AAMC Report on Residents 2021

 The AAMC recently published their Report on Residents 2021. Of note,

• The percentage of medical residents who identify as Black or African American and as Hispanic, Latino, or of Spanish origin has increased since last year.
• Women make up the vast majority in obstetrics and gynecology (85.2%) and pediatrics (72.7%).
• Only 27.0% of the 2020-21 graduates intended to train in the specialties they had listed as their preference when they began medical school.
• The majority of medical residents (57.1%) who completed residency training from 2011 through 2020 practice in the state where they completed their residencies.
• In a tip of the hat to my favorite state, physician retention after medical residency is highest in California (77.8%).

There are more goodies; the information is summed up in this table.

Medical School Interviews: Preparing for your Virtual MMI

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. Despite the virtual approach, a number of schools are still using MMI. 

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 (especially remotely!), 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. 

The Residency and Medical School Application 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, burnout, 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. 

Here's a fun article on imposter syndrome by Joelle Borhart MD, the Associate Program Director at Georgetown University. I also recommend Amy Cuddy's TED talk with over 63 million views. 

Perils of the Virtual Match

I've written before about the benefits of virtual interviews - both with regard to finances and equity. However, the ability to easily hoard residency interviews now has led to an unintended consequence of online access: An increase in qualified applicants who don't match. Thomas Cook MD, an emergency medicine program director in South Carolina, covers this topic in his piece "The Virtual Match is Like the Toilet Paper Rush." In it, he points out that when superior candidates accept a very large number of interviews, there are serious negative consequences for their peers. Cook has a suggestion for a potential remedy based on transparency. The piece is worth a read. 

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 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?" 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.

Happiness

As you interview now for medical school, dental school, residency, or fellowship, it's important to think about what will make you happy in the next phase of your career.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad advice. 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 training is as important as the quality of your training program. The reasons are several-fold:

1. Training is time-consuming, and you want to be in a city you can enjoy fully when you’re able to blow off steam. 

2. Training is stressful, and you want to be in a city where you have social support.

3. 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've trained for the rest of your life. If you’re in a long-term relationship, you may decide to have children (or already have them); down the road you might not want to relocate your family.

Not everyone gets the opportunity to train at an institution in a city s/he likes. But prioritizing your contentment will increase your opportunity for well-being and career longevity.

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. A third recently told me that, after calling in the morning, he was offered an interview by the afternoon. (Generally, I recommend calls over emails 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. Shockingly, 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, of course.

An additional strong option is to send an effective update letter or letter of recommendation from an influential writer (alumnus, for example). I do edit letters of 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).

Medical School Admissions and Residency Applicant Rankings: It's Not Personal

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. 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. 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.

I say the same to those I mentor. Candidates get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix applicants up with one another. Some turn up wholly unprepared - reading students' applications for the first time during the interview itself. Remember: It's not personal. This process is arduous and long, and most candidates, faculty, and program coordinators are tired and doing their best. 

When things are rough, give others the benefit of the doubt. It will help you get through this stressful process with your sanity intact. 

Your Residency Application: Program Directors Don't Want Headaches

If you were a program director (PD), you'd be trying to avoid two big headaches as you assessed a residency candidate:

First, a PD doesn't want to field complaints from patients, faculty, or other services about his/her residents. Therefore, every far-seeing PD asks him/herself the simple question: Will this person be competent and collegial?

Second, a PD doesn't want to see the day when s/he's scurrying around to fill a residency slot and the consequent open call schedule. So, the oracular PD asks the simple question: Will this person leave the program prematurely?

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 personality. For the latter, highlight research projects in the specialty, sub-internships, and knowledge about the program and city.

Just making sure the PD knows you are not going to cause him/her pain is half the battle.

Emergency Medicine: A Career That's Currently Taking a Lot of Hits

Having been in the field of emergency medicine since I started my residency in 1996, I can tell you that the discipline has had its ups and downs. Currently, the specialty is facing a lot of challenges: COVID has driven some physicians out (to utilization review, administration, research) and has adversely affected others emotionally. Additionally, there's a tremendous dearth of positions currently for emergency physicians. I've had friends and colleagues lose promised hours or their jobs entirely in the last 18 months. 

