Hanna Renaldi's Blog: All You Need to Know About Residency Applications and Matching

Residency Applications and Matching

You’re busy juggling med school and life, and if you don’t stay organized, one of those balls is going to come crashing down. Let’s take a look at what you need to do so you can stay focused, motivated, and completely on top of your juggling act.

What are the Components of a Residency Application?

ERAS is the electronic application shared by residency programs. Here are the parts of the application you will need to complete:

1. Personal Info

ERAS opens in July, so you can get your basic info entered during the summer.

2. The Residency Personal Statement

Just when you thought you had done all the essay writing you would ever have to do (remember getting into med school?), you are faced with the blank page of another personal statement. Only this time, you must explain why you are a good fit for your chosen specialty.

Start working on your personal statement as early as you can. Your essay should reflect the past four years, rather than rehashing high school or undergraduate experiences. In other words, it rarely works to recycle your med school AMCAS essay.

Your application should look professional and show the maturity you have gained in the past four years. Be sure to get feedback, either from your medical school or a medical school admissions expert.

3. Residency Program Selection

In September, you get to start choosing programs. Be sure to apply to programs that are a good fit for you. Do you want a program where there are fellows and subspecialists (which may improve your chance of getting a fellowship in that area)? Or would you prefer not to have fellows competing for cases? Do you like the idea of a large program with many personalities and teaching styles, or a smaller one that acts more like a large extended family? Your USMLE scores and letters of recommendation will weigh heavily for most residency programs, so be sure to focus on these and choose residency programs with numbers that match yours. Some applicants apply to two separate specialties with one as a backup if their first choice is highly competitive. Meet with your department chair or another trusted adviser to decide which residency programs you are competitive at and will succeed in.

4. Letters of Recommendation

Your letters should come from faculty who have worked closely with you and can attest to your strengths and readiness for residency. If you feel an attending has seen you at your best, ask for a letter immediately after you finish that rotation. Do not wait until application season begins, as they will have seen many med students by then and won’t have a strong memory of you. For all letter writers, share your CV and personal statement and ask them to complete the letter within 4-6 weeks.

It is generally advised to sign the waiver saying you agree to not see your letters. Not signing it will cause program directors to wonder what you are hiding.

ERAS makes it possible for you to submit and store as many letters as you need, then send certain letters out to each program. This allows you to individualize for each program. For example, if you have a letter from a faculty member who has connections to a program you are applying to, you can make sure that letter gets to them. In addition, if you are applying to more than one specialty, you can guide the appropriate letters to each program. You can continue sending letters out after you have submitted your application, so don’t hesitate to request a letter from attendings in your fourth-year rotations. These will often be your strongest letters due to the added independence and responsibility you get as a fourth-year. One of the best possible letters to receive is from an attending who writes that, as a fourth-year student, you performed equal to or better than the interns.

Finally, not all letters need to be from physicians in your chosen specialty. Letters from attendings in other departments can be especially convincing, as they show your ability to master other disciplines and earn respect from colleagues.

5. The MSPE (Medical Student Performance Evaluation)

Many medical schools have switched over to a P/NP grading system, so the MSPE was created as a way to rank and recommend students without a GPA. According to the AAMC, the MSPE is “a summary letter of evaluation intended to provide residency program directors an honest and objective summary of a student’s salient experiences, attributes, and academic performance.” In 2016, the AAMC released recommendations to standardize the MSPE across all schools. The six sections the MSPE includes are:

1. Identifying Information

2. Noteworthy Characteristics (three characteristics highlighting the most salient noteworthy characteristics of the student)

3. Academic History (dates, grades, and any disciplinary actions)

4. Academic Progress (strengths, weaknesses, professional performance, preclinical coursework, and cletrkships)

5. Summary (may include a graphic comparison of the student compared to their class)

6. Medical School Information

Most schools do their best to portray you as a strong candidate, as they want their graduate to be successful. According to AAMC, the “clerkship evaluations are a crucial piece of information for program directors and are considered by many to be the most important section of the MSPE in determining applicants for interview selection and rank order list.” The MSPE is required again if you apply to fellowships or other subspecialty programs, so it is essentially a permanent part of your academic record.

