The Complete Guide to Residency Applications
Transcript of The Complete Guide to Residency Applications
The Complete Guide toResidency Applications
David Flick MD, Associate Director of Advising, MedSchoolCoach
About the Author
David Flick MDAssociate Director of Advising
MedSchoolCoach
Dr. Flick graduated Magna Cum Laude from Loyola Marymount University in Los Angeles,
California with a BS in biology where he was heavily involved in high school and university
level tutoring. He then moved to Chiang Mai, Thailand where he worked as a high school
mathematics teacher at an international baccalaureate school. In the two years prior to
starting medical school, he volunteered in seven different countries throughout Asia with
international medical aid programs. Dr. Flick attended medical school at UC Irvine after
receiving the Army health professions scholarship. He served on the admissions committee
for four years including working on the selection committee board. He completed a family
medicine residency program in Oahu, HI and served on the residency admissions committee.
He is board certified in family medicine and now works as a flight surgeon for the Army.
Education
Medical School – MD from University of California, Irvine School of Medicine
Residency – Tripler Army Medical Center
Undergraduate – BS from Loyola Marymount
Dr. Flick was a four year member of the admissions committee at UC Irvine School of Medicine and is a Flight Surgeon for the Army.
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Applying to residency is a tedious process that requires plenty of forethought and planning.
The key to applying and matching well starts by understanding the process by which medical
students apply to residency, and how they match. This guide will:
Introduction
Ÿ Help you better understand the application process
Ÿ Walk you through putting together your application
Ÿ Provide interviewing tips
Let MedSchoolCoach help you match into the residency of your dreams.
Ÿ Advise you on structuring your rank order list
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Before we jump into the entire process of how you apply to residency and how the matching
process works, it's worth first discussing how to choose a specialty or specialties to apply
to. There are two basic principles in tackling this fundamental question.
In 2019, the average USMLE Step 1 score for applicants that successfully matched into
plastic surgery was 249 and USMLE Step 2 CK was 254. The average amount of
presentations, publications, and abstracts was 14 – and 40% of those that matched had
Alpha Omega Alpha (AOA) designation.
This discussion requires honesty and a certain degree of bluntness. No matter how much
you might love Dermatology, Plastic Surgery, or other highly competitive specialties, if
you don't have the academic performance to stack up to the competition, it's just not
realistic to go for it.
If you've got no relevant research experience, and low board scores, applying to Plastic Surgery
just is not realistic. For brand new medical students, keep this in mind, to be able to practice in
these highly competitive specialties, you must start out early building your resume. Reference
the data (nrmp.org/main-residency-match-data) to find Charting Outcomes in the Match
out more about the statistics for each specialty to see how you compare to the competition or
what you need to do to get there.
Choosing a Medical Specialty
1. Set Realistic Expectations
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Note: At the beginning of 2020, the USMLE announced that no sooner than January
2022, the USMLE Step 1 will become a pass/fail test. Practically speaking, this means
that Step 2 CK will become the new Step 1. Every effort should be made to excel on Step 1
and pass, but an exceptional performance on Step 2 CK will be a major deciding factor on
residency selection.
Ÿ Do you like the idea of a nice quiet office where you clock in and clock out?
Outpatient practice suits you well.
Ÿ Do you want to work in the public health arena? Consider preventive medicine.
Some students go into medical school already knowing what they want to practice and
go through with it. Others start out with a goal in mind and veer off on a completely
different path. Some students have no clue until their third-year rolls around.
Some basic principles are involved in understanding what kind of medical practice best
suits you:
2. Understand What You Want
Ÿ Do you like the idea of fast paced medicine with a bustling hospital? Inpatient
practice is your game.
Ÿ Do you like the cool, sterile feel of an operating room with scalpel in hand? Surgical
specialties sound about right.
Thinking about big picture ideas of practice will help narrow down your choices. For
some people, the kind of medicine is most important, and for others the lifestyle that
practice comes with is more important. Take time to think deeply about these choices
and spend time during your pre-clinical and clinical years observing doctors in these
fields to get an eyes-wide-open view of what it truly looks like. On that note, make sure
you spend time with residents as well as attendings to see the full scope.
