DIP Episode 617 - How To Match Into Internal Medicine (A Detailed Guide)

Alright, welcome to episode 617 of the Divine Intervention Podcasts. In today's podcast, I'm going to be addressing a very practical topic that I'm titling, How to March into Internal Medicine. How to March into Internal Medicine. To be honest with you, a lot of this advice also applies to many other disciplines, but I'm really going to hone in on internal medicine is probably the most commonly matched into specialty. That's why I think this is a podcast that you're going to find to be really helpful. And this is going to be a very detailed guide. Alright, so let's jump right into it. There are obviously multiple components, but the first thing I want to talk about here are scores, right? Scores. And again, people always ask, oh Divine, what's the score I need to get in? Well here's the thing, it's very context-dependent. It's very context-dependent. So I'm going to start off with general, a general scenario, and then I'm going to go specific. The general scenario is this. The general minimum you want to have for all comers, US medical students, residency, you know, international medical graduates, whatever. I'll say for all comers, you generally want to get at the minimum in the two thirties or higher, in the two thirties or higher. The thing is in my experience, and again, I've worked with many, many candidates over the years.

And people that I've worked with as, you know, with residency applications that I even now attendants have worked with lots of residents, lots of attendants, lots of medical students. I will say in generally my experience, if you have a decent application and you have a scoring the two thirties or higher, chances are you're going to match. There's a pretty good chance that you're going to match, right? Now let's look at the context of a US medical student that doesn't want anywhere closed off, right? Like you have a decent application, you have the research you need on all those things. Your US medical student and you're like, okay, divine, what score do I need? So I don't have any doors closed off to me. You want to look at the two forty-five's or higher, right? So it's like I want to be able to match into an elite program. I basically, I don't want to be worried that I won't be able to match into like the specific program I desire. If you have a decent application, you want to be in the two forty-five's or higher. Now for international medical graduates, if we're talking about that context, you want to look more at the two-fifthies or higher. That's the truth, right? High two forty's or higher, you know, like two forty-seven's, two forty-eight's or higher. As an international medical graduate, that puts you in a very good spot for matching into internal medicine. Again, please, these are generalizations, right?

Have there IM Gs that have matched with much lower scores than these? Yes. In fact, I've literally worked with international medical graduate that I've matched with much lower scores than what I'm saying here, right? But again, those people, they need more TLC with their, with the applications, right? Now, let's assume that you have an unusual circumstance. So, let me give this context. You have an unusual circumstance. Let's say you're like MD-PhD, you have a super strong application, you have tons of research, you have tons of very good experiences. You know, let's say like, for example, you were in the US military, right? You accomplished, you accomplished some really stellar things in your life. The thing is for these people, you can probably get away with the two thirty-five or higher on your exams, right? The thing is just in general, the better you have, the stronger your application, the stronger your application, the more leeway or wiggle room I will say you have with regards to scores. You don't have too much leeway, but you have some leeway, right? And then let's talk about the context of the kind of program. Let's assume you're trying to get into an academic program. If you're trying to get into an academic program, a two forty-five or higher is ideal. A two forty-five or higher is ideal. All right. Now what if you're trying to get into a community program? Again, a community program, I will say a two thirty's or higher is ideal. A two thirty's or higher is ideal.

Again, obviously, I want to shoot for the higher scores possible, right? So you can give yourself the most options, the better your scores, the more the life options you will have. All right. Now let's go to the second part of this, which I think is important, but many people actually ignore with internal medicine, which kind of makes me scratch my head sometimes. And that's the letters of recommendation, right? The letters of recommendation. Now the general minimum you need, you need three letters. You need three letters, right? And from those three letters, you want to have two of them come from internal medicine. And then you want to one to come from another strong patient-facing specialty, like psychiatry, for example, like psychiatry, for example, right? Like psychiatry, for example, right? Like a letter where all they are commenting on are your technical skills, you know, your skills with sutra and and stuff is not very useful for an internal medicine application, right? You know what I'm talking about, right? Now if you want a margin of safety, I would say you should try to get four just in case, just in case one is not as good because the good thing about your applications is you can get as many letters as you want. And then you can be targeted with how you assign letters. If for example, you know a letter is not strong, then maybe you don't want to assign needs to a program that you're really interested in going into. All right.

