Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Preparing for Residency Application- You can’t begin this process too early!


If you are a pre-medical student, nothing in this post is directed towards you. If you have not entered medical school, you can’t even think about residency. For you, your task is to get into medical school period. I am always mystified when premed students want to ask questions about residency application when they have no medical school acceptance in hand. A better strategy would be to concentrate your efforts on doing well in undergraduate coursework, on the Medical College Admissions Test and on putting a competitive medical school application together.

First Year Medical Students

If you are at this point, many of you have recently begun your medical studies or are about to begin your medical studies. Your first task is to get the best grades possible in your coursework. You are totally in control of your destiny in terms of your academics, thus you need to put most of your focus in that area. Hone your study skills, master your coursework thoroughly and look at doing a couple of things that may help you in making the residency application process a bit smoother when you get to that point in a couple of years. Trust me on this, the time zips by in medical school, once your classes are underway. You have to keep up and you have to anticipate the major steps so that you are ready for them when they come.

One of those little “extras” that you can do as a first-year medical student, is go to the Electronic Residency Application Service (ERAS) website and download a copy of “My ERAS Residency” User Guide.  The 2014 edition is available as a 34-page pdf which may be downloaded. This booklet will allow you to look at all of the elements that will be needed for a solid ERAS application. You will also get an idea of the time line that you will have to meet when your residency application begins.

Armed with that little book, you will see that academics (coursework and licensure board exams) are the main elements in your application. Also note that the application is going to ask about membership in Alpha Omega Alpha (if your school has a chapter) so you can investigate how you can become a member of this very prestigious organization for allopathic medical students. At this point in your medical school experience, Alpha Omega Alpha (AOA) is a great achievement to aspire to and you have time to investigate/perform what is needed for this honor. I can tell you from experience, every residency director/faculty member that interviewed me, make a comment about my AOA membership. Alpha Omega Alpha opens the door to securing a strong residency program in any specialty. Alpha Omega Alpha induction requirements vary from chapter to chapter thus you need to inquire at your particular school so that you know the requirements and can meet them.

Everyone isn’t going to be inducted into Alpha Omega Alpha but you can still keep your academics high by thorough mastery of your coursework because everything counts in terms of having a strong knowledge base for a strong board exam performance. Do not make the mistake of believing that you can “memorize” a board review book and ace your board exams. You can’t “review” what you haven’t learned in the first place. You also get one shot at not ruining your coursework performance in medical school, thus you need to be striving for solid coursework mastery at this point. Armed with a solid knowledge base, you will be able to review for boards more efficiently and will invariably score strongly if you prepare well.

You can also join some specialty interest groups at this point. Most medical schools have these groups which will give you some idea of what each specialty has to offer. Membership in these groups will help you meet the clinical faculty at your medical school which will be useful when you begin your clinical rotations. Being a member of a particular specialty interest group does not “lock” you into entering that specialty but will allow you to learn more about the practice. For example, I was a member of the pediatric interest group, the internal medicine interest group and the pathology interest group. I didn’t enter any of those specialties but I learned valuable information.

Second-Year Medical Students

At this point, you have one year, and a summer, behind you. You should have some idea of what is left in the pre-clinical curriculum for mastery so that you can plot your strategy for getting your coursework mastered. For most medical students, second year is a time when you begin putting much of your preclinical information together so that you can become a solid clinical practitioner.  You will gain much of the knowledge that you need to become an efficient clinician during second year but you will not gain much experience -wait until third year for that. Most medical students will be taking board exams at the end of second year, thus quizzing your upperclassmen, who just completed boards, should allow you to make some decisions as to what review books might be best for your style of study for your board exams.  Getting yourself in position for a solid review and a strong board exam performance coupled with a strong coursework performance is your main tasks of second year.

Again, have a look at the current MyERAS Residency User Guide and make sure that you are on track with setting a schedule for board review when that time nears. If you are going to be applying for and participating in a summer fellowship (I did a paid pathology fellowship between my second and third year), you will need to begin board review much earlier than your peers. Keep in mind that summer fellowships, especially paid research and specialty participation fellowships are competitive and require early application. They are also a good source of material for presentation at national meetings and publication in peer-reviewed journals, something that is very attractive to residency programs. The beginning of second year is a great time to investigate these opportunities so that you can apply for them in a timely fashion.

