by Cydney Foote
All You Need to Know About 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 (Electronic Residency Application Service) is the electronic application used by most residency programs and specialties. Here are the parts of the application you will need to complete.
1. Personal Info
ERAS opened in June, so you can enter your basic info during the summer. Most applicants shoot to have everything ready by the opening day, which in 2024 is September 4.
2. The Residency Personal Statement and Experiences
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 a blank page for another personal statement. Only this time, you must explain why you are a good fit for your chosen specialty.
This time, your focus should be on the past four years, rather than rehashing your high school or undergraduate experiences. As you write your personal statement and experience descriptions, pay attention to activities that demonstrate the core competencies in your target field. And remember, it rarely works to recycle your med school AMCAS personal statement! Your application should look professional and show the maturity you have gained in the past four years.
Start working on your personal statement and experiences as early as you can. 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 might improve your chances of getting a fellowship in that area)? Or would you prefer to not 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 Step 2 scores and your letters of recommendation will carry significant weight 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 serving as a backup if their first choice is highly competitive. Meet with your department chair or another trusted adviser to decide where you are competitive and will succeed.
4. Letters of Recommendation
Your letters should come from faculty members who have worked closely with you and can attest to your strengths and readiness for residency. If you feel that an attending has seen you at your best, ask them for a letter immediately after you finish that rotation. Do not wait until application season begins, because by then, they will have seen many med students and won’t have as strong a memory of you (despite how amazing and memorable you might be). Share your CV and personal statement with all your letter writers, and ask them to complete the letter within four to six weeks.
It is generally advised to sign the waiver saying that 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 your letters 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 person’s letter goes specifically to that program. 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 because of the added independence and responsibility you have as a fourth-year. One of the best possible letters you can get is one 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, because 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 of the MSPE are as follows:
- Identifying Information
- Noteworthy Characteristics (three of the student’s most salient and remarkable characteristics)
- Academic History (dates, grades, and any disciplinary actions)
- Academic Progress (strengths, weaknesses, professional performance, preclinical coursework, and clerkships)
- Summary (might include a graphic comparison of the student to others in their class)
- Medical School Information
Many medical schools will ask you to draft your noteworthy characteristics. These can highlight accomplishments or experiences from any time in your life and are a good way to bring in information that might not otherwise fit in your personal statement or experiences. Follow your medical school’s guidelines, and submit them as early as possible so you have time to incorporate any feedback.
Most schools will do their best to portray you as a strong candidate, because they want their graduates to be successful. According to AAMC, “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
Interviews are a vital step in the application process and give you a chance to speak with a variety of people in each program. Be expected to meet with faculty members as well as administrative staff; programs also rely heavily on their residents to evaluate whether a candidate would 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 with everyone you meet on interview day. If your medical school interviews were very stressful, or you tend to get nervous and stumble with your words, you should plan to do some mock interviews before the big day. See What’s the Best Way to Prep for Your Residency Interview? for more info.
Also, remember that your residency interview is a two-way interview. You are looking at and evaluating them as much as the other way around. Some schools look great on paper, but applicants find that when they visit those schools, they don’t gel with them. Take notes immediately after your interview, when things are still fresh in your mind, so you’ll have this information to refer back to when you rank programs.
How Does the Residency Match Program Work?
The National Resident Matching Program (NRMP) administers the match algorithm for most residency and fellowship programs. Applicants rank the programs they have applied to, and residencies rank the students they have interviewed, and a computer goes through both sets of inputs one by one, matching applicants with the highest school on their list that has spots open. Once Applicant A gets matched to a program on their list (let’s say their second choice), they are removed from consideration for all programs lower on their list, which opens those spots up for other applicants. If Applicant B was matched to Applicant A’s first choice but then gets matched higher on their own list (Applicant B’s), Applicant A’s first-choice school will then reopen that spot. In the end, you only find out which single program you are going to, not all the temporary matches that occurred 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 and 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 might be giving up their chance to go there. The upside is that if you let programs know you are applying as a couple, they might push another department to accept your partner. For example, if the department of surgery really wants one half of a couple, they might encourage the department of internal medicine to accept their mate.
What Happens If You Don’t Match or Only Partially Match?
Reasons for not matching vary but can include doing poorly on the USMLE, not being competitive in your chosen specialty, or not specifying/ranking enough programs.
Some residencies require a transitional, one-year internship before specialty training begins (e.g., anesthesiology, dermatology, ophthalmology, radiology). 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.
The following are options for individuals who are unmatched or partially matched:
- The SOAP (Supplemental Offer and Acceptance Program): This is a three-day rematch, during which residencies with available slots are opened to applicants who did not match or who only partially matched. It is administered by the NRMP, the same organization that conducts the match. It has 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 individuals who did not go through SOAP. This is not overseen by the NRMP, so applicants must contact programs individually.
- Research fellowship: Research can boost your qualifications for some specialties. 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 pursue a master’s of public health or other 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 about 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!
Since 2001, Cydney Foote has advised hundreds of successful applicants for medical and dental education, residency and fellowship training, and other health-related degrees. Admissions consulting combines her many years of creating marketing content with five years on fellowship and research selection committees at the University of Washington School of Medicine. She’s also shared her strategy for impressing interviewers in a popular webinar and written three books and numerous articles on the admissions process. Want Cydney to help you get Accepted? Click here to get in touch!
Related Resources:
