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 208   0  

I am Dr. Don Morrish, a former Residency Program Director and I've reviewed thousands of ERAS® applications. AMA.

Hi r/MedicalSchool!

Residency application season is upon us and I have the rest of today to answer any questions you have about the ERAS® application, personal statement, and interview process. When I was a Residency Program Director at Lutheran Medical Center, I reviewed thousands of applications and I'd be happy to help as many redditors as possible.

Currently, I am a board certified practicing physician and I run ResidencyPro.com, a business I started a few years back to help medical students through the residency match process.

I look forward to your questions, I'll answer as many as I can!

Update: Thanks for all the questions! That was fun, but I'm fried for tonight. Best of luck to everyone entering the match process this year!

 41   0  

How much does Step 2 actually matter? Can a good Step 2 score make up for a below average Step 1?

 29   0  

HUGE! I'll say it again...it's HUGE! Here's the play. If you have an ok USMLE I and a great, or significantly improved USMLE II there are so many ways to benefit from this accomplishment. You exhibit a growing fund of WORKING medical knowledge (that's what step II tests and PDs evaluate, your medical knowledge) it exhibits your self improvement skills, being able to analyze your performance, set a plan and execute it and produce! It exhibits professionalism, working medical knowledge, self-improvement, maturity, etc. You can use it as a strength during your interview as well. PD asks, what are some of your strengths your response..." I'm goal-oriented. I recognized the need to improve my fund of woking medical knowledge that would be translated in to better patient care activities so I did a little reflection, changed my study habits, improved my test taking skills and achieved my goal of scoring a 260 on my STEP II." That a hell of a lot better than the standard med stud response, "I'm hard working, good team player." The goal oriented response score some major points and distinguishes you as a strong candidate with solid interpersonal and communication skills too. Wow, that's a lot but that's how much a difference a professional can teach you. It's all in the details! Best of luck and do a killer prep for step II.

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Did you find a good correlation between the success of your residents and their step scores?

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This is a really good though difficult question to answer. On first answer, strong step scores = residents with good in-service scores. That being said in-service scores aren't everything. PDs evaluate residents on interpersonal and communication skills, professionalism. Practice-based learning and Improvement, Systems-based practice and Patient care abilities too. These remauing 5 areas can be easily evaluated through the quality of your ERAS app, supporting documents (LORS, MSPE) your interview too. Hope that answered your question. Best of luck!

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Does the status or prestige of the person who writes your LORs matter?

Thanks so much for taking time out to help us out

 8   0  

Yes, immensely. Not all LORs are created equally. The boots on the ground preceptors who know what PDs are searching for should be your authors not residents, podiatrists, dentists. There's a ton to learn on obtaining a phenomenal LOR and it's one of the biggest mistakes candidates make in submitting the wrong number, wrong author and poor content. I wish you the best of luck, get what you deserve a phenomenal LOR whenu perform well during a rotations.

 10   0  

Do readers have an eye for breadth vs depth wrt activities? I know some who will list multiple single occasion volunteer experience as if they were each long-term projects.

 13   0  

The ERAS application requests information on the dates of the activities and let me tell you. PDs are a r pretty savy group of accomplished individuals who know the ins' and outs' of when their are being bs'ed! Candidates who pad their apps loose out because most PDs have been around the block a few times and spot padding a mile away. Solid activities that are socially redeeming and NOT a "Health Fair" such as Big Brothers' Big Sister's are great organizations where you as an candidate can exhibit your substantial volunteer work. I always tell med suds, add meaningful content to your application because it only gets reviewed once. Good luck!

 8   0  

How much time was spent reading each personal statement? Any point in putting in some serious effort? What made some personal statements stand out?

 9   0  

Pds will read your entire personal statement if your ERAS app piqued their interest. Oftentimes, PDs will ask themselves, does this candidate interest me enough to interview?...it's simply that important. Write a personal statement that distinguishes your candidacy. Let a PD want to meet you in person. Write about your interest in the specialty, give examples about why your the best cnadidate and express your true likable personality. Best of Luck!

 8   0  

Thanks for doing this, Dr. Morrish.

Where does continuity in your chosen specialty rank among factors for matching? For instance, if I'm interested in EM and have been continually involved in EM (research and volunteering), how does it appear to PDs in the grand scheme of things?

 3   0  

Big! It speaks to your professionalism. A core competency PDs evaluate residency candidates on. Consistent involvement involvement in the specialty score points and it will give you more street cred when you claim in your personal statement EM was a mature, professional choice based on first hand experience. Good luck!

