I’ve heard this question posed several times and its same sentiment expressed countless more. As the deadline for submitting an application for residency approaches, the pressure mounts for getting last minute bolsters to your curriculum vitae. And you are certainly not alone in this. I found myself in a very similar situation this time last year. Despite already working tremendously hard in the first three years of medical school, with just a couple months left before applying, there were many integral pieces of my application that were missing.
As of June 1st during my application cycle, I had zero letters of recommendation. I had not completed any of my away rotations or my home sub-internship in plastic surgery. I had many research projects that were stalled in various stages from data collection to manuscript drafting to submission. I had not taken Step 2 CK or CS. I had not drafted a personal statement. Still, I was able to find success throughout busy audition rotations and normal medical school coursework to significantly enhance my CV in these last three months.* You may find yourself in similar circumstances, and don’t stress! Most applicants will be in the same boat. Here’s a guide through each of these facets of your application. They will each be individual topics for more extensive discussion, but here is the sparknotes on each.
Letters of Recommendation
Letters of recommendation can be an extremely anxiety provoking endeavor. I remember the uncertainty of how many letters I should get, who they should be from, and if I should try to get any on away rotations. Away rotation rec letters would be out of the question this year for most students as sub-internships opportunities (if any) are virtual. Ideally, for letters of recommendation you want them to be from faculty members in the field to which you are applying, though I think there will be more leniency with programs across specialties given the special circumstances of this application cycle. At the same time, you want to be sure that the individual writing the letter knows you well enough to write a positive, strong letter of recommendation for you. When I asked each of my letter writers, I specifically asked them, “Would you be willing and able to write me a positive, strong letter of recommendation for my residency application?” Letters of rec are an important part of the application, and you want to make sure that your letters portray you in your best self. Another important component is the timing of when you ask. You want to give letter writers ample time (at least 1 month’s notice, preferably more) before the deadline. I asked my letter writers from my home institution in person in late June before I was going to be gone for two months on two away rotations. I provided them with a copy of my CV and a rough draft of my personal statement (which you should as well), and emailed them any major updates to my application (new presentations being accepted, articles published, test scores, ect). Follow up with them and give them a professional, gentle nudge if you haven’t heard from them as the deadline approaches. Concern if letter writers were going to have their letters in by the deadline was one of the most anxious parts of the process for me, largely because I didn’t have control over it.
Sub-Internships (Home and Away)
Sub-internships are one of the biggest components of the summer and fall months for applicants to plastic surgery (and any competitive specialty). Visiting medical students for sub-internships during this season, appear that they will be severely restricted both at institutional and national levels given the ongoing COVID-19 pandemic. Be on the look out for virtual opportunities that many programs are beginning to offer to gain familiarity with programs. This places even more of an emphasis on your home rotation performance. As there will be no opportunities for external rotations, all of one’s letters of recommendation will likely be garnered based on a student’s performance on their home sub-internship. Be well prepared for these rotations; study hard, be present, and be an active learner. Additionally, in the 2021 match, we will likely see a spike of applicants matching at their home institutions across specialties given the familiarity between programs and the applicants.
One of the theme’s you will notice in my approach towards building a successful application is a strong emphasis on research. It is one of the only ways you can buffer your application for lower academic performance both on clinical rotations and board scores. Strong research experiences, posters, presentations, and publications demonstrate many qualities that program directors are looking for. These include dedication, hard work, persistence, scientific-inquiry, teamwork, and active learning just to name a few. In June, with just a few months before applications are submitted, it is very difficult to start (much less complete) a new randomized control trial. One of the most important point in the entire application process that I was not aware until approximately June of my application cycle that for research posters, abstracts, presentations, and papers they do not have to be already published for you to be able to list them on your official Electronic Residency Application Service (ERAS) application. You can list items that programs will see that are still in press, have just been accepted, and most importantly have been submitted. This is why research is one of the easiest ways that you can bolster your application in the final months before applying, namely you just have to submit it to be able to list it on your CV. In reviewing my ERAS application which I will do in more depth in later posts, about 37% of my research activity section was sub-classified as ‘other than published’, namely it either had been accepted and was still in press or more often had just been submitted. Taking research projects from an idea to when you see it finally published and indexed on Pubmed is an incredibly long period of time. While even getting a project to the point of submitting it to a conference for presentation or to a journal for publication takes a substantial period of time, it is much shorter than waiting until it is presented or published to be able to count it. Thus, the biggest advice I have for you today is to examine the projects you currently have ongoing and access which of them you and your team are most readily able to finish up and submit prior to submitting your application. Honesty and integrity are of the utmost importance to uphold in your application and in your career. Don’t say that something is submitted if its not, and don’t make up any items just to list it on your CV. While 37% of my application was ‘other than published’, 95% of that portion was accepted for presentation or publication in the months after applications were due.