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The Application Process
Most residency positions are offered through the Electronic Residency Application Service,
or ERAS. The timeline each year varies, but generally follows the same month structure that
starts in June and culminates with “The Match” in March of the following year. You can
reference the 2019 timeline to prepare for your own application cycle.
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June 6, 2019 March, 2020September 5, 2019 October 1, 2019
ERAS 2020 Begins
– Applicants can
register on
MyEARS and begin
working on their
application.
Visit:apps.aamc.org
/account.
Applicants start applying
to ACGME-accredited
residency programs only.
MSPEs released to
residency programs.
National Residency
Match Program
(NRMP) main
residency match
results are available.
Visit nrmp.org.
ERAs Timeline Example
Ÿ Ophthalmology Match – Applicants apply through the Central Application
Service (CAS) and match through the SF Match in January. More information can be
found on the at aao.org.American Academy of Ophthalmology website
While most programs operate in this way there are several programs that operate outside
of this structure or alongside it:
Ÿ Preventive Medicine – Applicants must contact individual programs to
determine their process. Some use ERAS, and some use a preventive medicine
residency application service. Most use a separate matching service outside the
NRMP called the Standardized Acceptance Process, or SAP. However, some use
thNRMP. The SAP deadline for rank lists is on January 10 . Match Day is around January
th20 . More information can be found on the American College of Preventive Medicine
website at acpm.org.
Ÿ The Military Match – Applicants apply through ERAS as above, but complete a
rank order list and match through a system called the Military Operational Data
stSystem, or MODS. Application to programs ends August 31 , and rank lists are due
th thOctober 15 . Match results are released around December 12 . Notice, there is no
involvement of the NRMP.
Ÿ The Urology Match – Applicants apply through ERAS and rank lists are due
rdJanuary 3 . Some programs use NRMP, and some use a urology match program.
thMatch Day is around January 18 . More information can be found on the American
Urology Associate website at auanet.org.
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It is important to understand that the application process and the matching process are
two separate entities. You'll need to register for both systems for most residency
applications in order to match. ERAS allows you to package your application and get it to
programs which in turn will offer you interviews. NRMP allows you to rank those programs in
order from most to least desirable, then submit that ranking so their algorithm can match
you into a program. The NRMP publishes calendars each year with deadlines for the
process. In general, NRMP opens in September, the registration deadline is in November,
and rank order lists are due in February.
The National Residency Matching Program (NRMP)
As the process became more competitive, it also became less fair, with students and
hospitals accepting and filling programs at will through the year. To standardize this, the
powers that be invented this matching algorithm to pair up applicants and programs at one
thpoint-in-time in the 4 year – to even the playing field. Interestingly enough, the research
used to create this algorithm even won a Nobel prize!
nrmp.org/matching-algorithm
The Match is basically an algorithm that takes rank order lists of applicants' programs and
compares them to the rank order lists developed by programs that rank the applicants. The
algorithm attempts to pair these together as best possible taking into consideration every
applicant at the same time.
Applicants often wonder why you don't just apply, interview, and get acceptances to
programs like you did for medical school.
This algorithm-driven process was invented to solve a very specific situation. Before the
match, hospitals were under a great deal of pressure to try to fill their programs, which
meant as time went on, hospitals would reach out and extend offers to medical students
nd rdsooner and sooner – often in their 2 and 3 years. Students would snatch up these offers
and hospitals would start filling their programs early to secure their futures.
Learn more about the matching algorithm :
Understanding the Match
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Before the actual application process begins, a successful bid for residency requires
careful planning of the second half of third-year and the first half of fourth-year. The
important parts here are away rotations and use of electives.
Away rotations are particularly useful for you to find out more about a program, while at the
same time, showcasing your talents. These are essentially working interviews, or audition
rotations. For this reason, away rotations should be chosen based on your interest of
matching into one of these locations. Plus, you can use them as a required rotation. For
instance, when using an away rotation as an elective or a Sub-Internship rotation, you'll
also get a free interview out of the rotation without having to travel back for another visit.
Keep in mind that nearly every medical school has set-aside time for you to do interviews in
your fourth year, so you don't need to feel compelled to get all your interviews done through
away rotations.
Regarding timing, there is no right time to do your audition rotation, just a wrong time. One
wrong time is early in your third year when you're not strong clinically. The other wrong time
would be too close to your rank order list being due in February. That makes the ideal time
anywhere from late Spring of your third year through the end of that calendar year.
