Applying in Two Specialties

Most residency candidates know that their lives will be made easier if they apply in only one specialty, but some apply to a competitive field with a backup, and others are still deciding between two at the time of ERAS submission. 

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 (IM) statement to IM 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.)

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, that will be viewed by your IM readers as well and might make them question your commitment to IM.)

If you are thinking of applying in three specialties, I'd say don't. Navigating the application and interview process while showing commitment to each field could be miserable. If you're at three, take a moment for some reflection, and pare your list to one or two.

How the New ERAS Schedule Might Relieve Your Stress

This year, in light of the COVID crisis, while ERAS will open on September 1, residency programs will not have access to applications until October 21, which is more than a month later than last year's date of September 15. At first glance, this alteration might seem minor: After all, if programs download applications in batches by chronological order, an applicant would still be better off submitting on September 1. However, all applications submitted September 1 through October 21 will appear to programs as being submitted on October 21. This affords residency applicants more time to get their applications in order. 

Having said that, ECFMG is still recommending that applicants submit by October 14 to be on the safe side, and I'd also suggest not waiting until the last minute. Good writing takes a long time, and you do not want to be behind the eight ball, submitting suboptimal written materials. 

For help with your residency written materials, contact me. 

"Why Our School" Secondary Essay: How to Get Started

Secondary essay prompts vary, but there are a few that are standard fare. See my recent blog entry for guidance on the familiar "diversity essay." "Why do you want to attend our school?" is also a common topic pre-meds will encounter.

Medical school admissions officers want to be assured that you know their institution, are seriously considering it, and will fit in well there. In approaching the "why-our-school" question, do your research on the institution and link something specific about you with the school's philosophy, curriculum, patient population, and/or extracurricular programs.

For instance, if you were a teaching assistant for chemistry in college, you might link your use of the Socratic method with a school's tutorial-based learning. In that way, you demonstrate knowledge of the school, show that you connect well with it, and showcase your accomplishment.  

The paradox here is that - although you are theoretically focusing your essay on one school - because so many institutions have overlapping philosophies, curricula, and objectives - you can oftentimes use the same essay framework for many different schools. 

That's one strategic way to cut down the overwhelming workload that secondary applications present. 

AAMC Fee Assistance Program Expands

In light of the COVID crisis, the AAMC has recently expanded its Fee Assistance Program income eligibility. Please take a look here for current requirements. For more information on the FAP, including an online webinar, see this AAMC page.  

To support those with financial need, l continue to offer a discount to those applicants who can demonstrate a current FAP. Contact me with questions. 

Diversity Essay: How to Get Started

I've had several questions on how to approach the secondary essay diversity prompt. In considering your strategy and content, I'd recommend you ask yourself the following question: 

What ethnic, religious, racial, gender, language, socioeconomic, or sexual orientation aspects of me, my family, or my experience make me distinctive?   

Please note that experience is part of the question I have posed. An applicant I mentored a few years back wrote me concerned that she did not fit into a minority category and thus, could not answer the prompt effectively. I suggested she consider an experience that targeted the prompt's theme, and she wrote a strong essay about her successful efforts to increase diversity during sorority rush. I crafted one of my secondary essays on my experience hearing Spike Lee speak in person. Don't be afraid to think outside the box.

How to Get Clinical Experience Safely During the COVID Pandemic

I've written before about the importance of premeds' getting clinical experience. Not only is robust clinical participation critical to obtaining a medical school acceptance, it's also important to ensure you like working with patients before heading down the long medical training path. 

During this pandemic, working as an EMT, scribe, or certified phlebotomist can be risky. So how can you get clinical experience without being in the clinic?

Here are three ideas:

1. Become a contact tracer -  I tweeted last month about a great Johns Hopkins training opportunity. Working as a contact tracer is a way to do a good deed, learn to convey difficult information to lay people, and make some money. 

2. Work on a crisis hotline (phone or text) - Many people are, understandably, in distress right now, and learning to assist those having emotional challenges will help you as a future physician.

3. Work on a COVID information hotline - There is a lot of misinformation floating about. Conveying accurate scientific concepts to the public is, again, an excellent skill to have in your tool box as a future doctor. 

Check out my goofy, less-than-one-minute video about the importance of getting clinical experience here. 

Brevity is the Soul of Wit

As William Shakespeare so wisely pointed out, being concise is critical for good writing.

I've been editing a lot of personal statements over the last few months, and I deliberately recommend a word count of 750 or fewer for my advisees for a couple of reasons:

First, I've found that that number is just the right balance of content and streamlining: Over 750 words for an admissions essay lends itself to meandering writing.

Second, your reader is likely reviewing tens or even scores of applications in a short period of time. S/he is looking to spend as little time as possible on your written materials, while still getting a good flavor for your candidacy. Don't burden your reader with verbiage.

Having trouble being brief? Here's a helpful trick: Imagine AMCAS, AACOMAS, or ERAS is charging you $10 per word. How would you keep costs down?

