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.

Letters of Recommendation: Lead the Witness

When pre-meds, medical students, residents, nurses, and physician colleagues asked me to write them letters of recommendation (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, whether you are applying to medical school, dental school, residency, or fellowship, 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 and/or
4. Your transcripts.

With regard to the cover letter, keep it streamlined: Thank the writer and highlight your pre-professional achievements on one page. The point of the cover letter is to supplement a writer’s knowledge of your candidacy and offer flattering content for inclusion. A college professor may know  you made the only A in an organic chemistry class, but her LOR for medical school 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. Poorly organized background information leaves your writer with 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 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. The savvy applicant can take subtle advantage of her ability to "lead the witness."

Match Results 2023: Why Did Emergency Medicine Do So Badly?

Emergency medicine has had its ups and downs over the years with regard to desirability. Soon after the show "ER" became popular, emergency medicine programs also were suddenly in vogue. Over the interim years, the field's cachet has declined and increased, but up until recent years, emergency medicine programs routinely filled 99% of their available spots in the Match.

The fact that 554 emergency spots went unfilled in this past Match was particularly distasteful to many emergency physicians, accordingly.

The reasons for this plummeting interest in the field is well described in a recent piece in ACEP Now. (ACEP stands for the American College of Emergency Physicians.) The authors note multiple issues, including burnout, decreasing remuneration, and systemic problems in the emergency healthcare system that frustrate clinicians. 

Of note, these issues have driven out many middle-aged emergency physicians, as well.

Even if you are not interested in becoming an emergency doctor, take a look at the piece here, keeping in mind that certain factors may soon adversely affect other specialties as well.

(I'd like to give a shout out to my old friend Jonathan Fisher MD MPH who was one of the reporters on this article.) 

Changes in the AMCAS

Premeds applying this cycle will notice a few changes to the AMCAS. There are no drastic modifications, so don't worry, but it's worth knowing what to expect.

Back in 2012, an important, new addition appeared on the AMCAS: Applicants were being asked to identify their most significant extracurricular experiences (up to three) and support their choices with more writing. Now the Most Meaningful Paragraphs are par for the course, but the change was a big surprise back then.

This year the updates are comparatively minor. One difference is the Other Impactful Experiences section. It is not an addition, however. It replaces the Disadvantaged Status section, allowing for a broader understanding of challenges that can adversely affect an applicant's life and candidacy.

To their credit, the AAMC also changed the "other" pronoun and gender identity categories to "another pronoun set" and  "another gender identity."

Please see this short article from the AAMC regarding other changes in this year's AMCAS.

BS/MD Programs

Here is an AAMC piece about BS/MD programs. While these curricula do provide some benefits to students with an early interest in medicine, I am generally not a proponent of the BS/MD option, as it really precludes most participants' ability to take full advantage of the college experience; the caveat may be 8-year programs (like Brown or Tufts) that don't accelerate students, as much as give them early assurance of admission to medical school (assuming individuals maintain their grades). 

My bias is that taking more time - for example, a gap year - is a way to enjoy the school experience and approach medical training with maturity and career choice confidence. 

2023 Match Data

The NRMP recently published data regarding the most recent Match. Of note, emergency medicine – my specialty – had a whopping 554 positions that remained unfilled. Ouch! Additionally, although the numbers were better than last year, IMGs still struggled: US citizen IMGs saw only a 67.6% Match rate and non-US citizen IMGs had only a 59.4% Match rate.

There is a lot of data to review, so take a look here if you want more information on DO Match rates, specialty competitiveness, and SOAP. 

USMLE Performance Data 2022

The National Board of Medical Examiners (NBME) publishes USMLE performance data year after year, and the most recent information regarding the 2022 testing cycle is particularly interesting. Frankly, I'm not sure what to make of it, but performance on Step 1 is notably worse than years prior (e.g. 2021 compared to 2020; 2020 compared to 2019). I'm not sure if this is related to the pandemic, changes in the test itself, or some other factor. Here is the data.

What Coursework is Really Required for Medical School?

