Category: The Match: Spotlight Series

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How To Match Into Dermatology: an interview with a dermatology resident

Dermatology is one of the most competitive specialties in medicine. Today I sat down with Benny Wu who is a current dermatologyy resident at Broward Health Medical Center. He shared his journey to dermatology and some advice on how to match into derm.

 

Thanks for letting me pick your brain, Benny. Can you tell my readers a little bit about yourself?

It is an honor for me to share my path to Dermatology residency with your readers and followers. I am currently a PGY-2 Dermatology Resident at Broward Health Medical Center in sunny Fort Lauderdale, Florida. Before medical school, I was a figure skater for thirteen years – competed on the national and international level. In 2005, I chose to end my competitive skating career due to recurring injuries and realized it was ‘time’ to move forward with life by pursuing my second passion: medicine and science. Unfortunately, during college, I did not juggle my college coursework and figure skating very well. I had an embarrassingly low G.P.A. from the University of California, Irvine and did terribly on my MCAT. The next pivotal moment that had a direct impact on my medical career came in 2007. A medical school formerly known as the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, now called Rowan University School of Osteopathic Medicine (RowanSOM), offered a Master’s in Biomedical Sciences degree for students who performed poorly during college but remained interested in attending medical school. RowanSOM advised me that my chances of being accepted into their medical school would be greatly increased if I performed exceptionally well in the Master’s program and if I improved my MCAT score. I performed extremely well in the Master’s program and brought my MCAT score way up (I distinctly remembered in 2005, my Physical Science score was 5/15, but in 2008 my Physical Science score went up to 10/15). Luckily, I was accepted into RowanSOM’s D.O. program in 2008. During the Master’s program and pre-clinical years I fell in love with immunology and became invested in how the body worked from the cellular and molecular level. Because of my fascination with immunology and medical research RowanSOM invited me to complete the D.O./Ph.D. combined program in 2011. Outside of medicine, I enjoy staying physically active (running and cycling) and cooking. One of my therapeutic outlets is cooking with fresh ingredients accompanied by a glass (or several glasses) of wine!

 

What motivated you to pursue dermatology?

Answering the following two questions can best explain my motivation for pursuing Dermatology

(1) What interests me in Dermatology – Dermatology requires a STRONG background and fund of knowledge in Internal Medicine and its subspecialties (Infectious Disease, Rheumatology, Nephrology, Pulmonology). Response to treatment is readily appreciated and is not heavily dependent on laboratory findings. One example I share with medical students is this – imagine being able to make a clinical diagnosis and assess response to treatment independent of lab findings – of course, more often than not, a confirmatory diagnosis will require a skin biopsy (side note: there are lots of procedures in Dermatology, too!). On the other hand, as much as we would like to refute this way of thinking, the importance of outward appearance in our society, and how it impacts one’s sense of self-worth, cannot be ignored or disregarded – just ask any severe nodulocystic acne patient how he feels after a full course of Accutane – it really is life-changing!

(2) What problems do I think Dermatology faces – I emphasize the difficulties because issues in any specialty can serve as motivating factors for medical students and young attendings. In Dermatology, the pathophysiology of many skin conditions remain unclear or unknown – there is a lot of opportunities for both basic science and clinical research in Dermatology. However, the more pressing concern is the dwindling interest in complex medical Dermatology – this may be due to decreased reimbursements from insurance carriers – but I see this unique problem as an opportunity for Dermatologists-in-training to start new Dermatology fellowship programs, such as Dermatology Hospitalists. For example, severe pemphigus patients admitted for rituximab infusion – this is classically a Dermatology-driven problem that can be managed by the primary Dermatology service.

 

Something that impressed me about you is that how persistent you were in pursuing your desired specialty. You didn’t match into dermatology…twice. But you persisted and landed a residency position in your dream job. What did the experiences of not matching into dermatology teach you?

Not matching into Dermatology taught me the importance of focusing on my modifiable weaknesses.

After failing to match again during my intern year at Drexel, I had to ask myself two questions: (i) is Dermatology the only specialty for me? (ii) if so, what can I do to maximize my chances the third time around?

Facts are facts. I am a D.O. with average USMLE scores for Dermatology (these are not modifiable). However, my lack of publication and research experience in Dermatology was modifiable. Thus, I made a promise to myself that I would give myself one last chance – reapply to Dermatology – but this time as a Northwestern Dermatology Clinical Research Fellow.

Also, I learned how much ‘grit’ I have. Dr. Angela Duckworth’s book, “Grit: the power of passion and perseverance” discussed the importance of being ‘gritty’ especially when dealing with failures or disappointments. If you have not read this book, I urge every one of your followers to read it, especially before the interview season begins – I believe in the two equations outlined by Dr. Duckworth: talent x effort = skill; skill x effort = achievement; TALENT counts ONCE while EFFORT counts TWICE.

 

Why do you think you didn’t match multiple times?

I failed to match numerous times because of the following reasons:

  1. Did not initially consider D.O. Dermatology programs
  2. Did not apply broadly (limited myself geographically).
  3. My degree, D.O. – Dermatology is a competitive specialty even for U.S. M.D. graduates.
  4. Average to below-average USMLE Step 1 score (238) for matched applicants – as a D.O., a spectacular Step 1 score (>250) would have helped – but not a guarantee by any means.
  5. CV did not differ much between the first and second time applying.

What did you do differently the second time to improve your chances of matching? Why do you think you failed to match a second time?

I did not do anything differently the second time around – as you know, we were co-interns at the time and had limited time to add significant publications or research experiences to my CV. The only addition to my CV in the 2017 cycle was one publication – a review article on drug-induced pyoderma gangrenosum.

 

So you finished your required preliminary year in internal medicine and you are offered the opportunity to stay and complete a categorical three-year residency in internal medicine. Why didn’t you stay?

Do you want a fluffy answer or the real answer? ☺ I did not stay because Dermatology remained one of the few medical specialties that I could see myself doing long-term. However, I loved infectious disease as well. Like I said before, there was one modifiable ‘weakness’ in my application – Dermatology research experience. Near the end of intern year, I was offered a Dermatology Clinical Research Fellow position at Northwestern University, Feinberg School of Medicine. Privately, I told myself that if I did not match the third time around, I would complete Categorical-Medicine residency and possibly pursue Infectious Disease.

 

What did you do professionally after your preliminary year to improve your application while you re-applied for the third time?

Right after the Medicine-Preliminary year, I moved to Chicago and completed a Dermatology Clinical Research Fellowship at Northwestern University. Simultaneously, I entered the 2018 ERAS and NRMP and applied with new recommendation letter writers (2 from Northwestern Dermatology Faculty, 1 from University of Pennsylvania Dermatology Faculty, 1 from Drexel/Hahnemann University Hospital Medicine Residency PD) and 1 new publication (ichthyosis, X-linked) with the Northwestern Dermatology Chair, Dr. Amy Paller (https://www.ncbi.nlm.nih.gov/pubmed/28846233).

 

Thankfully you matched. What do you think you would have done if you didn’t match for a third time?

If I did not match, after three attempts, I would have done the following in sequential order:

  1. Try to secure an unfilled position through the SOAP.
  2. Apply to the few programs that secured extra funding for more spots or received ACGME-approval to increase program size after the NRMP Match quota deadline. Because Dermatology is a relatively small community, one advantage of doing a research fellowship at a major academic institution, such as Northwestern, is that PDs will advertise open positions on a listserv available to only Association of Professors of Dermatology Members (Dermatology PDs). Northwestern forwarded open positions to their research fellows since 2 out of 5 research fellows did not match.
  3. If number 1 and 2 don’t work in my favor, then I would seek out available PGY-2 Medicine Categorical positions, with the hope of specializing in Infectious Disease later down the road.

How many dermatology programs did you apply to each year? How many did you rank?

– In 2016, I applied to ~50 Dermatology Programs and 18 Medicine-Preliminary Programs. Ranked 5 Dermatology Programs (NRMP).

– In 2017, I applied to ~90 Dermatology Programs (including both Advanced ‘A’ and Physician-only ‘R’ positions). Ranked 2 Dermatology Programs (NRMP).

– In 2018, I applied to 95 Dermatology Programs (15 AOA-accredited “D.O.” programs and 80 Dermatology Programs – including both ‘A’ and ‘R’ positions). Ranked 2 AOA-accredited Dermatology Programs (NMS Match). Ranked 6 Dermatology Programs (NRMP)

 

What advice do you have for medical students who want to pursue dermatology?

– Read, read, and read more: highly recommend Lookingbill and Marks Dermatology textbook – this is a basic Dermatology textbook – very user-friendly.

– Approach to reading primary research articles: learn how to interpret and formulate questions as you read research articles – (i) is the study design robust – assess strengths and weaknesses (ii) any bias (iii) does it directly address the hypothesis – keep in mind that negative papers can still be valuable (iv) author financial relationship disclosure – is there a conflict of interest? Learning these skills early on will help you tremendously at audition rotations – this will quickly set you apart from other applicants – always remain inquisitive.

– Align yourself with a Dermatology mentor as soon as possible: if your school does not have a home Dermatology Department then search for a local Dermatology Society (for example, Chicago Dermatological Society [CDS] and PhillyDerm in Philadelphia, PA).

– No need to submit to only Dermatology journals: if you see a compelling case in your non-Dermatology clerkships that is Dermatology-relevant (for example, VZV reactivation in an immunocompromised patient) submit the case as a Continuing Medical Education (CME) quiz to a Family Medicine or Internal Medicine journal.

– Ask yourself these question: “is Dermatology the only specialty I see myself doing?” Remember, Dermatology has significant overlap with Rheumatology, Infectious Disease, and Family Medicine/Primary Care. By not limiting your publications to Dermatology journals, should you decide to apply to Family Medicine or Internal Medicine down the road, it will appear less likely that you ‘settled’ for another specialty.

 

What are important aspects of a residency application for dermatology? Is it heavily research oriented?

– Research is critical (except for a few Dermatology programs, most are academically-driven and require residents to publish annually). Many of the applicants I met on the interview trail took a year off to do research. However, a dedicated research year is not critical – instead, focus on getting 2-3 FIRST author PMID (PubMed Indexed) publications by the time ERAS is ‘due’ (typically ~ September 15)

– First authorship holds much more weight – keep in mind papers can come in a variety of flavors: case-reports, case-series, CME quizzes, and review articles.

– By taking command of your publications, this will serve you well during the interview – you may be interviewing with a faculty member who is an ‘expert’ in the topic of your research or publication(s).

 

Any residency interview tips specific to dermatology that you wish someone told you before you hit the interview trail?

(i) Please do not discount the value and importance of PCs! I believe that Kaiser-Los Angeles Dermatology granted me an interview because I was professional and courteous when communicating with the PC.

(ii) Compile a list of programs that you would like to receive an interview – construct a personalized letter of interest to each program – outline the reasons why that program is attractive (besides being Dermatology!) – email the letter to the PC in late September so it can be added to your file for review.

(iii) Pay attention to your speaking volume and level of engagement during the pre-interview dinner and interview day – I lived by this saying ‘loose lips sink ships.’

(iv) If you are placed on the wait-list, email the PC and ask when the interview(s) are held? – Three weeks before the interview date(s), send the PC an email reminding him/her of your interest and provide application updates, if applicable.

(v) Avoid emailing or calling the PC with general questions about the program – study and thoroughly comb through the program websites.

(vi) Only reserve emails when you have SIGNIFICANT application updates – for example, I was asked to give an oral presentation at the 2018 American Academy of Dermatology (AAD) Annual Meeting [https://www.aad.org/scientificsessions/am2018/SessionDetails.aspx?id=11492] after I certified my ERAS – after updating my programs of interest, I received an interview invite from one program several hours later.