If you don’t have any ongoing projects, this is a great time to reach out to residents and attendings, and ask them if there are any projects that they need some assistance with. Case reports generally can be written up quickly. Many times, you can submit high quality abstracts with preliminary data. When it comes to research, its all about quantity over quality, but more on that later.
Step 2 CK
I did not apply with a Step 2 CK score on my application. I took the exam in late November in between interviews and was only ever asked my Step 2 CK once. That being said, I had a Step 1 score in the 98th percentile and realized that it was more likely that my Step 2 CK score would decrease relative to my Step 1 score. For plastic surgery, there is maybe 1 program that I have heard rumors of that requires a Step 2 CK score to get an interview, but I know cases of people that interviewed there and matched there without having a Step 2 CK score as a part of their application. For the group of people that is comfortable with their Step 1 performance and believe they have a highly competitive score, I would strongly advise against taking Step 2 CK before you apply. The risk of a poor performance on the exam is not worth any marginal benefit of topping an already outstanding Step 1 score. I have heard from many friends in other competitive specialties (orthopedics, ENT, ect) that a Step 2 CK score is more or less expected with your application. In those cases, it is important to perform well on Step 2 CK and try to maintain the same relative score to your Step 1 score or improve.
For individuals with lower Step 1 scores, my advice is completely different. Showing a substantial improvement on Step 2 CK can be crucial in signaling to programs what caliber of applicant you really are (and as Step 1 becomes pass/fail, this will become important for all applicants). I know it is extremely difficult to study and prepare for Step 2 CK amidst the demands of asking for letters of recommendation, researching programs, working hard on away rotations, and everything else, but it is one of the best ways to demonstrate to programs your capabilities, determination, and work ethic. Despite the difficulty, it is well worth the effort and having that improved score will pay out dividends when interview invites are released.
Step 2 CS
My advice on Step 2 CS is similar to that which I gave for Step 2 CK. I don’t think there are many programs that require it by the time of your application,. Certainly as CS is pass/fail, it doesn’t particularly provide any value to your application. I would not be concerned about having the result on your application, and take it when the timing is write for you. And I won’t spend any more time on it in this post, given that the exam has been suspended for the next 12-18 months.
Writing a personal statement is one of the more challenging aspects of applying to residency. It is an open ended prompt. You can do anything with it. You have 1 page (while there is a rather generous character/word count limit, I would not write anything over one page) to tell your story: who you are, where you have been, what you have done, where you want to go, and why this field. It is daunting. There are a multitude of approaches that you can use, a plethora of opinions, and innumerable pitfalls you can make. While I will address each of these subsequently and provide you with my own steps towards writing it, my overarching opinion after discussions with numerous program directors and faculty members across the country is that the personal statement hurts more applicants than it helps. My personal statement ended up being not very personal. It was succinct and formulaic: this is what I’ve done and this is what I want to do. I read plenty of personal statements that are more story based, that try to capture someone’s attention with a patient story or a family experience that led them to be where they are today. I think there is value in both, and I really think it comes down to your personality and what you want to portray. But I think it is also important to think about your audience…program directors, faculty members, and residents on the other end that are extremely busy and will be reading 100+ personal statements. That’s why I say if you have a solid, well-rounded application, the personal statement may not provide much value to you. Almost every surgical applicant has that ‘one day’ where they just ‘knew’ they wanted to do surgery. And I think that it is fine to be consistent with that mold.
The most important advice I have for writing the personal statement is getting a draft (no matter what it is) written early. Get feedback from family, friends outside of medicine, mentors. You want to have a well-polished draft to hand to faculty members that you ask for letters of recommendation, and you want to have apple time to refine it and edit it. Getting started is the hardest part. I recommend looking back to essays that you wrote for going into medical school. Reviewing these were a thought provoking exercise for me and helped to ground me in why I went to medical school in the first place. In summary, start writing it today and eventually some idea or theme will click with you.
I know that this may appear as a general outline and I just barely scratch the surface of each of these broader topics. If you are an applicant and its June, these are the main areas I would focus on to propel your application to the next level. Look for more in depth content on each topic coming out from Med Student Edge and contact us with any specific questions that you have. Know a medical student that could benefit from this information? Be sure to share our page and this article with them.
*My application deadline was September 15th. As a part of a response to the ongoing COVID-19 pandemic, the AAMC has pushed the date back for when programs gain access to applications. The date for this application cycle is October 21, 2020.