Personal Statement Russian Roulette

It's time (okay - not to freak you out - but actually late) to start working on your medical school personal statement. Check out this under-one-minute Guru on the Go© video on an important misstep to avoid when crafting your essay.

The AMCAS Most Meaningful Paragraphs: Three Mistakes to Avoid

In 2012, seemingly out of blue, a significant, 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:

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:

1) 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. The fact that these are two different tasks might seem obvious, but every year, I get AMCAS drafts to edit that include this error.

2) Do not 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 condescending.

3) Don't repeat what you have written in your descriptor. The Most Meaningful is an opportunity to delve deeper into your achievement. Let's say you are showcasing your experience as a biochemistry teaching assistant. In the Most Meaningful paragraph, give concrete examples of what you taught, to whom, how often, using what techniques. If you were promoted to head TA or asked to come back the next semester, showcase teaching achievements that propelled you to get the position. Did you get excellent teaching reviews from students? Did you offer an unconventional way of learning the difficult material? If so, what was it? 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."


The Most Meaningful paragraphs are an opportunity for you to demonstrate your distinctiveness and worthiness for medical school. Don't waste this chance to further your candidacy.

Physician Burnout Report 2018

Medscape has published its 2018 Physician Burnout Report. (You may have to sign in to view.) Congratulations to my field of emergency medicine for moving down from #1 on the list of burnout specialties a few years back to #6 this year. (The rate of burnout was a scary 45% for emergency physicians. To find out why, check out this piece.) Among all physician respondents, 42% reported burnout.

The lowest rates of burnout were found in plastic surgeons (23%), dermatologists (32%) and pathologists (32%). Medscape attributes this fact to these specialists' decreased likelihood of working under emergent conditions. (The highest burnout was among critical care doctors at 48%.)

A higher level of burnout was reported in female physicians (48%) compared to male (38%). 

In a different approach to the question, those specialists who reported they were very to extremely happy at work were ophthalmologists (37%), orthopedists (35%), and plastic surgeons (35%). 

Paralympic-Medalist Physician Asks to be Recognized for her Tremendous Abilities, Not her Wheelchair

Check out this well-written New York Times piece by Dr. Cheri Blauwet, an American wheelchair racer (Paralympic and Olympic medal winner) and physician in PM&R. I'm sure Dr. Blauwet's assertions are true about bias among patients, colleagues, and admissions officers: In my career, I've met very few doctor colleagues with overt physical disabilities.

Tomorrow Belongs to Those Who Can Hear it Coming

That's right: Tomorrow, May 1 is the day before the official open date of AMCAS 2019. (Okay, I know that sounds confusing, but originally the AMCAS open date looked to be May 1 and is still posted as such in multiple locations. As it turns out, it is May 2.) So, at 9:30am EST on Wednesday, you can start inputting your data. 

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; it means you should start early enough (now, at the latest!) 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.

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.

Making a List and Checking it Twice: The Fellowship Match Checklist

The 2018-9 Fellowship Match process is heating up. The NRMP recently posted a brief but useful fellowship match check list with links to important dates for all fellowship matches.

As many of you may know, the range of time frames varies tremendously among the different fields - from abdominal transplant surgery (now) to adolescent medicine (autumn) - so it's worth taking a look at this information even if you just matched for residency, believe it or not.

DNR

Recently, I was socializing with an old friend who reviews residency applications for his academic program. We were discussing personal statement errors (don't worry - we chatted about nonprofessional topics too), and he told me that he and his colleagues have a term for candidacies that are represented by bad written materials: DNR, or Do Not Rank.

Make sure your candidacy is not hamstrung by bad writing. Avoid common personal statement errors that can bomb your application. Good writing takes a lot of time, so make sure to start early. AMCAS is opening on May 1, so medical school applicants should be completing their essays and experience descriptors. Residency applicants should be starting an outline for their personal statements and a draft of their experiences.

Contact me (soon) for help.

Talented Pre-Meds: Leverage your Money

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

Well, it’s worth a try.

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

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

You Can Lead the Witness: Letters of Recommendation Part 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Match Day and Financial Security

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

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

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

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

An Offer You Can't Refuse

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

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

Bias in Residency Evaluations

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

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

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

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

As you can imagine, the applicant was not hired.

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

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

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

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

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

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

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

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

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

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

Yes, Sleep is a Medical Necessity

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

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

Read the Fine Print

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

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

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

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

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

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

That does not sound very flattering. Instead you can say something like "I would be thrilled to be at your institution," or " I’m confident I can make a positive contribution." In other words, you don't need to lie (which I never recommend); but you don't have to shoot yourself in the foot either.

I do edit letters of intent and have been busy with them this season. Let me know if you need assistance.

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

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

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

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

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

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

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

Pre-Med? Avoid a Big Mistake

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

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

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

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

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