How To Match: a Guide

[NeuroEng]

Here is a guide for how to match, to any specialty, including ultra-competetive ones, whether you are an internal or external candidate. There are of course already posts out there, and I don't mean to take anything away from those, but from someone who has just gone through the match, I think things are actually alot simpler. I can break it down into easy steps:

 

1) Decide early on what your interests are. This doesn't mean you have it all figured out at the end of first year. It means that nearing the end of your second year (for those in four-year programs) you have a short list of say one or two possibilities that you think would interest you.

 

2) Take clinical experience in the fields that intest you EARLY ON. Choose your rotations such that you can try out those that interest you early. Otherwise you risk finding out much later that they are not what you thought and wasting valuable time. Your clinical experience should help you make a final, informed decision about your career choice in your third year.

 

3) Do multiple electives in your specialty of interest. *** Do at least one siginificant length elective at the program you want to go to ***. This is critical, especially if you are an outside candidate. This shouldn't be too difficult to arrange, either, no matter where it is, with adequate planning. Despite what you have heard about the value of breadth etc, it is actually more important to demonstrate your strong interest in a program and field.

 

4) Apply to several programs in your chosen field. I really think there is a downside to "backing up". It is actually quite difficult to be competitive for multiple specialties, and it is also hard to fool program directors and admission committees that you are genuinely interested if your CV does not show a clear focus.

 

5) Get at least one strong reference letter from someone at the program you want to match to. This is your goal when you are there on elective. Talk to the residents and staff and express your genuine interest in the specialty and program. Make sure you will spend enough time with a single staff person to write you a letter and ask them towards the end of the rotation. Find out who are the people you should meet from residents and watch for them and try to meet them while you are there. Get past the inane schedules you are given and spend more time with people you connect with.

 

6) Focus on reference letters from practitioners in your field. While again there is some value in breadth, programs really want to hear from people they know. Select your referees accordingly. For instance, try two strong letters from people in your specialty of choice and one other one testifying to your well-rounded clinical skills.

 

7) Perform well in the interviews. These are critical, though there is no need to be stressed if you are well prepared. Put your best foot foward. They want to know you will be someone they will want to work with for several years. Get past the monotonous questions they ask and tell them the story of why you are perfect for their program and field. Before you start interviewing, construct a story of who you are and how you got to where you are now (applying for their program) and practice telling it to your friends and families. Medicine is all about telling stories, and you need to communicate this story to them during the interview. This is called a connection. If you can do this, they will understand you and who you are and why they should admit you.

 

8) If you have done all of the above you can be pretty confident you will get one of your top choices (most likely your number one) so rank carefully but don't be overly stressed.

 

9) Enjoy your career!

 

As you can see it is not really that complicated. There is much more politics to it than people realize, but you can navigate it with ease and overcome most obstacles by demonstrating your strong interest, being a nice person, and creating allies within the program you want to go to. Other factors like research, extracurricular interest, graduate degrees etc are nice and can never hurt your chances, but are no substitute for the above guidelines. You will be fine if you follow the above but have no "extras" to speak of.

 

All of this advice is based on direct experience and observation of people's journey through the match. I matched to a very competitive program in a competitive field as an outside candidate. If a disaster occurs and you realize very late you have made a mistake, first give yourself time to calm down. Wait a few days before taking action to make sure you are being rational. Talk it over with friends and family, but make your own decision in the end. If you are ready to radically alter your career path, you need serious help. Talk to the career people at your school and talk with physicians in your new chosen field and explain your situation. You may yet succeed so do not lose hope. The advice above is not the only way to be happy in the match, just the simplest and most straightforward. Hope this was helpful for people.

[swedeboy]

Excellent post NeuroEng and congrats on your match result! I agree with almost everything you stated but just wanted to clarify a few things on there.

 

Re: #3) A significant length elective does NOT have to be 4 weeks long. Given the value of your elective time, 3 weeks in any one centre should be more than enough time to make that strong impression with staff you hope will write that LOR for you.

 

Re: #7) Interviews will make or break your chances of matching to that specialty/location in nearly every case. You might have a few rocky points in each interview but as long as you can get across that you are affable and easy to talk to, you are already ahead of the game.

