Hello friends! This post is very belated. It was meant to be my first official post since graduation and clearly multiple posts (although not as many as I anticipated) have come between that time and now. It’s hard to believe that this space–that I first used to document my experience as an pre-medical student–has become such a resource for other individuals. It is even harder to believe that there are individuals who have followed my journey (via this blog) for five years. I am in serious shock and I feel serious gratitude.

Since my last life update: I completed my MD/MPH, received awards from both the MD program and the MPH program, drove a rental van with all my belongings to Philadelphia (24 hours – alone, the scenery is gorgeous; the drive was…long), and started residency. Today marks my first entire week of elective (child abuse & adoption medicine) after completing my inpatient rotations for this year. Residency is not easy but I like it more than medical school. There’s no comparison. At all.

I meant to write about residency application season right after match day but I got caught up in writing my public health analysis and then I graduated and then I moved and then I wanted to spend time with my co-interns (basically, I have a ton of excuses). I think the delay is beneficial. I have now had the opportunity to evaluate medical students and sub-interns (which feels totally wild because I was literally a medical student not too long ago) and have heard a little bit from co-residents and administration about what aspects can hurt your application.

This post will be divided into four sections: pre-interview season, interview season, post-interview season, and general tips. It is important to keep in mind that I applied for pediatrics and so not all of this advice is generalizable. I recommend taking a look at my dear friend Yang’s Match Series to see high-yield advice from now-residents who matched into specialties aside from pediatrics. For those of you who are going in the amazing field of pediatrics, I have a document that I made for my mentees applying into pediatrics last year that you can use to set goals to get your application ready.

Pre-Interview Season: the pre-interview season is a period of excitement and anxiety. Okay to be honest, majority of this process is anxiety-riddled. This time period involves standardized examinations, sub-internships, away rotations (depending on your specialty) in addition to curating your application. That’s a lot to manage in a short period of time and it’s challenging to balance this stress surrounded by a ton of peers who are going through the same process, equally stressed about said process, and have strong opinions about what the right/wrong thing is to do during this process. If you thought the second-hand anxiety that you acquired during USMLE  I was insufferable, this is next level. I cannot say this enough: think critically from whom you receive your advice. Your favorite faculty mentor may mean well but are they up to speed on the data regarding your specialty of interest; does said faculty mentor have different goals for you than what you have for yourself; are your fellow medical students who are just as oblivious about the application process who you should receive majority of your advice?