 3   0  

Sincere thanks. It's greatly appreciated.

To those of us who still have a few years before ERAS, what steps can we take now (besides scores) to make ourselves as competitive as possible?

 2   0  

Reseacrh, network within your intended specialty, advanced certifications, strong personalized LORs, and a commitment to setting yourself apart from those who do the basics! Good luck you're on the right track!!!

 8   0  

Thanks for doing this Dr. Morrish!

When doing away rotations, I understand it's our opportunity to "audition ourselves" to the PD/institution. Is there any real way surefire to obtain a letter of rec from the chair in an away rotation? I guess I'm just really unsure if there's an appropriate way to do it (especially if you've maybe worked with the chair a few times)

Thanks!

 10   0  

When someone sends me a chair's letter I don't place much value in it. Multiple reasons, Chair's are very busy docs the have admin responsibilities, some do clinical work, some do consulting, (like myself) and don't get to know med studs as much as the PD, Division chiefs etc. Chairs don't write phenomenal LORs, you get a form letter and last but probably most important. PDs know Chairs don't spend much time with med studs, they're with their residents. Bottom line go for the boots on the ground docs who know how to write letters and can attest to your abilities. One last comment, don't ask for a lor on the fly be professional, make an appointment and provide them with solid information about you. The extra effort pays off tremendously. Good luck!

 6   0  

Considering absolutely everything equal the general rule AMG, DO then IMG. Best of luck, never assume three candidates are the same!!! I've seen PDs and I have taken IMGs over AMGs and have every order possible. That's why the ERAS application to candidates is just an application. PDs view it as great opportunity to assess sooooo many of the applicant's abilities. Best of Luck!

 5   0  

Can you match into a competitive specialty without research at all?

 4   0  

Anything is possible but if you're looking to increase your odds research is one of the important characteristics strong candidates exhibit to garner more interviews. Research isn't all about peer reviewed journal publications, it can include abstracts, poster presentations, etc. There are great ways to exhibit Practice-based Learning and Improvement Skills (research) without formal research experience and publications! It's my secret weapon in teaching candidates! Best of Luck and try to get some experience! the higher the overall rating the better the chance for an interview and once you get your foot in the door, promote and distinguish your candidacy! Best of Luck!!!

 3   0  

Among the thousands of applicants that you've considered, is there one in particular that still stands out to you to this day?

I'd love to read a small non-identifying explanation of what made such an applicant memorable to you as a program director.

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Yes, there's one application that stood out. The applicant's ERAS application was "good" not great though met our criteria then I read the individuals LORs, that had killer content and then their personal statement was so honest that I wanted to interview the applicant. What made the LORs stand out was the content of each lor was individualized as if the author knew the candidate and spoke of their specific skills, qualities and accomplishments and then added a personal note. Not a typical form LOR, the author wrote specific interesting qualities about the candidate to validate their first hand knowledge of candidate. Then the applicant's personal statement spoke to me as a PD and as a human. The candidate told me why those chose the specialty (with sincerity) backed up their claim of great skills and qualities and let me in on their personality. I wanted to interview the candidate myself and I was happy I did. Bottom line, strong LORs (can be done easilty though not the usual way) a solid, well-written personal statement that gives another dimension to your candidacy. Good luck.

 4   0  

Great, exactly what I was looking for!

How could you tell that the applicant was writing sincerely.. was it more a matter of content or writing style?

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Great! It was both, let me teach you a very important lesson. The content and the style of the personal statement was solid. But what impressed me more, the writing style found on the applicant's ERAS application was consistent with their personal statement. Candidate's oftentimes have professionals write their personal statement and then the PD looks at the quality of the ERAS description section. If they appear dfferent, you didn't write your own personal statement or ERAS application. Your ERAS app will be tossed into the round file! The mistake is what I call the ERAS application/ personal statement Mismatch...no pun intended. It's great to get expert advice and editing but not legal to have a inexperienced (re:residency) write your personal statement. Good luck!

 25   0  

Yet you offer a service on your website that reviews and edits applicants' personal statements...

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You're correct I review your work for content and edit want doesn't belong.

 4   0  

You've spoken of red flags, how would you view someone who had to repeat a year of med school for failing classes, but still did well on boards and during rotations? Are "red flags" non-negotiable, meaning do you outright reject candidates for them, or just move them to the bottom of the pile? or what? Thanks for your time!

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Extension of medical school training is certainly a challenge and each PD views it diffrently. For some PDs it's a deal-breaker and others' will seek the reason in the allocated section of the ERAS application. I suggest you speak to an experienced individual on how to expalin it in the best light. You won't match to ortho but you do have other redeeming qualities a PD may give you a chance to interview and explain. I tell all med studs, never give up, there's always an angle!

