How to succeed in the NRMP® match

Hi, everyone. We're here today to discuss all things match related.

We have a fantastic match panel event. My name is Rishi Desai and my own background.

I'm a pediatric infectious disease physician. I've worked at a number of universities and I also have a background in public health.

We have a pretty spectacular list of panelists that are gonna be joining us today. Our first Panelist is Doctor Lilia Soln.

Doctor Solna is the program director for the diagnostic radiology residency at Johns Hopkins University. We also have Doctor Jesse Moore.

Doctor Moore is a colon and rectal surgeon at the University of Vermont Medical Center. We also have Doctor Sean Tackett who is an internal medicine physician working also at Johns Hopkins University and Doctor Amin Azam who's a psychiatrist practicing at UC San Francisco.

So welcome to all the panelists. Thank you for joining us.

Uh We're gonna dive right in. I know you guys have uh tons of experience in this.

So I thought we'd kick it off with our first question around residency applications. And what I wanna know is a little bit about your own path from medical school and residency.

Uh Tell us your own kind of top three tips for successful residency applications. And then we start with Doctor Jessie Moore.

Thanks uh and thanks for inviting me to be part of this panel. Um I think uh my, my own path uh I was originally from New Hampshire.

I was in medical school in New York City and I really loved being in a big city for medical school. It was uh a fun experience.

Uh but I knew that I wanted to get back to, uh, New England. Uh, and I also was about to, uh, get married.

Um, so those two factors probably, um, had the biggest determinants in terms of my own uh path. And when I reflect on that path, the, the three tips that I would have is that first, you really need to know yourself.

Uh, and what makes you happy, um, no matter what you're gonna go into residency is gonna be an intense, uh, time of your life, it's gonna take up the majority of your time and your week.

Uh, so you need to know what's gonna make you happy. Um, think about your, your family support if that's important.

Um, think about the hobbies and things that you are gonna wanna be able to do easily, uh when you're not training. Um And then also think about if you wanna be part of a bigger organization or a smaller organization, if you're a, a person who likes smaller groups and is more introverted, then you probably shouldn't go to um residency at a, at a giant hospital uh where you're gonna get lost in the in the shuffle.

My second step is that you need to uh be realistic about your competitiveness and that's hard for medical students. There's no algorithm you can plug into online that says how competitive you are.

And so the, the only way you're gonna know how competitive you are is if you have good mentors who, you know, are gonna be honest about your chances in their specialty.

Um And then my last tip is that I think you really have to divorce um the training period from the rest of your life, meaning you have to think about what you wanna have for a career and not think about the training.

I get very focused on how many years you're gonna do if you're gonna do this specialty versus how many years of that specialty training.

Um But training residency is a means to an end, you're gonna do 3 to 67 years, but then you're gonna work in that field for 30 years.

I think you have to really focus on the, on the career and not the training that's really helpful. I thought when you were talking about competitiveness or you're gonna say something about board games.

So I was, I was kinda waiting for that. Uh Lilia, what are your thoughts?

Tell us a little bit about your path and and residency and tips. Yes.

So, uh I actually also went to medical school in New York, um, wanted to stay in New York and uh I kind of stumbled upon radiology um through a mentor who had gone to my high school.

I was kinda lost during my 3rd and 4th years. Not sure what I wanted to do.

And I just got lucky and he encouraged me to uh consider radiology and pursue radiology. Some of the tips that I would suggest uh sort of echo Doctor Moore's tips.

And one of them is make sure you like what you're going to do because you're gonna do it for the rest of your life. And the only way to really figure it, figure it out is to spend some time with the people who do it for a living.

Um The other thing is um try to find a mentor or a sponsor who will really help you kind of tailor your application as you go along through medical school.

Um and then pick the right place for residency for your life, both in the hospital and outside the hospital, right? Because I think you do your best work when you're happy.

So that would be my three tips. I'm seeing some themes emerge around mentorship and, and making sure that you love what you do.

Uh I mean, do you wanna go next? Sure, thanks.

It's fun actually, to hear everybody's path to residencies and their tips. I've been writing them down and then crossing mine off because I have to come up with a new tip.

Um, first let me just share sort of, I, uh went into psychiatry, fell in love with it during medical school, not before.

And I had to take a year off during med school to do research, to figure out whether I really loved it enough to hand the stigma within health care of being a mental health professional.

