing that one door is closing to see another one opening. 

The Fauci Effect

As I write this, I am listening in the background to an interview of Dr. Anthony Fauci by Dr. Sanjay Gupta through the Harvard School of Public Health. Dr. Fauci's leadership (along with that of other physicians and epidemiologists) has apparently prompted what news outlets are calling the Fauci Effect, an 18% increase in the number of applications to medical school this year. I find this encouraging. After all, one could envision people running for the hills with the physical threat that COVID has posed for physicians (and other critical medical staff and front line workers). See the interview (oriented for a medical and public health community) with Dr. Fauci here. 

The New York Times Ethicist

I field questions from clients about how to identify themselves racially and ethnically on their applications, and as diversity becomes a more prominent priority for many academic institutions, this issue will come up more often. The New York Times Ethicist answers an interesting moral dilemma posed by a medical school applicant in a recent column. Enjoy. 

Medical School Interviews: Preparing for your MMI

All bets are off this year when it comes to interviews, although I do think that virtual interviews will be more conventional and equitable than in past years. While the majority of medical school interviews are traditional, an increasing number of institutions (including dental schools) are using the MMI platform. The MMI (multiple mini interview) is a format that uses several timed stations to assess applicants' interpersonal skills and judgment.

A few things to note about MMI interview questions:

1) They are not always medically-related. You may be asked to manage an everyday problem (e.g. a disagreement at the supermarket).

2) They are not always situational. You need to be prepared for conventional questions too (e.g. what are your three greatest strengths?).

3) Schools are trying to assess whether you can skillfully employ important techniques and demonstrate professionalism. Underlying topics might include your ability to offer effective counseling, your understanding of patient-doctor confidentiality, your ability to diffuse a heated situation, or your capacity to admit wrongdoing, etc.

4) Make sure you know what structure the school is using and employ the right mindset: Working with an actor is different from executing a group project, which is, in turn, different from answering questions about your opinions. This year, because everything is virtual, I'm noticing that many schools are focusing on the latter type of problems for logistical reasons. 

5) Practice MMI questions before you "go" to your interview. Even if you have excellent social skills, there are techniques you should hone to expertly manage the challenging MMI format. 

Is Step 1 Still on Track to Go Pass/Fail?

Earlier this year, United States Medical Licensing Exam (USMLE) administrators announced that, after a long process of consideration, Step 1 would be scored as pass/fail going forward. With the global pandemic and many systems in disarray, some students had been concerned that the plans might be delayed, but according to the USMLE, the transition to Step 1 pass/fail score reporting is on track to be implemented in January 2022. The USMLE is also considering some changes to Step 2CS, although the details of those modifications are not yet available to the general public. 

Check out this piece about the details of the Step 1 scoring change.

Love Letters

Letters of interest (LOI) - or what some applicants jokingly call "love letters" - can be used in several types of situations:

1) Residency applicants who want to make an impression post-interview before program directors (PD) submit their rank lists

2) Medical school applicants who have been interviewed but have not yet been accepted or rejected
3) Medical school and residency applicants who have not yet been invited to interview

4) Medical school applicants who have been wait listed  

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

1) Restating your strong interest in the institution
2) Positioning yourself as a distinctive candidate who can contribute fully to the institution

The biggest errors I see in LOIs are:

1) Too much content about a specific institution's advantages. There is no reason to spend a paragraph or more telling a PD or medical school admissions member what makes their institutions special. Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant.

2) Writing about how the program or school will help you. The focus should be on how you will be a contributor to their institution. (It's the "What have you done for me lately?" principle.)

Finally, let me say that I am coming to think that the term "letter of interest" might be better than "letter of intent" because, generally, I don't recommend you let institutions know what your intent is since it might change. Note that you can create one general letter that you modify and send to different institutions with different goals (i.e. requesting an interview or demonstrating your interest post-interview). You can also modify the letter and send it to your top choices because, if you are not making commitments, then you can honestly use it for multiple institutions. 

