The Application Process: A Timetable for Success

Written by Jeff González, M.D.,Resident, Department of Medicine, Hospital of the University of Pennsylvania; MAC Governing Council, Resident and Fellow Section Representative

The best advice I know about the application process is summed up in 2 words: “Apply Early”. Now is the time to start. With this in mind, the following is an outline of what you need to attend to, and when:

Please note: The following timetable is particular to INTERNAL MEDICINE only, and may be applicable to most other specialty programs. However, for those residencies that are considered “early match” -- e.g., Military, Neurology, Neurosurgery, ENT, Ophthalmology, Plastic Surgery, Urology -- the deadlines will begin much earlier. PLEASE REVISE YOUR OWN SCHEDULE ACCORDINGLY.

Spring/Summer:

In the spring of your 3rd year of medical school you should:

1. Do your sub-internship and medicine electives in the specialty you’re applying to, and consider an ICU month.
2. Get a letter from your sub-internship attending, if possible (If not, definitely do an ICU month), and ask for it during your month or shortly thereafter! The longer you wait to ask for a letter, the less they remember you, the less personal the letter, and the longer it seems to take them to send it to your medical school residency coordinator. I suggest providing a copy of your C.V. along with your personal statement at this time.
3. Arrange to obtain at least one more letter from an medicine attending with whom you have worked. Have the attending send the recommendation letter to your residency coordinator, to remain there, awaiting the rest of your application. Some will tell you that the bigger the name, or the higher the title, or the more prestigious the position, the more pull the letter will have. All will agree that whoever knows you the best will write the most personal letter. Remember that you can ask for multiple letters of recommendation and, when all have been received, you can then decide which ones to forward to programs. Usually your Dean will be able to tell you which letter is stronger or weaker.

Summer:

1. Work on C.V., personal statement, and paragraphs of extra curricular activities for the Dean’s Letter.
2. Meet with Dean of Students for an official meeting. However, if possible, you really should try and meet with them much earlier than this. Again, the more familiar they are with you and what you have done in medical school, the better the “Dean’s Letter will be.
3. Figure out where you want to be for your residency, and make a BIG list. This usually entails considerations of geography and academic intensity. If you are restricted geographically, go deep and apply to many programs in that area. Use your resources: fellow students, attendings, residents, and advisors.
4. Make a list of addresses, contact names and phone numbers for all your programs of interest. You can get this from the AMA’s FREIDA Web site here. This is an excellent site to compare programs and has excellent search tools.
5. Send self-addressed postcards requesting information or call the programs directly. A fancy letter is not needed -- no one will read it! Just request a brochure and application. Be sure to specify what you want, i.e., for “a 3 year residency in internal medicine. Remember most programs now provide all their program information on-line. Their URL’s can be found on FREIDA as well.
6. Plan your winter schedule so that December and/or January are light or free. Most people take one month off and then plan for the other month during a course that is known to be flexible like Radiology, Dermatology, etc.

August:

1. Call places whose information you want but have not received.
2. Consider designing a grid/sheet to compare programs.
3. Meet with your assigned advisor to discuss the appropriateness of your list.
4. Work on polishing your C.V. and personal statement.

September:

1. You can start putting information on ERAS; refer to their website at www.aamc.org/eras.
2. Read through all of your brochures and start to narrow list somewhat (you’ll do more of this when deciding on interviews).
3. Meet with your school’s program director to discuss your list and request a Department letter. You should bring to the meeting your C.V., personal statement, your list of programs, and all of your medicine grades including clerkships, consults, sub-internships, etc.

October:

1. Finish your ERAS application and send it off. Most programs will not send interview requests until they receive the Dean’s Letter.

Around November 1:

1. The Dean’s Letter, Department of Medicine Letter, and your transcript are sent out.
2. Now is a good time to send a thank-you letter to the attendings who wrote your letters of recommendation.
3. You can check ERAS applicant information on the web to see which things each of your programs has downloaded, and/or if anything is missing.

October/November:

1. Respond to your interview offers. This is tricky. You can try and wait a little to schedule things in one city together, but if you wait too long you might not get what day you want. So play it by ear.
2. Have the suit you wore for medical school interviews dry cleaned, or buy a new one now. You will not go wrong with either of two colors: black or navy blue. Remember that often the most prestigious programs are the most conservative for the interview process.

Late November through early February:

1. Interviews: There is a controversy over whether notes are necessary after these interviews. At some institutions, for instance, they are NOT EVEN READ and may even be thrown out. However, many of us have stories of letters being written back to us, referencing these notes and assuming a level of interest/enthusiasm based on them. While they may not help, everyone agrees that they can’t hurt. Most agree that form letters, however, are a waste of everyone’s time.
2. Keep those who have written letters of recommendations up-to date on how your interviews are going and your perceptions of the programs that you are interviewing. Gather their feelings and gestalt on different programs. Your goal is to engage them in your application process in order for them to call and make a strong push for the residency of your choice. However, you cannot expect to walk into an attending’s office and say: “Do you remember writing a letter of recommendation for me 5 months ago, can you call so-and-so for me?” Instead, make this an ongoing relationship.

Late January:

1. Many agree that a letter sent out now, goes further than a post-interview “obligatory” note. It is not appropriate to mention ranking, per se, but if a particular program is your top choice, then go ahead and tell them this. You have nothing to lose; just don’t change your mind!
2. Now is the time to have any phone calls made on your behalf. Most program directors offer “one phone call” per student. Many programs also encourage “second looks”. While a few programs use this as a sign of your interest, most programs offer this for the student’s benefit. A well placed phone call or letter can often help make the distinction. Remember, most programs will meet to finalize their match list by February 5th.

Other Considerations:

There are several other issues that are often of concern to students.

The Need for Research Experience: This is an issue that always comes up. The way to approach it is two-fold. First you need to figure out if you are going to apply to a high ranking academic program and what career you want to pursue. If you are interested in academic medicine, you will find that most applicants will have performed some kind of scholarly pursuit. Many will have taken a year out, are MD-PhD, or have done research in college. Scholarship may also include leadership positions or community service activities.

However, if you have decided to pursue primary care, research is much less important. If you feel that, academically, you would benefit from research, then consider it. But, remember to speak to a wide variety of individuals for their insights.

What counts most in your application?
First, it is difficult to assess one’s own competitiveness -- i.e., grades, boards, AOA, Dean’s Letter, etc.—and different programs place importance on different things. But most programs seem to place a lot of importance on letters of recommendation. Board scores are important, but do not compromise a large portion of the evaluation process. They will help/hurt you if you are on the edge of the match list at a particular institution. In evaluating your application, how well you do in your other core clerkships particularly (OBGYN, Pediatrics, and Family Medicine) is important. If you are looking to attend a top tier program, it is very important that you receive a grade of honors for your core/introductory medicine clerkship.

Should I do an ICU rotation?
Again, this pertains to how well you have performed during your clerkships and electives. If you did not receive honors in a medicine clerkship and would like to attend a top tier program, it is recommended you take an ICU rotation. If you want to do Primary Care, it is not.

I hope the above information has been helpful and informative. And remember: “Apply Early.”