(vii) After the interview, prepare handwritten thank you cards for the PD and PC – note: in 2018, several programs explicitly stated NO thank you cards.

(viii) Prepare written templates for the following scenarios: (a) requesting letter of recommendations (b) accepting interview invites (because rarely do Dermatology applicants reject interview invitations) (c) letter of interest – tailored to specific programs (d) post-interview thank you card (e) top choice/you are my number one letter. I have templates (Dermatology-specific) for all these scenarios – please contact me directly if you wish to see my templates.

(ix) Avoid post-interview communication with the PD, PC, and residents – unless it is for SIGNIFICANT application updates – also, no harm in sending your number one a letter of intent several weeks before the rank list is due – note: in 2018, several programs explicitly said no post-interview communications.

 

Here are some facts for you and my followers. In 2016, based on NRMP match rate data, dermatology was the 5th most difficult specialty to match into behind only neurosurgery, orthopedic surgery, plastic surgery, and vascular surgery. Likewise in 2016, dermatology was among the six specialties with the highest average USMLE step 1 score for applicants who matched into their preferred specialty along with neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and radiation oncology. That average USMLE step 1 score was 250. Although I believe that high board scores shouldn’t be the only important aspect of a medical student’s residency application, it is hard to argue with objective data in that if you want to match into a highly competitive residency like dermatology you need to ace your boards. What advice do you have for medical students who want to pursue dermatology but don’t have those ultra-competitive board scores?

I scored a 238 on my USMLE Step 1 (please keep in mind that I took my Step 1 in 2011 – the passing score changed several years later). Regardless, 238 is not a strong score for Dermatology. If you scored <240 on USMLE Step 1, focus on the modifiable aspects of your application – (i) research – aim for 3 to 4 first author publications (ii) mentorship – seek out mentors as soon as possible so you have time to develop a relationship with them – this will lead to STRONG letters of recommendation (iii) research year – consider a research year (between MS III/IV) – I highly recommend the Northwestern Dermatology Pre-Doctoral Fellowship (iv) I cannot stress this enough – if you want to pursue Dermatology, remain focused on the modifiable aspects of your CV!

 

How did you find and develop a relationship with a mentor in dermatology?

My Ph.D. was on neutrophil biology in sepsis. Naturally, I asked myself the question “which skin conditions are driven by neutrophil dysfunction?” I found out that several neutrophil-mediated skin diseases fall under the spectrum of diseases commonly known as ‘neutrophilic dermatoses (ND).” As a fourth-year medical student, I reached out to Drs. Misha Rosenbach and Robert Micheletti from the University of Pennsylvania Dermatology (they are both Dermatology Hospitalists and have research interests in ND) – I contacted them and expressed my interest in Dermatology and ‘expertise’ in neutrophil biology. At that time, they happened to be in the process of spearheading a retrospective chart review of patients admitted with Sweet’s syndrome! Long story short, I completed two months of research with them, and they became my mentors through this process. Although I was not a University of Pennsylvania medical student, Dr. Micheletti supported my Dermatology Residency Application all three times – Dr. Micheletti emailed me on Match Monday, one hour after NRMP released the much anticipated “Did I Match?” email, and asked how I am doing and if I matched. Mentors do not have to be from your home institution. The mentor-mentee relationship takes work – take these relationships seriously but also show your ‘humanistic side’ or ‘brand of personality’ when appropriate. Remember, there are MANY ways to find and develop a relationship with a mentor – this is just one example of how I did it.

 

What is the biggest misconception about the field of dermatology?

The biggest misconception about Dermatology is that it is an ‘isolated’ specialty – like I mentioned before, Dermatology overlaps with many, if not all, of the Internal Medicine subspecialties – think: systemic lupus erythematosus (Rheumatology), HIV-associated dermatoses (Infectious Disease), systemic sclerosis (Rheumatology, Nephrology, Gastrointestinal, Pulmonology). There is significant overlap between all of the previously mentioned specialties – we see more multidisciplinary clinics, such as Rheumatology-Dermatology, for connective tissue disease patients with skin manifestations. Again, you do not need to limit your manuscript submissions to Dermatology journals – many internal diseases present on the skin – for instance, a CME quiz or review paper on atypical presentations of sarcoidosis can be submitted to a Pulmonology journal.

 

What are the strangest, most bizarre, or most unique questions you’ve been asked after people find out that you’re going into dermatology?

What people commonly say when they find out I am a Dermatology Resident is “oh, that is why you have such nice skin.” The most common question is “what should I do about X, Y, and Z (insert common COSMETIC complaints here) – because of this, I tell new people I meet that I am a Medicine Resident ☺. Also, my phone will occasionally receive pictures of rashes and bumps from my friends – I usually respond with “not interested” haha, just kidding! All jokes aside, I enjoy the question “why Dermatology?” – this question reminds me of the reasons why I chose to pursue Dermatology – and I take this opportunity to educate the public that Dermatologists are not merely ‘pimple-poppers, cyst-removers, and soft tissue injectors.’

 

Okay, so now the question that I’m sure you must be asked non-stop: what’s your skincare regimen?

Well, I do have pretty fabulous skin… ☺ haha. Disclaimer: ‘healthy’ skin is heavily driven by his/her genetic makeup – but evidence-based medicine suggests that sun protection and intact skin barrier are critical for optimal skin health. And of course you should not use this as medical advice. If you have skin questions or concerns you should always seek out an expert consultation with a dermatologist. This is my skin care routine:

 

Morning

In the shower: limit shower time to <10 min and use lukewarm, NOT HOT, water.

(a) Panoxyl 10% benzoyl peroxide (BPO) face and body wash – apply wash to my face only – prevents acne breakouts – has antibacterial and anti-inflammatory properties (BPO will whiten colored clothing so make sure you thoroughly rinse off the BPO, especially if you use colored towels).

(b) Cetaphil Gentle Cleansing Bar Soap.

 

Post-shower

If you are prone to eczema or dry skin – use towel to damp dry – followed by emollient (cream-based, not lotion) application – emollient will ‘lock-in’ moisture.

– Cetaphil Men’s Daily Facial Moisturizer SPF 15 – quick word about SPF – unless you have a genetic skin disease (i.e. Gorlin’s syndrome) – no need for SPF>30 – SPF and percentage of UV blocked employs a base-10 logarithmic scale – this means that an SPF of 10 blocks out 90% of UV, SPF 15 blocks out 93.3% of UV and so forth – the percentage of UV blockage basically levels off above SPF 30 – save your money and spend it on an excellent emollient, instead – see below.

– Cetaphil or CeraVe Moisturizing Cream (from tub NOT pump or squeeze bottle) – I use this to prevent moisture loss and to maintain an intact skin barrier – this is especially important for long hours in the hospital (definitely experienced this as a Preliminary-Medicine intern) – apply liberally to arms and legs.

 

Evening

Same as morning routine (BPO face wash) with the addition of topical retinoids – retinoids such as adapalene 0.1 or 0.3%. Retinoids are indicated for acne and pre-cancerous skin lesions, but they have also demonstrated repeatedly in several controlled studies to improve fine wrinkling, increase dermal collagen synthesis, and lighten uneven pigmentation – because of these reasons, I use adapalene 0.3% nightly – if your insurance does not cover retinoids (tretinoin, adapalene) it can be purchased over-the-counter under the brand name Differin (adapalene).

 

Things to avoid

Alcohol-based products (dries skin) and anything scented.

 

Benny Wu was born in Taipei, Taiwan and immigrated to the United States (Cupertino, California) when he was 10 years-old. Before medical school, he was a figure skater for thirteen years – competing on the national and international level. He graduated from the University of California at Irvine (Irvine, California) the same year he decided to end his competitive skating career. Before attending Rowan University School of Osteopathic Medicine, Bennybecame interested in medical research while he earned a Master’s of Biomedical Sciences from the University of Medicine and Dentistry of New Jersey. This led him to enroll in the combined D.O./Ph.D. program at Rowan University in 2009. Upon graduation from Rowan University in 2016, Bennycompleted an intense but rewarding Medicine-Preliminary internship year at Drexel/Hahnemann University Hospital in the ‘City of Brotherly Love’ (Philadelphia, PA). After his internship year, Benny fully immersed him in Dermatology clinical research by completing a Dermatology Clinical Research Fellowship at Northwestern University, Feinberg School of Medicine. Besides immunodermatology and translational research, he is passionate about mentoring medical students serious about pursuing Dermatology. Outside of Dermatology, Benny enjoys cycling, completing workouts that incorporate stability, endurance, strength, and athletic power, cooking, baking, and traveling. His next dream vacation spot is South Africa (cage dive with Great Whites). To learn more about Benny including his winding path to a dermatology residency you can follow him on Instagram at dermination_sk8r.

 

Interested in other specialty specific resident interviews? Check out these resident interviews and subscribe so you don’t miss out on the next blog post!

https://mykittykatz.com/what-happens-when-you-dont-match-into-residency-twice/

 

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What Happens When You Don’t Match Into Residency…Twice

Two years ago I interviewed a fellow Caribbean medical graduate. I interviewed him because of his failure. Specifically his failure to match into residency. I wanted to shed light on what the medical education community seems to shun and ignore- what happens after you fail to match into residency. Last year we were both hopeful that we would be able to share a comforting update on his path toward residency. His story was seemingly not yet ready to be told because for the second year in a row he heartbreakingly failed to match into a residency position. However, as the old adage goes, third times the charm.

 

 

It’s been two years since I interviewed you the first time. Back then you were recoiling from not matching into residency. Then you went through the match for a second time. What did you do during that first year after not matching your first time?

Hi Marc, it’s been quite some time and I’m happy to be back talking with you and answering your questions. After the first time of not matching, I began the process of getting my MBA in Health Services Management, studied for Step 3, and worked part-time for Ross University as a standardized patient. I also shadowed one of the pediatricians I worked with to keep my clinical skills fresh as she saw both adults and children.

 

 

How did you deal with the emotions of not matching for a second time?

To be quite honest, at first, I didn’t deal with the emotions. I was rather numb for a while and chose to ignore the feelings. But I started to really develop that anger more than I felt the depression stage of grief (Kubler-Ross knew what she was talking about). I had a hard time accepting the fact I did not match, considering what a program director told me, in which they implied that I was going to match at that program. I felt betrayed and became distrustful in the whole process.

 

 

What strategies did you change the second time around? Different specialties? How many interviews did you get the second time? Why don’t you think you matched the second time? 

I applied strictly to Family Medicine, which I definitely felt comfortable doing and I had wanted to really do it after attending the AAFP National Conference in July 2016. I met a lot of people and had some meaningful conversations with program directors. However, with all that said, I only had two interviews. It wasn’t that I was a repeat applicant that held me back, but it was the fact that I was never able to obtain a letter of recommendation from a board-certified Family Medicine physician. I do not believe that it was my interviews that did me in, but simply the numbers were against me.

 

 

So it’s your second match day and you find out you didn’t match, again. Take me through that week for you. 