In general, it is not wise to do your first core rotation as an away rotation at a program you're
interested in. So, if you haven't done Internal Medicine yet, don't show up to an audition
rotation for internal medicine. Sure, you'll learn a ton about the program, but you won't make
much of a strong impression. You want to show up to audition rotations looking strong, so
usually this means doing a Sub-I or just an elective in that specialty late in your third-year
or early in your fourth year.
Planning Your Third- and Fourth-Year Rotations
Practically speaking, you cannot use all your electives and away time to do audition
rotations. Your school will have limitations, but also you also don't want to spend your whole
fourth year just doing the same rotations at different hospitals. You'd be shortchanging
your clinical education. Most applicants can afford to do one or two of these, and the rest of
exposure to these programs will come from interviews. Every school is different, so make
sure you sit down with your deans to find out how many aways you can do, when you can do
them, what specialties you can do them with, and how much time is set aside for electives.
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To begin the Dean's letter, you'll need to start by talking to your Dean. Each school has
different policies on how this is conducted, but the school will notify the applicant and
ultimately generate the letter and upload it to ERAS.
Start by preparing a comprehensive CV (curriculum vitae) to structure your experiences.
You will take that CV and expand on each topic to write small paragraphs for each section
of research, volunteer activity, clinical activities, and employment. Since the application
assumes you have completed your entire medical curriculum (or will) it is not beneficial to
write about rotations unless they were particularly meaningful. If you decide to write about
a rotation, pick just one.
Now review the format for both the Activities and Personal Statement sections.
1. Gather a Dean's Letter/Medical Student Performance
Evaluation (MSPE)
ERAS Application
Just as it is wise to start prepping your medical school application in advance of the
season, applicants should prepare their application well before ERAS opens in the
beginning of June.
ERAS allows for a personal statement about five pages long. You should aim for just about a
page and a paragraph. You should not need five pages, nor do admissions committees want
to read that much. Describe why you want to pursue your residency of choice and what will
make you exceptional at it.
Most schools will automate this and there will be set deadlines from your Dean. Your
school will likely require you to attend a meeting before writing the Dean's
Letter/MSPE and will require you to present three noteworthy characteristics.
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Ÿ This section should be presented as a dot bulleted list (DO NOT
NUMBER).
Ÿ This section is written in third person.
Ÿ The word count is 35-40 per bullet.
Provide a maximum of three characteristics highlighting the most salient
noteworthy characteristics of the student.
Ÿ Each characteristic should be described in 2 sentences or less.
Ÿ Information about any significant challenges or hardships
encountered by the student during medical school may be
included.
Dean's Letter/MSPE Instructions Example
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3. Write Your Personal Statement
Applicants should start writing their personal statement far in advance of the
ndapplication. If you know you want to be a general surgeon halfway through your 2
year, go ahead and start then. Do not wait until the application season to start your
personal statement. Applicants are allotted 28,000 characters with spaces.
If you will be applying to more than one specialty, you'll need a separate personal
statement for each program. Technically, you could write a different personal
statement for every program, but this is not necessary. You will have the option to
assign a specific personal statement to each program.
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Writing a strong personal statement starts with structure. A clear format breaks the
essay into manageable pieces for the reader to read and for you to write:
Ÿ Content – To make a personal statement truly unique, you need to look beyond
your activities. Write about something you are passionate about. It doesn't have to
be medicine. I've read great personal statements that talk about the lessons the
writer learned as a dancer, as a baseball player, or as a teacher. They show how
they've learned humility, compassion, perseverance, diligence, patience, and all
sorts of characteristics that apply to medicine. Picking something that you're
passionate about allows you to demonstrate how these characteristics are woven
into aspects of your life – not that you learned them by being involved in an activity,
but the activity is an expression of the underlying characteristic.
Ÿ Body paragraphs 1 to 3 – Explore your theme(s). Focus on traits that will make
you a good physician or otherwise prepare you to excel in medical school and
beyond. Do not tell more stories here, and do not rehash your resume/work and
activities section. Introduce activities only to provide context to how they've shaped
you. Pick a theme and use two activities to prove that you possess the skill/trait. In
this way, you show that the activities are an expression of yourself, not a simple
lesson you learned from an experience. Why two? Because one doesn't provide
enough evidence and three or more sounds like a list. Two is the sweet spot.