Choosing the Right Category for your AMCAS Experiences

AMCAS provides 18 categories in which you can classify your experiences. They are

Artistic Endeavors
Community Service/Volunteer – Not Medical/Clinical
Community Service/Volunteer – Medical/Clinical
Conferences Attended
Extracurricular Activities
Hobbies
Honors/Awards/Recognitions
Intercollegiate Athletics
Leadership – Not listed elsewhere
Military Service
Other
Paid Employment – Medical/Clinical
Paid Employment – Not Medical/Clinical
Physician Shadowing/Clinical Observation
Presentations/Posters
Publications
Research/Lab
Teaching/Tutoring/Teaching Assistant  

Sometimes an activity can match two categories. When that happens, lean on the clinical categories, if applicable. (For example, if your activity is both Leadership and Community Service - Medical/ Clinical, chose the latter.) If clinical is not relevant, then choose the category in which you have the fewest activities. 

A client who came to me as a re-applicant told me that a school from which she was rejected indicated that they had not counted a clearly clinical activity as clinical because she had classified it differently. Be sure you consider the categories deliberately in crafting your AMCAS.  

Strategic Tips for the AMCAS Most Meaningful Paragraphs

Back 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. The instructions stated:

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. Here are tips to craft your best work:

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 clear to some, 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 Paragraphs are 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.” Make sure to pick at least one of those three topics and answer it in the Most Meaningful Paragraphs. 

Bottom line: 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.

An Offer you Can't Refuse: Writing Your Own Letter of Recommendation

In the last few weeks, several medical school applicants have contacted me saying that potential letter of recommendation writers are asking the candidates to write their own letters.

If you have this opportunity for medical school, dental school, residency, or fellowship, 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 the topic.

The mistake I see candidates make in this situation 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 s/he doesn't agree. But if s/he does, you've utilized an opportunity fully and bolstered your candidacy tremendously.

AAMC is Encouraging Both a Systemic Virtual Medical School Interview and Virtual Residency Interview Policy During the COVID Pandemic

There is no time like the present to plan how you'll practice for your virtual medical school interview: Last week the Association of American Medical Colleges (AAMC) announced that they are strongly encouraging medical schools and teaching hospital faculty (that's you, residency programs) to conduct all interviews with applicants in a virtual setting. In an additional, reinforcing announcement on away rotations (see below), the AAMC specifically addressed the residency cycle for this coming year saying that they recommend that all residency programs commit to online interviews and virtual visits for all applicants for the entire cycle. The AAMC suggests "that the medical education community commit to creating a robust digital environment and set of tools that will yield the best experiences for programs and applicants." I applaud the AAMC for their willingness to be proactive, encourage public health, and decrease medical school and residency applicant anxiety. 

Assuming there are no in-person interviews, this medical school and residency application cycle will look completely different with no applicant visits to institutions or face to face conversations with current students/residents and faculty. Schools and residency programs will be left with quite a burden to make their institutions looks distinctive and to select qualified applicants.

For the latter, be prepared to strategically handle a virtual medical school interview. Consider getting my help. For the virtual residency interview, get my help here. 

On the same date that AAMC announced the recommendation regarding the virtual medical school interview, they also announced that for the 2020-21 academic year, because of COVID, away rotations should be discouraged and that ERAS' opening be delayed. The latter has already come to fruition: While ERAS will open on September 1 for candidates to submit their applications, residency programs will not being reviewing applications and MSPEs will not be released to residency programs until October 21 this year (compared to September 15 and October 1 last cycle). Of note, ERAS did not announce a change in Match Day yet. 

There are a lot of changes afoot. To keep up, check this web page, which AAMC has been updating regularly. 

How to Use the MSAR to Your Advantage

The Medical School Admission Requirements (MSAR) is an online database that allows users to search, sort and compare information about U.S. and Canadian medical schools.The 2020 MSAR came out last month, and if you are applying to medical school, I'd recommend purchasing it ($28 for one year) because it provides so much information about schools and their admissions statistics. The MSAR allows you sort and compare schools by median MCAT scores, AMCAS GPAs, and other criteria.

You should use the MSAR to help determine which schools are in your range and which are "reach" schools. While it's fine to have a lot of "reach" schools (if you can afford it), it's critical to ensure you are applying wisely to schools that match your numbers. The advantage of the MSAR is that you can make evidence-based decisions. I've found some applicants have eye-opening experiences when they thoroughly review schools' statistics and either realize that their numbers are low and that they should apply accordingly or, happily, that they have numbers that match with top schools. Either way, reviewing the data is critical to good decision making.

USMLE® Step 1 Scoring Will Change to Pass/Fail

Some students were pleasantly surprised this February to find out that the USMLE will be making a major change to Step 1: The test will be scored as pass/fail starting in 2022. Despite what seemed like a bombshell announcement to some, the USMLE had been working on the transition for over a year. Check out this piece, "Step 1 Score Change: One Small Step for USMLE, One Giant Leap for Medical Student Well-Being" on why the USMLE implemented the new scoring system, what opponents had to say, and the timeline for implementation.

Get a Better Letter: How to Get the Best Letter of Recommendation for Medical School or Residency

COVID-19 continues to upend experiences for pre-meds and medical students, as well as the entire med school and residency application process, but certain truths do not change: Submitting outstanding letters of recommendation for medical school and residency is critical for a successful candidacy. 

