Being the Squeaky Wheel

Several years ago I helped a strong applicant who had been rejected by a top medical school. He thought he was a very good fit for this particular institution, so he called the school to make his case. Surprisingly, after the applicant's phone call, the school granted him an interview, reversing their original rejection.

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

Ultimately, after being initially rejected, this applicant was admitted to that top school.

Of course, this is an exceedingly rare occurrence. But to me, the moral of this story is that it is worth being assertive (not aggressive!) in the medical school and residency admissions processes: Send an update letter, call institutions (politely) to inquire about your status (if they do not expressly prohibit phone calls), and be proactive during your interviews.

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

Physician Dissatisfaction in the News

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

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

Coaching and Mentorship

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

Facebook and Twitter

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

Do Interviews Matter?

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

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

NRMP Stats

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

The NRMP comments as follows regarding their analysis:

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

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

I Wish I Had Known...

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

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

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

MD/MBAs

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

ERAS: September 1

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

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

ERAS Support Services at ECFMG to Start Live Chat Option

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

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

Decision Fatigue

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

Being Repetitive… Again and Again and Again

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

Think of the medical admissions process as an onion. Your application (AMCAS, ERAS, post bacc CV, AADSAS) and letters serve as one layer of that onion, albeit a thin one. In other words, your accomplishments are conveyed simply and succinctly there. The personal statement is your opportunity to apply a thicker layer, one in which you flesh out your achievements, thus persuading the reader of your distinctiveness. Finally, the interview is your chance to add on the thickest peel. Discussing your accomplishments in detail can seal the interviewer’s positive impression of you.

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

Applying in Two Specialties

Here are some clarifications about what ERAS offers that will help you apply in two specialties:

1) Different personal statements can be assigned to different programs. This means you can assign your ob/gyn essay to ob/gyn programs and your internal medicine statement to internal medicine residencies.
2) Different letters of recommendation (LORs) can be assigned to different residency programs as well. (A maximum of four letters may be assigned to each program.)
3) You will have only one MyEras application. It will go to all of your programs.

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

Ordering Your AMCAS Activities and ERAS Experiences

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

Be a Minimalist

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

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

Optional Secondary Essays: Are They Really Optional?

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

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

California Licensure for IMGs

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

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

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

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

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

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

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

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

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

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

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

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

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

IMGs: Your ERAS Tokens are Here

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

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

Formal Attire Required

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

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

Contact me for editing help.

Scribes

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