And so it sort of ties nicely into the my first tip, which is really to trust your gut. Um I like to uh tell my students that the gut lining has serotonin receptors for a reason.

It's the only other part of the body that does. And so we should, we shouldn't ignore those gut feelings.

Um I uh I did keep get mentorship on there because whatever area of medicine you're gonna go into, um you need local mentors to give you advice about as Jessie said, your competitiveness, but also um thinking about sort of lifestyle choices and specialties that make you happy.

And so my, my uh third tip would be to remember why you went to med school in the first place that can get lost during the shuffle of the clerkship years.

And I think that uh that uh almost every medical student comes with a, with a wonderful, sincere desire to help people and remembering that will help you think about exactly what kind of help.

Do you wanna offer people the most? Thank you.

I mean, that was, that was well put Sean Sean, what are some of your tips? And, and what was your road like?

And so I went to medical school in Pittsburgh and I was one of those medical students who like everything. Um And so therefore chose to do internal medicine because I couldn't make a decision.

I wanted to keep my options open and, and then now I'm a general internist. So I, you know, I never really kind of narrowed my myself down.

Um, you know, like Jesse, I was about to get married, so I got married uh two days before graduation of medical school. And so residency th thinking about programs, I was thinking about very much thinking about life choices.

Um I, my tips would be and as I thought about this before I heard everybody else's great tips about, you know, know, yourself, be happy, uh think about decades.

Uh You know, the tips I came up with on my own, uh were, uh I guess more related to how to be competitive frankly. And so, um and you know, and so the, the first thought I had it when I, when I saw this question was um to be successful with your residency application, you know, it help you really need to be uh dedicated throughout medical school because residency is all about spending a lot of time with people in clinical care.

And so residency programs like people who, who they can trust to provide excellent clinical care and who, who, who, like they like to be around for long hours.

Um So I thought that was one tip that, that came to mind, another tip would be, you know, it helps to have mentorship and then go to let recommendations all from that a lot of the time.

And then, uh and then I think whenever I've interviewed candidates, you know, I've, I've often looked for something unique uh about them.

And, and so, um so, um you know, my, my advice would be to dedicate yourself to learning medicine and excelling clinically.

Um Don't ignore extracurriculars or your passion because, you know, the passion ultimately will help you stand up sean. I'm gonna, I'm gonna advance the question too and maybe continue with what you just said.

Um A lot of 1st and 2nd year medical students are, are thinking ahead to residency and uh what are some specific things that they could be doing uh as they're going through their didactic work to prepare for the residency application process.

So my, my, one of my regrets frankly from medical school was that during 1st and 2nd year, uh II was very used to cramming all the time in college and, and doing perfectly well cramming.

Um And, and when I got to medical school, II really was not ready for, for the volume of material and, and so, II still adopted those habits of just cramming before the exam.

And again, I did well enough. Right.

And II figured that if you give me a few weeks to study for step one that, that'll be fine, like, you know, weeks is way more than like the half a day or day that I ever put in any exam before a step one.

And it just, I mean, it, it, that was, you know, just a reality check and, and, and so my, my advice and I guess I it has been a lot of my first two years expe exploring extracurriculars.

Um And so how to, how to do it all over again. I would spend more time, sort of daily learning medicine and spreading it out.

Um So that I built that Knowledge foundation, which I mean, helped me with step one for sure, but also would prepare me for, for clinical, for the clinical rotations later on.

Um So, II mean, that's, that's my own personal experience and sort of like my, my biggest rec my biggest piece of advice.

Great. Yeah.

Any other thoughts on that question? Sure, I'll jump in.

Um I think that in terms of preparing for the application process, the, the big challenge is you gotta figure out what you're gonna do and what you're gonna apply to.

Uh And there's really relatively little opportunity to explore things outside of the core clerkships and the core clerkships themselves.

That's you know, most schools at 6 to 8 rotations. Uh And there's a lot of fascinating other fields out there um that you never really get to explore.

You know, you don't usually get radiology on. Um So I think when you do have time, um and you can make some time finding opportunities to look at some of those uh non-core specialties and, and spend some time if you are considering those to be able to make an informed decision.

Uh because the last thing you wanna do is to get halfway through fourth year and realize you're applying to the wrong thing.

Um And when you're thinking about what you're gonna go into, it's helpful of students think not about who they wanna be, try not to label, you know, pick a label.

I don't, don't think about it. Do I wanna be a surgeon or do I wanna be an internist?