It was a dark week. No…a dark couple of weeks. I was teaching our Ambulatory Care Competencies elective, which prepare MS-IV’s for Step 2 CS. We had finished around 10:45 AM and as I was walking to my car, I get the e-mail AGAIN that states “You did not match.” Again, there was no “oh hey girl” or “what’s going on” or anything like that. Just a simple “You did not match.” I immediately drove back to our school’s campus and got to work on SOAP. I actually had a phone interview at a university-based internal medicine program for a categorical position, which did not happen the year before. I spoke with three people and I naively felt very optimistic, thinking I was going to get the position. Well, the rounds of offers went by and there was nothing. It was very difficult to show up to work on Tuesday being surrounded by people who were celebrating having matched. In no way, shape, or form was I jealous or bitter. I knew that all of our journeys were our own and our applications were all different. However, it was just a little tough to be happy around them because I wanted to know what that feeling was like, so I took a break from social media. When I did that, the outpouring of support via text and email came from my former classmates and colleagues. So many people voluntarily reached out to me offering positive thoughts and were willing to put in good words for me for the next process. These people knew my work ethic and personality and were willing to put their reputation on the line by recommending me. That was a huge motivation for me to keep going and to get back on the horse again.

 

 

What did you do for the year after your second time not matching? Where did you work? 

I managed to get a full-time position with Ross University teaching for their Internal Medicine Foundations clerkship. However, I wasn’t even on their radar! According to the requirements, I was too far removed from graduation to be hired but they took me on the team on a per diem basis, if you will. I was working 40 hours a week, but just for the six-week clerkship. Unfortunately for one of the hires, he was unable to take the position and I had proven myself worthy of the position. They liked my teaching and mentoring style so much that they ended up offering me a full-time job and eventually, I became the Chief Clinical Teaching Fellow. I went from not even being considered for the team to becoming the team captain, which gave me the confidence going forward in the application process and it was something that I spoke about in my interviews.

 

 

Fast forward to your third time going through the match. You finally get a categorical position in internal medicine. What do you think was different this time around?

Well, my MBA was finished (and I graduated with highest honors) and my Step 3 score was in. I had taken Step 3 in January 2017, hoping to have it in time for the rank order list that was due in February 2017. Of course, I was part of the group of exams that wouldn’t get their score until May. May 2017 rolled around, and I passed so this showed that I am in good standing to eventually pass the boards, whether I ended up in Internal Medicine or Family Medicine. I also finally got that FM board-certified LOR for my application, which was a bonus since the writer is also a program director. Also, I was working on getting published in a medical textbook.

I knew that it was going to be very difficult to get residency interviews on my own, so I had to reach out to as many people as I could that were in residency programs. I asked people to talk about my character and work ethic. I looked at as many Family Medicine programs as I could and saw what scores they were looking for and narrowed Internal Medicine programs to the east coast and Chicago. Overall, I applied to 260+ programs. To my surprise, within the first week, I had my first interview offer and within four weeks of applying, I had four interviews lined up. I also constantly checked for new programs that were opening up and applied to those, which gave me some additional interviews. Overall, I had 3 IM interviews and 5 FM interviews (one of them was an interview I had last year, for which I was really grateful). Some of the interviews were from the help of people in the program, but that’s the main help I received. It helped me get my foot in the door, but I had to impress in the interviews. I did not take that help for granted and realized that I was not only representing me, but I was also representing them.

 

 

Do you know a lot of other students who didn’t match? What about people like you who didn’t match multiple times? What do people do who don’t match for a third time? What would you have done?

I have heard of a handful of students who matched after a third or fourth attempt. After I matched, I posted my story on Facebook and I got a huge number of messages with people asking for ideas on how to help them match and the best I could do was help brainstorm. Everyone’s application is different and since I don’t know what’s on their application or record, I could only speak on what I ended up doing.

To be quite honest, I don’t know what I would have done if I hadn’t matched a third time. I have been living in Florida already for my rotations and one thing that I was considering was applying for my ACN (Area of Critical Need) license. Since I had passed all the Step exams, I would’ve been able to practice medicine under the license of another primary care physician.

 

What general advise do you have for pre-med students researching Caribbean medical schools with regard to match rates? Did your medical school have resources available to you after you didn’t match?

Match rates are definitely useful, but you have to take them with a grain of salt, as you do with the match residency placements. Sure, Ross has matched at Yale and Duke, but you have to realize they are a rarity and have worked with the right people to earn that opportunity. However, use that as motivation to push yourself further to get that opportunity. Also, be aware of the school’s data. Take a look at what year the data came from because it may be slightly outdated. Take a look at where the graduates are able to practice. Even if you transfer into a “Big Four” (I guess Big Five school with AUA) medical school for your rotations, where you did your basic sciences will limit where you can obtain licensure so keep that in mind before you go to a cheaper Caribbean medical school. The extra cost is completely worth it.

 

 

What advise do you have for medical students who don’t match? What about if they don’t match twice?

Excellent question, Marc. Simply do not give up. It’s not a matter of if you will match, but rather WHEN you will match. Do not be afraid to reach out to colleagues who are in residency programs. I was hesitant at first because I wanted to earn it on my own merit, but if other industries interview people based on reference from those within the company, why can’t we do it in medicine? I know many people who got residencies because their parents knew people. My parents are not physicians. No one in my family is a physician. However, my friends from medical school could vouch for me, which in my opinion, carries more weight as there is no obligation to push for me.

Also, take Step 3!!!! You might as well get it out of the way, especially if you have lower scores like me, a failed attempt, or need a visa for residency. It can definitely open doors because every single interview mentioned that they were glad I had Step 3 done. One PD told me that it was a deciding factor in my application. In the words of Larry the Cable Guy, GIT ‘ER DONE.

To see our original interview after Steven’s first failed match check it out here- what happens when you don’t match.

Thank you again Steven for being so open and honest about your success and failures. I wish you only the best during residency and beyond.

 

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Intern Interview Spotlight Update- The Life of a Pediatrics Intern

Prior to starting intern year I interviewed Zack Manier about the residency application and interview process. Today he is six months into his intern year, the first year of his pediatrics residency at The Children’s Hospital at St. Peter’s University Hospital in New Brunswick, NJ. I sat down with Dr. Manier to find out what it’s like to be a freshly minted medical doctor.

Thanks for taking the time to let me interview you again. I introduced my readers to you a few months ago before we both started residency in an interview about the residency application and interview process. Fast-forward to today and we’re a little more than six months into intern year. What’s it like being a doctor?

Ummmmm…so many feels. Important, accomplished, nerve-wracking, busy, overwhelmed, stimulated, stressed, anxious, lost, rewarding, powerful, prolific…shall I go on?

 

That sounds like the all too familiar. So what’s the most rewarding part of being a pediatrician?

Honestly, the gratitude from the parents. Hearing parents (and even adolescent patients) compliment me or compliment me to an attending saying things like “best doctor we’ve had” (yes, that’s happened…I’m not just bragging) is so amazing. It makes all the times I feel completely stupid and useless worth it. Also, definitely having parents ask to specifically have me as their child’s doctor and come to my Thursday afternoon office hour. Clearly my competence (or confidence) is showing, and that is just as rewarding.

 

 

To contrast that story what has been the most frustrating part of residency?

Continuing to be at the bottom of the totem pole. “Yay, I’m a doctor now and no longer a student! I’ve moved up in the ranks!” Wrong. You’re back on the bottom. You’re just the intern. And yes, interns still do [female dog] work. Definitely not as much as when I was a student, but it happens. Oh, and overnight nursery pages. It’s frustrating, but hey…that’s the way the cookie crumbles, right? Now I want a cookie…

 

 

Ah, answering pages. Grey’s Anatomy made it always seem like every page was life and death. Turns out its more often that the patient is having too few or too many bowel movements. So what about residency do you find most challenging?

Trying to be confident with my decisions and not just looking to my senior for everything I’m unsure of (even though they are the best and are always happy to help). I’m not a student anymore. I’m not supposed to just ask my senior to do everything. I have to do it. It’s on me now. I make the phone calls. I order the medications. I call the attendings in the middle of the night. I tell the parents that Child Protective Services is taking their child away. I decide a baby’s respiratory status is improved enough to discontinue oxygen. And if that baby decompensates? It’s on me now. That’s something that you have to realize from day one…you’re a doctor now. This is the start of the rest of your career.

 

 

Our jobs can indeed be quite humbling and terrifying at times. Can you speak on what your biggest fear going into intern year was? 

 Probably what I just discussed above…that even though, yes, you have your seniors…you have to make your own decisions and become a self-sufficient physician. It was hard a first, but I quickly realized I didn’t have a choice. I couldn’t be passive (not that I am that type of person anyway). You have to. That made that fear dissolve within the first two months.

Also, one fear that I’m sure everyone shares…feeling incompetent. You’re going to enter feeling like you know nothing, especially when you’re put on the spot. I imagine that’s what tabula rasa feels like. But magically, somehow…from somewhere…the answers pop out. Your hand starts writing the corrects words. You’re entering medications like you’ve been doing this for years, and you start to realize you know more than you think. The knowledge is there…you just have to apply it.

Thankfully, my co-interns were/are all in the same boat. Having them around and spending time outside of the hospital with them to talk and vent (and drink) have helped to depress those fears.

 

 

Ah your co-interns. As corny as it sounds, I’ve found that they truly are the best part of any residency program. You spend so much time with them in the hospital that it’s nice to enjoy their company too. Speaking of hours, what are yours like? What’s a typical day for a pediatric intern?

This is obviously institution-dependent, but I guess I’ll give you a little snapshot into mine…

It all depends on the rotation. ER is just 18 shifts/month, and we basically make our own schedule— clutch. Lighter rotations like nursery and neurodevelopment as well as outpatient electives are typical M-F 8-5, with weekend floor calls here and there. Floor sucks. Floor sucks everywhere. Sign-out is at 6:30am, and intern sign-out to the oncoming evening intern is at 7:00pm. Yes, that’s 12+ hours a day, usually 6 days/week. Morning report every morning from 8-9am, noon conferences daily from 12-1pm, grand rounds from 9:30am-10:30am every Thursday, and my office hours (or continuity clinic) Thursday afternoons.

Oh, and nights…nights are great. We specifically do 3 sets of 2 weeks of nights as interns, which are 7pm-9am Sunday-Thursday. Which means weekends off (for the most part). Lovely.

My institution is (amazingly) different in a way…interns get every Friday night off. Every one. For the entire year. All eight of us. Those nights…we drink and complain. I also usually get at least one entire weekend off per month, and use that time to get the hell out of New Brunswick for sanity purposes.

 

 

Speaking of sanity, what do you do outside of the hospital to keep it? 

I guess I covered a lot of that above. But yes…relax, drink, travel…in that order. I need it. We all do. Get close with your interns. Go out when you can. If not to drink then for dinner. Vent. Complain without your seniors around. Even if you think you’re in the most amazing place at the start (which I did), you will start to realize the flaws as you become familiar with the inner-workings and the politics. Every institution has them. And you need close people to talk about it with. That’s what we do. I can’t stress enough how important it is to be close with your co-interns, or as in my case, even your second (and sometimes third) years. Also, I get away when you can. I have friends and family all over, and getting out of the little hospital bubble with all your (likely) hospital friends is necessary to stay sane. Plus, I’m in the cold…I hate the cold. Winter sucks. I go to Miami every chance I get.

 

 

That’s great advice. How about exercising? How often do you find yourself exercising compared to before residency started?

This will be a short one. I don’t. I exercise the same amount as before, because I didn’t. Should I? Definitely. Quite honestly though, my feet hurt (I hate dress shoes). And after the day is over, I want to be horizontal. In my bed. Am I complaining? Yes. Do I plan to change this soon? Yes! You can’t be a doctor (especially a pediatrician) promoting health and wellness when you don’t do it yourself.

 

 

How often are you able to see your family or significant other?

This is something I struggle with daily. My family is in one city, my SO is in another, and I’m in a third. So when I get the chance, where do I go? To see my SO. It’s a hard decision, but I’m used to being away from my family…I went to college out of state, medical school internationally, and I haven’t lived at “home” in almost 10 years. It’s difficult being apart from my SO, and we need frequent visits to maintain our relationship, just like all long-distance relationships. Thankfully, we see each other at least monthly (whether I go there or he comes here), and Facetime is a live-saver. Since I moved to NJ in June, I haven’t been back home. My family did come visit for Thanksgiving, and I’m currently writing this on the plane home for Christmas. Holidays and occasions…that’s been pretty typical for seeing my family over the past years.