While there is a core curriculum that is a prerequisite for medical school, certain schools require additional coursework or competencies (like the CASPer exam). The AAMC does a good job of keeping up a database of that information, listed by school. An applicant can sort through to see what each institution requires. You might have to do a little bit of digging once you open a school's link, but the information is usually accessible.

Of note, if a course is required for admission, it's probably best not to take the class on a pass/fail basis.

Start Your Engines...

The medical school application cycle is revving up soon, so it's time to get started on your candidacy. Here's an article I wrote for Student Doctor Network a few years back called "Ten Ways to Improve your Medical School Application." The piece includes statistical truths, strategies for optimizing your approach, and philosophical guidance. It covers grades, clinical experience, letters of recommendation, where to apply, the MCAT, the personal statement, and your happiness, among other critical factors. Enjoy!

Your Residency Application: Five Factors to Prioritize When Creating your Rank List

Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want - first goes first, second goes second, etc.
2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.
3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.
4. Consider whether you could spend your whole life at the institution or in that program's location. It's a lot to grapple with, but many residents graduate and stay for the rest of their careers.
5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

How Race and Gender Affect Medical Specialty

The AAMC published an interesting piece recently showcasing the results of their Physician Specialty Data Report on the interplay of race, gender, and specialty. 

It's worth combing through the data yourself, but here are a few takeaways:

Doctors from underrepresented groups are more concentrated in primary care fields. These specialties are extremely needed and noble, but since primary care is less well remunerated than surgical specialties, it's worth thinking about the disproportionate density of minority physicians.

Women make up the majority of medical school students for the fourth year in a row.  

Women represent a significant minority in surgical specialties like orthopedic surgery (5.9%), thoracic surgery (8.3%) and neurosurgery (9.6%). Ouch.

Focusing on another demographic, the doctor workforce has grown older. Over 46% of active U.S. doctors are 55+. That number was ~38% in 2007. 

For more details, read the report here.

What to Know about the AAMC Fee Assistance Program

Now that the 2022-23 medical school application process is on the horizon, I want to remind candidates about the Association of American Medical Colleges' (AAMC) Fee Assistance Program (FAP) and Insider Medical Admissions' available discount for those with a current FAP. The FAP is designed to offer help to individuals with financial limitations who cannot pay the MCAT registration and/or AMCAS application fees without financial support. (Of note, there also exists an FAP for  dental school candidates through the American Dental Education Association.)

If you think you are eligible, it's worth applying for an FAP grant early: When applicants submit their AMCASes prior to receiving decisions on their FAP applications, those candidates are ineligible to receive the FAP benefits for the AMCAS even if their FAP grants are approved. In other words, the FAP is not retroactive. You snooze, you lose.

For more information on the FAP, please click here. I offer a significant discount on one non-package service for any applicant who can demonstrate financial hardship through a current AAMC FAP grant. After researching the issue, I believe Insider Medical Admissions is the only medical consulting company that currently supports a discount for FAP grant recipients. (I apologize if I'm missing a company.) Once you have been granted the FAP and thus, can prove receipt, please feel free to contact me for more information.

Medscape's Annual Physician Burnout Report is Out and - As Usual - It's Disturbing

Every year Medscape surveys physicians about career satisfaction. The last few annual reports have been pretty upsetting. Unfortunately, 2022's results are not happy either.

This year emergency physicians (my colleagues) reported the highest burnout rates of all specialties at 60%. Last year this number was 43%, so there was a large jump in already-high dissatisfaction levels. Next in line were critical care physicians at 56%. But even the specialty with the smallest percentage of burned out physicians – public health and preventive medicine – had rates at 26%. So even in the happiest cohort, one in four surveyed doctors reported burnout.

Looking at gender, fifty-six percent of female physicians surveyed reported burnout; men seemed less dissatisfied, but they were at 36% so that's not so great either.

Bureaucratic tasks were perceived to be the biggest contributor to physician burnout by their own assessment.

It's important for those who are considering a career in medicine to approach it with eyes wide open: Take a look at the Medscape National Physician Burnout & Suicide Report 2022 slide deck yourself for more details, and check out my Kevin MD piece on EM burnout here.

