**Fourth Year Advice**

Now that I’ve matched I decided to compile a bunch of general advice that I’ve gathered from the past year. A lot of it is from my own experience (and the mistakes I’ve made). I hope it helps someone out!

Auditions

  • Apply EARLY. MD auditions are through VSAS, so you will need to submit materials through there. Every institution usually has their own immunization form. Do your research ahead of time and gather all the forms that need to be filled out so that you can just make one trip to your doctor’s office to get the shots and have them fill out all the paperwork. There is also an AAMC universal immunization form that some programs may use, so get that filled out too just in case. Make sure you meet requirements to apply. Some require a USMLE or a minimum passing score. Others may require a Letter of Recommendation or Statement of Interest. It just depends the program, the specialty, and how many applications they get for auditions. Plan ahead!
  • DO auditions are not done through VSAS. You will need to cold call/email the medical student coordinators and ask them about availabilities and dates. Again, they may also require different immunization forms to be filled out so you’ll need to do your research. Like MD auditions, it is FIRST COME FIRST SERVE. The DO audition spots go quick since there’s no official date that you can start calling and they generally have less spots. I’ve heard of people calling as early as November of the previous year. If you’re interested in competitive specialties, you must contact these places early since there are limited spots. Primary care fields are generally more forgiving if you end up calling later.
  • Auditions early in the cycle (summer) are important because you will need to get a LOR. Make sure to set those up first so you have some audition rotations in the bag. This is especially important for AOA programs as they place more emphasis on auditions. I recommend auditioning at your “top” choice program second or third when you’re more of a seasoned sub-I. This way it will be a little easier to impress attendings and residents.
  • During audition season, you’re expected to do more than the average M4. This is the time when you should force yourself out of your comfort zone. Volunteer for presentations, introduce yourself to faculty and the PD, stay late, take on more patients, ask to do things even if you think they’ll say no, teach the M3s, show your passion for the program and the field. Assume that everyone is watching you, because they are!

Letters of Recommendation

  • Look up requirements for each program for LORs. Some want a Chair letter, some want one from a separate field than the one you’re applying to, some want at least 2 letters to be from your M4 year, etc.
  • It’s a good idea to get a Chair letter just in case a program requires it. Don’t worry about not having interacted with the Chair before. Email them and ask for a letter. They get asked this all the time, so chances are they’ll say yes and then ask to meet with you to get to know you better. Give them your Personal Statement (if you have it done), and your CV, as well as any copies of board exam scores if they need it.
  • If you get a letter from someone during M3 year and you don’t have access to ERAS yet, have the attending save the letter on their computer so that they can upload it onto ERAS when you get access.
  • The letters you get as an M4 are more important and will carry more weight. Ideally you want to ask someone who you worked with extensively and who has a high academic position/is well-known in the field.

Applications

  • There are two matches- the NMS (DO) and the NRMP (MD), but there is only one application (ERAS).
  • Fill out the easy bio stuff whenever you have down time during your third year.
  • Start getting your CV together second semester of M3 year. The more time you spend on it the less time you’ll be fumbling around on ERAS trying to add things. For all activities, mention your role and why it was significant. It’s not typical to put that on a CV, but I did and then I just copy/pasted onto ERAS with some minor elaboration. Saved me a lot of time.
  • Start brainstorming how you want to write your Personal Statement the second half of M3 year. Make it interesting and unique. It should be about 1.0-1.25 pages long with standard margins, 12 pt font, and single spaced. Also, have people read it- not just your friends either.
  • Have your board scores in when you submit (or soon thereafter), both the PE and the CE. Assuming you didn’t bomb either, it will give you an advantage over people that don’t have it in by the time you submit applications. Some programs require all boards scores for interviews and for an applicant to be ranked! This goes for any specialty, including primary care fields! Don’t assume just because your specialty is a primary care field that they won’t care when you get your PE or CE scores. It definitely will give you an advantage if you have them in early on in the cycle!
  • Releasing USMLE scores: As far as I know, you have to release your USMLE scores only if you applied to ACGME programs. Make sure to double check the rulebook for this one, as it probably varies by year and could be a violation of match rules if you do not disclose all board exam results.
  • Applying to multiple specialties: You can apply to multiple specialties, but you will need a separate Personal Statement and set of Letters of Recommendation for each specialty to show you are actually interested in the field. Obviously, this takes some planning ahead of time. If you’re thinking of applying to multiple specialties, try to decide by late spring of third year so you can start contacting people for LORs and starting writing a second PS. Programs will not know you applied to multiple specialties unless you 1.) explicitly tell them or if 2.) the PD of one specialty program happens to also be the PD for another specialty program at the same institution (rare). In this case they’ll see you applied to both when they look into their ERAS account. Also, if you apply to more than one specialty, then you should be 100% okay with matching in either one! Remember you’ll be bound by legal contract if you match!
  • If you’re torn between specialties, then apply to both and get a feel for which specialty you can see yourself in during auditions and interviews.
  • Be realistic. If you have a red flag on your application, you will need to apply broadly. The application process is extremely expensive, but this is NOT the time to get stingy!