For those of you interested in LOI assistance for medical school or residency applicants, please contact me.

The Residency and Medical School Interview Process: Moving Past Impostor Syndrome

First described by psychologists Drs. Suzanne Imes and Pauline Rose Clance in the 1970s, impostor phenomenon occurs among high achievers who cannot easily internalize their successes. They often externally attribute their accomplishments to luck and worry that others will eventually realize they are frauds.

Recognize this phenomenon of self-doubt?

You are not alone. Although many people suffer in silence (as they do not want to be revealed for what they perceive to be major deficiencies), the syndrome is quite common, especially in medical school. According to one 2016 study, almost a quarter of male medical students and nearly half of female students surveyed suffered with impostor syndrome. The phenomenon can be associated with depression, burn out, and anxiety. The American Psychological Association offers a few tips for overcoming impostor syndrome including speaking to mentors, recognizing what you excel at, and talking to a professional if necessary.

Part of interviewing well is demonstrating confidence, according to Amy Cuddy, whose compelling TED talk has been viewed almost 60 million times. Practice a lot and then fake it until you make it, as she suggests. How you present yourself can make a big difference in the outcome of your interviews.

Post-ERAS, Pre-Interview Supplemental Questions

Several residency applicants have told me that since they submitted their ERASes, some programs have asked them to answer additional, written questions like "Why our program?" and "How will you bring diversity to our institution?" The additional workload seems burdensome, especially this year, but I suspect residency directors are concerned about interview hoarding - since sessions will be virtual and thus easier to accept and attend - and are trying to weed out applicants accordingly. 

Although originally written for medical school candidates, see my blog entry here to help with the "Why our program?" question and here to help with the diversity prompt. 

Remember: This is a marathon, not a sprint. 

 

Medical School Applicants: Here's How to Hit the Ground Running

For those applicants looking forward to starting their medical education next August and those who just started a few months ago, here's a piece called, "Setting the Right Goals During Medical School." How do you set yourself up for a successful residency Match while avoiding burnout? This short piece will give you some ideas to chew on.

Wednesday is Only Two Days Away, Which Means the ERAS Open Date is Fast Approaching

Residency applicants, this is a reminder that this Wednesday, October 21 at 9am EST is when programs can begin reviewing applications. ERASes submitted today through Wednesday will still display an application date of October 21 so ensure your ERAS experience section and personal statement are in tip top shape and then, simply submit by Wednesday. (Applications submitted after that day will be date-stamped in real-time.) For help, check out "15 ERAS Tips to Boost Your Residency Application" and "5 ERAS Platform Quirks to Heed." Then get your ERAS in and take a well-deserved break. 

How to Handle the Toughest Medical School and Residency Interview Questions

With medical school interviews in full gear and the start of the residency admissions cycle merely a few weeks away, it's past time to start practicing for your interviews. Personal experience and situational questions can be tough, but what happens when you have a serious gap in your candidacy or are faced with an awkward or even illegal question? Check out my two Student Doctor pieces:

Redemption Awaits: Let Your Medical School Interview Transform Liabilities into Assets
and 

Difficult Interview Questions: Learning To Hit A Curveball Out Of The Park

for clear and detailed guidance. 

You don't want to be caught with your pants down: As always, planning and robust practice are your friends.  

Awesome Paid Summer Opportunity

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

Applications for this year's AAAS Mass Media Science and Engineering Fellowship just opened on October 1 and will remain available through January 1, 2021. This cycle's fellowship dates are June 2 through August 17, 2021. Here's the link to application information. The scholarship is a 10-week summer program that places science, engineering, and math undergraduate and graduate students at media organizations across the nation - outlets like NPR, the Los Angeles Times, and WIRED. I worked at the Oregonian in Portland and had a tremendous time, learning how to write effectively and edit. I also gained an appreciation for the amazing public health opportunities journalists have.