How to Match Into a Top Residency Program Without Excellent Test Scores

A Primer on Achieving ERAS Excellency Without Stellar Stats

Oct 01, 2020 · Doximity Blog

The “Road to Residency” series is developed by Residency Navigator, the most comprehensive online directory of U.S. residency programs. The program is used by 90% of 4th-year medical students to view program stats, read hand-written reviews from current and former residents, and view ratings on 4,000+ residency programs.

There’s a common misperception that you must have stellar test scores extracurriculars in order to match with the top program in your rank order list for a competitive specialty. This isn’t necessarily true; afterall, when I matched into my #1 ranked Transitional Year and Anesthesiology residency program, I didn’t have USMLE scores 2 standard deviations above average, honors across the board, or a pile of scientific publications. Similarly, I was coming from a brand new medical school that no one had ever heard of (at least at the time).

So how did I, a typical, run-of-the-mill candidate, stand out amongst the hundreds of applicants that applied for my competitive program? I’ll break down some of the key strategies and best practices that I’ve learned through my own application experience along with insights I developed by serving on two resident selection committees. Here’s how you get into your dream residency program without any fancy stats or exceptional extracurriculars.

Preparation is the Key to Success

It’s never too early to be thinking about residency. There will be a lot of advice surrounding specialty selection based on USMLE Step 1 scores and clerkship performance. But you cannot listen to the noise. There are individuals out there with below average scores and research that still match into competitive specialties. There are individuals out there with incredible scores and a publication list that spans 10+ pages… that don’t do so well with the Match. What matters is what your goal is and what you want to achieve. What matters is that you put yourself in the best possible position when the application time rolls around. Preparation is the key to success.

As you consider what programs to apply to and interview at, take a look at Doximity’s Residency Navigator. It is a helpful resource to learn more about a specific residency program by reading reviews from current and former residents and checking out ratings on a variety of metrics, including work-life balance, clinical diversity, and more.

If you already know your heart is set on a competitive specialty, then dive right in. If you have no idea (that was me!), then go into every experience with an open mind and consider joining specialty interest groups to gain exposure to what each clinical practice can look like. Remember that residency is a finite period of time; you have to imagine your life as an attending. What does that attending job look like? Will decades of that kind of work be fulfilling?

Start imagining your future early. Remind yourself daily of what brought you to medicine. Remember those clinical encounters that made you laugh aloud, or cry ugly tears. Consider the stories of those that came before you, and remember that feeling when you decide what kind of physician you want to be.

Residency Program Screening

Every single medical school and adviser will tell you the same thing – get good grades and test scores - in order to pass the first screen by residency programs. Some schools have truly moved toward Pass/Fail grading so those students rely heavily on the reputation of the school, standardized test scores, and letters of recommendation. If you’re at a school that still has some sort of gradation – Honors, High Pass, Pass, Fail, etc – then make sure to take those courses seriously.

The reality is that what medical school you attend influences the initial screening of your application and sometimes even your rank after interviewing. If a residency program has had successful residents from a particular medical school, they tend to favor that school. Typically, residency programs that are directly affiliated with the medical school you attend will look more favorably on their “own” candidates. After all, if you did clerkships at that residency program’s clinical site, then you’ve essentially done an “audition” rotation.

A commonly missed opportunity is the residency alumni network. Many programs value the opinion of a successful graduate. This means that if one of your attendings graduated from your dream residency program, they will be an asset in advocating for your candidacy.

A residency admissions committee will typically weigh clinical clerkship grades more heavily than pre-clinical grades. Especially the grades in the specialty you’re applying (or tangentially related – so anesthesiology programs typically pay attention to internal medicine and surgery clerkship performance). Either way, if you’re like me and struggled with honoring the preclinical years, do not worry, you can wow them with your stellar clerkship performance. Don’t forget to use my guide to success during clerkships!

What if You Don’t Have the Best Grades or Test Scores?

It’s ok, I promise. This is where your well-roundedness and focus on playing to your strengths matters. Some of us enter medical school with more of a service-oriented mindset. Some of us enter medical school with a side-hustle. Some of us hate memorizing things but shine when asked to describe a differential for a patient’s presentation or pontificate on a plan (that’s me!).

If you’re passionate about something, invest the time and energy into it. I spent a lot of time setting up the foundation for the AMWA at OUWB branch and planning the AMWA national conference. I loved the catharsis and learning I did through blogging. I enjoyed the opportunities to engage with strangers across the country and world through social media. Both of these extracurricular activities taught me skills – communication, conflict-mediation, research, self-promotion, networking – that are important for clinical practice and overall career success. Do not participate in something just to put it on your resume. Those types of activities really become abundantly clear.