Here's a short piece on the job scarcity issue. Those choosing a specialty must consider the atmosphere of the job market (while recognizing it might improve in a few years).

You Don’t Have to Go to Every Party You’re Invited to, or Taking the Fifth

The goal of every medical school, dental school, residency, and fellowship interview is to distinguish yourself from everyone else to demonstrate you're worthy of a competitive spot.

So what happens when you get this (ugly) question:  

If there were one reason not to accept you, what would it be?

When a (salty) faculty member asks you this interview question, her motivation might be to determine whether there's a weakness in your application that she's missing. Or she may be assessing how you manage stressful situations by posing a question that is unpleasant.

While you need to be honest throughout the entire application process, you do not need to volunteer information that might harm you. So, for a charged question like this one that opposes your goal, you might answer, “While every candidacy has room to improve, I have a strong application." Then you can use the question as an opportunity to mention the strengths of your candidacy. Remember: You have a duty to further your candidacy, not damage it. 

Contact me for mock interview help. I still have some October slots open, as of this writing. 

Nailing the Residency or Medical School Interview (or "Just the Facts, Ma'am")

Google had a problem.

As an oldie but goodie New York Times article describes it, over a decade ago Google executives were growing increasingly aware they were not hiring enough women, and they were attracting negative attention about it. So, Google did what Google does best: They amassed data and mined it.

In their analysis, among other findings, Google concluded that the company was overlooking women who tended to be more modest than comparable male applicants during interviews. The interviewers inappropriately perceived the women applicants to be less accomplished, and the female candidates were not offered jobs. (Once they understood the problem, Google asserts they altered their internal hiring policies accordingly.) 

This story is instructive in understanding the importance of your residency or medical school interview.

Let’s start with your overarching strategy, one that can be gleaned from the Google story: The residency and medical school interview processes are persuasive ones. Your role is to convince faculty that you deserve a slot at their institutions. The best way to persuade is with facts, just like a lawyer does when s/he is trying a case in front of a judge. Saying you are compassionate or hardworking is not convincing, and it doesn’t distinguish you from the scores of other people the interviewer is meeting. You need to prove your worth by highlighting your academic, clinical, research, community service, leadership, international, and/or teaching achievements.

When mentoring applicants, I hear them ask: Michelle, if I showcase my accomplishments in my residency/ medical school interview, doesn’t that mean I’m being redundant? My answer: Absolutely! Think of the medical admissions process like building a house. Your ERAS®/AMCAS® and letters serve as one layer of that house – like scaffolding. In other words, your accomplishments are conveyed simply and succinctly there. The personal statement is your opportunity to apply a thicker layer, one in which you flesh out your achievements, thus persuading the reader of your distinctiveness (plumbing, pipes, electrical). Finally, the interview is your chance to add on the thickest peel (exterior, roof). Discussing your accomplishments in detail can seal the interviewer’s positive impression of you. 

Applicants also ask me if showcasing their achievements is bragging. Not if you state "just the facts, ma'am," meaning you can be polite, confident, and accurate without being arrogant. When candidates still feel shy about drawing attention to their achievements, I remind them that occasionally residency and medical school interviewers don't leave adequate time to review materials for the candidates they will ultimately judge, or they are asked to interview such a large number of applicants they might understandably get candidates confused. If you treat every residency and medical school interview as though it were a “blind” one, you address these obstacles. 

Determine in advance how you want your interviewers to remember you when they represent you to the committee, and tailor your interview to leave that impression. At the end of the week, when your interviewer asks what others thought of the "young woman who volunteered with Mother Teresa while doing malaria research and competitive hammer-throwing,” all the other admissions officers know immediately she is referring to you.

Medical School and Residency Interview Questions: How to Handle the Illegal Ones

In the United States, a professional interview is subject to basic legal rules. Specifically, admissions officers and residency directors should refrain from asking 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 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 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.