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

For those of you who are starting to craft your Match rank order list, please make sure you follow this simple strategy: Rank your first choice first, your second second, your third third, etc.

In other words, your most successful approach is to create your list in order of your real preferences. Although the Match algorithm is mathematically quite complicated, because the process always begins with an attempt to match an applicant to the program most preferred on the applicant’s 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.

Two weeks ago I posted a short NRMP video that explains the Match algorithm. Here it is again. Here’s also a less-than-one-minute Guru on the Go© video “NRMP Ranking to Avoid a Spanking” to emphasize your optimal strategy.

The Main Demographic Factor Associated with Decreased Satisfaction for Physician Work-life Balance is Female Gender

Wow. When I read that fact in a recent piece on time management by Dr. Sandra Scott Simons in Emergency Medicine News, I was a bit taken aback. It's not surprising once you really think about it, but at first, it's a slap in the face. 

In her article, Dr. Simons' discussion of the pitfalls of distractions is particularly resonant for me. If you haven't already, make sure to familiarize yourself with the concept of Deep Work by Cal Newport. (He has a book, a podcast, you can also find many interviews of him online.)

Check Yourself Before You Wreck Yourself: How to Create a Match Rank Order List

As you look toward the NRMP Match rank order list deadline on March 1, you'll want to avoid simple missteps. Improving written materials and interview skills is critical, but all of that work can go to waste if applicants do not understand basic strategies for the Match. Way back 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 still relevant today.

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

• Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.
• Not attending all interviews, thus failing to capitalize on every opportunity to market themselves. (I suspect this error is less common now with the advent of virtual interviews.)
• Misunderstanding the Match and, thus, 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 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.

Match Schedule 2022-3

Here are some important upcoming dates for those applying for the Match:

January

Jan. 31, 2023: The registration deadline for the NRMP Match is at 11:59 pm EST on this date. After this time, applicants will incur a $50 late fee. (The process is expensive enough; no need to pay more.)

February

Feb. 1, 2023: Rank order list entry opens at 12 pm EST. 

March

March 1, 2023: Rank order list deadline. Candidates must have their rank order lists certified by 9 pm EST.

March 13, 2023: NRMP Match Week starts. SOAP applicants can begin preparing applications in the ERAS® system.

March 16, 2023: SOAP rounds 1-4.

March 17, 2023: NRMP Match Day.  Match results are available at 12 pm EST.

Over the course of this month and next, I'll be blogging with tips on how to create your best Match list. 

“Unhappy is He Who Depends on Success to be Happy" - Alex Dias Ribeiro, Former Formula 1 Race Car Driver

Age-related professional decline is the last thing many doctors want to think about. Those who have just finished years of arduous training can't imagine that they have only 15 years until they will deteriorate (statistically true), and those of us in middle age don't want to think about our impending, cognitive retreat from medicine. And yet, this fantastic piece in the Atlantic "Your Professional Decline is Coming (Much) Sooner than You Think" by Arthur C. Brooks is a fascinating, well written article about happiness, gifted and accomplished people, and personal relevance with multiple interesting celebrity examples. Brooks also proposes some quasi-solutions (or at least some work-arounds). I strongly recommend this compelling piece for physicians of all ages and stages.

Medical School Interviews: Preparing for your MMI

Although the majority of medical school interviews are still traditional, many institutions (including dental schools) are using the MMI platform - even though interviews are now held in a virtual setting. 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, your capacity to admit wrongdoing, etc.

It is important that you practice MMI questions before you go to your medical school interview. Even if you have excellent social skills, there are techniques you should hone to expertly manage the challenging MMI format. 

The Medical School Waitlist: Can Anything Be Done?

Just when you’ve completed your interviews and feel that you can finally sit back and relax a little because – after all – the rest is out of your hands, you may be surprised by a medical school waitlist notification. What can you do?