• Standardized examinations: the start of fourth year is the typical time period for USMLE 2 CS and CK for which I have described my approach to these examinations in a previous post. It is worthwhile to set a realistic goal prior to the start of any examination – this goal may be impacted by your dream specialty or dream program; if USMLE 1 did not go the way you hoped, USMLE 2 CK can serve as a second chance. If that was the case, I would recommend taking USMLE 2s prior to the end of July so that the scores are available at the time you submit ERAS.
• Sub-internship: depending on your specialty of interest or whether you are uncertain about your ultimate specialty interest at the onset of fourth year, you’ll complete 1-2 sub-internships. Your sub-internship (if completed in the inpatient setting) affords you the opportunity to play the role of an intern. Depending on the comfort level of your team, you will have the opportunity to place orders, manage patients under the oversight of your attending rather than the residents, and play the principal role of documentation. If you are on a team with other medical students, you can start to craft an approach to teaching fellow members of your team and helping them to articulate plans – a role you will fill as a first year resident. There is a lot of pressure to know the answer to everything and to anticipate any hangups during your patients’ hospital courses. Be kind to yourself: even residents misspeak on rounds, fail to answer the ‘pimp’ questions, and have their plans tweaked by the attending. Here are the things you can focus on: connecting with your families and your team, providing compassionate care, showing up early and staying late (not just for the optics but because you are dedicated to your work), functioning as independently as you are able to do so (but remaining aware of what is outside of your role), and diligently reading the literature about the pathology that impacts your patient panel. Ideally one of your attending from your sub-internship will write one of your letters of recommendation.
• Away Rotations: I feel as though away rotations are becoming more “necessary” across specialties although less so in primary care fields as compared to more competitive specialities. Away rotations can be a financial burden and I have a curated list of funded away rotations and my thoughts on away rotations in another post. Here I will just state that is important to choose away rotations that will help inform you regarding what you want out of your residency program. I say that instead of “rotate where you want to match” because I think away rotations can give you an opportunity to explore what is outside of your home institution. Is there a geographic region in which you have few ties but a lot of interest? Do an away in the area! Are you at a small institution but have curiosities about life at a large institution? Do an away! Do you feel dead-set that you want to match at a particular program? Think critically before you complete your away. If the away goes poorly it could hinder your chances of a match at that program; it could seal the deal if things go excellently; it could demonstrate that your dream program is not without flaws.
• Chairman Interview: It is not uncommon for an institution to require a letter from the chairman for your specialty of application at your home institution. It is worth it to schedule your meeting early in the summer, get the letter completed, and have it available in case you need it.
• Curriculum Vitae: Make sure your CV is up-to-date and include high school or college information only if it was of extreme importance. There is a two-fold purpose of updating your CV – 1) your letter writers will likely want to refer to your CV and 2) you can utilize your CV as a launching off point to describe your extracurriculars on ERAS.
• Letters of Recommendation: Start to ask for letters of recommendation in May/June.  Your letter writers will not submit their letters at this point in time but it’s worth it to have them begin to think about what they will write for you. Ask for what you want: a strong letter that demonstrates that you are passionate in x, y, and z. If your letter writer cannot commit to a strong letter, search elsewhere. Ask for more letters than you will need because it’s better to have extra letters than too few.  Seek letters from individuals who can speak to your persona and your work ethic. It’s ideal to obtain letters from individuals in your specialty of interest although one letter from someone who can speak to your character who is outside of said specialty is worth consideration. In general: inpatient letters are generally preferred to outpatient letters given residencies tend to skew more towards inpatient time than outpatient time.
• Personal Statement: Try to pen a first draft of your personal statement prior to the middle of June. Your letter writers may wish to read your personal statement. My advice for personal statements is simple: write something honest. An ideal application has a coherent message or theme. I shared my personal statement in another blog post. My overall theme for my application: advocacy and public health via narrative medicine. For the long-term readers, that probably comes as no surprise. The best individuals to read your personal statement are the people who know you the absolute best. I did not have fellow fourth year medical students read my statement because I felt as though they could not be unbiased. My closest friends from college and individuals a year below and a year above me in medicine read my statement and provided beyond useful commentary.
• Application List: Curating your application list is a very personal process. A smart list should include: schools in the area you are geographically from, schools in the area where you are in medical school, schools with an average USMLE 1 lower than your score, and schools that have taken students from your home institution. I met with my academic dean, the chairman of pediatrics, and the clerkship director of pediatrics to discuss which schools would be worthy of application. I took a list of the past five match lists to see where Tulane medical students matched for pediatrics. I stalked FRIEDA to obtain information about: the size of programs, average USMLE 1 and USMLE 2, and salary. 
• ERAS Photograph: It seems superficial but the photograph is not trivial. My dear friend Jenny has a wonderful post about what you should shoot for in regard to your application photo.

Interview Season: so ERAS is submitted and it’s time for interviews. What a flurry of travel, deep conversations with interviewers and co-interviewees, and excitement. People told me interview season would be the most expensive vacation I would take. It was…expensive. It did not necessarily feel like a vacation. As many of y’all know, I completed a four year MD/MPHTM program and had to complete five tropical medicine courses alongside rotations in the fall semester of my fourth year. Scheduling interviews around my laboratory schedule and my examinations led to two weeks of four interviews per week. Please do yourself a favor and schedule your interviews in a way that is not completely tiresome. Okay let’s jump into it.