Participating in some extra-curricular medical school activities at this point may be a great option for you, but unlike undergraduate school, medical school is not the place to join lots of clubs to the point that your coursework performance begins to suffer. Do some activities, perform some community service but be very mindful of your time and of anything that takes you away from your medical school coursework study and mastery. Spend some quality time with younger(newer) attendings in specialties that are of interest to you. Pick the brains of the folks and allow them to point you in the best direction for you to be as competitive as possible. I always recommend that people seek out the newer attending physicians because they tend to be closer to the residency process and are usually honing their mentor skills thus they will answer questions and will guide you in the specialty selection process.

Some students at this point have some idea of what they might be interested in pursuing and start to angst about third-year clinical rotation order. This practice is useless because order of clinical rotations makes no difference in your grade. When I encounter third year medical students at the beginning of third year, I hold them to a different standard than third year medical students at the end of their third year. As clinical teaching faculty, we know how much clinical experience a student will have at a particular point in time and we judge that student accordingly.

Third Year Medical Students

By this time, you should have your Step I board score in hand. If it is a strong score and your coursework performance is good, you will have more specialty options that someone who is lacking in either of these two aspects. At this point, you either have to do “damage-control” or you keep doing excellent work. A strong third year will not offset a poor performance on boards and in coursework but you can help yourself by doing well clinically. Do be aware that grading in clinical rotations is quite subjective. You need to be sure that you can be a valuable member of the clinical team to which you are assigned regardless of clinical rotation and your interest in that rotations’ subject matter. If you don’t know what you want to enter, don’t lie to the intern, resident or attending of any specialty because you believe you will get a better grade. A strong work ethic coupled with an interest in all things that pertain to the care of your patients will help you in getting the best clinical grade.

Don’t make the mistake of “sucking up” to the attending physician and ignoring the intern or resident because you believe they won’t be grading you. My main resource as to a medical student’s clinical performance is the intern that they have been working under. When a medical student begins on our rotation, we don’t know your preclinical grades and we don’t care about those. Every student is judged according to our standards for solid clinical performance, thus, you have an opportunity to start with a clean slate and do well.

Sometime around the middle of third year, you should have decided what you want to do, within the context of your Step I performance and course academics. This is the time to ask for letters of recommendation from attendings on the services that you have done rotations. When I asked for a letter of recommendation, I included a packet which had the address of my academic deans office, my personal statement and my curriculum vitae/resume. I also included a photo so that the attending could remember me. Don’t wait too late in your third year for these letters because your Deans office will have started a file and will be submitting these to ERAS as you designate them. You also want them to be in your file so that the dean can submit your Medical Student Performance Evaluation (MSPE) in a timely fashion. The MSPE usually is not submitted with the early ERAS documents but if you have strong letters of recommendation in your file, your dean will submit a strong MSPE which can move you to the top of the bunch when you are being evaluated by the residency faculty committee.

If you haven’t had professional wallet-sized (passport) photographs taken, the beginning of third year is a good time to get this done. Please dress professionally and conservatively for these portraits. Get at least a dozen of these photos as you are going to need them for your ERAS, your licensure application and other documents. Just keep them handy so that you can get things out quickly without having to run and have photos taken.

Fourth Year Medical Students

At this point, you should have all of your ERAS documents ready and submitted to your Deans office. If you haven’t do so already, you need to register for the MATCH and get your ERAS submitted. Ideally, you should take Step Ii (both steps) as soon as you have completed third year but no later than September of your fourth year. If you wait to take Step II, it just gets in the way of your fourth year electives and travel for residency interviews. I took Step II the first week of August of my third year, before my fourth year started. That way, I had my Step II score back and ready for my ERAS transcript. It was also nice to have nothing between Match Day and graduation except to show up and get my diploma- I used the time to house hunt at my residency location.


Meet and exceed every deadline when it comes to matters of residency in medical school. Know the process, especially the requirements for entry into various specialties. You may love Dermatology but you are not going to match into Derm without very strong academics. You may love Orthopedic Surgery but you are not going to match into Orthopedic Surgery without very strong academics and so forth. If you have performed well in medical school, you have more options but you need to be realistic about your match chances for any given specialty in addition to making sure that all of your application documents are submitted as early as possible.

You need to know the process so that you can optimize your application. Get good advice from the people who have just completed the process and from medical faculty who can look at your documents and advise you on changes. With the increased numbers of applicants, you can’t afford to be one of those people who are trying to find a residency slot because you didn’t match. Good luck.


30 August, 2013 - Posted by | applying for Residency |

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