1. Realize that getting into medical school has become increasingly competitive year by year. Being waitlisted is infinitely better than being rejected, and thus a positive, despite the anxiety it causes.
2. Send a letter of interest. Let the school know of your continued enthusiasm and your new accomplishments. Ensure the letter is well written, streamlined, and brief. If the school is absolutely, positively your first choice, let the admissions committee know that. Feel free to send more than one letter if you are on a medical school wait list for months.
3. Ask the school if you can set up a second look. A supplementary visit indicates to the institution that you are serious, and it offers you more data in making your decision if you're later offered a spot.
4. Do not neglect your other options. Don’t focus all of your attention on this institution to the exclusion of others: Ensure you are well-prepared for any late interview invites at other medical schools.
5. Ask a well-positioned faculty member who knows your work to make a call or send an email on your behalf. This tactic is especially helpful if the supervisor has a connection to the institution. (I do not recommend that a family friend who hasn't worked with you contacts the school.)
6. Plan for last minute notice. At some institutions, applicants are offered slots off the medical school wait list throughout the summer. I’ve even heard of acceptances being offered the day before school was to begin. Would you be able to change your living situation, move your personal belongings, and uproot if this were to happen? Be prepared. 

Being Valued is Undervalued

I read an interesting JAMA study on burnout recently. We've all heard about the problem and its growth over the past few years. But I found the results of this study particularly interesting: The authors found that chaotic workplaces and lack of control of workload were associated with higher burnout (think emergency departments or a poorly run, overscheduled clinic), while efficient teamwork and feeling valued were associated with lower burnout. People sometimes pay lip service to the importance of being appreciated, but this study really proves its significance. 

It's worth considering this study's results when making decisions about what field to choose, where to train, and what position to take after residency. Here's the article.

Pared to the Bone

I heard a great Fresh Air interview of Siddhartha Mukherjee, who was a lovely acquaintance of mine at Harvard and who has since won the Pulitzer Prize for his book The Emperor of All Maladies. Sid is a hematologist/oncologist clinician/scientist who has a new book out called The Song of the Cell. 

Terry Gross asked Sid how he successfully writes for both the scientific community through his journal articles and for lay people through his books - two different skill sets. Sid responded by explaining the importance - for any genre - of crafting manuscripts that are "pared to the bone," meaning they avoid verbiage. His recommendation was excellent advice for any writer, even one who is crafting a personal statement. Take a listen to the full interview with Dr. Mukherjee here. 

Leaving the Medical Workforce

Beware: The article I'm about to recommend has a bitter tone, but it's important for those who are considering the medical field to hear all perspectives. Plus, many of the issues this anonymous writer brings up - understaffing, corporate medicine, twisted financial incentives,  lack of fulfillment - are on point. 

Here's the piece.

Surgery Without Anesthesia

As we look forward to Thanksgiving, I recommend this short NYT piece by AJ Jacobs on gratitude. It’s a few years old, but it's still relevant, fun, and reflective.

How to Evaluate an Institution: Consider Your Happiness and Trust Your Intuition

A few medical school and residency applicants have asked me how to evaluate institutions, especially since interviews are virtual. This is a huge topic, but here are some thoughts:

• To me, geography is one of the most important factors – at least equal to the reputation of the institution. You want to make sure you are in a location that will make you happy – near community, family, friends and/ or the ability to enjoy your hobbies.
• Cost is sometimes a deal breaker when it comes to medical school. There's not much more to say here except that most institutions are extremely expensive.
• Of course, didactics and academic opportunities are critically important for both medical school and residency. However, many medical schools of similar caliber have equivalent curricula and programs. You likely could be happy at many different medical schools. With regard to residency, it's important to ensure you are getting a lot of hands-on experience and to look at what fellowships are available, with your interests in mind.
• Faculty is hard to assess because – like anything – there are good and bad ones. Also, faculty come and go. Having said that, if you are applying to residency, the program director is very important (understanding that he or she could leave).
• With regard to residency, call schedule and overall work hours are important to consider. Certain programs within the same specialty require a lot more hours and scut work than others.
• One of your best bets is to talk to current students at medical school or current residents in a training program. Oftentimes they will be very honest about the pros and cons of their institution.