Now for international medical graduates, right? What kinds of letters do you want? You want letters from US physicians? You want letters from US physicians? I'm sorry to say, but letters from foreign physicians honestly don't really count for much. You can include them, but don't make them the central point of your application because if I'm being honest with you, they're not really going to count for much. They're not really going to count for much, right? The thing is for a foreign letter to count, that foreign letter has to have some unusual characteristics. Right? Like what are some of these unusual characteristics? Well, let's say for example, that foreign letter was exceptionally well written, right? There are some letters I've seen from foreign faculty that were like, wow, this was, you know, that I've like edited or whatever I've seen. And they're like outstanding letters. Those you can certainly include in your application, it can actually make a big difference for you, right? Another unusual characteristic that we make a foreign letter count is if it comes from like a notable school, right? So see, for example, you're a person that went to like some top flight medical school in the UK, right? Let's say you have like a letter from a professor at university college, London, or from Oxford University, right? Those are probably better than most US institutions. I can pretty much promise you that those letters will count for something, right?

Another unusual situation that makes a foreign letter count is if it's a letter from like a research mentor that you did a lot of research with, you did a lot of research with, or it's from a research mentor that is very notable in the field, very notable in the field, very well known in the field, has published really well, has been cited a lot. Then that's a letter I would say you should absolutely include with your application, right? Now one thing I want to say for people that are IM Gs especially, but also for US medical students, make sure those letters are recent. Make sure those letters are recent, right? So for example, if a person, let's say you are reapplying and a person wrote to you letters last year, have those letters updated. Don't use the exact same stuff from last year for this year. That's just laziness and it's going to bite you in the butt as you're applying for residency, right? And then what are the kinds of things you want to be discussed, right? I've edited many recommendation letters. I've done many, a lot of work with recommendation letters. What are some things you want to include for internal medicine? The thing is, first, the rec letter has to comment on the capacity in which the person worked with you. What kind of capacity do they work with you, right? You know, this person wrote it with me as a medical student who has a sub-interno, whatever, right?

And then you want the letter to comment on specifics that are important to internal medicine, right? What do I mean by that? Well, I want to, you know, things like, what's your attitude with patients, right? What's your attitude with patients? What's your attitude with patients? What's your attitude with patients, right? What are your presentation skills? What are your presentation skills, right? Let them comment on how good you are presenting your clinical reasoning because a lot of internal medicine is clinical reasoning, right? They should also talk about your documentation skills. How good are you with documentation? How good are you with documentation, right? How good are you with documentation? Because again, you're going to be doing a lot of not writing in internal medicine, right? You know what I'm talking about, right? So clinical reasoning and how do you handle feedback? I am all about feedback, feedback feedback, right? Feedback feedback feedback. How do you handle feedback, right? How do you handle feedback? How do you handle patients that may be difficult, right? The thing is, the more specific a letter is, the better that letter will be. I'm going to say that again. The more specific a letter is, the more relevant that, or helpful that letter will be, right? They should even comment on how you are relative to your peers. Are you a person that interacts with your peers? Are you a person that tries to warn up on your peers? Obviously, that's a bad thing, right?

So they need to comment on those things in letters, right? And the thing is, internal medicine, the law of substance, internal medicine, the law of substance, right? Half-page letters, if I'm being honest with you, they're not ideal. They are not ideal, right? I have seen some very atrocious letters. Again, those things are pretty much not going to be a factor in your residency application. You need good letters, right? Now, let's go to the third major bucket. So we've talked about the bucket of scores. We've talked about the bucket of letters. Now, let's talk about the bucket of the application itself. Let's talk about the application itself, right? Now, first thing I want to say, and this is something that I see so much with IM Gs, or people that have gone to a medical school in the Caribbean, is listing rotations. There are 30-year rotations as their experiences in errors. That makes absolutely no sense. Everybody is supposed to do clinical rotations when they're in medical school. Please don't do that. Please don't do that, right? So what are things to include in your application itself? Well, include your research experiences, right? Include your research experiences. And the thing is you want to comment on how these research experiences helped you grow, right? How did it help you grow as a person? How they will influence your practice of medicine? Those are things you want to comment on, right? Only briefly summarize what the project was.