 

 

How are you handling the debt?

Debt? What’s that? Oh, right…I mean, the cronies automatically take money from my account monthly, and I don’t think about it. And that’s all I have to say about that.

 

 

When do you plan on taking step 3? 

Bleh. Adult medicine. I don’t want to study it. It’s like, I want to take it and get it over with so I never have to study adult medicine again, but at the same time…I don’t want to start studying adults again. But alas, I must. I’m either taking it mid-February or end of April, as those are the times that work with my lighter rotations. I’m getting UWorld for Christmas (yay, adulting), so I’m about to start on that. Mainly, I don’t want to spend the $900 or whatever is it to take the exam. I’d rather spend it on drinks. Medicine is a damn money pit, ya know?

 

 

What’s it like having the responsibility of teaching medical students?

I love it. It’s great. I’ve tutored in the past and was a head anatomy TA in medical school, so it’s something I enjoy. It’s also nice to have attendings tell me that medical students compliment me and enjoy working with me. They don’t think I’m dumb! However, it is sometimes hard to give them full attention as the intern…especially on floor when it’s super busy and I have one million things to do. That’s what the seniors and attendings are for.

Also, pro-tip: get the medical students to follow your patients. That’s what I do. Why? Because on floor rounds, the student presents and gets pimped, not me.

 

 

In retrospect, with the knowledge that you have now, are there any questions you would recommend to medical students to ask during their interviews? 

Other than all of the medical knowledge, you mean? I don’t think there is anything that I now wish I had asked…I pretty much knew what I was getting into, and I feel like it’s on par with my expectations. The most important thing is to ask the resident’s if they’re happy. We won’t lie. We really do tell it like it is. And definitely ask how they feel they attendings are and what their relationships are with the attendings. It will make a world of difference. I’m fortunate enough to have amazing attending physicians. It’s something I have been bragging about to all the interviewees this season. Like, you know how in medical school or residency even there are those physicians that people are “scared” to work with or grumble about being placed with? Yeah, we don’t have any. None. I would say 90-95% of ours are absolutely amazing, and the rest are good but ever-so-slightly more intimidating. That might be the best part of my residency. Definitely ask about that.

 

 

Speaking of medical students, do you strongly feel that there is anything you wish you did differently while you were in medical school that would have better prepared you for residency?

My one and only regret is not taking USMLE Step 3 prior to residency. I was going to, but I ended up drinking and traveling instead. (A common thread here, clearly) So, if you have time, seriously consider taking it. It will save you a load of stress and annoyance later, when that is the last thing you have on your mind or want to deal with. Otherwise, just be proactive. Act like a resident on rotations, not a student or a shadow. Ask to do procedures, to see extra patients, to write notes, to have your H&Ps checked and reflected on, to stay later, to make phone calls. These are all things you have to do as a resident, and the sooner you start, the better. These are all things I did, and not only did it get my outstanding grades and letters of recommendation, but it also significantly prepared me for residency. If you have all of these things (mostly) down before starting, you can focus on expanding your knowledge and being the best provider for your patients you can be.

 

 

For the current medical students reading this, what general advice do you have regarding residency?

First and foremost, the last line I just said. Be the best provider you can be FOR YOUR PATIENTS. That’s what it’s really about, and why (most) of us all are in this profession. It’s for the patients. Check your egos at the door. This isn’t about you, it’s about them. The rest…the knowledge, the fearlessness, the confidence, the competence…that will come with time. But your patients always come first, no matter what.

 

 

Zack, thank you so much for taking the time to let me interview you. I appreciate your words of wisdom and motivation.

Check back next week for my next intern interview update. And as always subscribe so you don’t miss out!

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Spotlight Interview: DO graduate earns OB/GYN residency

Tell us a little about yourself. What are your career goals in medicine? Who are you outside of medicine?

I’m Maureen. I’m 27 and originally from California. The first question people ask me when they learn that is “why did you leave beautiful sunny California to come to gross Philadelphia?” but I actually really love it here. I guess you could say I’m more of an east coast, fast paced type of person…probably part of why I love OB/GYN. I hope to be an adolescent gynecologist but I’m sure I will change my mind in the next four years. Outside of medicine, I love to cook, travel, and hang out with my friends with a glass of cab.

 

 

What should fourth year medical students do the summer before medical school? What did you do?

Before medical school, I took a vacation. I stopped working about two months before med school started to travel with friends and reset my mind. I also had to move from San Diego to Philadelphia, so I road tripped across the country with my dad. I wouldn’t suggest anything else. Relax. Don’t study. Spend time with family and friends. Work on your friendships because free time will be compromised.

 

 

Where did you go to medical school?

I went to PCOM—the Harvard of DO schools! I only applied to DO school. I had a 33 MCAT, but my GPA was only a 3.2. I knew I wasn’t competitive for MD schools in locations I wanted to live (California, Philadelphia, NYC). PCOM was the first school I interviewed at, in the beginning of October. I got my acceptance October 31st. I went to one other interview and cancelled the rest. I knew PCOM was the right place for me.

 

 

What advice would you give to pre-med applicants about applying to medical school?

I would tell pre-med students to do well on their MCAT and to not neglect their GPA. Scores get you in the door—a theme that will ring true again for residency. Nothing else will guarantee interviews like solid numbers.

 

 

So for those of us who don’t know, what’s the difference between a DO and an MD medical school?

At DO schools you learn osteopathic manipulative medicine (OMM). It means 1-2 extra lecture hours a week along with one 90-minute lab session to practice the techniques. It means taking a different board examination. Otherwise, I don’t think there are any differences—but I am a little biased.

 

 

Do you plan on continuing to use OMM in practice?

Unfortunately it’s not realistic to use OMM in residency. You just don’t have time. If I end up in private practice then I will 100% use OMM. It really does help patients with musculoskeletal issues. If you learn to bill correctly, it can also be extremely lucrative. I spent two months of my fourth year working in my school’s OMM department so I was able to see what consistent treatment can do for a patient with low back pain or carpal tunnel. I probably have a bigger appreciation for OMM than most other current DO students.

 

 

Let’s fast forward to fourth year of medical school. How many OBGYN programs did you apply to? Any backup specialties?

I applied to 59 programs. Philadelphia, New Jersey, and NYC. I didn’t apply to any backup specialties. I got around 20ish interviews and stopped counting. I really wanted to be in either Center City, Philadelphia or NYC, so I cancelled most of my NJ interviews when I had a few in Philadelphia. I went on 9 interviews—much less than the average candidate. I would say most people did 15-20 at least. I also took a big risk and only ranked 6 programs. I honestly just had a hard time picturing myself being happy at any program outside of my top 4. It was a hard decision but I risked it. Luckily, I got my first choice and it’s been 6 weeks and I haven’t cried yet. Complete success.

 

 

Do you think you had an advantage or disadvantage applying to residency as a DO?

Definite disadvantage in a few areas. First, certain schools do not accept you. Waste of money to apply. Second, some sites, especially those tied to Caribbean schools, do not allow you to rotate there. Which takes away the chance to do sub-internships there which are important for almost every specialty. I definitely got asked awkwardly on interviews “What is a DO?” and it sucked.

 

 

Every potential applicant is probably dying to know, so what were your step scores? Did anything on your resume separate you from the crowd?

  • COMLEX level 1: 629
  • COMLEX level 2: 627
  • USMLE step 1: 233
  • USMLE step 2: 251

Those scores definitely helped me land interviews at solid allopathic university programs like Drexel, Temple, SUNY- Downstate who have a paucity of DO’s in their resident pools. I was often the only DO or one of a handful on interview day. I also did research between first and second year of med school and got a paper published in Menopause. I think my research my scores are 100% what got me interviews. I also was president of PCOM’s OB/GYN club, served as a class representative in our student government, and taught gymnastics during first and second year.

 

 

What advice do you have for someone who wants to apply to OBGYN but didn’t score that well on step 1 and/or step 2?

Apply early and broadly for sub-I’s and show up and work your ass off. That’s the single best, and in some cases only, thing you can do to get an interview.

 

 

What were OBGYN interviews like? Any advice on how to succeed on interview day?

Lots of women, ha. I actually made some great friends on the interview trail. It was really comforting. Know your application, know your research, know where you want to be in five years. Have questions ready—my favorite was “how do you hope to see the program improve in the next 5 years?” Know where the program director trained. Otherwise, just be friendly. Talk to the residents about their personal lives. Ask if they residents hang out together—if the answer is anything other than “oh yeah! We’re all friends!” you know that program probably isn’t very social. Really try to see how you fit with the residents. That’s the most important thing. Who do you want to be stuck on 15-hour nights, 6 nights a week with?

 

 

What should current applicants look out for in an OB/GYN program? (besides free food on interview day)

They should look how they fit in with the residents. Go to the pre interview dinners and talk to them about how they feel about the program. Interviews will get very cumbersome by the end so you will cancel a few. Rationalize it in that you’re opening the door for someone else who might really want that spot. Figure out your non-negotiables and make your rank list from there.

 

 

Any other advice that you’d want to give fourth year medical students currently applying for the match?

Breathe!

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Spotlight interview: from the Caribbean to a categorical surgery residency

Today I had the good fortune to interview a close friend who matched into one of the toughest specialties in the medical field. Not only did she match into general surgery but she also earned a categorical position. Here’s her advice on how she did it.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

 

I go by Laura Edwards, or just Laura. I am a native South Floridian but I was raised by a strong mid-western mother. I come from an extremely diverse place, which was paired with values that cherish a nonjudgmental attitude and service for others.

I carry those values with me into practice. I use these with patients and colleagues just the same. I am a team player, whatever that means today or tomorrow. I feel comfortable to take the lead or to coordinate behind the scenes.

Outside of the hospital, I am a laid back lady. I binge-watch amazing TV shows, I meet friends for a brewsky, I read fiction, and I have dog. And yes, I study too.

 

 

What specialties did you apply to? How did you come to choose it/them?

I applied to general surgery positions (categorical and preliminary) only. Not applying for other specialties was a serious decision that was made with much thought and care. Many people encouraged me to have a back-up plan. I had to ask myself all the ‘What if’s?’; “what if I get a preliminary spot the first year, and then AGAIN the second year?’, “How will I significantly improve my application before the next cycle?”, “What will I do if I don’t become a surgeon?”, “How will I cope with that?” etc. I calculated the risks as best I could. Yet, in the end I listened to my gut, which told me that I was going to be a surgeon.

 

  

For those who don’t know, what is the difference between a categorical and a preliminary surgical residency?

In the world of general surgery, a preliminary position is a 1-year contract whereas a categorical position is a 5-year contract (or the amount of years required to finish the program). A preliminary position is for a Post Graduate Year (PGY) -1, -2 or even -3 resident. Going into a preliminary position will require the resident to apply for another position the following year, which means entering ERAS again, i.e. residency starts in July and you start your new application in September, only 2 months later. And as many of us know, the more times one enters ERAS the poorer the outcomes can become with each cycle.

When preliminary positions are offered to general surgery candidates it likely means there is something about your application isn’t absolutely perfect. This can be a variety of things: your medical school, your evaluations, your grades or scores, something said on your interview day, etc. It is my understanding that preliminary positions are usually given as a trial year. The program is confident enough to train you for one year but not enough to commit to 5 years.