 3   0  

What step 1 score is considered too low to invite for an interview? I know this can be program-specific but did you use a cut-off at your program?

 3   0  

Yes we did and it well above the first deviation. Very few programs will publish or give specifics b/c we look at multiple components of the ERAS. If I say 230 on USMLE I'll get a load of emails from applicants saying I got a 235 and no interview... Another word of advice, don't go by old data...each academic year brings about new cut-offs and desires... Best of luck!

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Outside activities are great in the hobbies and interest section and the average med stud places 2 recent volunteer experiences on their apps. Good luck.

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IMG's who are US Citizens match at a higher rate than non-US citizens who attended a international medical schools. 53% vs. 47% that may seem a small diffrenece though it's significant. That being said, US rotations do make a difference though when IMG write in the description section of their ERAS application "hands-on, licensed rotation" it automatically raises the red flag. PDs' think you paid for the rotation vs. impressed an institution other than your medical school affiliated hospitals to take you on. There are many nuances that PDs pick up on. Good luck. Rotate a different instituions in your intended specialty and get strong letters of rec! Best of Luck!

 6   0  

Can you tell me a bit more about applying for residency as a IMG? I'm a Canadian who is enrolled in an undergraduate medicine in Australia.

 7   0  

Applying for a US residency is competitive these days and an increasing challenge although doable. Look at the 2014 match statitics and they'll show you that the match rate; take a look at the stats I provided above. If you've decided to pursue a US residency as a Canadian citizen then you'll need to get phenomenal USMLE Step scores, do some US clinical rotations, network and most important start planning for success today. There are many things you can do to improve the quality of your residency candidacy starting on day one if your willing to put in the time and effort. Good luck!

 2   0  

What sort of things should be included in a personal statement? Also, how badly will 1 poor grade in a clerkship hurt an otherwise strong application?

 11   0  

Why you chose the specialty, what specific qualities, skills and accomplishments you bring to the specialty and program. Promote your candidacy in a modest though interesting way. Clinical vignettes, talk of a dying family member (although life changing, PDs' don't want to read it again), choosing to be an MD/Do at ean early age, etc is so pedestrian and boring. Perform a self assessment of your skills, the you chose the specialty, highlight the skills PDs seek. If your aa Psychiatrist, have stellar interpersonal and communication skills, the quality of your ERAS descriptions, attention to detail, a fluid personal statement, etc. will open doors. One poor grade shows your human. If you say some died or you thought your preceptor was an idiot, I wouldn't hire you. If you claimed responsibilty for the "shortcoming" and told me what you did to rectify it and exhibited proof, cool, I'll look at your application. Good luck!

 1   0  

Thank you for this reply. That is what I have tried to do. It is basically a 5 paragraph essay highlighting my strengths that I think would make me good in my chosen field (pathology) and expressing why I am interested in that field. My poor grade I think was mostly due to an average shelf score (which was odd because I studied the same as I did for my other shelves and they were all in the top 25-33%).

 2   0  

What rotation was it in?

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You learned a life lesson by realizing staus quo isn't always going to produce a consistent outcome...

 1   0  

Pediatrics. I also think that my evaluation was slightly unfair (PM if you want the reason, I don't want to air a grievance in public). All my other rotations where high satisfactory with one honors. My USMLE is good so I'm not worried about matching but I would like to go to a good program.

 1   0  

Submit a stellar application and personal statement then interview like a pro and one less than perfect score will not impede your success! Good luck!

 2   0  

Hi Dr.Morrish, I wanted to know your take on having research done in college/achievements obtained while in college on our ERAS app? Thank you!

 1   0  

If your ERAS application lacks some significant meaningful content such as recent pubs and advanced certifications, etc. then place the research on your app. I know I'm beating a dead horse on this comment though...highlight the research skills, qualities and accomplishments you worked so hard to learn during the project. Eg, biostatistics, epidemiology, etc. The project itself isn't too important to PDs. I wouldn't include the college achievements b/c PDs will say to themselves what have you done lately. Best of luck!

 2   0  

I am very interested in doing surgery residency but the research I am doing isn't really in that field. Basically, the research I am doing involves determining the mechanism of a pathway that presumably leads to a certain autoimmune disease through micro arrays and assays. Will my research, which is more immunology and microbio, hinder my chances of landing a residency in surgery because it isn't specifically related to that field?

Thanks for doing this!!!

