The Complete Guide to Residency Applications

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The Complete Guide to Residency Applications David Flick MD, Associate Director of Advising, MedSchoolCoach

Transcript of The Complete Guide to Residency Applications

Page 1: The Complete Guide to Residency Applications

The Complete Guide toResidency Applications

David Flick MD, Associate Director of Advising, MedSchoolCoach

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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.

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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

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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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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.