Ÿ Introduction – Open with an anecdote, story, or other creative writing technique to
draw the reader in. End this paragraph by introducing your theme(s) to be explored.
Ÿ Conclusion – Wrap it up and end on a catchy or more emotional note. If the
introduction serves to draw the reader in, then the conclusion will help leave a
lasting impression on the reader.
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Ÿ What do you like to do?
Ÿ Do you have a unique perspective?
Ÿ What values are important to you?
Don't think activities. Think THEMES. Think YOU. Here's some questions to get you thinking:
WARNING: Try to weave description and content together. Most applicants use a
paragraph to tell a story and then use a sentence or two at the end to reflect on it (which is
perfect for a work/activities section, but not for a personal statement). When I see this as
an admissions committee member, I just start skipping the story and reading the last
sentence of each paragraph.
“I began my family medicine clerkship in a community clinic dedicated to the less fortunate.
There I found a group of family physicians, each with their own niche, working together to form an
incredibly comprehensive team. One physician in particular specialized in the behavioral
sciences, amongst other things. He saw the kinds of patients I found so fulfilling to treat on my
psychiatry rotation, but he also saw just about everything else under the sun. From depression, to
skin cancer, to a well-woman exam, I found the pace and surprise of the daily schedule
invigorating. What truly impressed me was how he applied the same principles of the one-on-
one real, personal connection required in mental-health to every patient. He laughed, he joked,
he hugged, he spoke with authority, and to me it seemed like every patient was a member of his
own extended family. To me this is what family medicine really means and I will strive to make
every patient leave feeling as though they were listened to, understood, and given the best
possible medical care available.”
Here's a snippet from a successful personal statement that highlights attributes of good
writing in a personal statement:
Ÿ What are you great at?
Ÿ What are you passionate about?
Ÿ What do you have that other applicants don't have?
Ÿ Do you have a unique approach to problem solving?
Ÿ Do you have a unique way of thinking in general?
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Should you write out your description in bullet form or paragraph form? If you go with
bullets, don't make each bullet a paragraph. If you go with paragraph form, you need to
use complete sentences.
4. ERAS Activities
The applicant can enter as many experiences as they would like to. Be sure to aim for
quality, not quantity.
· Member of pediatrics interest group
· Attended lectures about pediatrics cases
· Volunteered at events for promoting interest group
· Participated in group meetings
Applicant A:
Bullet Form Example
I prefer the paragraph form because you can be more reflective. Consider that most
applicants will have many similar activities – like participating in an interest group for
example. Let's look at two approaches to illustrate a few advantages of the paragraph form.
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For 2 years now, I have been an active member of the pediatrics interest
group. I attend group meetings to learn more about pediatrics, listen to
lectures from pediatricians to get an up-close look at practicing
pediatrics, and help promote the group. Not only have I formed strong
friendships and collegial relationships with my fellow members, I have
also had a chance to evaluate my own strengths and weaknesses and
thoughtfully consider if pediatrics is the right specialty for me. The
lessons learned from my membership have bolstered my performance on
rotations and I hope will make me a stronger pediatrics resident in the
future.
Applicant B:
Paragraph Form Example
Notice there's just so much more you can say with a paragraph. Suppose both applicants
had the exact same resume and both chose bullet form. How would the program director
decide which was a better applicant? Choosing to write in paragraph form allows you to
identify and highlight all the unique aspects and attributes of your application to help you
stand out.
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Experience Format
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Residency Explorer is to residency applications what the MSAR (medical school
application requirements) is to medical school applications. It has vast amounts of
data on each individual program. Everything from average step scores to the total
number of residents and which schools they come from.
Due to the vast number of programs offered for each specialty, we are not able to offer
detailed program list selection help. The applicant should start by entering their
information into residencyexplorer.org. This site will give an idea of where the applicant
is competitive based on multiple factors, and they can filter the results based on
location and program type. Your adviser will help you to determine which programs are
a best fit for you in broader strokes.
5. Program Lists
Note that you can only enter your scores in Residency Explorer three times, so applicants
should not “play around” with different score scenarios, otherwise they will lock out the
account – you can still access the information, you just can't change the numbers.