[TwinTurbo]

Hey NeuroEng, I think it's wonderful you took the time to share your experiences and thoughts in order to help others.

 

I was someone who went through med school wanting to do plastics. I was lucky because I had an early elective block after my surgery clerkship and decided to use it to see if plastics was a good fit for me. When I did my elective in the field, I knew it wasn't for me. Afterwards, I then went through the rest of my third year not being able to see myself in any of the core clerkships and this really bothered me especially since everyone I talked to in my class seemed to know exactly what it was they were applying into.

 

Not to play devil's advocate, but to be realistic, I think many med students don't really have a solid idea of what they're going into until the end of their third year, so it's hard to plan accordingly for a specific specialty.

 

I think that rather than narrow it down to one or two specialties you think you have an interest in, my advice (for anyone who wants it) would be consider your options broadly in terms of what all residency programs want regardless of specialty.

 

For example:

 

1. Research - program directors like to see evidence of research in their applicants. If you think you might like derm, rad onc, med onc, medicine, family med, but are unsure which one is the best fit, you could pick a research project on a topic such as melanoma and cover your ground for numerous fields.

 

2. Leadership - when push comes to shove, programs want residents they can boast about. You need to stand out of the crowd regardless of which specialty you apply into. Do something that sets you apart and will get you noticed. For example, if you like to read, consider being a medical book reviewer for a publishing company and get your name in the books you review. Did you start a club at your school? Get involved with "change/reform" at your school .. either through curriculum, policy, etc. These are all example of things that will make you more unique among interviewees and more memorable to interviewers.

 

3. Academics - programs want residents with solid knowledge bases. Unless you've done an away at the program ... they won't know you so the narrative comments included verbatim usually are really important and unfortunately that's usually all the info that most PDs have to go by to assess your clinical competence. I'm def. not saying to kiss ass but I wanted to point out that positive narratives play a very important part in the interview selection process for residency.

 

4. Acountability - programs want residents they can trust.

 

More importantly, You have to weigh in on what's important to you in a residency and a specialty.

 

The following questions might help.

 

You should consider things such as:

 

-how important is lifestyle for you during residency? (ie. 2 hr lunch daily vs. eating on the go and not knowing when your next break will be)

-how important is compensation/ # hrs worked for you after residency?

-how many total hours of patient care/ wk would you like after residency? (45 hr/wk vs. 100 hr/wk)

-are you a technology person?

-are you a people person?

-what population of patients?

-do you want continuity of care or get em in and out?

-do you want to see results right away in patients?

-how many years do you want to spend in residency?

 

5. Flexibility - How flexible are you willing to be? If location is not a big factor for you, keep your options open by taking the USMLE at the end of your 2nd yr. It's a nasty exam and will cost you a few hundred bucks but in the long run could save you time, money and a big headache. For example, Derm is only 4 yrs (vs 5 in can) in the US, EM is only 3 vs. 5 in can), Nuc Med is 4 (vs. 5 in can).

 

Sorry for the long post but I think the key to matching successfully is to be able to sort out all of these things ahead of time. Easier said than done I know!

 

Good to everyone!

[NeuroEng]

Deciding what to do is difficult, but it has to be done. I don't really believe that there is only one field that is perfect for everyone. Deciding at the end of third year is fine if you have sufficient time to arrange electives. You bring up several good criteria about what to consider when thinking about which specialty to pursue. Note that different choices offer different amounts of flexibility. Choosing family medicine or internal medicine would probably offer alot more flexibility in career arrangements than choosing neurosurgery, though every field has a spectrum of careers within it. One point about research was raised though that I think is not correct. Program directors and committees are actually not looking for everyone to have an interest in research, even at the most academically oriented schools (with the exception of certain programs for instance Toronto Neurosurgery). Having a goal of being an excellent community practitioner and clinician is laudable and much better than trying to feign an interest in research if you don't like it. Sharing your genuine goals and having a rational reason for choosing a program is what is important.

[Blake]

Chances are that I interviewed you, NeuroEng. PM me (I think I remember you). I take it you matched in NS, right? Congratulations.

[Diabetes dude]

This is a great thread. Thanks all for your contribution to it.