Therefore, categorical positions i.e. full-contract positions are the goal. When a categorical position is offered, the program director is saying “We see you as a real potential surgeon. We believe with our training and your foundation you could complete our residency program successfully.”

 

 

How many programs did you end up applying to? 

I applied to approximately 230 categorical positions and 150 preliminary positions. As a international medical graduate, I was very unsure of how my application would fare. Fortunately, my family supported my efforts during this time. We all believed the more applications sent the more opportunities I would find. Every penny is worth it.

 

 

How many interviews did you go on for each?

I went on 6-7 categorical interviews and 5 preliminary interviews.

 

 

Any crazy stories from the interview trail?

No crazy stories really. But always be friendly with the other applicants; they might become your co-resident or you will see them again at another interview.

 

 

What did you find to be the most frustrating part of the interview process?

 

There were two things that left me frustrated again and again. The first was waiting.

Waiting for interview invitation emails to come in is the most gut-wrenching part. I found myself going through highs of triumph and hope and lows of defeat and fear. It is an extremely unpredictable and emotionally taxing time. I highly suggest taking up some activity that will strongly distract your mind.

Once on the interviews, the second thing I found most frustrating was that many interviewers were unaware of how the Caribbean schools are structured. I found that my interviewers assumed that I completed all my rotations on the island. I found myself explaining the general flow of my medical education. Once I was able to explain that I had done 2 years of clinical rotations at various hospitals in the US, they were much more open to me as a candidate.

I guess, you would think that all interviewers at least glance through your transcript or would see that your letters were from American institutions, but unfortunately this was not always my experience. My advice concerning this is just to assume your interviewer has no idea where you completed the 3rd and 4th years. Use this as an opportunity to talk up your experience.

 

 

Do you feel that coming from a Caribbean medical school hindered your chances to match in one of the most competitive residency specialties?

Yes, without a doubt. The US applicants I interviewed alongside were overall more relaxed with the whole process. They spoke of turning down interviews and gave off the vibe of “It will all be okay; I’ll end up somewhere [as a categorical surgical resident].”

But let’s step back a bit.

I decided to go for surgery very early on in medical school. Therefore, everything I did was geared towards this goal. I joined the surgery interest group, attended knot-tying sessions and studied as hard as I could without going crazy for Step 1. I spent my entire third year lining up sub-internships (aka audition rotations) at hospitals outside of my medical school’s network. I pursued research within the surgical department from the 2nd week of my third year. I nurtured and maintained a MEANINGFUL relationship with my research mentor (and still do to this day). Everyday I woke up; I made sure I did something to become closer to my goal. I thought about it multiple times a day. I made a phone call to a surgery department while walking in between patients, sent a quick email to a coordinator. My efforts were relentless.

I’m sure some US graduates work this hard to attain their goal but I did not get the feeling from fellow applicants that they had the same level of intensity. I truly believe that my edge/aggressive attitude was what got me to where I am today.

In my mind, there is only one chance to gain that cherished categorical surgery spot, so hold nothing back and have no regrets.

 

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

 

My step scores got my application through the filters. Then, my letters of recommendation only confirmed what others saw in me. And lastly, probably what set me apart was the friendly and confident-yet-humble manor I held during interviews.

I also have a MA degree in Marriage and Family Therapy. This was the unique twist I had in my application. This gave my application depth and made my reasons for applying to surgery even more sincere and pragmatic. In reality, I use counseling skills in every relationship I have and more importantly at work and with my patients.

For my program in particular, what set me apart in their eyes was my work and patient care they saw during my sub-internship. I went out of my way to make sure the program director knew my name. I always asked my attendings how I could be better. I made sure my chiefs knew I was reading and following up on previous concepts I was unsure of. I was so intent on being impressive that it actually worked and they vouched for me following my interview.

 

 

In contrast, what were your greatest weaknesses about your application?

Of course, the fact that I was an international graduate and had average step scores were things that I had to compensate for, but at the same time, these are things you cannot change.

The one weakness I could have prevented was a particularly bad evaluation from a particularly important person. The clerkship director for my 3rd year surgery rotation knew my interest in surgery and therefore held me to those standards. Instead of striving for excellence, I became overwhelmed and eventually gave up on trying to impress her. That led to poor decisions that only worsened the situation. I knew her evaluation of me would not be stellar but I did not think she would be so damming either.

The lesson to learn from this is to never let anyone get so down on you that you start to believe them. You are your best advocate and champion. Never let that go.

 

 

How did you do on the USMLE’s? 

I studied hard for Step 1 and received a 233.

I took a risk and scheduled my first sub-internship during the month I was also studying for Step 2 CK. I ended up splitting my time 90% rotation and 10% on CK. So inevitably, I got a 233, the same score as Step 1. This was devastating because all institutions look for an increase in score. A stagnant or decrease in score is can be seen as a red flag. Interviewers asked about my CK score on two occasions. Once I explained that I was also doing my first sub-internship rotation they all understood and did not ask any further questions.

However, the risk I took was worth it because that first sub-internship is where I matched that following March. Hennepin County Medical Center saw me as a person, as a blooming surgeon and not as a number. I hope you all find this too when searching for your residency spot.

 

 

What advice would you give to other international medical graduates who want to pursue a categorical residency position?

 

First of all, thank you Marc for interviewing me. The process of getting this all down on paper has been a good exercise. It has helped me to realize new foundational truths that will help others and me along the way. My main pieces of advice for those pursuing a categorical surgical position are as follows:

  • Be your own champion, always
  • Be relentless in your efforts to stand out
  • Do away rotations at non-affiliated hospitals
  • If you don’t have the scores (~230 or above), be realistic about your chances

 

 

Thank you Laura for taking the time to let me interview you. Your tenacity is inspiring.

Be sure to subscribe below and like me on Facebook so you don’t miss you next week’s interview!

 

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What happens when you don’t match

What happens to medical students who don’t match? Here’s what one unmatched psychiatry applicant had to say.

 

Thanks for letting me interview you Steven. You have a pretty unique story that my readers would love to hear about but before we delve in can you tell us a little bit about yourself? Who are you professionally? Did you go straight from undergrad to Ross? Who are you outside of the hospital?

My pleasure, Marc. I appreciate the opportunity to share my story as I feel people can learn from any experience in this process, both good and bad. I graduated from NYU in 2010 with a Bachelor of Arts in Mathematics. After graduation, I had about six months before starting with Ross University’s MERP (Medical Education Review Program) and I knew I needed to make money. So I took a job that any medical school bound person takes – working in the jewelry and diamond industry. I did mostly bookkeeping but I also prepared orders for a wholesale company that dealt with Macy’s, JcPenney, Sears, HSN, QVC, etc. It taught me a lot about dealing with large staffs and it was a nice break away from the science and math world I had spent so much time with in undergrad.

Professionally, I’m the one making jokes in the office but I focus on the patient when I’m in the room. I like to be a reason people enjoy coming to work, because they know it’ll be fun and productive. On the same token, I’m also someone who isn’t afraid to call someone out for their BS because I expect someone to do the same to me if I ever act out of line. I also am one of the first people to teach someone how things run in the office, how to order labs, do procedures, etc. Not only do people feel comfortable if it’s a peer teaching them but it helps me better my skills as well.

 

 

What specialties did you apply for? How many programs in each specialty? What was your reasoning for that number of programs?

I applied to psychiatry, internal medicine, and internal medicine-psychiatry combined. For psychiatry, I applied to 76 programs. For internal medicine, I applied to 10. And for IM-psych, I applied to all 9 programs in the country. My step scores weren’t that competitive and there are only 196 psychiatry programs in the country. I went through each program on FREIDA and checked to see if I matched their step requirements. If I did, I tried to see who the residents were. If there were zero or one Caribbean grad in all the PGY positions, then I didn’t apply as I felt that that one particular Caribbean grad may have had a connection there or had stellar scores. Plus, why would I spend money on programs that were going to outright reject me?

For IM, I applied to where I had rotated and since I could apply up to 10 for one fee, I applied to some hospitals in the NY/NJ area (which is where I’m from). And for IM-psych programs, there were only 9 so it made the most sense to apply to all of them.

 

 

How many interviews did you end up receiving? How did you feel your chances were at matching?

Formally, I received three interviews, but in total, I ranked four positions. I received 2 for psychiatry and I was taken off the waitlist for 1 IM-psych program. All of them were university-based programs. At the IM-psych program, I had mentioned that I had also applied for a psychiatry categorical position at the same place and I wanted to know if I had to come back for another interview, which I was totally willing to do. Ten minutes after that mini-interview, I had an impromptu meeting with the program director of psychiatry and she told me that she will see what the other four interviewers had to say about me from that day and she would let me know if I needed to come back or not. Two weeks later, I’m notified that she had enough to consider me for a position. Throughout the next two months prior to match day, I had received several emails about how the psychiatry program is expanding and there’s new facilities and all these wonderful things. I didn’t think I was a shoo-in but I felt that maybe I had a great shot.

 

 

So, it’s Monday, March 14th. The day applicants find out if they matched. You open the e-mail and find out that you did not obtain a residency. What’s going through your head?

Before that day, I told myself whatever happens, happens. I actually slept well the night before! I was driving in Fort Lauderdale and taking care of some errands and I happened to look at my phone. For five seconds, I was completely numb. And then it hit me. My biggest fear came true. All that work, all that money, all the stress, and for what? Nothing.

*cue Kim Kardashian ugly crying*

I can honestly say that it is one of the most devastating experiences and I would not even wish it upon an enemy. The e-mail just says “you did not match”. Not even a “good morning” or “hey girl!” Just one line that says you’re not good enough to continue in your career. After quickly doing my errands and a few snot-filled tissues later, I sped home passing several cops on the way and began on SOAP.

Most of us aren’t familiar with the SOAP, or the Supplemental Offer & Acceptance Program. Can you walk us through your experience with it? (Here’s a link to the SOAP schedule for my readers)

SOAP is a chance for unmatched applicants to apply to unfilled spots in all fields of medicine. However, this means that you will have to come up with new personal statements in the matter of hours, which is exactly what I had to do for family medicine. As Markus said in a previous posting, the website was down and no one could send in applications (because like LOL, heaven forbid the ERAS website works when it needs to).

I spoke with a friend who match into IM the year before through SOAP and she guided me through the process while she was at work. She told me to apply to the IM prelim, IM categorical, and family med programs that had the MOST open spots. I had only 45 spots to pick from and I used 5 of them on psychiatry programs that were unfilled. Then I went through family medicine and internal medicine. In retrospect, I could’ve used those 5 on family medicine or IM spots but what’s done is done.

 

 

So on Monday you found out that you didn’t match. Then during the week you went through the SOAP.  Friday comes along and you find out that you didn’t SOAP into a residency. How did that feel?

By that point, I had already gone through the five stages of grief. Denial set in when I was in the car. Then anger when I was cursing at anyone on the road that was slowing me down from getting home (which is what I do on a regular basis and I’ve been trying to work on but YOU try driving on I-95 in Fort Lauderdale and Miami and tell me you don’t have road rage, but I digress…). Bargaining was SOAP. Depression set in when the 5th round of SOAP happened and I hadn’t received any offers. It continued for a week when all I saw on Facebook were my friends posting that they matched at their number one or number two choices. It wasn’t that I wasn’t happy for them. Every single one of us had a unique journey and even the people I didn’t like, I respected them enough in a professional sense to be proud that they get to continue their journey. It was more about the fact that I didn’t get to continue my journey with them.