Residency Explorer
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Ÿ – this tool allows applicants to see how many AAMCs Apply Smart Tool
applicants applied with a given Step 1 score and what percent matched. It also
provides data on the point of diminishing returns. This is a statistical point where 1
more program applied to does not confer a significant advantage in return. It does
NOT mean that applying to more schools decreases your chance of matching, just
that the rate of return is lower.
Visit https://bit.ly/AAMC-apply-smart
6. Helpful Tools
There are several different tools to help you understand and navigate the residency
application process.
Ÿ – this tool allows the user to Interactive Charting Outcomes of the Match
identify specific categories (step scores, research experience, volunteer experience,
etc.) and see exactly what percent of applicants matched with these
characteristics. By plugging in numbers, one can see their statistical chance of
matching similar to the MCAT/GPA grid utilized for pre-meds.
Visit https://bit.ly/charting-outcomes
Ÿ – Every year, the NRMP publishes all data on the Main Residency Match Data
match. This is where every piece of data can be accessed. The SAP Crystal report
(Item number 2 at the top under Data Reports) is particularly useful. You can see in
each state, how many applicants there are for each specialty and how many match
from DO, MD, IMG, and US-IMG. This is particularly useful in structuring applications
based on geography to make sure your degree, citizenship, location, and specialty
choice are all compatible.
Visit http://www.nrmp.org/main-residency-match-data/
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Ÿ What is your interest in this program?
Ÿ How would you handle a non-compliant patient?
Ÿ What are you looking for in a residency program?
Ÿ How do you manage stress?
Ÿ Describe a time when you overcame a great challenge.
Ÿ What makes you want to be a ____? (fill in the specialty)
Ÿ Where do you see yourself in 5 years? 10 years?
Ÿ What would you do if you saw a senior resident or attending do something wrong?
Ÿ What are your greatest weaknesses?
Ÿ Describe a time where you disagreed with someone or something and how you
handled it
Ÿ Describe a research project you were involved in?
Ÿ What is the most interesting case you have encountered?
Ÿ What 3 words would your patients describe you with?
Ÿ What 3 words would your colleagues describe you with?
Ÿ Name 3 things wrong with the U.S. healthcare system and propose some fixes.
Ÿ Why did you become a physician?
Ÿ How do you handle interpersonal conflict?
Ÿ Describe an accomplishment you are most proud of.
Ÿ What other specialties did you consider?
Ÿ What are your greatest strengths?
Interviews typically start rolling in around late Fall and early Winter. Aim to interview at as
many programs as you can afford to attend. Preparing for interviews should start with
becoming familiar with typical interview questions. You can expect to find these questions
and prompts in a typical interview:
Ÿ Tell me about yourself.
Ÿ What do you like to do outside of medicine?
Ÿ Please explain any gaps or discrepancies in your education.
Ÿ What elements do you think make a great ____? (fill in specialty)
Interviews
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General tips on interview day:
Ÿ Stature – Sit upright and lean in just like you would when speaking to a patient. Body
language conveys interest, so leaning back with crossed arms may send the wrong message.
Ÿ Ask Questions – Every interview will end with the same question: What questions
do you have for me? The only wrong answer is to walk away without asking questions.
Rather than reinvent the wheel, check out the extremely exhaustive list the American
Academy of Family Physicians prepared on this topic: https://bit.ly/AAFP-questions
Ÿ Attire – Dress professionally, and remember this is not a fashion show. If you happen
to be up to date on the newest fashion trends, just remember that your interviewer
might not. Interview day is probably not the best day for an ironic tie or pink gator
boots. Your clothes should be neat and presentable, and should not distract from the
content of your message. The same goes for jewelry. Try not to wear anything that
draws the attention away from you.
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Applicant A:
2. Family med 1
4. Family med 1
Applying to Multiple Specialties
4. Family med 2
1. Derm program 1
Applicant B:
Notice that both applicants have three Derm programs and two family med programs.
Applicant A has three contiguous ranks for Derm and two contiguous ranks for Family Med.
Applicant B has no contiguous ranks.
1. Derm program 1
3. Derm program 2
5. Derm program3
The number of contiguous ranks is very important, and there is data in Charting Outcomes
in The Match (nrmp.org/main-residency-match-data) that provides more detail. For
example, of the derm applicants in 2019 that had one contiguous rank for Derm, 30%
matched. Of the derm applicants with 12+ contiguous ranks, 100% matched. How you
organize your rank list is clearly very important.
