Getting into residency: What medical students need to know

by James Lamberg

When medical students are applying for residency positions, what do program directors care about most? This may become the ultimate question for many students on clinical rotations.

Thankfully, publications exist to help answer this very problem.

Unfortunately, many students are not aware of this published information. In a 2005 article from Medical Education Online titled “Residency Selection Criteria: What Medical Students Perceive As Important,” it is evident that students have major misperceptions. Students tend to overestimate the importance of subjective criteria and underestimate objective criteria.

A 2009 article in Academic Medicine titled “Selection Criteria For Residency” is the result of a questionnaire sent to program directors around the country. The most important criteria for residency selection are based on clinical performance as well as board scores. Although this article breaks down the importance of each criterion by specialty, clinical performance was valued by program directors across all specialties. The exception for competitive specialties is increased value on research. Recommendation letters were ranked as important in most specialties. The Medical Student Performance Evaluation (MSPE, Dean’s Letter) was consistently ranked the least important.

Here is a quick breakdown of criteria importance from this article:

Most Important:
Required Clerkship Grades > USMLE Step 1 > Specialty Elective Grades > Clerkship Honors Grades > USMLE Step 2

Least Important:
MSPE < Research/Publications < Preclinical Grades < Medical School Awards < Medical School Reputation

Over a decade ago, a similar article was published as a result of a program director questionnaire. This 1999 article in Academic Medicine showed similar results. Even though this article was available in 2005, medical student still showed great misperceptions of what criteria programs directors deem important. Not surprisingly, that article also showed:

Most Important:
Required Clerkship Grades > Clerkship Honors Grades > Specialty Elective Grades

Least Important:
Preclinical Grades < Research/Publications < Medical School Reputation

Almost the exact same findings were published in a 2000 Academic Emergency Medicine article specific to emergency medicine residency applicants. Further, the National Residency Match Program (NRMP) publishes match information annually. The “Charting Outcomes In The Match” shows preferred board scores for each specialty, which can further help students understand what program directors want to see from applicants.

There is a myriad of resources such as these that answer important questions about the residency application process. As medical students, we should be looking to more objective references rather than relying on unfounded opinions.

James Lamberg is a medical student and medical software developer and can be reached on Twitter and on his website.

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