Consolidated FAQs for Internal Medicine Residency Applicants

I've had the pleasure of working in graduate medical education affiliated with large teaching hospitals for years. There have been many blogs, posts, books, videos, lectures, and every other form of media coverage on how to prepare for residency.  What I have found, over the years, is that despite the changing faces (and yes they are looking younger) many of the questions have remained the same.   Here I am listing the some of the most frequently asked questions (FAQs):

Do USMLE scores count?  Simply stated YES.  USMLE scores are the only objective  measure that allow Program Directors (PDs) to measure the academic aptitude of applicants.  Some critics have said that it only demonstrates people who are good test takers.  This type of criticism is near sighted at best and usually authored by those who did not score well.  Let's put this into perspective:  While I point to a fictitious scenario, it is just one of many real applicants.  An applicant presents with a 204 (2 attempts on step1) and a 235 (1 attempt on step2).  As the interview progresses the eventual question comes "so what happened on Step1?"  To which the applicant responds (pick the excuse), "I was faced with illness in the family/my wife left me/my husband left me/I have a personal tragedy."  This answer shoots the applicant in the foot.  He does not take ownership for his circumstances and clearly can not handle important matters under stress.  Picture an ICU rotation with 2 crashing patients and 2 admissions: talk about stressful.  Think about providing care to patients, if you screw up are you going to say "oh it was a bad day, I had gastritis or what ever).

Literature shows that USMLE scores are a good predictor of Board passing.  PDs will generally not say this but they are under the gun to keep their pass rate up.  One of the major indicators ACGME monitors programs for is their board pass rate, which for IM is 80% of first time test takers.  When you fall below this threshold PDs jobs are threatened.  So there is a balance between finding residents with good scores and the right personality fit for their respective institutions.

Can I overcome poor USMLE scores? This is difficult to answer.  However, the best course of action when faced with the question during your interview is own up to it.  "Yes, I did poorly and it really upset me as it does not really reflect my knowledge base as well as my ability to perform during highly stressed circumstances."  Beware, you will be challenged so if you answer like this you may get hit with a STEP or board review type question that you better be able to answer.

Which USMLE Step exam is more important? Simply put Step 1, 2, and 3.  Let's qualify.  We already answered that step scores matter.  But what if you didn't do well on Step1 and did very well on Step2?  The thinking from several PDs is "redemption" and "You are capable."  This is important.  Pass big on the Step2.

Should I take Step3 before applying?  It depends.  PDs philosophy is that they need to see that you are capable.  If you did not perform well on Steps 1 & 2, you should take Step 3.  But better prepare yourself to score BIG!  Having said that, if you are satisfied with your results and they will meet the PDs criteria for interview (usually above 230) then don't take it until afterwards as you have nothing to gain.

What's the issue with Visas?  Many programs do not take visas.  The issue for PDs is that residents don't always show up on time for various reasons.  This creates scheduling problems and stresses the program on day one.  However, some PDs open their programs to visas to give opportunity and broaden the quality pool of applicants.

When should I submit my application?  Opening day for applications is September 15th.  Do not be fooled that this is the day you MUST have your application in by.  Applications are filtered and reviewed for weeks prior to interviewing.  Some programs don't start interviewing until October and some not until November.  Better to have a more complete and inclusive application rather than getting it in on opening day.

Do Letters of Recommendation (LORs) matter?  LORs are not as important as the content of that letter.  It is very important when seeking an LOR from someone that it contains something personal.  Form letters and neutral letters are not helpful as they all sound the same.  PDs hate reading them.  A personal letter distinguishes your performance and contribution.  Not all preceptors should be writing a letter.  Choose your author carefully and remember if you want it to say something special, you have to do something special.

Any application red flags?  Gaps in training or changing medical schools are red flags.  They lead to questioning in an interview that generally does not work favorably for the applicant.  Years post grad is also a red flag unless it is filled with something appropriate like finishing a PhD or some other advanced training

How can I write a killer Personal Statement and does it matter?  This seems to be the most difficult part of the application for folks.  Know that a poorly written and grammatically incorrect letter will hurt you.  Personal statements should be just that...personal.  Personal statements should be like an LOR and your 60 second commercial distinguishing you.  Say something about an issue you encountered and how you overcame it.  Do not write I always wanted to be a doctor since I was a zygote.  But give some indicator as to why you chose medicine.  Check it and have someone else check it.  A basic rule of thumb is that it cannot be checked enough and keep it to one page.

Do publications help?  This is one of those questions that always comes up.  Publications are never looked at to determine eligibility for interview.  However when PDs are faced with a choice between 2 persons for one remaining slot, the one who has distinguished themselves more will likely get the slot.  This means publications help distinguish your overall application.

How are candidates selected for interviews?  Simple.  ERAS is a system that is used to sort by scores, schools and any other criteria that PDs want to filter out.  Generally this is done by someone other than the PD, generally the coordinator or administrator.  Only after those filters are applied are other elements looked at to invite for an interview.

What are other interview tips are there?  Understand that there are certain things that you can not change: where you went to medical school, where you were born, etc... Work hard, sacrifice, and prepare.  But you can change your USMLE scores by preparing for them.  This requires a high degree of honesty with yourself and following this formula:  Knowledge x Effort = Results.  If you are smart you will not have to prepare as much as the guy who is not as smart.

Interview tips:

  • Show up on time;
  • Make eye contact;
  • Sit up straight;
  • Look professional (this does not mean wearing a black or navy colored suit as almost all applicants do);
  • Distinguish yourself from the pack by highlighting what you have done and your knowledge/skill set;
  • Know as much about the program you are going to interview with;
  • Do not criticize the program (it's insulting);
  • Be prepared with open ended follow-up questions;
  • Prepare a 60 second commercial about who you are.  This is your opening line to introduce yourself.  Practice this over and over until you feel right with it.
  • Send a hand written thank you note.  It doesn't hurt and shows interest.

Well, that rounds out the top 12 questions from students and graduates who are applying for residency.  If anyone has any additional questions that were not listed here please let me know and if I don't already have an answer for you I'll get it.