• Interview Preparation: Know your application inside-and-out because you are likely to receive questions about your extracurriculars or your personal statement. Some institutions will have one interviewer be a “blind” interviewer – this means they do not have your application at all or not your complete application. These interviewers often lead with “tell me about yourself” and you can find yourself literally in a 30 minute conversation without any pointed questions. Be prepared to launch into a conversation that is primarily self-directed. Have a reasonable answer to “tell me about yourself” that affords you the opportunity to highlight the aspects of yourself that you value the most and ways to continue the conversation. Have at least 5-10 questions about the program to fill time in case your interviewer has few questions for you. Practice answering the classic interview questions: weaknesses/aspects you are working on/strengths/passions/why medicine/why this specialty/leadership style/patient encounter that has impacted you? Find a way when you detail your weaknesses to demonstrate your growth and efforts to move forward. Find an interview outfit or multiple outfits that make you feel competent and collected. You are what you wear my dears. For the ladies, if you decide to wear heels (which I did), have a pair of flats on hand for the tour.  Here are a couple of questions I would ask on interviews when I needed something quick to ask:
  • What would make a candidate a poor fit for this program?
  • How would you describe the culture of this program?
  • What is the dynamic on rounds? Is it education focused? Is it about getting work done? Is it family-centered? Multi-disciplinary?
  • Are there resident liaisons or care team assistants to help with sending documentation to primary care providers, updating primary care providers, and scheduling appointments?
  • How do most residents get around: is this a community where it’s almost expected to drive or do residents walk/take public transportation?
  • How many institutions do residents rotate at? Where are these other institutions?
  • Is this program hierarchical?
  • What time is sign-out?
  • I’m interested in [insert subspecialty], is it possible for me to explore that as a first year resident?
  • What advocacy work is popular with your residents?
  • What opportunities are there for global health engagement as a resident in this program?
  • Is this a program where people learn by reading or primarily from the wards?
• Interview Scheduling: Interview invites tend to flood in after the dean’s letter is received by programs. Once institutions have downloaded applications, keep your phone on hand (and on loud) at all times. There are multiple approaches to scheduling interviews and I can share with y’all what my approach was. I had all communications sent to my gmail account given that I was worried about filtering of emails if I selected my institutional email. I informed all attendings and fellows that I would check my phone frequently and that it should not be indicative of a lack of interest. Most interview invites were received at an appropriate time (8 AM – 5 PM EST) although I did receive one invite at 10 PM EST which was absolutely wild and I was grateful that I happened to be awake at that time. I think that was an outlier although I would ask residents in the field of your interest what the typical time frame was for interview invites. I’d also ask about when the typical time frame is for interviews. Some specialties tend to interview into January. Some specialities don’t really start interviews until December. Some specialities are beyond done by the middle of December. In regard to scheduling your interviews: attempt to schedule geographically if able but don’t kill yourself over this. Try to shoot for a maximum of 3 interviews per week. Build in a week or two without interviews as a breather so you aren’t entirely burnt out by the time you hit the end of the trail.
• Financial Management: So I feel as though nobody ever told me how much their ERAS to match process cost: it was approximately $5200 for applications and interview travel and stay. Ultimately, I cannot give you advice on how to handle the price point of this process. Some individuals open up credit cards to acquire points/miles throughout medical school in order to utilize those points/miles during interview season. Some individuals take out just a little more than they may need per semester re: loans in order to pay for the interview period (although they accrue more interest that way); some individuals have to take out additional loans. Some individuals have parents who pay for some/majority of the process. Some individuals do a mix of the afore-mentioned strategies. I recommend making the process as affordable as possible: take trains/buses as able (flights are expensive). Try to schedule your interviews in a geographic manner. Stay at your friends’ place is able. One pro-tip: you can email the interview scheduler to ask if they can email all the interviewees for you interview date to see if anyone wants to share a hotel room. I noticed that a few individuals did this on my interview trail. Feel comfortable canceling interviews if you have a sense that you have reached your financial quota/if your interest wanes. Seriously, it is okay to cancel (if you give appropriate notice). It is okay.
• Interview Social: Interviews will have pre-interview or post-interview socials which could be a variety of things – dinner, happy hour, or something a little more random. These are unnecessarily more stressful than they need to be. Now that I’m on the other side and attending these interview social, I can tell you that most people are not there to be incredibly judgmental. Many of the residents in attendance are hoping to have a good time and kick it with their peers outside of the hospital. The stress about what the wear (whatever makes you comfortable – business casual is a safe bet), what to say, and how to act is seriously not worth it. Use the opportunity to observe the dynamic between residents and to ask them about their experience. Pro-tip: don’t talk about other programs. I’ve seen co-interviewees and applicants do this and it never really goes over well.
• Thank You Notes: People will tell you different things regarding writing thank you notes versus not. I sent thank you notes to all of my interviewers because I knew that it would drive me crazy to not do so. Of course, if a program definitively tells you to not send thank you notes, don’t do it. I have a bare-bones thank you note that I would add more details to but if you want a starting off point:
  • Hello Dr. [insert name]!

    I just wanted to send a quick note to thank you for taking the time to speak with me on my interview day. It was a pleasure to get to know you and hear about your journey in medicine. Your love for [insert city name] and [insert program name] was both apparent and encouraging. I greatly enjoyed my interview day and I took away a true sense of what it would my life would be like as a member of the [insert program name] family and the [insert city name] community. Thank you again. 

    Best wishes, 

    [name] 

• Rank List: People will tell you to “trust your gut.” I heard that advice and I grimaced. I can explain. The residency interview process feels exquisitely like early dating. You don’t want to be too forward. You can’t get a sense of what your love (aka the program) thinks about you. How many of us have trusted our gut and ended up in a trash relationship? Exactlyyyy. So I knew that I needed to have a little bit of logic on the trail and use my gestalt to shift programs on my rank list. Before you go on your first interview, make a list of what you think is important to you. I had a template to document my thoughts following each interview and I filled it out when traveling home/to my next interview. I heard a lot of creative approaches: snapchat videos of how they felt post interview, calling a best friend after each interview so that the friend could help them make the decision, and excel documents with point systems. Ultimately, those are all good ideas but I think it’s important to take that next step: make your rank list as you go. After I filled in information about the interview, I shifted the program on my rank list. Weeks later, I had forgotten some of the aspects that made me feel strongly yay/nay about a program and I felt as though my immediate rank list (which is what I ultimately submitted) was more honest and true to my needs than the list that would have been created by the increasing doubt and anxiety as I got closer to rank list submission time. Below are the aspects of my template:
  • General impressions at the social
  • Some of the aspects that the residents mentioned that they love about the program
  • Some of the aspects that the residents did not like
  • General impression of fellow applicants (what is the spirit of applicants who are drawn to this program)
  • Commitment to hematology/oncology (my specialty of interest)
  • Commitment to advocacy and advocacy opportunities
  • [Insert city name]
  • Diversity of the program and patient population
  • Global health opportunities
  • Camaraderie
  • Overall impression of the program

Post-Interview Season: so your last flight has landed, you drop your suit off at the dry cleaner’s for the final time, and settle into reflection of the season. You and your friends are all in the same place for the first time – commiserating on how crazy of a ride this whole thing is. So what comes after submitting your rank list?

• Love Letter: Do it. Send a letter to your number one to declare your interest. At this point, what do you have to lose? I wrote a love letter that was approximately the length of my personal statement. It was emotional and long-winded. It was similar to those monologues in romantic movies. It’s worth it to know you have said everything you need to prior to match day so however things turn out, you know you have done everything in your power. I discourage individuals from sending “I anticipate ranking this program highly” emails to your top five programs. They can read between the lines. Send an email only to your top choice and stop there. And in responding to love letters you receive from programs, it is worthwhile to find a balance between being enthusiastic and non-committal. Definitely respond.
• Coping with Anxiety: You are more than this process and you are more than where you match / do not match. This process and being around individuals who are going through this process can lead to you feeling as though there is nothing else to discuss or think about aside from match. I fixate – believe me, I struggled with thinking about my rank list after I submitted. Make the most of your post-interview season, enjoy your life, enjoy your time with your friends before multiple cities separate y’all, and encourage your friends to discuss the other aspects of your life aside from your impending match.

I hope that to some degree this was helpful to you guys. Very happy to answer questions in the comments or via email. Of course, I am not a guidance counselor or academic advisor so specific questions may be best directed to your academic advisor.