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

Remember: If you're a medical school applicant, consider yourself fortunate if you have more than one option to choose from. Earning admission to medical school is getting harder every year. It's a great problem if you need to struggle to decide among multiple schools!

Your Residency Interview: What Do Program Directors Really Want?

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

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

2) Will this person "play well with others" and not create complaints from patients, faculty, 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, extracurricular activities that demonstrate teamwork, and - if asked - hobbies and reading materials that demonstrate your agreeable personality. For the latter, highlight research projects in the specialty, sub-internships, and knowledge about the program and city.

Simply making sure the PD knows you're not going to cause him/her trouble is at least half the battle.

Love Letters and Janet Jackson

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

1. Residency and medical school applicants who want to make an impression post-interview before decisions are made about their candidacies.
2. Medical school and residency applicants who have not yet been invited to interview.
3. Medical school applicants who have been waitlisted.

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

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

Errors to avoid in LOIs are:

1. Don't include generic content about a specific institution's advantages. There is no reason to spend a paragraph or more telling a PD or medical school admissions member what makes his/her institution special. ("Your faculty is strong and your trainees are collegial" or "You are a world-renowned institution.") Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant. Having said that, it is very reasonable to link a particular interest of yours with a specific opportunity at an institution. For example if you have done cancer research, make sure to mention how you will contribute to the renowned oncology program the institution is associated with.
2. Don't write about how the program or school will help you. ("I know your residency will make me into a great doctor.") The focus should, instead, be on how you will be a contributor to their institution. For example, you can detail how a specific leadership experience of yours has given you the skills to make you a future leader at this institution. (It's the "What have you done for me lately?" Janet Jackson principle.)

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

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

Highly Recommended Paid Summer Opportunity

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

Applications for this year's AAAS Mass Media Science and Engineering Fellowship just opened on October 1 and will remain available through January 2, 2023. 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 influence journalists can have. It's really an amazing program. 

Finding - and Redefining - Balance: It's Not about Better Multitasking

This time of year, when residency and medical school interview processes are revving up, many of us feel overwhelmed. Here's a brief but thoughtful piece I've saved over the years; it's about balance. As you consider your future career choices, it's worth thinking about issues the author covers like clarifying what brings you joy, considering your goals while understanding they will change, and defining balance for yourself.

In this day and age, one can choose a traditionally tough specialty but work in a practice setting that allows for some autonomy and flexibility. But you need to know what you want, and you need to give yourself the room to explore those goals in order to guide yourself in the right direction.

How to Turn Bad Advice on its Head

As you get to know different institutions during this interview season, I encourage you to take the opportunity to reflect and consider what will make you happy in the upcoming years.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad advice: After interviewing at several institutions, I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. Where you live for your medical training - medical school, residency, or fellowship - is as important as the quality of your training program! The reasons are several-fold:

1. Medical training is time-consuming, and you want to be in a city you can enjoy fully when you have a few moments to blow off steam.
2. Medical training is stressful, and you want to be in a city where you have social support.
3. Medical training is not completed in a vacuum. Your personal life continues. If you’re single you may meet someone and end up staying in the city where you have trained for the rest of your life. If you’re in a long-term relationship you may decide to have children or may already have them. Down the road you may not want to relocate your family.

Not everyone gets the opportunity to go to medical school or train in residency and fellowship programs in a city s/he likes. But you can make choices that will increase your chances. Consider these options - and your happiness - as you make professional decisions this interview season and in the coming year. 

Residency and Medical School Interview Questions: How to Answer that Icky Decade One

"Where do you see yourself in 10 years?" the interviewer asks you, and you squirm...

A physician-administrator once complained to me that whenever he asked potential new faculty hires where they saw themselves in a decade they always said they were interested in global health or teaching. "Most of them have nothing in their CVs to support their interest in international work or education," he remarked. "They just say it because it's sexy."

When asked where you see yourself in ten years, consider how you might demonstrate a clear trajectory. Throwing out activities just because they sound appealing doesn't make you look professional or your candidacy seem well-synthesized. The idea is to have a path you can back up, defend, and easily justify. This doesn't mean you're stuck with what you've done even if you didn't like it. You could point out that having tried myocardial bench research, you realize that your real interest is in clinical investigations of new cardiac markers.