Interviews

  • This section is pretty common sense. If you made it to the interview, then it means the residency committee saw something on your application they liked and they’re interested in getting to know you in person to see if you’ll be a good fit for their program. I’m not going to talk about professionalism, because after 4 years of medical school you should know how to act and dress when meeting attendings and residents in a formal setting.
  • Pre-interview dinner: Not required, but there is an advantage to going to the pre-interview dinners in that 1.) you’ll feel more relaxed during the interview itself when you see the familiar faces of the residents and other interviewees, and 2.) sometimes residents will drop hints and tips about the interviews.
  • Be smart. Do research on the program ahead of time and be able to adjust your answers accordingly. Think about specific things in your application that you can bring up to put yourself in a good light, and incorporate those when you answer questions. You want to convince the interviewer that 1.) you’re a good fit for the program, and 2.) you’re not some psycho weirdo that no one will want to work with. Bonus points if you can sell yourself as an asset. Why would the residency benefit by having you vs. someone else?

Post-interview

  • Thank you emails/notes: This is up to the applicant. It’s nice to send a short email thanking the interviewers for their time. You can also handwrite a note if you want and ask the secretary where to address it. Don’t invest any emotion in it- in other words, this isn’t going to move your ranking. It’s just a nice thing to do.
  • #1 Ranking email: If you have a program that is clearly your #1 rank, then send an email to the PD expressing why they are your top choice. I also recommend sending this towards the end of the interview season, as sending it early may seem disingenuous, even if it is your #1. For some programs, a #1 email will positively influence your position on their rank list. For others, they won’t care. It definitely won’t lower your ranking though, so if you have a program that you really want to go to, then it can’t hurt to let them know. Like the thank you emails, don’t invest any emotion into it. Some programs have a strict no-contact post interview rule, so they won’t respond to your love letter. Others may just reply with a “cool, thanks”. Don’t read too much into it.
  • Top choice email: You can also email other programs that aren’t your #1, but that are still a top choice program for you.
  • Phone calls: As the rank list deadline approaches, some programs may reach out to you to let you know they’re interested in ranking you and will try to get a feel for how much you liked their program. If you really liked the program, then let them know so they can take that into consideration when they finalize their rank list.
  • Offers outside the match: This only occurs for AOA programs and no longer with ACGME programs. You may be contacted by a PD offering you a guaranteed spot in their program if you sign a contract with them outside of the match (i.e. you don’t submit a rank list). The contract is still legally binding, so think carefully. Make sure to check out the program and see if they filled all their spots the previous years. Programs that have a hard time filling may try to use this strategy to fill their spots- make sure it’s a good program that you actually would want to go to!

Post-match

  • Congrats! You matched! You have a job for the next 3-8 years! You can now sit back and relax. If you match AOA, you will automatically be taken out of the ACGME match.
  • If you didn’t match, it’s not the end of the world. There’s still the scramble (AOA) or SOAP (ACGME). For the AOA scramble, you have to cold call programs once you receive a list of available positions. For the SOAP, you have three rounds to “apply” for open positions and a limited number of positions that you can apply to. Once you finish the three rounds or if you have used up all the positions you can apply to, you’re done for the cycle.
  • If you forgo the AOA match and then did not match ACGME, you can still retroactively scramble for any open AOA positions, although there will significantly fewer positions available by that time.
  • AOA programs are legally obligated to email you the contract within 10 working days. Check your email frequently that you listed on ERAS. They’ll be using that to communicate with you.
  • Hopefully you scheduled the last half of fourth year to be easier (I know I did), and it’s not jam packed with any sub-I’s! Trust me, you’ll want to take it easy after matching.

Fourth year is both incredible stressful and laid back. The summer months are the worst since you’re getting ready to submit your application, doing audition rotations, and studying for board exams. Then you’re traveling for interviews for months and months and you feel like it’s never going to end. Things start to finally calm down after the last interview and of course when you find out where you’re going for residency. Fourth year is really one hell of a ride. I’m glad the worst is over! If you guys have any questions, feel free to shoot me an email or comment below.

-NB

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