Think about what you wanna do with your career and with your daily activities and some things I think uh you can answer for yourself as a student or you know, do you wanna have long term relationships with patients or do you wanna have short term relationships with patients?

Um Do you wanna do procedures or do you not wanna do procedures? Uh who do you wanna talk with every day?

Do you wanna talk with patients or do you wanna talk with colleagues? Uh If you wanna talk with colleagues, then you should not be an internist, you should be a radiologist or a pathologist.

Um And do you wanna have a practice that's inpatient or outpatient? Um If you can start making some of those determinations, uh as a first and a second year, it's gonna help you really figure out what fields you should be exploring.

Uh So that you go into your residency application process, feeling confident that you're making the right choice. There's one thing I would add to what Jessie said.

If you know, early on what you wanna be, if you've always known you wanted to be a certain type of physician, then one piece of advice that offers to join your professional organization as a medical student because it gives you the opportunity to get exposed to those people, your peeps across other schools and institutions and levels of career.

That's a great point. And, and in today's day and uh age with social media, even joining Twitter chats and things like that with people from your specialty or interested uh specialty can help.

But II like Jessie's way of kind of framing it around um skills or, or, or interest rather than just, you know, specialty.

I think that would have helped me myself as I was going through. Um for the next question, question three, how important uh this is for Lily, I'd like to get your perspective on this.

How important is performance on clerkships and other clinical experiences and specifically do things like AOA matter. Um Yeah, I think your performance on clerkships um do matter because it is an indication on how you'll perform as a resident.

Um AO a matters because it, it, you, it helps distinguish you as an applicant. It doesn't make or break you.

Um There are many things that can help you distinguish your, yourself and your application, but AOA certainly helps. What are, what are some other experiences that you guys had uh around uh clinical clerkships and AOA specifically?

And what were the other ways that you guys uh were able to distinguish yourselves? Uh as Lily is pointing out?

Ok. I'll be the uh my uh my team today will be I'm a bad med student um because II did an honor uh my clerkship and I did not get AOA even though our school had AOA for both like basic sciences and um in clinic.

And so 1/4 year AOA. Um you know, so I II think it's important um to, to do well on your clerkships.

But a again, it, it's not gonna, even if you don't get honors in, in everything you do, things are can turn out. Ok.

Um So II think personally for me and during medical school, II identified my main interest as, as medical education. And, and so when I was looking for programs, um the program I went to was John Stops Bayview and I actually went there because they had a lot of interest in medical education and a lot of they did a lot of medical education research, um a lot of faculty development Act uh activities.

Um you were kind of leaders in that. And, and so, um you know, so I ended up cho choosing a program that was just right for me.

Um And, you know, and I think, you know, had, II guess gotten a LA and honors in all my courts may not have turned out the same.

I may have been in a big program. That wasn't right.

So, yeah, II would say, um I would respectfully disagree and I would say that doing well is important. Um So that you have the foundational knowledge.

Um But II don't wanna overemphasize honors in a clerkship or AOA status because that is for um a small percentage of most school students.

And it's not like if you i it it's not the case that if you don't have honors or you're not a AOA that you're not gonna be able to be well trained at a very good program and become an outstanding physician.

Uh There are tons of excellent programs in this country. Um And it really the best program for you is gonna be one that you have a good fit with.

So I think students should do as well as possible, but I don't think they should be um you know, putting honors or AOA status above um personal wellness or honestly enjoying the clerkships and and having some fun with it.

Um So I think we have to be a little careful about saying it's saying it's too important. Um And uh because it's just uh we don't wanna create too much uh stress for our, our students.

So you wanna do as well as you can. I think the most important thing to me and clerkships is not having a professionalism Gaff or a failure.

So I think as long as you avoid those because those are almost uh I wouldn't say they're insurmountable, but those black marks have a much higher weight than getting all honors or AOA if you have a, a mistake with professionalism and there's something in your, your dean's letter about professionalism.

Um It won't matter how many clerkship honors you have or AOA status, that's gonna be a bigger hurdle to overcome. Yeah, I absolutely agree with that at that point that uh that makes a lot of sense and it actually segues pretty well into the next question.

Question four, which is really about um how important are these awake clerk trips and rotations at programs you're specifically interested in?

And if you guys have a commentary on the second question, which is about how do IM GS find these opportunities that would be really helpful as well?

