Med Schools Have No Patience for No Patients

For those undergraduates who are starting to think about their medical school applications, I will tell you a secret: One of the biggest weaknesses I advise candidates on is their lack of clinical experience. I've seen students with outstanding MCAT scores who did not get into medical school on their first try. They had little or no patient experience.

So, ensure your application has robust clinical activities. Some suggestions:

Scribe
Clinical Care Extender
EMT
Low Income Clinic Volunteer
Hospice Volunteer
Veterinarian's Assistant (a great way to get hands-on procedural experience)
Phlebotomist

If you are not excited about getting clinical experience, it is time to question your interest in a career in medicine... which is exactly what admissions committees will do if they don't see that experience :).

Take a look below at my Guru on the Go© Video about this topic.

Flaunting our Failures?

The New York Times had a recent, thought-provoking article for perfectionists, overachievers, those with impostor syndrome, and any combination of the above. "Do you Keep a Failure Resume?" is a great reminder that chronicling our failures (something that isn't encouraged in medicine) can help us determine what the operational roadblocks were to our successes so that we avoid those obstacles in the future. (Perhaps the issue was lack of preparation or speeding through a project unnecessarily.) Reviewed in retrospect, an "anti-portfolio" is also a good reminder that a failure is sometimes the first step to a success in another realm.

Doctors are Crispy

The annual Medscape Burnout Survey is out and the news this year is  - again - somber. More than 15,000 physicians were surveyed in 29 specialties, and 44% of the respondents reported feeling burned out. Urologists made a jump up to the number one burnout specialty with a rate of 54% - with neurologists close behind at 53%. My field of emergency medicine was at 48%, compared to 45% last year. (Click here to see the 2018 Medscape Burnout Survey.) Women are more burned out than men at 50% versus 39%. 

For the brave of heart, take a look at all of the 2019 results here. 

Love Letters

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

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

2) Medical school applicants who have been interviewed but have not yet been accepted or rejected
3) Medical school applicants who have not yet been invited to interview (It's a little late in the cycle now for residency applicants, but LOIs can be used in this way in October through December for residency.)

4) Medical school applicants who have been wait listed  

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

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

The biggest errors I see in LOIs are:

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

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

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

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

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

This is an important reminder that Wednesday, February 20 at 9pm EST is the rank order list certification deadline. Start now to think about your priorities and specifically, where you will be happiest. Waiting until the last minute and making impulsive changes to your list is not a great idea.

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

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

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

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

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

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

Here is 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.

Do No Harm

I recommend reading this piece in Emergency Medicine News by Dr. Graham Walker. He writes about a physician colleague who recently committed suicide. The article notes that anesthesiologists and surgeons are the most likely to die by suicide, and emergency physicians come next in the specialties. 

As a follow up, this NYT piece on physician suicide is also worth a read - old but still relevant. Sadly, it notes that pre-meds enter medical training with mental health profiles similar to those of their peers but end up experiencing depression at greater rates.

I've written about depression in doctors before and would like to reinforce the importance and urgency of seeking professional help for depressed clinicians.  

Evidence-Based Decision Making Regarding Your Planned Specialty

For those first-, second-, and third-year medical students who are trying to pick a specialty, remember to start with the facts: The NRMP published Charting Outcomes of the Match to give applicants an idea of what characteristics successful 2018 Main Residency Match candidates had. While sobering (the mean Step 2 score for successful radiology U.S. senior applicants was 249), the information is valuable as you approach the decision-making process.

If you're just starting medical school, you can strategically plan your candidacy for success. If you're more senior, you can decide whether you have the characteristics necessary to pursue a successful Match process.

The “No Contact” Rule After Interviews

Just a brief reminder about the “no contact” rule that some residency programs (and medical schools) follow. While thank you notes and letters of interest are often warranted, if the institution requests no contact, it is important that you follow that rule. First, you don’t want to be seen as someone who is trying to gain an advantage when others are holding back, and second, you would like to be viewed as a candidate and future practicing physician who notes and follows instructions.

Importantly, if you are contacted by residency programs after your interview and promised a ranking to Match, I’d suggest you take that information with a grain of salt. It is flattering, but it should not change your Match list in any way. If a medical school contacts you with a positive review but no acceptance (yet), I would suggest being gracious while you continue to move through the admissions process. In other words, don’t let compliments affect your good judgment.

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

For those of you who are starting to think about your Match rank order list, please make sure you follow this (simple) strategy: Rank your first choice first, your second second, etc. The Match algorithm is mathematically quite complicated, but because the process always begins with an attempt to match an applicant to the program most preferred on the applicant's rank 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.

Here's a video the NRMP created last year to better explain the Match algorithm. Here's also a less-than-one-minute Guru on the Go© video "NRMP Ranking to Avoid a Spanking" to emphasize your optimal ranking strategy.

If You Don't Laugh...

I posted this piece on social media last week, but it's so clever that I wanted to showcase it in a blog.  "A lexicon for gender bias in academia and medicine" is hilarious (and sad) - definitely worth a read. While I do not know Dr. Esther Choo personally, I have heard from an emergency medicine colleague that she is a powerhouse. She clearly also has a great sense of humor.

Happy Medical Training: An Oxymoron?

Medical school and residency training usually decrease one's happiness for several reasons. Happiness researchers have demonstrated that a feeling of control and the amount of spare time one has both correlate with happiness. Both of those factors are limited during med school and residency. Relationships are also correlated with happiness, and those can be squashed during medical training as well.

I'm not trying to be a downer here! I want to encourage applicants to consider this happiness quotient when selecting an institution and training program. A lovely client recently emailed me to ask if he should consider medical schools' residency program director scores in deciding where to matriculate. (He had already gotten multiple acceptances!) I advised him to consider where he would be happiest instead. If you are able, maximizing your contentment by choosing an institution that fosters your greatest happiness is key. Geography; proximity to family, friends and community; and a location that provides an opportunity to enjoy hobbies during limited free time are significant.

Excellent training is important, but, in the end, many programs turn out equally qualified clinicians. At least consider your well-being as a factor in selecting where you might be for the next three plus years of your life.

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...

An influential 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. "It sounds sexy," he remarked. "But many of them have nothing in their C.V.s to bolster their interest in either pursuit."

When asked where you see yourself in ten years, consider how your accomplishments thus far might demonstrate an evolution. The idea is to have a trajectory that 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, though. 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. That's okay! And many residency applicants don't know if they want to do a fellowship. That's also to be expected. The point is to focus on your previous strengths and achievements and leverage them to demonstrate a logical path, going forward.

Specificity is Golden

I’ve been editing and mock interviewing up a storm recently, and I want to offer a tip: Avoid words like “various,” “numerous,” and “several.”

“I’ve been involved in various community service projects” can imply a lack of true substance or even an attempt at obfuscation. (Is it just two afternoon health fairs you’re talking about?) Worse still, your strong accomplishments are overlooked when you lack specificity. It may feel redundant to showcase an activity you highlighted in your application materials, but - as you’ve heard me say before - your reader/interviewer is likely reviewing scores of candidacies. Yours won’t stand out if you don’t make it.

Surgery Without Anesthesia

As we recover from our big Thanksgiving celebrations, I recommend this recent short NYT piece by A.J. Jacobs on gratitude. It’s fun and reflective - just what the doctor ordered.

Top 25!

While I've written before about my (and Malcom Gladwell's) hesitation with school rankings, I do reluctantly use them in listing where my clients have been accepted because they are more illustrative than alphabetic order. Please note that the top 25 schools are all represented on the Insider accepted list (plus many, many more). 

If you are a previous Insider medical school admissions client and you do not see all of the schools that accepted you on the list, email me. 

It’s Not Personal

When I was in my second year of medical school, a third-year student came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on 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 am saying the same to my clients. I've had applicants complain that faculty interviewers mixed them up with other candidates or were wholly unprepared - reading their 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. 

Clinical Medicine: Know What You're Getting Yourself Into

The article I'm about to recommend is not for the faint of heart. 

Alex Mohseni MD wrote a very pointed, compelling piece in a recent Emergency Medicine News called, "Why I Quit Emergency Medicine." It has created quite a buzz in emergency medicine circles.

It's painful, but a really great read. Here it is.

Early Acceptances

Great news!  Insider clients have already been accepted to Georgetown Medical School, Ohio State University College of Medicine, Virginia Tech Carillion, University of Cincinnati School of Medicine, University of Arizona-Tucson, and UMass Medical School. 

Current clients, please make sure to email me with your updates!

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 start contacting institutions to inquire about your status. After I offered that advice to some residency applicants I was advising this year, several recently emailed me to say they obtained interviews after sending emails. 

I've seen this 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. Surprisingly, 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.

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

This process is an uncertain one, but asserting some small bit of control can be useful (and comforting).

Residency and Medical School Interviews: Moving Past Impostor Syndrome

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

Recognize this phenomenon of self-doubt?

You are not alone. Although many people suffer in silence (as they do not want to be revealed for what they perceive to be major deficiencies), the syndrome is quite common, especially in medical school. According to one 2016 study, almost a quarter of male medical students and nearly half of female students surveyed suffered with impostor syndrome. The phenomenon can be associated with depression, burn out, and anxiety.

The American Psychological Association offers a few tips for overcoming impostor syndrome including speaking to mentors, recognizing what you excel at, and talking to a professional if necessary. Here is a fun piece in Emergency Medicine News for more information.