 2   0  

My pleasure being here. You have a great group! Your research will not hurt your chances. I'd like to see you do more clinical research instead of "bench" work. Any research project is beneficial if you stress the skills, qualities and accomplishments you gained during the experience. Eg, Biostatistics, epidemiology, scientific writing, formulation of research protocols. PDs want to see your skills! Nice work, try to focus more on your specialty if possible. Best of luck!

 2   0  

I am currently a UK medical student and considering working at some point during my career in the USA. So much so that I am spending a month of my elective over at NY to see how I feel about it.

This may sound like a random/silly question, but is it an absolute requirement to have the USMLE in order to do a fellowship in the USA or get into a residency program? Could passing the Royal College exams (UK) exempt from this?

The prospect of sitting Step 1/2 whilst working and preparing for my other exams which I would be taking at the time just seem so daunting!

 1   0  

You'll need to pass the USMLE I and II to obtain a residency and an ECFMG certificate. You'll more than likely need a US residency to enter into a fellowship as well. It's tough but doable! Good question and best of luck to you!

 1   0  

Dr. Morrish,

What are the biggest red flags for an applicant? Repeated courses etc.?

Thanks!

 9   0  

Repeating the same mistake over and over. Multiple failures on USMLE/ COMLEX exams, LOA's, poorly prepared ERAS app. Once saw an ERAS app from an IVY med school stud. Spelling, grammar, syntax mistakes. It screams I don't pay attention to detail. One of the most important applications of your life deserve tremendous attention to detail and meaningful content. Every aspect of the ERAS application is important from consistent format to your hobbies and interests. I can write a laundry list of red flags but mistakes are mistakes but repeatedly making them is a deal-breaker. Good luck!

 1   0  

I'm not a medical student, but I am wondering for more selective specialties, how are multiple research in different fields looked upon? Let's say I wanted to go into...I dunno....say Ortho. And I have 2 posters of Anesthesio here, 1 abstract from a Plastics basic science research stint, 2 pubs from a clinical ortho lab, and 1 paper from endocrine basic science lab. If you were an ortho PD, would you care only for the 2 pubs from the Ortho lab or would you look at the entire package?

Also how do you view publications/research done in undergrad/gap year if they were in a medical field?

Thank you for answering these questions!

 2   0  

My pleasure, you're a part of a great group! Good question, maybe u should pursue ortho! Entire package because I'm looking for the skills, qualities and accomplishments not the specific project. If you have an application that doesn't distinguish your ortho candidacy and it's so generic and not geared towards ortho that you have some "splaining" to do. You'll need to convince a PD you're a good ORTO candidate otherwise will chose another awesome candidate and there are plenty to chose from.

 1   0  

Hey Rudy, On the ERAS application there's a section requesting you explain the LOA. The most important factor is how you explain it and what you did during the time fame. For eg., if you did research and a journal publication you'll need to provide a significant reason why you chose to perform these activities instead of the following the curriculum. Any specialty will expect a solid answer. PDs will be skittish that you don't follow the "routine." PDs want to graduate residents in the allotted time. Good luck!

 1   0  

Any general advice for foreign grads and older, foreign grads in particular?

 1   0  

Older IMGs' face an uphill battle for a multitude of reasons. If you've completed a formal residency outside the US and applying to the same specialty you can play the experience card, or if your board certified in the specialty even better. Networking is probably the most effective way to pursue a residency. Good luck!

 1   0  

I'm interested in plastic surgery in a trauma setting. Besides the standard volunteering and researching in the ER, what kind of activities do you like to see that are specific to a residency

 1   0  

Besides high USMLE scores, honoring your rotations, etc. memberships in professional organizations, advanced certifications, strong personalized LORs from your chosen specialty from different healthcare settings, a strong ERAS app, solid personal statement, etc. Best of luck!

 1   0  

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 1   0  

Be honest with yourself and pinpoint the reason, did you study enough, change your test taking skills, choose an alternative resource? Did you address the shortcoming? How did you do it and do you have any proof of a positive outcome? (better rotation grades, etc.) Then be straightforward with your interviewer, they'll appreciate your candor and you've reassured them you're a true professional. Good luck!

 1   0  

What date do you realistically start looking at ERAS applications?

Do you wait for MSPE letters or do you start looking at applications immediately on september 15?

As it stands, I'll likely not have everything in by september 15 and am scared this might hurt my application.