What are your thoughts there? Oh, and I'll, I'll start with Lily and maybe uh kick it off with you.

OK. Um I think uh away rotations are, are helpful.

It helps the program to get to know you and what kind of worker you are? Do you get along with people?

So I think they are very helpful uh in terms of finding opportunities. Um I think the easiest way is if you have a interest and a focus is to find a person in a location or a medical center that you're interested to be at, um and just email them and ask them if there are any opportunities.

Uh I've been surprised in my career how often people are helpful and wanna have you join their work or whatever it may be.

Um So it doesn't hurt to just reach out. And I think the answer to this really depends on the specialty that you're applying to.

Um If you look, there's a great resource for medical students, which is the national residency programs, uh, program directors survey that comes out every two years just came out 2018.

And um, they survey all the program directors of each specialty and the questions they ask are, um, what factors do you use to determine whether or not you're gonna invite somebody for an interview?

And then also whether or not you're gonna rank them. And you can see that there's a huge difference across specialties with respect to what are called away rotations or audition electives.

Um, for instance, in general surgery, um, it's got a rating of about 40% meaning 40% of program directors consider it when they're deciding whether or not to, to interview.

Um, you contrast that with orthopedics or ear, nose and throat where it's around 80% consider it. Um, so, uh, in similar plastic surgery, totally different, you have to do additional electives and plastics, Ortho and ent, you don't have to do them in general surgery.

So II think it's not a one size fits all. Um, and so what I tell my students because it's not important, I say go do an away rotation if you wanna have an adventure.

Um If you're curious about, you know, if you did surgery rotations and you never got to see liver transplant, we go to some giant center where they do nothing but liver transplants all night.

Um Or if you're curious about living in a part of the country that you've never been in and you're not sure if you should apply to programs there, go do a rotation.

Um So I think it really that, that uh publication is a, a really good resource for students to look at that can help them make the determination about how many of these they wanna do.

The thing I would add to what's been said is um uh it, I very much agree that it matters what uh specialty you're in because the, the importance of this is quite variable.

Um I'm in Psychiatry. We have a lot of IM GS that come to psychiatry.

And so I think one thing I would add to what's been said is, um, look for places that have already had a lot of IM GS come before you because that's a sign that that's very I MG friendly.

Yeah, absolutely. Sean Sean.

Any thoughts on this particular question for your perspective? Yeah, I can say in, in medicine, I think the, the away rotations are, are not really as important as they are and the, the the sort of the most competitive, especially Jesse was saying and um so yeah, so not that important uh related to in GSI mean, there are different for medical students, there are different uh exchange programs for people who are currently in, in an international medical school.

Uh Once you get out of medical school, you're, you're typically talking about observers rather than, you know, the opportunity to engage in clinical care.

Um And those observers, yeah, it's, it's something, what will you said that like if you just sort of reach out to people, often people will are happy to try to help you um get those kinds of experiences, let's go to the next question cause I think it, it builds upon this a little bit.

So uh it's really about how do you get good letters of recommendation and what should they include? Uh again, any specific advice for IE GS.

And one thing I wanted to kind of stress here is that a lot, I think a lot of times people go to these, uh like you said, uh just the auditions or, or away rotations with the expectation that May, that are gonna get a letter out of it.

Um Is there anything that I from, from any of your perspectives should or shouldn't be included in that? Of course, you don't wanna have a professional Gaff um that would be obviously the, the worst kind of possible outcome, but anything on the positive side that, that you think could or should be uh highlighted in these letters.

So I'll go first on this one. So um um is the term observer for uh I MG.

So people who have already finished medical school and are here in this country and looking for starting their professional careers here.

So those observers can be tremendously valuable for, for exactly this letter of recommendations because you have an opportunity to um observe clinical care in this country and offer um sort of your perspective to your uh the people you're observing, you're not doing direct care, but you're the people who are, are you we watching see your interactions?

And, and so that can lead to that human uh story about who you are as a person for as an I MG applying. So II really think that it's really important to find letter writers who know you well and can speak to your humanity and your human connections.

So that would be my strongest recommendation and that's true for not whether you're an I MG, not only for IM GS, but for anybody who's looking for letters, you need that letter writer to know you not just know that you're applying in their specialty.

I think that's one of the challenges with getting those letters when you do the audition elective, you know, every, every student hopes they're gonna go and, and rotate at the big name hospital and, and get to work with the, the big name professor, the chair.