6. Residency Interviews

Your residency interview is a two-way interview. You are looking at them as much as the other way around. Some schools look great on paper, but applicants find that when they visit a program, they don’t gel with the residents. Residencies often rely heavily on their residents to evaluate whether a candidate will be a good fit (after all, they will be your closest colleagues for the next several years). Make sure you come across as easy to get along with and a team player on interview day. If your medical school interviews were very stressful, or you tend to get nervous and stumble with your words, you will want to do some mock interviews before the big day. See “What’s the Best Way to Prepare for Your Interview” for more info.

How Does the Residency Match Program Work?

Applicants rank the programs they have applied to and residencies rank the students they have interviewed, and a computer goes through one by one, matching you to the highest school on your list that has spots open. Once Applicant A gets matched to a program on their list (let’s say their second choice), they will be removed from all programs lower on their list, which opens those up for other applicants. If Applicant B was matched to Applicant A’s first choice, but then gets matched higher on their list, Applicant A’s first choice school will then open. In the end, you only find out which ONE PROGRAM you are going to, not all the temporary matches along the way.

What is the Couples Match?

When faced with the possibility of spending the next three (or more) years apart, many fourth-year med student couples opt to apply through the couples match. You each register for the match independently, apply and interview as individuals, but then you become one unit at the time of the match. When the lists are computed, the couple is accepted to the highest ranked program on their list that accepted BOTH of them. The drawback is that if one half of the couple is not accepted at a program, the other person may be giving up their chance to go there. The upside is that if you let programs know you are applying as a couple, they may push another department to accept your partner. For example, if the department of surgery really wants one half of a couple, they may encourage the department of internal medicine to accept their mate.

What Happens If You Don’t Match or Partially Match?

Reasons for not matching vary, but may include doing poorly on the USMLE exams, not being competitive in your chosen specialty, or not including/ranking enough programs.

Some residencies require a transitional one-year internship before specialty training begins (anesthesiology, dermatology, ophthalmology, radiology, and several others). Sometimes applicants successfully match to the transitional internship year but not the residency, while other times they match to a residency but not an internship.

Options for those who are unmatched or partially matched:

• The SOAP (Supplemental Offer and Acceptance Program)

This is a three-day rematch where residencies with available slots are opened to applicants who did not match or who partially matched. It is administered by NRMP, the same organization that conducted the match. They have all your information and can quickly disseminate it to programs with open spots.

Eligible applicants can apply to up to 45 programs through SOAP. This is followed by an intense period of three rounds of offers, in which applicants must be prepared to make a quick decision. If possible, get counseling from your medical school on how to navigate the SOAP, and what your best options are.

After SOAP ends, residencies can open their spots to anyone who did not match, including those who did not go through SOAP. This is not overseen by the NRMP, so applicants must contact programs individually.

• Research Fellowship

Some medical schools offer a one-year program to boost your resume while you reapply. If needed, applicants can retake the USMLE.

• Other Degrees

Some applicants choose to do an MPH or pursue another degree while deciding what direction to take.

• Reapplying

If an applicant does not get into any training programs, they can reapply the following year to a different specialty or to less competitive programs in the same specialty. If you are in this situation, it is imperative to take a close and honest look at your entire application, including your letters of reference, and work with a counselor or consultant to create the best strategy going forward.

Graduating from Medical School

This is the last phase of your medical school experience. There will be speeches from doctors and public health officials on the future of healthcare and your role in making the world a healthier place. Go ahead and imagine all that you can accomplish. Above all, enjoy this moment. You worked hard for it!

Do you need help with your residency application? Explore our Residency Application Package and work one-on-one with an expert admissions consultant who will help you match at your top choice program!

Suzi Schweikert is a former UCSD School of Medicine adcom member who has mentored students in healthcare programs for over 20 years. She has a BA in English Lit from UCLA, an MD from UCSD, and an MPH from SDSU. Want Suzi to help you get Accepted? Click here to get in touch!