 3   0  

Take a deep breath! PDs don't start looking at ERAS application on 9/15. A very good reason, all ERAS apps would be incomplete and PDs like to look at everything at once, not piece by piece. They want USMLE/COMLEX transcripts, all the LORs, etc. Most PDs will take a peek at the end of September most beginning of October. MSPE's aren't sent out til November and therefore most if not all do not base their entire decision to interview the candidate. It may come down to that but not often. Most PDs will review the majority of applications on a rolling basis. There were 340270 applicants vying for 26,678 first year and 2,993 2nd year positions...now that's a ton of applicants who apply to a ton of programs that means PDs need to review 100's of applications and it takes time. Good luck, don't submit and incomplete or less than stellar application and personal statement!

 1   0  

Hello and thanks for doing this!

Question for you regarding taking a year off to pursue a second degree during med school. My girlfriend is about to start med school (at Harvard no less) a year behind when I started at my school. That said, we have discussed the possibility of me moving to Boston to do a one year MPH. I would get to pursue a degree I'm interested in and we would be able to couples match. I'm curious though how residency programs would view this move. Thoughts?

 4   0  

My pleasure being here! Ok, this is a little complicated but I'll show you how a PD will look at this. I want to train all my residents according to my schedule and have them graduate on time without any gaps in their training. I look for med studs who will do the same. Taking a year off of school to do a couples match makes your situation more complicated because you have to explain yourself thus weakening your collective applications. Harvard med is great but it doesn't guarantee you a match. An MPH is great but when weighing the risks and benefits I see too much risk in taking time off. Hope that places it in perspective... Best of Luck to both of you!

 1   0  

How important is research in getting into a competitive specialty? Would a 260+ with strong recommendations be sufficient to get into something like neurosurg, derm, ortho?

Thank you so much for doing this!

 2   0  

My pleasure. I always like to be prepared to enter into any situation be the most prepared. Yeah a 260 on Step I is fantastic, congrats but it doesn't ensure you a match in a super competitive specialty. You'll need an equally stellar Step II score and be the total package which includes research to be matched. Have a seen candidates match with your hypothetical situation yes, have I seen other fail to match yes. Bottom line be prepared and be more competitive than you competition.

Best of luck!!!

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1) Go to a big name institution known for its research for the summer (my home institution is not so i used loans to travel to aforementioned research institution)

2) Do clinical research, but research that matters. the "matters" part was the key to motivation. see #4.

3) Love the research, your mentor and people you work with.

4) Don't say no to anyone/ any projects; ask for more projects--make a name real quick for yourself as a hard worker (not smart...just hard working). Meaning: working independently and getting things done well before the deadline given to you.

5) Wake up at 4:30 a.m. and work straight until 10/11p.m. for 2 months straight. a couple of days off here and there, but very few. Each day is optimized for research--i.e. 1 huge meal a day so you don't waste time eating 3.

6) These aren't done yet, so I'm just speculating at this point but before I apply for the match I should have (from this past summer): 1 or 2 first authors (maybe more), several abstracts, a couple of papers where I'll be 2nd author, several where I'm on the paper, but not #'s 1 or 2.

It was a hard works meets luck game at the end of the day and I used hard work to maximize the returns of the luck.

 3   0  

It will pay off for you. Congrats, nice job!

 0   0  

Thank you! Out of curiosity, what kind of things can I do to be competitive at a place like CHOP/UPenn Ob/Gyn or Gen Surg residency? My guess is my Step 1 score will just a bit higher than average, but probably not by much.

 0   0  

Shoot to be much higher and that will improve your chances of matching. Hard to say what exact number but when I took the USMLEs I killed myself and it paid off! Goor luck and prepare, prepare, prepare. You cna't be complacent and hang your hat one aspect of your application (general advice that doesn't pertain specifically to you...) a 260 on a USMLE I and an INABILITY to communicate will kill a cnadiacy. You need to be the whole package. An Aston Martin is an Aston Martin because of the total package, not just the engine! Best of Luck and keep up the good work!

 -1   0  

How are out-of-specialty research experiences viewed? For example, in my summer after M1, I published heavily in CT Surg. If i decide to go into neurosurgery or Ob/Gyn, how is that research experience viewed?

Also, this was brought up earlier on here...Why are males so highly desired in Ob/Gyn?

 0   0  

If you publish within your intended specialty that's great! If you've published in a related specialty (surgically-based) then apply to a specialty that performs surgery it's good too. Many applicants don't have publications in peer-reviewed journals. It's not necessarily the topic PDs are searching for it's those skills you developed. Eg. epidemiology, biostatistics, scientific writing. Promote those qualities if you apply to a specialty to other than CT and if you apply to CT exhibit those skills too!

Males are highly sought after in Ob because over the years more woman have been applying and matching.

Good luck!