And then inevitably, what happens is the student spends the first week trying to find the bathroom. Uh, the second week, the uh chair is away.

Uh the third week, their clinic gets canceled and then it's the fourth week before the student even gets to introduce themselves.

Um And so those letters just having read a lot of um letters over the year, I personally find that those letters recommendation from audition electives tend to be lukewarm at best and often are just a, a rehash of the students.

CV. Um There just isn't enough time to build a relationship in additionally that those folks on, on, on additional electives, the faculty, you know, they don't have any skin in the game.

There's no vested interest um for them in the visiting student to do well. And you contrast that to letters that come from a student's own school, um where faculty typically have um or opportunity to get to know you.

The, the student has uh familiarity with the institution and, and hits the ground running. Um And the faculty has a vested interest in making sure the student's letter is as glowing as possible and the students gonna do as well as possible.

So I think those letters really are best when they come from your home school faculty. Uh And I also think it's important for residency that they come from either acting internships or subinternship, at least in surgery.

Um That's really where we have an opportunity to see how you work on a team. Um How you've developed some skills in the clerkship.

Uh The clerkship letters are, are generally less valuable, I think. And I don't know if that's different for um radiology, medicine or psychiatry.

But that's certainly I think how we feel in surgery kinda tied to this question. I'm also curious at the outset a lot of you spoke about mentorship and um this question of letters, a recommendation obviously directly ties to mentorship.

I'm curious how you found good mentors that wrote your letters. And a lot of students have a hard time identifying people that they can consider real mentors.

Uh So maybe hearing your stories can be helpful. Yeah, I can, you have to, it's hard to find good mentors.

You just have to seize every opportunity that comes your way. Most of the time you will not find uh a mentor that will be with you long term.

But there's always that one person that will come along, that'll maybe change your career or change your life or change where you go in the future.

Um You just have to put yourself out there. It's a little bit of luck and being willing to take a risk.

I think I would build off of what said. Um uh It's not one mentor, it's a package of mentors and the mentors, mentor you in different ways and different different elements of you.

So as you think about that mentorship uh package, you, you might start asking yourself, do I have a clinical mentor that can advise me in, in direct patient care if I'm interested in research?

Do I have a research mentor? Um if I'm interested in community service, do I have a community service mentor?

And, and I think that that in that way you can think about the package of your letters of recommendations and make sure that they're speaking to different aspects of you.

So then the whole package of your application shows who you are as a, as a broad person. I think this thing is a uh a 1st and 2nd year student.

If there are clinicians who are coming in to teach in the 1st and 2nd year curriculum, then those are faculty at your medical school who are really interested in teaching and education.

And um so they're likely gonna be people who are gonna be receptive um to uh students saying, hey, I'm interested in your specialty I really enjoyed your teaching session.

Um You know, I've got some free time. Can I come shadow you for a while?

Uh So those are people often who you can get linked up with early on uh in the year. The other thing is if your school has a student interest group, um the leaders of those.

Um And then also you can always reach out to the clerkship directors for each of the core specialties um and ask them if they've got a list of people who typically do advising for students and, and start to build those relationships.

Yeah, you can also reach out to the program directors. Um I have many medical students reach out to me and, and, and once I gauge what they're interested in, I will sort of make the connection with other faculty that makes a lot of sense.

Uh Thank you for those, those uh personal bits. I wanna switch now to the match process and uh specifically getting into how it works.

Um Maybe, I mean, you can kick this off. How do residency programs decide which applicants to invite for interviews?

And does it differ for us versus uh us grads versus IM GS? Well, my answer will be short because I'm not involved with versus you training.

I know that other colleagues here will be able to say this. I would just say that obviously, this is specialty dependent because some specialties will use board scores as an artificial cut off uh to decide who to interview because they're extremely competitive.

Um And other programs will uh more heavily weigh that personal statement or performance in clerkships. And so it's very much dependent upon the specialty and how competitive that particular program is within the specialty.

And that is probably why it does differ between us and IM GS. But let's hear what others have to say.

I actually, I think it varies by specialty, but also varies by the program director and what kind of program they wanna run.

I actually read every application that comes across and I'm looking for various things. It's not just grades AOA.

Um It is, I read the personal statements. I get a flavor of uh who the candidate is.

I look at their letter. So it's really a, a whole composite.

