For students studying at Caribbean medical schools, success in the residency match is a major concern. And it should be, because Caribbean medical students have unique challenges. At the same time, strategizing early in your medical school career can significantly impact your ultimate success.

Here are five rules that are critical in residency match success:

1. Yes, your exam score matters. The reality of the current day residency match is that programs are often inundated with applications. A single residency program might have 100 applications or more for just a single residency position. In response, many programs have instituted threshold (a.k.a. cut-off) scores. In other words, to even be considered for an interview, your USMLE score needs to be above that threshold score.

2. Relationships matter as much as your scores. I know many applicants who have matched into competitive specialties or programs despite not making a cut-off score. Oftentimes this comes down to personal relationships. In other words, if you have a direct relationship with a faculty member or attending who is known to that program, a program may decide to look at your application. This may be based on a strong letter of recommendation or even communication to the faculty member’s program.  Although many students think of these cut-off scores as hard and fast rules, at most programs, they are instead just one tool to help a program narrow down this large number of applications.

There are many ways to go about relationship-building with faculty. The most common, of course, is rotating with a faculty member. This might be via your core rotations or elective rotations. But there are many ways beyond that.

As a pre-clinical student, you can utilize the blocks of time to build your profile and build relationships.

• You may be able to do a research project with a faculty member in a completely different state.
• If you are a student member of a national medical organization, you may serve on committees with attendings.
• Professional societies and organizations often have mentoring programs where interested students can be linked with available faculty mentors.
• You may be able to network with physicians at professional meetings.
• As a pre-clinical student, you may get to know attendings while serving on mission trips.
• You may connect to physicians through your involvement in community organizations such as nonprofits, free health clinics, and health fairs.

3. Be strategic about your core rotations. Many Caribbean medical schools offer rotation opportunities in different parts of the U.S. However, not every region in the U.S. is considered “IMG-friendly.”  By IMG-friendly, I mean that some regions or programs are far more likely to consider and match IMG applicants. This should definitely factor into your rotation decisions.

For example, you might have a choice between rotating close to home or rotating in a hospital linked to a residency program with a relatively high number of IMG residents. This is an important decision.  While the former would allow you to spend more time with family and cut down on expenses, the latter allows you to build key relationships in places where you have a chance to match.

You might also have the chance to rotate at a hospital or clinic without any direct ties to a residency program. However, your preceptor may have ties. Often, these preceptors may be established in their community, and your presence there may allow you to attend grand rounds, attend local medical society meetings, or otherwise network in that area.

4. Along the same lines, you need to be very strategic with your choice of electives. After you complete your core rotations, you’ll be ready to do your electives. And while there may be some electives that are ideal for you among your school’s offerings, don’t forget that your school may allow you to participate in other electives. If a residency program offers an elective at a program where you might have a strong chance of matching, you should consider that elective.

Would you like to establish connections in a region where you don’t have any ties? If so, then electives offered by residency programs in that region, or even with independent physicians with ties to those programs, may be a great option.

5. Programs consider far more than exam scores and clinical performance. With so much attention being placed on exam scores, it’s easy to lose sight that the things you do outside of the classroom do matter to residency programs. Programs are looking for applicants who have taken part in activities, showed passion for these activities, and made contributions. They view that as evidence that as a resident, you would be motivated and likely to make similar contributions for their program. You can demonstrate this by taking part in volunteer, research, and extracurricular activities that speak to you. Your in-depth involvement in these experiences can make a strong impression on programs.

The process of matching successfully can be challenging. It requires that you take stock of where you are today, where you want to be in the future, and what steps you need to take to get there. Taking action on these steps now can have a large impact on your ultimate chances for success.

Samir Desai is an internal medicine and the author of The Successful Match. He can be reached on Facebook, Instagram, and YouTube.

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