Play to your strengths. You got into medical school, so there must be something you are good at. During clerkships, I realized that I was pretty good at being a useful medical student and loved my clinical encounters. I knew that OUWB wasn’t a brand name medical school, so I scheduled away rotations at reputable institutions to showcase my strengths. It paid off. Ask a trusted mentor what your strengths are and consider how you can highlight them in your application.

Avoid These Pitfalls

Failing to prepare. Successful applicants have read the instructions for filling out ERAS, made a timeline to submit, and have researched the programs they are applying to. Take the time to invest in preparation as you enter the residency application process. Also take the time to ensure that your rank list is submitted correctly – especially if you’re applying to preliminary year/transitional year programs, advanced programs, and categorical programs OR if you’re couples matching. These add another layer of complexity to the process and can be another area where people will make mistakes.

Typos in your application. I have to say it because I’ve seen it. Make sure you’ve had MULTIPLE sets of eyes read through your application before you submit.

Fake news on your application. The further along you get in your training, the smaller the community gets. Program directors talk to one another and have friends at medical schools across the country. Lying on your application does nothing more than harm your candidacy and legitimacy as you progress. Don’t tarnish your reputation before you’ve started your career.

A late application. There are a finite number of interview spots for each specialty. As the first wave of applications is reviewed and interviews are extended, this lessens the total number of spots available for later applications. Maximize your chances by submitting early (or by October 21, 2020, when MSPEs are released to programs).

Having a bad attitude. This goes back to the point on fake news – our community is small and having a sour attitude about something often gets back to program directors or residency committee members. Programs want to fill with individuals that will work well together and elevate the program as a whole.

An unprofessional online persona. An overwhelming majority of applicants will have a social media account of some sort. Some people advocate for locking down all of your accounts [change your name, handle, make the privacy settings so that no one can find you]. I personally believe that it’s important to maintain a professional online presence. If you’re writing about what you’re learning in medicine or documenting what you’ve accomplished, that’s great! I think that if a program values this asset of yours, then it’ll be a better fit for you, anyway. On the other hand, if you’ve posted something unprofessional and need to hide it, maybe it’s time to re-think what you’re posting in the first place.

How do the best looking candidates on paper fail to match at one of their top choice programs? A big stumbling block is the interview. I’ve seen applicants fall asleep during the Program Director introduction [maybe they needed coffee?]. I’ve seen some very questionable wardrobe choices [it’s not about having the most expensive suit; it’s about the attire being clean, fitted, and conservative]. I’ve shaken many hands that have fallen onto the spectrum of dead fish to death grip. I’ve encountered various forms of body odor. I’ve met individuals that couldn’t meet my gaze. Typically, just one or two of these undesirable behaviors will not completely ruin your candidacy, however, they may cause your rank to fall a bit lower on the list.

When you’re preparing for your interview, really think about where your potential weaknesses are. Can’t find any? Ask someone to help you. It’s really hard to receive this kind of feedback, but I promise you that it’s a good investment.

The other issue I encounter is the perception of what a “top choice” program should be. Your top choice program should be a good fit for you. Don’t go looking for name brands or “desirable” locations. You need to decide what type of program will provide you with the exposure, resources, and support that YOU need to succeed.

Embrace the Application Process

I considered 4th year to be one of the highlights of medical school. The months leading up to ERAS submission were rough - setting up away rotations, actually performing well on aways, taking Step 2, writing my personal statement, securing letters of recommendation, putting my whole life into ERAS without typos, etc - the list goes on and on.

However, once I clicked the “submit” button, I found the experience to be rewarding. I won’t lie - the time between submitting and my first interview was anxiety-provoking, however, once the first interview came in, the flood gates opened. During the interview process, I enjoyed meeting applicants from across the country and getting to know about programs through meeting residents and faculty. The application season was an opportunity to be introspective and really consider what matters to you. By the time Match day rolled around, I felt like I had a much clearer idea of my priorities and how my training program was going to help me get there.

Parting Words

This season is an unconventional one, but many of the factors that go into a successful Match still remain the same. There may be additional items that contribute to an applicant’s candidacy that were not considered in the past (i.e. Zoom etiquette - look out for a future entry on tips for Zoom), but overall the process remains the same. Remember that the Match algorithm prioritizes your rankings, so the goal of interviews is to determine which programs are a good fit for you to succeed.

Although the process can be stressful, don’t forget about the big picture - you’re going to become an anesthesiologist! Good luck and feel free to reach out to me with questions along the way!

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Amanda Xi, MD, MSE is an anesthesiologist and intensivist at Massachusetts General Hospital (MGH). This blog was adapted from her original post, found here. She was part of the Charter Class of Oakland University William Beaumont School of Medicine and completed her Transitional Year internship at Henry Ford Hospital prior to starting her anesthesiology residency and critical care fellowship at MGH. Amanda is passionate about gender equity, medical education, and social media (@amandasximd on Instagram and Twitter).

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