Many medical school applicants say they don't know what field they want to go into. Of course not! And many residency applicants don't know if they want to do a fellowship. That's okay. Again, the point is to focus on your previous strengths and achievements and leverage them.

Contact me for help with tough interview questions. (If you're planning to seek mock interview help from me, please do it now. I'm booking several weeks in advance.)

We Need to Decrease the Stress and Inefficiencies Associated with the Residency Application Process

Inefficiencies in the residency application system have been a problem for many years. While the AAMC and NRMP have made efforts to improve the process, including the move from the Scramble to SOAP a few years back, the lack of adequate slots for a large number of candidates leads to a tremendous amount of unnecessary stress and waste. With the introduction of virtual interviews, hoarding became a new problem.

To their credit, the AAMC is considering some reforms to the system. Allowing applicants to identify favored residency programs, called "preference signaling" through the supplemental ERAS, for example, has improved candidates' abilities to get interviews at chosen programs. Additionally, some specialties – with AAMC's support – have implemented a common interview invitation release date and a minimum response time for invitees. In the latter case, for example, most surgery programs provide candidates a minimum of 48 hours to accept or reject an invitation, such that applicants don't need to sleep with one eye open, jumping to respond to an invitation to avoid the wait list. There has even been a consideration of capping the number of interviews each applicant can have to avoid interview hoarding.

I recommend reading this piece on proposed reforms to the system. Having gone through the stressful process myself, I wholly support strategies that would increase transparency and decrease unnecessary anxiety. 

Medical and Dental School Interviews: Preparing for your MMI

While the majority of medical school interviews are traditional, some institutions (including dental schools) are using the MMI platform. The MMI (multiple mini interview) is a format that uses several timed stations (yes, even virtually) 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. 

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. Contact me for help. 

How Do I Strategically Apply in Two Fields?

Occasionally I help residency applicants who are applying in two specialties. This tactic can be strategic in specific scenarios, but it also makes the process more complicated. Here are some quick clarifications to help:

1) Different personal statements can be assigned to different programs. This means you can assign your ob/gyn essay to ob/gyn programs and your internal medicine essay to internal medicine residencies. Of course, in this case, you need to have two versions of your statement in the first place, and you need to ensure you assign correctly. 

2) Different letters of recommendation can be assigned to different residency programs as well. (A maximum of four letters may be assigned to each program.) You'll either need to have letter writers for different fields, letter writers who will craft two types of letters, generic letters (less compelling), or a mix of these approaches.

3) You will have only one MyEras application. It will go to all of your programs. Note that if you list your membership in multiple ob/gyn organizations, for example, that will be viewed by your internal medicine readers as well - and might make them question your commitment to IM.

Contact me for help.

Five ERAS Platform Quirks to Heed

On September 7th, ERAS will open for submission, so it's time to get moving on your written materials. Let's briefly cover five quirks of the ERAS platform to help you get through the drafting process. The ERAS platform...

1. Does not support italics. While journal articles and some phrases (e.g. "summa cum laude") should be italicized, don't be surprised when you can't.
2. Prompts you for a supervisor for each activity. In some cases, you simply may not have one, but whenever you can, name someone. A name validates the experience.
3. Prompts you for average hours per week for each activity. It can be difficult to calculate this number for certain experiences, especially those that are intermittent, but it's worth making your best estimate rather than leaving the question blank.
4. Offers space to include a "reason for leaving" for each activity. Don't skip this section, but keep your answers brief.
5. Limits you to 1020 characters for experiences, 510 for the interruption in the medical training section, and 510 for each of the awards sections. Be aware of these limits as you write, so you are not furiously cutting later.  

For tips on how to craft your ERAS, check out these 15 ERAS tips.

Contact me for help with this weird, wild process.