You see some people, they go into tons and tons and tons of detail on their research projects. To be honest with you, that is absolutely not wise. Now the next thing you want to keep in mind here is that you want to put in substantial experiences. It is not just the research part, but just your experiences in general. The experiences they have make their way into your errors application. They have to be substantial experiences. Oh, like, oh, I did this teaching. I did this volunteering, right? Or you can list some rotations, but it has to be like an unusual rotation that, like, for example, most people do not do. Let's say you did a rotation at the CDC. That's something you should probably go ahead and mention. It's probably something that is useful, right? Or like, commit to your group work that you did that was substantial, right? You know, like, you were the leader of some group that did this thing over longitudinally over like a year or two. That stuff you want to comment on, right? But something you only did for an hour or once is not ideal, right? People are going to know that you're literally trying to party your application, right? And then in terms of geographical experiences, geographical preferences, please don't list the geographical preference and then put your reason that, oh, I just like this area, the weather is amazing. No, no, no, no, no, no, that is not going to be helpful. What should you do?

You need to explain your ties and you want to be very specific, right? Oh, I have a brother that lives here, right? Like, you want to be very specific. Do you have family in the area, right? Do you have a significant other? Did you have a significant portion of your upbringing in this area, right? Do you have a long-term desire to settle in this area? Why do you want to settle in this area? Provide that reasoning, right? What kind of support systems do you have in that area? Provide that reason, right? And again, let's talk about honors and awards, right? If you're discussing honors and awards again, include substance, include substance, right? One of the most egregious things I have seen in applications is that you see people spending copious amounts of time and giving multiple entries to them being on the dean's list when they were in undergrad. This is ridiculous. It is literally ridiculous, right? The thing is, a person that is reading an application, again, I've been on an admissions committee before, I've evaluated tons and tons and tons of residency applications, right? The thing is, people are going to see right through all that facade, include things that are substantial, right? So repeating the same thing over and over again, over and over again, over and over again, people are going to see that as an embellishment. They're going to see that as embellishment, right?

And then, you know, another big section of the application is where you talk about your impactful experiences, right? Impactful experiences. Remember, for your impactful experiences, first, you know, usually you're going to get a section to describe the experience. And then you're going to get another section to talk about why the experience was impactful to you, right? The thing is, in terms of your description of the experience, be very brief. Be very brief in describing that experience. Be very, very brief. Be very, very brief, right? Be very, very brief. Be very, very brief. And then, after you briefly described that experience, when you're not talking about how the experience helped you, right, correlate it with good reasons, right? Like, how did this experience help you grow? These are things you want to think about as your answering this question. How did this experience help you grow? How has this experience shaped you to become, to have the potential to be a good internist in the future, right? Don't be general. I'm telling you this, the name of the game with error's applications is not being general. Be specific, right? Specifically pick out one or two things that the experience did for you and comment on them, right? So like, for example, if it was a research experience, you can talk about how, oh, wow, this thing helped you, you know, growing your ability to evaluate scientific data and make useful abstractions, right?

And then you can say that all that this is going to help you. Let's say, for example, that you plan to go into him like a research heavy discipline in internal medicine, like rheumatology or whatever, you can talk about how, oh, this is something having this experience is going to help you answer even more research questions in the future, right? Or you can talk about how, oh, you know, evaluating scientific data on all these things has really helped you build your critical reasoning faculties, right? That this is going to help you in patient care, right? Because patients are going to present with all these symptoms and you're supposed to make judgment calls on them, right? You know, again, I'm kind of giving like some quich pills here, right? But you kind of get my drift in what I'm trying to, trying to do, right? And the thing is, when you're talking about your impactful experiences, I will encourage you to try to have variation, right? Don't make all your impactful experiences be all research experiences, right? They want to see that you have more to your life than just research, right? You have more to your life than just research, right? Okay. Now, the fourth big bucket is the personal statement. The fourth big bucket is the personal statement, right? What are some key things that you want to make into a personal statement that is dealing with internal medicine? Again, number one, how did you get into wanting to be a physician, right?

What make you do even decide to go into a medical school, right? And then, how did you narrow things down to internal medicine? You know, compared to other disciplines, why did you go for internal medicine, right? And then, why do you want to do internal medicine? You want to give at least four cogent reasons. You want to give at least four cogent reasons, right? And the thing is, give the reason be specific about it and then elaborate on it in like two or three sentences, right? Two or three sentences per reason, right? And then, in later paragraphs in your personal statement, you want to comment on what you are bringing to the table. Literally, what do you bring to the table? What are some personal characteristics you have? How will they positively impact your patient care? How they positively impact the residency environment, right? And then, at the tail end, you want to talk about what you're looking for in a program. What are you looking for in a program, right? What are you looking for in a program, right? And then, if you have red flags, right, you also want to address it towards the end of the personal statement. You want to address it like, you don't like a failed USMD score, whatever. Again, a failed USMD score doesn't mean you're not going to match, right? They are used to address those things, right? And the thing is, please do not overthink your personal statement. Do make it too hard to follow.