Several months had passed and I hadn’t reached the acceptance stage of grief. It wasn’t until I went to the AAFP National Conference in Kansas City at the end of July that I had realized that I had been in the wrong field all this time. I realized within the first hour of the conference that I had such a wrong idea as to what family medicine and primary care entailed. There are so many opportunities for me as a family medicine doctor, whether it be to provide medical care for a whole family, work as a hospitalist, deal with mental health issues, or even perform procedures. After I didn’t match, I had told myself that something big was in store for me, and I finally believed it. Networking at the expo hall with the residency programs made me realize that I was a perfect fit for family medicine and that there are programs out there that WANT me. As I’m writing this, I can definitely say that I wasn’t supposed to match into psychiatry because I realized that I was meant to match into family medicine (I’m hoping). It feels good to be in that acceptance part of grief!

 

 

Why do you think you didn’t match? What were your step scores? Was your application particularly weak in any one specific area?

I had thought about not giving exact numbers here, but in all honesty, who cares? Step 1 was a 208, and step 2 CK was a 209 (yes, the EXACT passing score). Step 2 CS was a pass and everything was on the first try. I expected my Step 1 score but my CK was an absolute miracle. I had worked harder for CK than I did for step 1 and yet, I was not getting anywhere with my studying. I took a UWorld assessment two days before just to get more questions in and I had about 179. So in two days, my score JUMPED 30 points. (This is NOT a plan I recommend to ANYONE, by the way.) I know I’m a terrible test taker and that in rotations, I shined and my letters of recommendation reflected that.

In addition, I had failed one course in basic sciences, and THAT was a reason why a program didn’t take me. They were too worried that I may not pass step 3 (which I’ll go into below) and therefore, not be able to be licensed. However, my scores were good enough to get some interviews at university programs so I must have done SOMETHING right.

 

 

Do you think the fact that you attended a Caribbean medical school played a factor?

Not at all. The places I had interviewed at were very IMG friendly, as were the residencies I spoke with at the AAFP National Conference.

 

 

What do you plan to do while you wait to apply for the 2017 match?

I am currently a Clinical Teaching Fellow for Ross University. Some of my colleagues know it as “junior faculty” but teaching fellow is the formal title and you better believe I am using that on my CV. For those who don’t know what that is, my role is to act as a standardized patient for the incoming 3rd year medical students and assist other junior faculty in teaching how to handle difficult patients and certain common primary care cases, as well as how to begin to formulate an efficient style of medical interviewing. I also assist in Ross’s Ambulatory Care Competencies elective, where we prep the 4th year students for Step 2 CS by presenting cases and critiquing their notes.

Outside of Ross University, I tutor for Huntington Learning Center (which I have been doing since 4th year of med school), where I mostly do SAT/ACT math and high school subject tutoring in math as well. In addition, I’m getting my MBA in Health Services Management through Keller Graduate School of Management, which is one of the sister schools of Ross University. What’s great about that is that they have an “MD to MBA” program where I was able to get credit for 5 out of the 16 courses, so now I only need to complete 11 of them. In addition to working, I plan on taking Step 3 by the end of October. Needless to say, I only know one speed and it is full speed ahead.

 

 

How are you handling your loan debt?

Some of my loan debt could not be deferred or put into forbearance, so I have been paying that off. However, since starting grad school, I’ve been able to defer most of my loans while taking out more. Thanks, Uncle Sam!

 

 

What words of wisdom would you give to someone knowing what you know now?

Have plans A through Z ready to go from the jump. You don’t want to rely on them, but you want them ready if you have to execute them.

Go to as many networking conferences as you can. I know those things can cost money, but at the very least, go to the big ones run by the specialties to which you are applying.

But most importantly, it’s not a matter of “if” you become a resident, but rather it’s a matter of WHEN. 2016 was not my time and I realize that now. However, come 2017, I will be a better applicant and in a better frame of mind to continue on in the next chapter.

 

 

Thank you Steven for an informative and entertaining interview. I look forward to finding out where you match in 2017.

 

Next week I interview a Ross University graduate who matched into a categorical general surgery position. Be sure to subscribe to my blog, like me on Facebook, and follow me on Twitter so you don’t miss it!

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Spotlight interview: Joey from Brooklyn lands a PM&R residency

I know him as Joey from Brooklyn and had the pleasure to rotate with him before he was Dr. Seldin. Here’s what he had to say about his journey to landing a Physical Management & Rehabilitation (PM&R) residency.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital? What was your path to medicine?

The best way to tell about myself is to start from where my family is from. My father is from Brooklyn and my Mother is from Queens. I grew up on Long Island and my wife is from the Bronx. And its not hard to tell when you talk to me, my accent says it all.

I went to college to the University of Buffalo and received a BS in Psychology. During this time I became very interested in Fitness and Nutrition, performed in Body Building Shows, and learned from one of the greatest Trainers in Buffalo John Schweikhard. This love for fitness and nutrition pushed me in the direction of perusing a masters degree in nutrition from Columbia University. While earning my Master’s I lived in Washington Heights and would spend my free time on the Upper West Side (UWS). One Friday in June of 2008 I was in a Bar on the UWS of Manhattan at a place called Burbon St. I was there early and she walked in, I looked at her and said “yo legs come over here” and we hit it off. At the end of the Summer, July 28, 2008 I was in a bad accident and lost my right eye. This was hard time for me. I finished my masters thesis a few months later. 90% of the people I studied with at Columbia went right into medical school all over the country.

I lost my flow, this was the first time in my life that I wasn’t in school anymore and didn’t have a job and didn’t know what to do. After a year and a half, when I had more confidence after loosing my sight and multiple surgeries, I fell back on my fitness and nutrition knowledge and decided to professionally train people. At the same time my little brother starting to box and I put a lot of effort into helping him train. I would make his meals and slept on his couch in return. Then I came to a point when I realized I needed to really go for what I wanted my whole life which was a to become a doctor. At this time I was professionally training several doctors and one of them who was a cardiologist said, ‘if you want it then go for it’. I took the MCAT and honestly very did poorly. So I took it again, and again and again. Finally I was at a party and this kid who was shadowing at one of my client’s offices was like, ‘I’m going to Ross’. I didn’t know anything about this school and said to myself it is worth a try.

Outside the hospital I am a family man, I had my son two weeks before the start of my 3rd year of medical school. It was hard to give time from my family and study but I pushed through. I had my 2nd child 6 weeks ago. She was due the day before we started residency but she arrived early. It was perfect timing because it gave me a chance to get to know her.

 

 

What specialties did you apply to? How did you come to choose them?

Before I started medical school, I came to know this field called PM&R, Physical Medicine and Rehabilitation. While I was training clients I came to build a lot of great relationships. One of them worked at North Shore LIJ hospital system and he helped me volunteer at their hospital in the PM&R division. I didn’t know it at the time but this small step may have gotten me the career I have today.

So I knew in my head before I started medical school that this may be the field for me. What most people don’t know is, I kept an open mind during my 3rd year of medical school and really enjoyed all of my rotations. The closest thing to PM&R for me was emergency medicine. I also met the best attending physician there who really inspired me and peaked my interested in that field too.

So I applied to both PM&R and EM.

 

 

So going into PM&R means you have to do a transition year. Did different programs have different requirements for that transition year?

Most programs require you to complete a preliminary year in either internal medicine, family medicine, surgery, or a transitional year (this is like 5th year medical school- you rotate in surgery, OB/GYN, medicine, the ICU, EM, and some electives). Some programs have a categorical position, meaning you do your first year in that program as a medicine resident. Medicine is the most relevant in my opinion. The thing I didn’t know was that internal medicine preliminary spots are very hard to get. See, the ophthalmology, dermatology, radiology, and anesthesia guys and gals are going for IM prelim spots as well. So they’ve got the top step scores and they are US students. Where I am just in the top of the scores applying as an international medical graduate.

 

 

What was it like applying and interviewing for both of them?

I truly enjoyed the interview process and anyone who knows me also knows I am a talker. And when it comes to interviews, I thought to myself this is probably the only time I can get away with talking about myself all day. Another thing about applying to specialty fields is you don’t get interviews until October and until late December. It was mid October and I had like 4 interviews. My buddy applying to IM had like 20 by the end of September. Then all of a sudden I was bombarded with them.

 

 

How many programs did you end up applying to? What was your reasoning for that number of programs? How many interviews did you receive for each respectively?

I applied to 129 programs but I didn’t break the bank like other people I know. It ended up costing about $1,600. I applied to 10 transitional, 39 PM&R, 55 EM, and 25 IM programs. I got 10 PM&R, 10 IM Prelim, 6 EM, 1 TY interview for a total of 27 interviews. Of these interviews, 6 of these interviews I got by bugging programs to interview me and one of them is where I matched.

 

 

How did you end of ranking your programs?

My ranking was not an easy task. I went on a lot of interviews and honestly there a few things to consider for you rank. Some people rank based on location, academics, specialty, and other things. For me the most important was location. Staying in NY and being close to both my wife’s family and my family meant a lot.

 

 

What was the most challenging aspect of applying to PM&R?

There are not a lot of programs and in many programs are only 2-4 spots per year. I think there is only like 116 spots in the whole northeast.
For EM the IMG is non-existant these days. The programs are big into US students. There was lots of spots, lots of programs but I got only a few interviews.

 

 

Any crazy stories from the interview trail?

So SUNY Downstate PM&R pre-interview social, was at a bar in the village. It was open bar with top-notch drinks. The kicker was that we had to drink a certain amount to get a discount. So the residents had us downing beers and shots. I drank 6 Chimays and Duvels and downed a glass of Jonny Walker Blue. Then I had the interview the next day…good thing it wasn’t until 12pm.

 

 

What do you think were your greatest strengths about your application?

I applied locally. There are by far the most programs in NYC and having ties to an area can boost your ranking. I also scored very well. It is a special feeling when you go on an interview and pretty much know you probably have better scores then most of the people sitting next to you. If you go to Ross you know how hard it is to make it off that island and you know how hard you can work. I know I can work harder than anyone out there. I had a child right before my 3rd year of school and still was able to go up 17 points on step 2.

 

 

In contrast, what were your greatest weaknesses about your application?

The medical school I attended I would say was the greatest weakness. But is only the limiting factor for getting interviews. 80% for sure if you get an interview, they really want you otherwise they wouldn’t interview you.

My first interview was at Stony Brook PM&R, the director said, hey you go to Ross, great school. I laughed hard in my mind. Turns out that a resident many years ago at Stony Brook was a super star. On the flip side, there are hurdles with advanced match. See you can score a PM&R place on match day but that is only years 2-4 for your residency. You still need to also match in prelim as well. Now I matched in both of course otherwise I wouldn’t be talking to you about it. But sometimes a programs ranks someone in PM&R and the person doesn’t secure a prelim spot, and can’t soap into a spot either. Pretty much just fucked.

 

 

How did you do on the USMLE’s? What were your step scores? Do you think your step scores negatively/positively affected the number of interviews your received?

Step 1 242 and Step 2 257. They definitely helped me and I looked up the average scores on the ERAS stats list. No one scored as high as I did in 2014 in PM&R on Step 2. I know if my scores weren’t as good I would not have gotten close to the number of interviews I had.

 

 

What advice would you give to other Caribbean and/or American medical graduates who want to apply to PM&R?

Take every interview you can get. Also make sure you can rotate at a place that will let you go on your interviews during your rotation. On one of my electives I went on 4 interviews in one week and they didn’t give me any shit about it, which was great.

If you have shit scores, plan for back ups. Don’t be foolish. And if your scores suck, make sure you can relate to the field you are going for and kill it on the interview. I know one guy (and if he reads this will know who he is) has bad step one scores, but improved on step 2 but still under the average and landed a great residency. The reason is he related to the field and in the end of the day you only need one place to rank you (or two places if you’re going into PM&R…one prelim and one advanced spot). Even if it was your last rank, it’s better than nothing.