2. Derm program 2
3. Derm program 3
5. Family med 2
Some applicants are not 100% sure on what specialty they are ready to enter, and others
may include 'backup specialties' to fill their list. There are certain benefits and drawbacks to
creating non-contiguous lists. The term 'contiguous ranks' refers to the number of
specialties that appear in a row. For example:
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That doesn't mean that you can't rank multiple specialties though. That is a separate piece
of data. In 2019, of the derm applicants that ranked one specialty, 89% matched, while 80%
of those that ranked three specialties matched. This is true of other specialties, but not all.
In the case of orthopedics, there was an 87% match rate for applicants with one specialty,
but that number drops down to 52% with two specialties. Having backup specialties is
neither good nor bad across the board, it is specialty specific, and should be a carefully
researched decision based on your specialty of choice.
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SOAP offers are extended in three rounds which start that Wednesday. There are two rounds
on Wednesday morning and one round on Thursday. Most positions are filled in that first
round. Programs extend offers during those rounds which are valid for only two hours. If you
do not respond in those two hours, any acceptances in that round are forfeited and will not
be extended to you in other rounds. So, you can either accept, reject, or do nothing. If you
reject an offer, it is the same as letting it expire – you can't come back to it in other rounds.
Applicants are notified the Monday of that week to let them know if they matched or not,
but there are no specifics on where they match.
If you match, you get to participate in a big ceremony at your medical school where
typically students walk to the front of a crowd, open up a sealed envelope, and announce
their match. If you find out on Monday that you did NOT match, there's more work to be
done. You'll need to work through the Supplemental Offer and Acceptance Program (SOAP).
The Supplemental Offers and Acceptances Program
SOAP works in a completely different way than the NRMP. There is no algorithm this time. If
you find out you don't match on Monday, you obtain access to a list of all unmatched
programs through the NRMP website. Through that website, you can select and apply to as
many as 45 programs. Now the ball is in the programs' court. You are not allowed to contact
programs at this time. You must wait for them to contact you. They will call and interview
you over the phone over the next several days.
The Match occurs over the process of one week in March – Match Week – and culminates
on Match Day, which is on a Friday.
The SOAP program is designed to fill in the gaps left by the algorithm. If you didn't get
paired up, this is the chance to remedy that. The Friday before Match Week kicks off,
applicants are notified if they are eligible for the SOAP. This has nothing to do with whether
you matched or not. To be eligible for SOAP, you must be registered in the main match
through NRMP, be available to start residency in June, and be unmatched. (You find that out
the Monday of Match Week).
Match Month
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On Thursday afternoon, the SOAP offers end. If you still have not matched at this point, you
still have access to that updated list of unfilled programs and now the rules change. At this
point, you can contact the programs on that list and ask for interviews. If they like you, they
can extend an offer to you at any time. This process is available from that Thursday during
stMatch Week until May 1 .
The residency application process is a long road requiring a well-planned out approach.
From carefully selected audition rotations all the way until Match day, staying ahead of the
curve by being prepared is the key to success!
Good Luck!
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A Special Note for International Medical Graduates (IMGs)
International medical graduates are inherently at a disadvantage compared to American
Medical Graduates (AMGs) for multiple reasons. Broadly speaking, this is because most
program directors are familiar with and confident about the medical education AMGs
receive. Since IMGs are somewhat of an unknown to many programs, and because there is a
large pool of applicants applying for a smaller group of positions, IMGs always need to have
more competitive stats. That means higher USMLE scores, more research, and more
volunteer activities. This helps give them the edge with applying.
All the same principles for a successful application apply to the IMG whether you're from
the U.S. or not. One note that is particularly important is selecting IMG “friendly” states. For
instance, if you were an IMG interested in Anesthesiology and applied to all programs in
Alabama, you simply will not be successful. Why? The reason is that the data shows (for
2019) that no IMGs were matched into any Anesthesiology positions in the state. This data
is available in the SAP Crystal Report. Using this report should be the first step in
identifying programs to apply to as an IMG.
Once you've identified which states match IMGs into the specialty of your choice, the next
step is to look at the Residency Explorer app to specifically find out how many IMGs match
into specific programs.
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