You see some people, there is almost like they are writing a Shakespearean work for their Shakespeare as a great author, but again, it's a personal statement, not a Shakespeare work, right? Okay, so you're not trying to get a Pulitzer prize for your personal statement. So just kind of be wise about those kinds of things, right? And the thing is again, it is completely okay to give cliché reasons. Many people, you see them, they think that they have to, you see them overthinking and they think they have to give like some crazy out of this world reason why they want to go into IM. No, the thing is the people reading these applications, they have seen almost pretty much every reason why a person want to go into IM. Just is all about stating things in an unusually good way. You can say something cliche, but say it in an unusually good way. And that's going to really, really help your application, right? And one thing I'll recommend is listen to episode 414, 414 on my website. I really do comment quite a bit on this whole thing with personal statement. I really go into a lot of detail on the personal statement, right? And then a few more quick things before I wrap this up. Again, something new application early, right? If possible, like I always tell people, if you know the era's deadline, where programs can start downloading your application, tell yourself that your own personal deadline is three days before that, is three days before that, right?

And then in terms of preparing for interviews, I have made podcasts on how to interview, right? Especially episode 485, right? Especially episode 485, it's a really good podcast to prep you for interviews, right? And again, I just want to say that again, in general for IM applications, you need some research, right? In terms of the lowest quality to the best quality, at least have a bunch of case reports, right? Have a bunch of case reports. If you, you know, second, you know, what is better than case reports are having like posters, if you have like poster presentations, right? And then obviously the best of the best is having like published papers, having published papers. Even if those papers have been sent in for publication and if not being published in the journal yet, you can include them as publications. All right, so I'm going to go ahead and stop here. Like if you need help with your ERAS application, you know, personal statements, rec letters, mock interviews, all these things, again, this is something I've done for years. Just shoot me an email and I can give you some more information. I've worked with many people that have matched into a residency, even with very questionable circumstances or like a lot of red flags. And then I also have a bunch of review classes in this month of August. I have like a test taking class, I have a bio stats class, social sciences and ethics class, you know, last mini review, you know, and a 20 hour step to step through review.

Again, many people have taken these classes and found them to be tremendously helpful. So I'll encourage you to the over Zoom. Shoot me an email and I can give you some more information. And then I also offer one or one to you during for all the USM million complex exams. And I have this podcast on Apple Google and Spotify. So please check those out. I also have another web, I also have a You Tube channel actually where I post the videos that I make. And then I also have another website called divine intervention life lessons dot com. Divine intervention life lessons dot com. Many of you know I'm a Christ follower of my Christian. And every week I post about one to two podcasts where from a biblical perspective, I address a life lesson. There is actually an Apple podcast associated with that called the divine intervention life lessons podcast. So thank you for listening to me today. I will see you God willing in episode 618. So have a wonderful rest of your day. Have a wonderful month. God bless you and bye for now. Thank you.

230 or higher.

245 or higher.

High 240s (e.g., 247+) or higher.

At least four specific and elaborated reasons.

Do not use vague reasons (like "good weather"); instead, explain concrete ties such as family members, significant other, or long-term desire to settle there.

How the experience helped them grow personally and how it will influence their future practice of medicine.

Patient attitude, clinical reasoning/presentation skills, and documentation skills.

Being exceptionally well written, coming from a notable school (e.g., Oxford), or originating from a highly notable research mentor.

Four letters.

Listing multiple entries for minor achievements (like Dean's List) repeatedly; this looks like embellishment.

What specific personal characteristics or skills you are bringing to the table and how they will positively impact patient care/the residency environment.

Patient attitude, clinical reasoning/presentation skills, and documentation skills.

Being exceptionally well written, coming from a notable school (e.g., Oxford), or originating from a highly notable research mentor.

Four letters.

Listing multiple entries for minor achievements (like Dean's List) repeatedly; this looks like embellishment.

What specific personal characteristics or skills you are bringing to the table and how they will positively impact patient care/the residency environment.