Um But, and it, I, and it doesn't matter whether I MG or local grown. And I think that, well, it does vary to some degree of specialty if you look at that NRM P.

Um again from the survey, uh step one is the top, the top item on the uh rank list factors that programs used to, to select applicants.

Um And II think the, it's an evil necessity. I think that it's not um necessarily because they, they being the program directors feel that a certain score is gonna guarantee success.

I think uh program records are all realists and they know that um scores don't predict success, but they are uh an easy tool for trimming a pile.

And program directors are all busy people and they've got, you know, 500 applicants for five spots and you and um some of them are willing to rea you know, need to trim that pile to a reasonable level.

And so the step one score becomes an easy tool for that. And then, um typically, I think most program directors then go to the, the letters of recommendation in the dean's letter.

Um things that don't matter as much or performance in the first and the second year. Um uh You again, you can see for each specialty in that program director survey, how they rank the different factors for deciding uh who to interview.

Yeah, I would only add to that which we already mentioned before. Uh A professionalism misstep is a quick way to get kinda removed from the pile.

Um But then I think program directors just vary on what their approach is and I'll let go a few things. I mean, the, the, the value of the NR NP reports is, is great.

I mean, it's, it's, it's a little bit benefit to the community that the NR NP puts out that data. Um Yeah, I and II think again to simplify things that in my mind and what I've seen in recent medicine is that it's all about, you know, again, residencies, long hours and clinical care.

And so programs want people who are gonna be nice to have around and who are gonna do a good job in that context. Um I, if they, you specifically, you know, it's, it's a, it's a program that especially also values the um people who, who have these unique characteristics, who are gonna be interested in advocacy and community involvement and um and innovation and research and other types of things.

Um Yeah, not all programs are like that. Um But I again, I think if you're, if you're preparing yourself to be successful with re applications, again, get yourself grounded with your clinical skills.

Um And then there's something about let's recommendation, um have them testify to, to your, to your clinical abilities as well as your character and likability and, and so on.

That makes a lot of sense. Um For the next question, it uh it, it piggybacks off this as well.

So a lot of times med students have interviewed maybe once in their life for med school and really, that's it. And now they're going for their second round of interviews in their life.

Um What are some specific things that you think people should do uh or or not do uh during or after an interview to help their chances of matching what are some common things that you guys have encountered uh either in your own interview experience or on the other side of the table as interviewers.

Uh Maybe we can start with uh Sean since you just kicked off the last question. Yeah, I was just gonna say one thing because I, because I interviewed more applicants, I guess, than II rank, you know.

But um Right. Thank you Note.

So after if, if you have faculty or other people that you met along the, the interview day, um write them a thank you note like, cause like I, I'm doing it as a volunteer.

All of them are just what everybody's doing as a volunteer. It takes a lot of time.

Um It, it takes time away from other things and so just like every time I've got a Thank you Note II feel I feel really appreciative.

I, and I'm getting to the point now where I get a little disgruntled if I don't get a, a thank you note, you know, II don't I evaluate people the same way regardless, you know, but, but uh at the same time it's just, just reflects well on your character.

It's, it's gonna, it's gonna pay dividends in the long run. I'm gonna have to make sure I send you a thank you note after this interview.

Uh Sean as well. I'm, I'm expecting one now too because you don't send it to all four of us as far high.

Uh No. Uh I mean, yeah, what are your thoughts on the?

I'd love to hear from all of you. Yeah.

Thank you. 22 key pieces of advice on this.

One. Number one um on the interview trail, I think it is perfectly appropriate to ask probing questions as an example.

What are the relative weaknesses of this residency? And any training director or program or interviewer says, oh, we're perfect is not really being uh sincere about the areas for growth for the program.

Every program has areas for growth and relative areas of strength. The idea here is if you ask probing questions, it demonstrates that you're deeply curious about that program and I think that's nothing but a sign of strength or interest in that program.

So ask it because you mean it not because you're just doing it because I told you to the second piece of advice then is ask current residents what they like about their residency and what they don't like.

Um, they have far less a vested interest of polishing it as a super package place than, um than other people might. And so they're gonna be sincere and real with you about what they love and also what they need or what they wish were better.

Well, what are your thoughts? Yeah.

So, uh um I would say be genuine. Uh don't inflate your, we all kinda know how to read C vs, don't inflate it during the interview process.

Um Also maybe think about how you can add value to the program or how you can be a good fit for that program and maybe be able to kind of articulate that to the PD and to the interviewing committee.