Don't Let Other People Freak You Out

I started Insider Medical Admissions over 15 years ago, so I'm pretty good at spotting trends. Every year about now I start getting emails from premed clients saying they're worried about their lack of (or minimal number of) interview invitations. Yes, even as early as late August folks are concerned. They say they have a classmate who says he's gotten multiple interview invitations or they read online that others are being contacted with many invites.

Sure, it's possible some people are getting tons of 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!).

The NRMP is Considering a Two-phase Residency Match

Recently the NRMP requested public comment on the concept of a two-phase residency Match. In part, the plan would mitigate weaknesses in the Supplemental Offer and Acceptance Program (SOAP), which provides the opportunity of unfilled positions to eligible unmatched residency candidates. SOAP replaced the Scramble, an inferior system from years ago. SOAP still has its weaknesses, however, including an expedited timeline for decision-making by candidates and programs.

See a full description of the proposed two-phase residency Match here. Of note, the first Match Day, which would be analogous to the current Match Day, would occur a month earlier in February. Accordingly, interview season would be shorter. 

The plan has many benefits, but it would require some adjustments in candidates' and residency directors' calendars and thinking.

Managing Difficult Interview Questions: Rehearse Your Elevator Pitch Now

An important key to preparing for tough medical school, residency, dental school, and fellowship interviews is realizing that a) interviewing is a skill and b) practice improves performance. Every year too many candidates expend tremendous energy assembling fantastic applications, only to undermine their chances by approaching the interview with twisted laws of entropy and enthalpy: They prepare for it with maximum randomness and minimum energy.

Once you’ve done adequate groundwork, the interview represents an opportunity to distinguish yourself and impress your interviewers as the type of candidate they’d love to have at their institution.

That’s not to say every interview will be full of hugs and puppy kisses. Like the story of the faculty member whose window was nailed shut, there may be uncomfortable moments and even illegal questions (although I suspect the latter are rarer with virtual interviews). With a bit of preparation, you can learn to hit these curveball questions out of the park. Let’s explore an example that has come up in the not-so-distant past.

Rehearse Your Elevator Pitch

While most interviewers take the time to read your application materials in advance, don’t be offended by the faculty member who did not prepare, is blankly flipping through your application right there in front of you, and who asks open-ended questions, such as “Tell me about yourself” to be brought up to speed. (A now-attending I helped prepare for residency interviews several years ago recently told me that the best advice I gave him was not to be shocked when interviewers were completely ignorant when it came to his candidacy.) View it this way: These faculty members are offering you the opportunity to define how you’d like to be remembered.

Your goal should be twofold: 1) to persuade them how much you’d add to their institution and 2) to make their job easier by giving them the bullet points they’ll need to persuade their peers about your candidacy’s worthiness. When your interviewer sits around a table advocating on your behalf, steer her to use terms that will be germane to your candidacy. Are you the “global health advocate who volunteered with Mother Teresa and ran his school’s homeless food program?” Or perhaps you are the “first-generation college graduate who held premier leadership positions in medical school?” Help your interviewer help you.

In the end, difficult interview questions are less intimidating if you both prepare well and have an attitude that they are an opportunity to clarify and further your candidacy. For help, secure your Mock Interview slot with me. I'm booking a few weeks in advance, so sooner is better than later.

Charting Outcomes in the Match 2022 is Out

The NRMP recently published their Charting Outcomes information for 2022; data I keep bookmarked and which I would recommend applicants review. The reports (for MDs and DOs) separate results into specialties and include extremely helpful information, including what mean board scores, number of contiguous ranks, and number of research experiences were for those who successfully matched - and those who did not.

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

Here is the MD report and the DO one.

Winning Strategies for Medical School Interviews

I've heard from several medical school applicant clients who've already been invited to interviews - in July! Congrats. If you're seeking my help with interview prep, please hire me at your earliest convenience; I'm scheduling 2 or 3 week in advance. 

Check out this piece on how to most effectively demonstrate your distinctiveness during your interview to show you are worthy of a competitive med school spot. And below are a couple of cute, under-one-minute Guru on the Go videos to reinforce the importance of practicing:

It's not luck; it's skill that will help you succeed!