Take your test seriously. In June during my last 3rd year rotation I took a practice NBME and got a 220. I took another NBME one month later and got a 225. I finished 3rd year and had 4 uninterupted weeks to study. I took my 3rd NBME and got a 235. Took another 1 week later and got a 236. I wasn’t too happy at this point. But had got a lot down in the last 2 weeks of studying. 1 week before my exam, I took the USMLE World self-assessment got a 256 and was happy. 1 week later and got a 257. Holy shit was I happy.

Don’t worry about how many hours you will work as a resident in one field or anther. Before I started I didn’t know if I could really do this. But I did know I can push myself hard. Honestly I am up at 5 am every day, get to hospital 6-6:15am and finish about 5-6pm on a regular day. Not to mention short call and weekends. But I never feel like I can’t do it. You will do it. You’re so busy that the day flies by. You know your job is awesome when I go in on a Saturday at 6:30am and look at my clock and its 5pm and I need to get these last few notes done before sign-out. You can do it too I promise. I really can say that I love my job.

 

 

Thank you Joey for giving us a candid look at your application process. Be sure to subscribe so you don’t miss my second interview with an unmatched psych applicant.

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Spotlight interview: from California to the Carribbean, an emergency medicine resident shares his advice

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

Well hello there everyone! My name is Ami, pronounced Ah-mee.

I’m an easy going but sometimes intense guy from Los Angeles, California (cough cough the best city in the world). I grew up in the suburbs or “the valley.” I went to UC-Irvine for my undergrad and double majored in International Studies and Biology, but mostly spent my time surfing… hence my atrocious bio GPA, average MCAT that eventually led me to Ross like many other people. As I answer these questions I’ll give a line of advice from my experience thus far.

There is a small caveat before Ross University where I decided to get serious towards the end of senior year of college (too late to take the “correct” path to med school). I graduated, then took some bio classes at UCLA, did some research in the ER at Children’s Hospital in LA (CHLA) and got EMT certified to boost the résumé. This still wasn’t enough.

Now bear with me because the story below has a lot to do with the next 5 years of my life.

The story: I had been surfing the same spot in North LA for around 5 years at the time and there was always this guy in the water, who was there so often, I just figured he was some surf bum with no job. So I start talking to this guy and I ask him “well what do you do?” and he causally answers, “Well, I’m a doctor…” I actually laughed out loud and said, “No, really what do you do?” He’s like “no, seriously.”

So at this point I’m intrigued and ask “well, what type of doctor are you and where do you work?” And to my surprise, he says “I’m an Emergency Medicine doctor and I work at UCLA for the past 15 years” So we talk more in depth about how I’m trying to go to med school and he tells me how he just started this Med-tech company and because I’m used to taking tests, “why don’t you come over to the office and do some quality assurance/beta testing on the ultrasound simulator…”

Thus begins my mini, 1 year career working for SonoSim, Inc. Being in that start-up environment where 9-5 is unheard of and 1 position equals 5, was the best experience of my life. It taught me how to actually work hard and made me responsible for the progression of a company where others depend on you and if you fail, the entire team/business fails. All this combined with a lot of ultrasound scanning made for the best med school prep I could’ve hoped for. It also gave me a close look into the world of emergency medicine, which is likely why I went for EM over Surgery in the end.

***Advice #1: Always say yes to new opportunities, the smallest door can change your life.

 

 

What specialties did you apply to? What attracted you to emergency medicine and surgery?

I double applied to Emergency Medicine and General Surgery, no back ups in Internal Medicine/Family Med etc. I’m an ADD, instant gratification, need challenges type of guy and I know that I would never find happiness in other specialties. I also love using my hands so I needed a specialty that was heavy on procedures. As many of my friends and wonderful girlfriend can attest to, I struggled immensely deciding between Surgery and EM. I applied to both realizing that I would love both for different reasons: EM would provide enough procedures and diagnostic challenge with great lifestyle. Surgery would be all procedures and the fulfillment of definitive care. Also, I still personally believe Surgery is slightly more intellectually stimulating/challenging than EM (says the EM resident lol).

***Advice #2: Introspection, knowing yourself, is the key to every life decision.

 

 

How many programs did you end up applying to? How many EM? Categorical? Prelim? What was your reasoning for that number of programs?

I applied to every single Emergency Medicine program in the country, some 180+ programs. I applied to about 100 general surgery programs and every prelim position at those programs as well. It cost upwards of $6,000 JUST. TO. APPLY.

Was it worth it? YES. For most, you are already in debt; the only thing that matters is that you give yourself the best chance possible to get a residency. Obviously, be realistic about your résumé, scores, personality, etc.

***Advice #3: You end up in the place your supposed to be. Trust the process.

 

 

How many interviews did you go on for each specialty?

EM: 8, Gen Surg: 3, Pre-lim: 2. I went to every interview I got, it was logistically difficult and expensive. I flew across the country about 5 times. Again, you’re a “foreign” graduate; you have to take every opportunity possible. The statistics and amount of people applying for certain specialties are in flux every year, so advice doesn’t hold true year-to-year. My interview excel sheet is below.

***Advice #4: You are never too good for a certain place or program. Be humble.

 

 

How did you end up ranking the programs? (Surgery higher than EM? Better the program the higher it went regardless of surgery or EM?)

It’s a combination of things. I really wanted to be close to home in California so I ranked those programs first, it was just a bonus that those programs had everything I wanted as well. UConn had everything the California programs had and I absolutely loved the leadership and residents, more than any other place I went.

Jackson Memorial was a gamble because the program is brand new, but you can’t beat the patient pathology/experience. The Detroit programs are amazing, well established programs, also with great patient pathology. I was really impressed with Detroit and would have been grateful to go there as well. I only ranked one Surgery program higher than some EM because I would’ve been happier with those people doing surgery than the others doing EM. Like everyone says, it’s a feeling during the interview that really sets your decision.

Below is the excel sheet of my interviews/dates/ranks

I ranked them:

1) Stanford Univ: EM

2) UCSF-Fresno: EM

3) UConn: EM

4) Jackson Memorial: EM

5) St. John: EM

6) DMC-Sinai Grace: EM

7) Cleveland Clinic – Florida: Gen Surg

8) Crozer Chester: EM

9) Lehigh Valley: EM

– The rest of Gen Surg

– Prelims

***Advice #5: Trust your gut.

 

 

Any crazy stories from the interview trail?

Noone I interviewed with ever passed out or threw up, but I heard one good story.

Apparently the year before at one of the hospitals an applicant for Emergency Medicine got so drunk at the meet-n-greet the night before, he blacked out, got alcohol poisoning and ended up in the hospital. The kicker is that the next morning when the applicants were getting the tour of the Emergency Department, he was passed out in one of the ED beds with an IV, recovering…

Needless to say, don’t be that guy.

***Advice #6: Don’t let your insecurities steer you into bad decisions.

 

 

What did you find to be the most frustrating part of the interview process?

Simply the cost. It’s hard to justify applying to so many places. A lot of people hedge their bets and apply only to places with a history of taking foreign grads, but you just never know. I pulled every string I could, called acquaintances, went to conferences to network, and tried everything I could. Now I’m at a program that usually never took Ross grads and I had interviews in places I would’ve never expected.

It’s a numbers game in the end; you want your face and résumé in as many hands as possible.

***Advice#7: Never give up because the feeling of comfort can be dangerous.

 

 

Do you feel that coming from a Caribbean medical school hindered your chances to match in one of the more competitive specialties?

Absolutely, 100% yes. It’s just the reality of the situation and you have to make the best of it. Interviewing in California as an IMG, likely means I would have easily been accepted as a US-grad. Everyone will ask on interviews “Why Ross/Caribbean and how was your experience?” The answer is always “It made me more resilient, hardworking and appreciative.”

I was very bitter about this fact for a long time, if you’re like me, my advice is to just let it go. You have to make peace with this because people will feel your animosity and energy during the interview, which will never end well. If you’ve made it into the match, then by definition you have worked your butt off and don’t let anyone make you feel any different.

***Advice #8: Be a politician. Being able to spin your story might make or break you. Practice.

 

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

I think my work experience and ultrasound research were really the 2 things that set me apart. I had really great letters of rec for Emergency med. I even had my old boss before med school write me a letter, remember he’s an ER doc at UCLA so his input was relevant. Besides the other 2 SLOEs (specific EM letters you need to apply in EM) I had the Ob/Gyn Program Director who I did ultrasound research with during my 3rd year write me a letter as well.

Letters of Rec are extremely important; on almost every interview people mentioned the letters. Its one of the only ways for programs to get an idea of who you really are, your work ethic, your personality, etc. For surgery, I had few interviews and I think this is a direct correlation to weaker more generic letters of rec in surgery. I was also only able to do 1 real surgery sub-I before applications, which hurt as well.

***Advice #9: Tell your story, figure out what part of your story is interesting, and let others give you feedback.

 

 

In contrast, what were your greatest weaknesses about your application?

I think my greatest weakness was the places I did Sub-I’s and away rotations. All my EM rotations were within the Ross network: 2 in Chicago at Mt. Sinai, and 1 in LA at California hospital. I would have had more interviews if I had set up better away rotations. It’s important to do Non-affiliate rotations. I have friends from other foreign med schools with similar scores and resumes that had 15+ interviews because they did a lot of away rotations and set them up early. Most places will give you a curtsy interview, but if you do well there, they will definitely consider you for a real spot. Again, you have to spin your story: I had great experiences from my rotations, inner city ED’s are very similar and an important exposure to have.

***Advice #10: Be informed about the process and plan ahead.

 

 

How did you do on the USMLE’s? What were your step scores? Do you think your step scores negatively/positively affected the number of interviews your received?

Step 1: 237, Step 2: 252, CS: Pass

Clearly these scores are critically important. For EM, 220 range might keep your application from going in the trash. But remember, the program coordinators are just clicking check boxes for criteria. If you call a program with any legitimate reason that you want to go there (i.e. spouse, family, I like snow, you guys look cool, my grandma’s brother’s daughter’s dog can’t live without me, whatever) they will pull your application out of the trash and look, hopefully. Have people make calls for you and never be afraid to call yourself and ask.

***Advice #11: Nothing beats a personal touch to create an empathetic connection. People will work harder for you if they feel connected.

 

 

What advice would you give to other international medical graduates who want to pursue residency in emergency medicine?

Work and study hard. Do many non-affiliate away rotations. Get your SLOEs in early. Go to ACEP and SAEM and get at least 3 program directors emails. Follow up! This is not the time to be shy but of course there is a balance and “business etiquette.” Be direct and if possible a little playful and funny. In the end, and maybe most importantly, these people have to like you and want to work with you.

***Advice #12: Regardless of what happens (match, no match, prelim or dream job) it’s a life long journey in medicine and you will end up in the right place.

 

 

Wow Ami (Ah-mee), thanks for a great interview and some amazing advice.

 

Subscribe and check back next week for an entertaining interview with another Caribbean graduate who matched into Physical Management & Rehabilitation!

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Spotlight Interview: a family medicine resident who failed step 1

Emily Chan is a Ross University graduate who successfully matched into her top choice residency program. However, it wasn’t an easy route to residency. As a Canadian citizen she could only apply to programs that would sponsor her visa. Oh and she also failed USMLE step 1. Here’s her story.

As a close friend, I know you pretty well. Can you tell my followers a little bit about yourself? Who are you professionally? Who are you outside of the hospital?

I’m from the beautiful area of Niagara Falls, Canada. True to stereotype, I am polite, love maple syrup, and say “eh” often. I received my Bachelor’s in biomedical sciences at the University of Montréal – in French.