Um But be polite, do the usual stuff, say thank you, write the thank you know, those kind of things. Um And really take the time to think about what kind of culture is fostered at each place to see if it really is a fit for you.

Um Both sides are interviewing each other. Um But just be courteous thankful, talk to the residents, those kind of things.

Have any of you had explicit uh Folks reach out after an interview and say, hey, I'm gonna rank you in my top three or top one or anything like that or, or, or is that something that's really done much in general and, and any thoughts on that?

Um I'll just go quickly on that one. I think that um I like to liken this to the semi per me brain.

Um, applicants are allowed to give as much information as they want. Um But there are restrictions on what training directors are allowed to say in response.

And so I think you should feel to as an applicant, you should feel comfortable to say those kinds of things. But don't lie.

I think you should be, be honest and sincere anything. Yeah, it's either Lily or Sean.

I'm just curious. Um I, yeah, I agree.

I think the candidates can uh communicate anything they want to the program. But be honest, I think the big one is do not tell two programs that you're ranking them number one.

that would be a big, no, no. Um, I would, some applicants do send those emails.

Others don't, it just kind of varies. That makes sense.

Sean, any thoughts? Yeah, I, II think like everybody else said, I mean, candidates can share as, as much information as they want.

Um, but just don't feel bad. I guess if the program doesn't immediately reciprocate uh what you said just because they're not allowed to.

Um And, and again, it logically the match is set up the algorithm set up such that it shouldn't matter what, you know, a candidate is going to do with the reckless.

But I think just people are not rational. Um And so I think the program probably would, you know, at least to some degree uh rank people slightly higher if they had a strong interest in the program.

Makes sense. I have a, a final question, I'd like to ask all of you.

And this is really just a kind of a personal story. II, I'm curious how you ranked, uh how you determine your rank list, what sort of factors played in at the very end.

Um And perhaps things changed as, as you went along, maybe you can walk through how it might have changed as well. OK.

So in my case, psychiatry is a less competitive specialty than some of the other specialties. And so I had the luxury of interviewing a number of places um And at that time, I was a single man.

I looked all over the country. Um and um I um wanted to, to change the parts of the country that I was living in and I was interested in another part.

Um And so I, I think um uh one of the things that happened for me, my last interview was AAA train right away from medical school and I was on the train ride back and I just kind of put the list of programs on a little piece of paper on on the tray table.

And the my rank was one through nine of and they just kinda melded into place. And so, you know, I think um uh I think it's important to consider geography, proximity of friends and family cost of living.

Um All of those things are worthy to consider in addition to academic prestige of the program size of the program, some of the things that have been mentioned before.

And so I give yourself permission to allow those to be factors. And ultimately, what uh what happened for me, I would hope what happened for all applicants was that they naturally fall into a very precise order.

Um So that way it's you can have some clarity with your side of the algorithm so that your list is in the way you want it and then the rest is up to uh is out of your hands, Jessie, what was your story?

So, um I think the the most important thing is finding the right fit. You know, most students create some big Excel document as they're getting ready to apply.

And they put all kinds of data into the Excel document of every bit of information they can glean uh from online searches about a program.

Uh So they've got like this kind of pseudo list already with rank order of what they think is their top choice. And, um, then they go out on the interviews and what you rapidly discover is that, that Excel spreadsheet was a waste of time.

Um, because it really is about the fit, you know, all programs that you're gonna apply to are gonna be accredited by the A C GME, which means they're gonna have basic requirements.

Um And so you can get trained at any one of them. And so it really is about fit and you won't, II can't tell you how, what fit is and, but you'll know it, you know, as a student, you go out, you start interviewing, you'll say that's the kind of program that I'm gonna need.

And those are the, I like the culture. I like the way people interacted.

I, the way I just like the way I felt when I left and that's where I wanna go. And I think it's important that you listen to that, that gut uh, like a mean, was telling, uh, saying earlier, um, ignore what all your friends are saying about different program.

You know, the people that are going into the field as well and they're gonna say, oh God, I loved LA and you're gonna say I didn't really love LA.

That's ok. Um, everyone's gonna have a different fit.

So you have to rank based on how you feel. I think it's really important that you don't try and game the system.

There's a great paper out there that talks about one of the biggest, um, factors that can lead to students not matching is if they try and actually guess what another, what a program is gonna rank them and makes their list based on that instead of on their own preferences.

