Not everyone dreams about their future the same way. Some think about what it would be like to succeed as a major recording artist, but you picture an eventual career as a physician. It’s the difference between fantasizing about a future that will never come to fruition and envisioning something that will inevitably happen.
This doesn’t mean you think pursuing medicine will be easy. You fully understand that hard work is an important part of the equation. You already got a taste of what it takes when you were applying to medical schools. It only makes sense that securing your spot as a medical resident will be just as challenging.
Now that you’re completing—or are about to begin—your medical school journey, it’s time to start planning your strategy for obtaining a postgraduate position. Landing the medical residency you want is less of a mystery than you might think. You’ll soon see that program directors have some pretty clear evaluation criteria.
8 factors program directors consider when reviewing medical residency candidates
Matching for residency is all about showing you’re a strong candidate and that you mesh well with the physicians at your desired program. Below, you’ll find some more specific information on just what residencies are looking for in a candidate.
1. Strong USMLE scores
Along with your grades, United States Medical Licensing Examination (USMLE) scores matter considerably to residency programs. Dr. Inna Husain, Assistant Residency Program Director for Simulation Education at Rush University Medical Center, explains why.
"Scores and grades can be incredibly important in this initial stage since all the reviewer has to compare files is objective data."
“Scores and grades can be incredibly important in this initial stage since all the reviewer has to compare files is objective data,” she says. “Some programs have a cutoff for scores.”
While the most recent program director survey from the National Resident Matching Program (NRMP) indicates Step 1 scores are weighed more heavily than Step 2 scores, this isn’t always true. Dr. Amber Ruest, St. George’s University (SGU) graduate and Program Director at the WellSpan York Hospital Emergency Medicine Residency Program, says it depends on what your results say about you as a person. She uses the example of someone who initially fails or scores low on Step 1.
“If their score increases significantly on Step 2, then we always want to know, ‘OK, how did you make such a significant improvement?’” she offers.
Dr. Ruest mentions there’s often something more to the story in these situations. It also shows a candidate’s intangible characteristics like self-reflection and motivation.
2. Solid grades
Good grades typically go hand in hand with strong test scores. Lifelong learning through continuing education requirements is an inherent part of being a doctor, so it’s in your best interest to show you’re successful as a student. You’ll be expected to learn a lot of material during postgraduate training.
“Residency is a job,” Dr. Ruest offers. “At the same time, you’re still a learner. In residency, you’re constantly getting feedback, learning, and acquiring more knowledge and experience.”
"You’re still a learner. In residency, you’re constantly getting feedback, learning, and acquiring more knowledge and experience."
3. Excellent letters of recommendation
Letters of recommendation are just as important for residency applicants as they are for medical school hopefuls—perhaps even more so. The NRMP’s program director survey indicates letters are especially critical for certain specialties.
“Especially in emergency medicine, letters of recommendation are very important,” Dr. Ruest says. “There’s a standardized letter of recommendation called a SLOE that I think emergency medicine residency programs take highly into consideration.”
Dr. Husain mentions letters as being important as well. And note that while other programs don’t use the same standardized format emergency medicine does, you still want to secure letters from physicians in the specialty you’re pursuing. Those individuals can speak to your preparedness for that field better than anyone.
4. A good Medical Student Performance Evaluation
While grades and test scores are typically scrutinized more carefully, your Medical Student Performance Evaluation (MSPE) is another way programs can objectively compare applicants. This document is essentially an evaluation of how well you’ve done in medical school.
While there is no standardized template, the Association of American Medical Colleges (AAMC) offers recommendations to include six sections: identifying information, noteworthy characteristics, academic history, academic progress, summary, and medical school information.
5. A thoughtful personal statement
Students are sometimes tempted to treat essays as throwaway application components, but don’t fool yourself. “We do read every piece of the application,” Dr. Ruest says.
Before meeting in person, your personal statement is the only real opportunity you have to show residency programs who you are outside of your academic profile. Furthermore, crafting a thoughtful personal statement can give you some talking points for interview season.
"Students are sometimes tempted to treat essays as throwaway application components. We do read every piece of the application."
The evaluation criteria shift a little bit once you start attending residency interviews. This is the first time residency programs will get a glimpse of what it would actually be like to work with you.
Not surprisingly, Dr. Husain says your professionalism is really important. That includes the way you dress and the way you conduct yourself. Program directors pay particular attention to how you interact with other students, residents, even secretaries. Dr. Husain also mentions it’s essential that you are on time.
7. Personality and fit for the program’s culture
While attending interviews can be nerve-racking, try to maintain perspective and be yourself. Residency programs only extend interview invitations to students who they’re actually interested in training. Now, they need to determine whether you mesh well with the rest of the team.
“If you have made it to the interview, the program thinks you are academically strong enough to succeed,” Dr. Husain explains, “however, if your personality doesn’t match the other residents or your goals don’t align, then you won’t be successful.”
Keep in mind that every program is a little different. Certain characteristics or personality traits will inevitably be better suited for some locations.
"We’re looking for people who are self-motivated, who are self-directed learners, who want to come to work every day and give 100 percent."
“We’re looking for people who are self-motivated, who are self-directed learners, who want to come to work every day and give 100 percent,” Dr. Ruest says of WellSpan York Hospital’s emergency medicine residency.
Inherent differences among programs mean there are places where you simply won’t be a good fit. But don’t feel discouraged if you notice this is the case, even if it’s at the program you initially thought was your top choice. You could be pleasantly surprised during the next interview.
8. Skills and experience relevant to the specialty
Lastly, your skills or expertise in a particular area may come into play. “For academic programs or certain specialties, research is a must,” Dr. Husain says, noting radiation oncology and hematology as examples. She also mentions that fine-motor skills are important to surgical programs.
"If there’s something that makes you stand out among other applicants, make it known."
If there’s something that makes you stand out among other applicants, make it known. Don’t think of it as bragging—it’s about putting your best foot forward.
Get yourself residency-ready
Hopefully, you can see that making yourself a competitive medical residency applicant is relatively straightforward. It’s all about doing your best in medical school and being authentic during interviews. Program directors are looking for candidates who are smart, hardworking, and who complement the existing culture.
While there are clearly numerous factors that speak to your intelligence and work ethic, USMLE Step 1 performance is particularly telling. A great score requires true mastery of the material. That takes time and a smart study strategy. Set yourself up for success by reading our article “How to Study for Step 1: Tips for USMLE Success.”
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