I see some applicants mistakenly filling the slots with faculty letter writers without thought as to whether these letters will further the applicants' candidacies. See my After Rounds piece, "How to Submit Outstanding Letters of Recommendation for Residency." It is relevant for students applying to medical school as well.  

Tips for Applying to Residency in a Competitive Field

While our minds are currently focused on our changed world, first-, second-, and third-year medical students are still plodding along through classes and rotations (albeit virtually in most cases), preparing for an eventual Match Day.

For those planning to apply in competitive specialties like plastic surgery, otolaryngology, neurosurgery, interventional radiology, dermatology or orthopedics, among others, the calculus of what needs to be accomplished for a successful residency candidacy is very different and must be planned well in advance of the ERAS open date (maybe even before entering medical school).

Please check out my piece, "Luck Is When Preparation Meets Opportunity: Strategies for Competitive Specialties" for clear guidance on the needed steps. 

The Myriad Ways COVID-19 is Affecting Current Medical Students

I've covered the adverse effects COVID-19 has had on dental and medical school applicants, but medical students' lives have been altered even more extensively. See the piece I wrote, "An Entirely Different, Very Frightening March Madness" for many details. The day before the piece posted on the Wolster-Kluwer After Rounds site, the New York Times followed up on New York University's early graduating seniors.

How is COVID-19 Affecting Pre-Meds and Pre-Dental Students?

COVID-19 has upended everyone's lives, and I really mean everyone. Last week I mentioned some issues specific to pre-meds and pre-dental students. Here's an update:

MCAT cancellations: As of last Wednesday, April 1, the AAMC extended the cancellation of MCAT testing through the month of April. (Prior, AAMC had only cancelled the March 27 and April 4 administration dates.)

Inability to acquire enough clinical, research, or volunteer hours is worsening, as applicants who had expected to get more experience this spring are being told that only essential workers should report for duties.

As the recession worsens, there is a decrease in individual wealth, leading to an inability to pay AMCAS/ AACOMS/ AADSAS fees or apply to as many schools as had been planned.

Difficulty accessing letter of recommendation writers who are no longer on campus or are, understandably, distracted with their own disruptions will continue to be a problem. 

A lack of enthusiasm for medicine (or an increase in it, for some) may rise as the great risk health care providers are currently assuming is more newsworthy. 

I've had an applicant or two ask me if this year is a better year to apply - perhaps less competitive - because of the above. I really have no crystal ball on that issue, although it's an interesting question.

Keep safe and stay in.

The Medical School Application Process and COVID

Greetings from California where we are hoping to flatten the curve by proudly being the first state to order residents to shelter in place. 

Last week I posted some truly excellent articles and a podcast on COVID. This week, I'm listing some considerations pre-meds need to ponder in the setting of the virus:

1) The March 27 and April 4 MCAT exam administrations have been canceled globally. It's unclear whether some future dates will be eliminated.

2) It is hard to get clinical experience right now. Many non-essential personnel are - rightly - being asked to stay home. 

3) Letter of recommendation writers may be harder to reach or focused on other concerns.

4) As of now, there is no indication that the AMCAS application calendar will change. 

Please stay home and stay safe.

Holding up and Holing Up

Greetings from California where we are sheltering in place. Newsom did the right thing to save lives, but this will not be easy here in the Golden State. I worked in the emergency department last week, but I was in the less acute side - not managing high risk, respiratory patients. From what I have seen, hospital systems in the area have tremendously organized plans in place. My concern is that they will get overwhelmed soon.

Like most of you, I've been reading a lot on COVID-19, both in the lay and medical press. I've compiled some of my favorites as of this writing:

A must-listen-to interview from the New York Times' Daily Podcast of an Italian ICU doctor managing the crisis in his country. Forward this one to your family and friends.

An Annals of Internal Medicine piece on incubation period of COVID-19 with a visual abstract.

A visual representation and accompanying article on hospital bed capacity exhaustion from the Harvard Global Health Institute published by the New York Times. 

A widely circulated "ICU one pager" for clinicians on COVID-19.

I'm also now subscribed to a daily update on COVID-19 from the Johns Hopkins Center for Health Security.

The St. Louis versus Philadelphia 1918 flu mortality graph with accompanying article. Send this to anyone who doesn't understand why social distancing is important. 

Please stay home as much as possible, and encourage your family and friends to do the same. 

COVID-19: Check out this Interesting Academic Lecture

I do not usually cover medical pathology in this blog, but I heard a compelling on-line lecture on COVID-19 by Amesh Adalja MD, who is a Senior Scholar at the Johns Hopkins Center for Health Security. His expertise is in emerging infectious diseases, pandemic preparedness, and biosecurity. For those of you interested in his medical career path (as I was), Dr. Adalja completed a combined residency in internal medicine and emergency medicine and then completed two fellowships - one in infectious diseases and one in critical care. The lecture does a great job of putting COVID-19 in historical, evolutionary, and policy context. One point: The lecture is about 2 weeks old, and, of course, much has occurred in that time frame, but understanding other pandemics and their lead up to this one is helpful. It's worth the time to listen.