Professionally, I am a hard worker and a team player. I show up to the office or the hospital with a smile and do my best. People have described me as a problem solver because I will come up with quick solutions for anything.

Outside of the hospital, I indulge in my hobby of cooking and baking. Nothing makes me happier than sharing good homemade food with friends. I also attempt, with varying degrees of success, to justify my paid gym membership even though I hate working out.

You matched into your top choice family medicine program. That’s an amazing accomplishment. Why did you choose to apply to family medicine?

Thank you! It is the most amazing feeling. I knew since I was 12 years old that I wanted to be a family doc. I’ve always loved talking to people and listening to stories about themselves, their families, and their lives. I believe that every personality fits in a certain branch of medicine. How will you know? Trust me, you’ll just feel it, you’ll know. Family medicine was my perfect fit.

Where are you from originally? Did you want to match in the US or Canada? Did you experience any extra hardships trying to match in American programs as a Canadian?

As a Canadian, I knew the odds were not in my favour across the board. Many factors influenced my choice to not pursue a Canadian residency. Canada made it very difficult for me to apply (poor matching stats, inconvenient availability of mandatory tests, and difficulty to obtain Canadian electives). I felt that if my own country made it so challenging for me to come back, then I wasn’t going to put up a fight. Instead, I concentrated all my energy to match in the US. I am very glad my strategic gamble paid off. Yes, you face discrimination because as a resident you will require a visa. I was ineligible to apply to many programs because they did not want to deal with the headache of visas. Disappointing, sure, but I don’t blame them.

Speaking of hardships, I remember the day that we all received our step one scores. You and I, along with three close friends of ours, were living together in Florida. I remember the moment when you came downstairs from your room and told us what every medical student dreads to even think of. That you failed step one. What happened? Why do you think you failed? Were you doing poorly in school? Did it come as a shock to you?

Oh that dreadful day… It was awful! I was so glad to be surrounded by friends like you when I found out I failed. You all rallied around me in a big group hug and reassured me that everything was going to be ok.

Failing Step 1 was a huge blow and I did not expect it at all. Granted, I’m not the strongest student so by no means did I expect to have a stellar score. I just expected to pass. So when I learned I was a few points shy of passing, I was crushed. I had done fine in school up to that point. I never failed any tests on the island, never repeated a semester, and I even passed the comp on the first try. Everything suggested that I’d be fine.

In hindsight, I realized what I thought was enough preparation for the test ended up being insufficient. To tackle Step 1 a second time around, I had to prepare more than ever before.

What was step 2 CK like for you? What steps did you take to make sure you didn’t make the same mistakes again?

Step 2 CK was definitely better than Step 1. I will say, all the self-doubting and insecurities resurfaced when I was prepping for Step 2. I spent 6 months studying and even delayed my test till October – meaning I applied to match without a CK score. As anyone and everyone will tell you, it’s best to apply to match with a full and complete application but mine lacked the CK. It was a risk I was willing to take. I absolutely could not afford to fail a second USMLE exam. Aside from doubling the time I dedicated to study, I got weekly tutor help to go over questions on UWorld that I got wrong. I also made sure that I took plenty of practice tests.

How many programs did you end up applying to? How many categorical? How many preliminary? How many interviews did you end up going on?

I applied to every single FM program in the US for which I was qualified. All categorical, no prelim. I spent a little over $3,100 on my 140+ applications. In the end, I only had 2 interviews. Yes, you read that right, two interviews. One interview was where I did all my core rotations in 3rd year. I got the other interview because I clicked well with residents from that program while attending the AAFP National Conference. I knew from the get go that on paper I was less than stellar so I worked hard on networking. I attended family medicine residency fairs like it was going out of style. In 12 months, I attended 3 residency conferences.

What was match day like for you?

Every medical student will tell you that match day is a nerve-wracking day, and for me, it was no different. I was hoping to match but I also mentally prepared myself that there was a good chance I would not match. When I learned that I successfully matched, I cried tears of joy and relief. Knowing that I beat the odds was the most incredible feeling. It validated all the people along the way who believed in me and said I would make it. I now had proof that outside people (not just family and friends) believed I was worthy of pursuing this profession.

I know we’ve talked a lot about a major weakness in your application but what do you think were your greatest strengths about your application? What set you apart from the other applicants?

Academia has never been my forte. I knew clinical years were my time to shine. It’s what I do best; it’s where I feel most comfortable. I worked diligently and was rewarded with A’s in all my core and elective rotations, except surgery. I genuinely connected with my attendings and they wrote me beautiful letters of recommendation. My strong LORs were undoubtedly a key component to my match success. I’ve always been a people person so interviews came naturally to me. When applying to medical schools, I had 4 interviews and was accepted to all 4. I knew I had strong interview skills. I harnessed that same energy and left my 2 residency interviews feeling confident.

The fact that you failed step one, the proverbial kiss of death to any applicant’s dream of obtaining a residency, but still managed to match into your top choice family medicine program is quite an accomplishment. In closing, what advice would you give to a medical student who failed or didn’t do well on step one?

I want people reading this to say to themselves, if she can match her top choice in her dream specialty with a 203 Step 1 score, a 215 Step 2 score, and only 2 interviews, I can do it too. One failure does not define you. You will encounter people along the road who will encourage you to quit medicine (one of my Ross professors counseled me to pursue non medical careers) or take time off (I was strongly encouraged to delay my graduation date and my match by a year) or give up all together. Take all that advice as fuel to prove them wrong.

Thank you Emily for bravely sharing your inspirational story. You are proof that it is possible to fail USMLE step 1 and still earn a residency. I’m sure it was an emotionally tumultuous path and taught you a lot about yourself along the way.

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UPDATE: Unfortunately due to the high volume of requests to speak with Dr. Chan I can no longer forward her private email. If you have questions for her please comment below. After sufficient questions have been posted we plan to release an updated blog post with the most frequently asked questions. Thank you for your understanding.

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Spotlight Interview: matching in Canada from a Caribbean medical school

Dana is a Ross University School of Medicine graduate from Toronto. She went through both the US and Canadian matches and successfully matched into her top choice Canadian program. I interviewed Dana about her experience going through the match and the difficulties she encountered along the way. Here’s what she had to say:

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

If I could describe myself professionally I would use the words inquisitive and dedicated. For as long as I can remember I have had a constant need to know how and why things work the way they do (growing up this was often to the annoyance of my parents). I’ve always strived to excel in any position I hold so I believe my dedicated nature has really found its niche in medicine. Outside of the hospital, I would describe myself and adventurous and thoughtful. I love to travel, try new things and for the most part view the world as limitless. I also don’t make hasty decisions and I place significant value on the relationships in my life.

 

How many programs did you apply to? How many categorical? Prelim? How many in the United States? How many in Canada?

Originally I applied to approximately 100 IM categorical US programs. I did not apply to any back up programs or prelim spots, against my medical school’s advice. I spoke with other colleagues and was aware that they applied to 150-200 programs on average, but my plan was to stay in large cities or close to the Canadian border. After only receiving 4 interviews in the first 3 weeks I applied to the remaining 150 IM categorical programs available in the US (this was a humbling and expensive lesson). The Canadian match was a few months later and after my experience in the US I applied to every Canadian IM program, I believe there’s 7, as well as a dozen Family Medicine programs.

 

What as the most difficult part of applying to both the Canadian and the American match?

I think the most difficult part was that each system uses a completely different application. This meant that I couldn’t just use the same documents twice. I had to rewrite statements of interest and reformat resumes, which is an enormous task. The letters of recommendation could be the same but I had to bother my preceptors twice to use two different uploading systems.

 

Roughly, how does the Canadian match work? Can you end up with both a Canadian and an American residency?

Luckily CaRMs (Canadian Residency Matching Service) match date is about two weeks before the US match date. This is great since your chances of getting into a Canadian program are much poorer than a US program so ideally you would want to try this route first and use the US match as a backup if it doesn’t work out. If you match into CaRMs you are automatically withdrawn from the US match. You are also never able to find out how you were ranked in the US match.

 

How did you end up ranking your programs? Would you have rather gone to your least favorite Canadian program over your top American program?

It was a difficult choice deciding how to rank my programs since being close to home, Toronto, was important to me but also the quality of the program. In the end I ended up ranking my first choice US program as the one that I believed was the best place to be academically, which happened to be the second closest geographically to my home in Canada. When I submitted my rank list for CaRMs I reluctantly ranked a program that was across the country, but did so based solely on the fact it was in Canada. If I would have matched at this program I would have been automatically withdrawn from the US match, as I mentioned earlier, so I knew that would mean giving up my first choice US program. This was definitely the most difficult decision I had to make in all of my ranking.

 

How many interviews did you go on in the end? How many in the US? In Canada?

In the end I was invited to 7 interviews in the US and 2 interviews in Canada. Some of these interviews were in very undesirable locations for me, but I felt it was good practice to keep all my options open since I was not invited to a lot of interviews. In the end I ranked them all.

 

Any crazy stories from the interview trail?

At the end of one of my interviews I realized my middle button of my blouse was undone. No idea how long that was like that for.

 

What did you find to be the most frustrating part of the interview process?

The days were way more exhausting than I expected them to be. The travelling combined with the anxiety about the day really gets to you after a while. A couple of my interviews started at 7am for morning rounds and didn’t end until 3 or 4pm. These days were long enough without having to also roll out my charm for 8 hours straight.

 

Do you feel that coming from a Caribbean medical school hindered your chances to match back home in Canada?

Yes, but I don’t think my chances would have been any better coming from a US or European school. The Canadian match first and foremost ensures all of its Canadian graduates have a residency. There are designated spots for international medical graduates (IMG’s) in the CaRMs match, but they are very few for very many.

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

I believe my work experience prior to Ross University was a strong point of my application; most programs asked about this during the interview process. I also made it a priority in my personal statement to express the hardships that came along with studying in a third world country and in constantly relocating during clinical years. In the end I believe that the impression I left on the staff during an elective rotation is what set me apart from the other applicants.

 

In contrast, what were your greatest weaknesses about your application?

A big weakness in my application was my USMLE Step 1 score. I was having personal troubles and knew going into the exam I was not as prepared as I should be. In hind sight I also wish I spent more time on my personal statement. I left it until the last minute and did not allow time to have people proof read it and critique it.

 

How did you do on the USMLE’s? What were your step scores? Do you think your step scores negatively/positively affected the number of interviews your received?

My USMLE Step 1 score was a full standard deviation below average, which I am disappointed with and believe negatively affected my interview invitations. I worked hard to redeem myself on USMLE Step 2 CK and scored 30 points higher, which I am very pleased with. On the Canadian version of the USMLE, the Medical Council of Canada Evaluation Examination (the MCCEE) I received two standard deviations above the average, which is the score I’m most proud of.

 

What advice would you give to other international medical graduates who want to pursue residency in Canada ?

I would tell other Canadians that if they want a residency in Canada to just try! I heard countless times along the way that it’s impossible as an IMG to get a residency in Canada. For this reason I was preparing the whole time to get rejected, but I worked really hard and was one of the lucky ones. If things would have gone the other way I was very excited for my US residency programs and looking forward to spending more time with our lovely neighbors to the south. Either way I would recommend that you keep all your options open; being an IMG does not mean you cannot have the residency you want.

 

Thank you Dana for sharing your experience with the Canadian and US match process. Going through the Electronic Residency Application Service (ERAS) was frustrating enough for me at times so I can only imagine what it was like to do it twice. I wish you the best during your internal medicine residency and hope to hear more from you soon.

Next in the spotlight series is an interview with a family medicine resident who failed step 1. Subscribe so you don’t miss out!