Um, so go with your gut. That's what I did.

I also had to consider, um, my wife was a year behind me in medical school and so she was gonna be applying to pediatrics.

And so we looked at the Peds programs where I had interviewed, um, and, uh, did a kind of a driving tour of the different cities.

Um, and so we made that decision together and I think that's the other important thing is, is think about the family, uh, considerations as well.

You don't wanna, um, leave them out of it. And then the, the last thing I would say is don't worry about what the name of, um, the name on the side of the hospital.

It doesn't matter if it's, you know, Ivy League or community. Um because it's really all about the training, you can have a great name on the side of the hospital.

But if it's not the culture for you, you're gonna be miserable for 3 to 5 years. And that's just not worth it to say at the end that you trained at the big name place.

If you come out of there um miserable. That's awesome.

Will Le Shawn anything to add? Yes.

So um I, for me it was location. I wanted to stay in New York.

I love New York. Um It turned out that I really liked my home institution.

I had my mentors there and I was fortunate enough that they um let me stay. Um But for me, it was location above all because that's kind of was my happy place and I knew I would uh do well when I was happy.

Um So you, you kinda have to do this introspection and kinda know yourself as you make these decisions. Um And it's important to know that you are able to make some of those decisions.

People aren't just making them for you. You have some say in where you go and, and what place fit and, and I can't um emphasize enough that gut feeling of fit is so important and you'll get that sense on your interview trial.

But for me, it was all location, it was New York or best. So I disagree with what Lilia said there.

There were some places on the trail when I got off the plane and I was like, oh, I don't think this is the right place for me even before I got to the hospital or so.

Yeah, that gut instinct again is really strong and it's there for reasons, trust it. Yeah.

Yeah. And my, my story is that, uh, you know, I was, I was engaged when I was going through this process and my wife was very much involved uh because she was finishing her phd at the same time in, in May of, of that year.

So we're gonna be relocating together. And uh and so, you know, one thing she did is she came with me on some interviews, like the, the glamorous ones like in San Diego, she wanted to come and, and so we made sort of a trip out of it.

Um Ultimately, I liked the program in New York City and uh I liked where I ended up at, at in Baltimore. And we really love New York City.

We, we met there. Uh We had like the best, some of our lives together in New York City and like all those forces were drawing us to be in the city.

It, it was gonna be like Upper East Side living. Um And the program was pretty good.

Uh uh But, but in, in Baltimore, we really did not like it, it was, it just felt like a, a dangerous place. To be.

Um, and, and so, so this is where, I mean, it really, so one tru yeah, I totally agree. Trust your God.

So, uh even though all these other forces were drawn us in New York City, my wife really wanted to go. She was very to this point that II ranked uh ba ahead of um, a Cornell in time.

Um But, uh, you know, but they really felt like had a good feel to it. Plus, like I got a better feeling and I went the second look and we had a really good time.

So hanging out with the faculty and the residents. Um so II would advocate for, you know, getting uh an additional look beyond interview day.

And the other thing I did that, I think that was smart and I'd recommend anybody is, you know, after, uh during my interviews, people would say, oh, you're interested in this talk to this person, oh, you're interested in this talk to that person.

I actually like reached out back to the program and the program connected me. And so I met, you know, my future mentor who's been my boss, who's now my boss.

This is like nine years later and, you know, before I even put, put together my right list. And so II think like those, those things getting to know the program really well and making sure that it's right.

Uh Was another, is another good thing to do. And again, programs usually are more than happy to help you get to know their program better.

That's fantastic advice from all of you. I'm just gonna recap.

So I've been sitting here taking notes and trying to be as quiet as possible. Uh It sounds like some, some basic uh advice you'd give and correctly if I, if I misstate any of this is find a team of mentors, not just one mentor but kind of uh a mentor for, for a specific thing like clinical work or advocacy.

Uh Tip number two, don't make a professional Gaff or do anything unethical, like telling two different programs, you know, they're your number one.

Um And I think I counted maybe 15 or 20 times. The phrase trust your gut was said.

Um and I think I learned from amine, apparently there are serotonin receptors which is good to remember. Um And uh and a bonus tip for our our viewers send out thank you notes and all four of you will, will be getting one.

So thank you very much. That was fantastic.

I think you did a great job and I appreciate all the advice. Bye bye guys.

Bye bye. Take care.

Bye.