Managing Difficult Medical School Interview Questions: Rehearse Your Elevator Pitch Now

An important key to preparing for tough medical school interview questions is realizing that a) interviewing is a skill and b) practice improves performance. Every year too many medical school (and residency, fellowship, and dental school) 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 medical school interview represents your 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 interviewer whose window was nailed shut, there may be uncomfortable moments and even illegal questions. 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 (and dreaded) medical school interview questions, such as “Tell me about yourself” to be brought up to speed. 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.

Supplemental ERAS Application

A few clients have asked me about the new supplemental ERAS application for dermatology, internal medicine (categorical and preliminary), and general surgery (categorical) applicants. The application is more work for these candidates, but the AAMC says the supplemental app will foster a more holistic approach to the residency process. For more information, check out the PowerPoint presentation from a recent webinar the AAMC held on the topic. The supplemental application opened last week.

ERAS Announces Candidates Can Submit their ERASes without penalty through September 29 at 9am EST

Last week ERAS Communications sent out a notice to candidates that while applicants may certify and submit their MyERASes as early as Wednesday, September 1 at 9 am EST,  applications submitted on or before September 29 at 9 am EST will display an application date of “September 29” to programs. (Applications submitted after September 29 will display the actual application date.) This means that there is no penalty for candidates to wait to submit their applications until the 29th at 9 am EST. This date is considerably later than recent past years.

This is great news for applicants who are still working on their written materials. Use the time to make sure yours are in the best shape possible.

 

NRMP® Data Suggests Residency Applicants Should Apply Broadly

A few years back, the NRMP published a short document called the Impact of Length of Rank Order List on Main Residency Match Outcome:2002-2016. There, the NRMP reported that matched applicants consistently had longer rank order lists than unmatched applicants.

This data is a bit old, but it assesses over a decade of Matches, so I take it seriously. In my mind, what it 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 financial cost to this strategy, and that expense needs to be balanced. However, according to this data, starting out with more options usually will provide more opportunities to interview and thus, the ability to create a longer rank order list.

Virtual Interviews Can Help Mitigate Systemic Sexism in Medical Interviews

Congratulations to a few applicants who have already received medical school interview invitations. For most, the season will start in the next month or so. Remote interviews are still with us, and my assertion is that the virtual interview process reduces discriminatory practices that have plagued the system for a while. See my Doximity article "How Virtual Interviews Might Mitigate Systemic Sexism in Medicine" for a personal story. 

Your Residency Application: Being Repetitive Again and Again

In writing their personal statements, many residency applicants ask me, "Isn't it regurgitating my CV if I highlight my accomplishments?" After all, they say, their achievements have already been noted in the application, MSPE, and letters of recommendation. Think of the residency admissions process as an onion. Your ERAS and letters serve as one layer of that onion, albeit a thin one. In other words, your accomplishments are conveyed simply and succinctly there. The personal statement is your opportunity to apply a thicker layer, one in which you flesh out your achievements, thus persuading the reader of your distinctiveness. Finally, the interview is your chance to add on the thickest peel. Discussing your accomplishments in detail can seal the interviewer’s positive impression of you.

So yes, you are going to be redundant throughout the residency application process, but each part serves a different and additive purpose. If you do not include your achievements in your personal statement, how will you be viewed as distinctive? Remember: Who you are is what you’ve done… and what traits and skills you’ve gained accordingly.

Mom and Dad May Think You Have Good People Skills, But That's Not Enough When It Comes to Interviews

 Every year I am hired by re-applicants for medical school and residency who tell me that the year before they received multiple interview invitations, thought they performed well on interview day, but then were left with no offers in the spring. 

This is the truth: Interviews are hard. You need to strategically respond to criticisms of your candidacy, showcase the strengths of your application, be prepared for awkward or even - sometimes - illegal questions, all while seeming fresh and enthusiastic.

There are applicants who spend months studying for their MCAT or Boards, but don't spend even an hour practicing for their interviews. It's a naive disconnect. 

If you can mock interview with someone who has been on a medical school admissions committee for years or a faculty member who has strong experience with residency applications, go for it. If not, check out my mock interview services here. Don't rely on a friend or family member with no experience.

Here is a funny, less-than-one-minute, stop-motion video to guide you on this topic.