DIP Episode 389 - My Thoughts On The ERAS 2022/2023 Match Cycle

Okay, welcome. My name is Divine. This is episode 389 of the Divine Intervention Podcasts. And into this podcast, I'm going to be talking about roles for the upcoming 2022-2023 March cycle. I promised that I'll meet the spotcast a few weeks ago, so now I'm getting to it. I'm very busy with the disk school, so that's taking a lot of my time and also have a lot of other commitments. But if you're taking step 2, see course step 3 anytime soon, I do have an NV Me test taking strategy scores that is going to be taking place next week Friday on the 20th of May. It's going to be taking place from 5 to 7 30 pm Pacific Standard Time. And there's tons of people that are taking these courses that are founded to be extremely helpful. And then I also have a 20 hour review course that's going to be taking place on the 21st. That's a Saturday and on the 20th, which is also Saturday of May. It's 20 hours total. 10 hours will be on day one, the 21st. 10 hours will be on day two, the 20th. And we're going to be taking multiple breaks in between so people can get an opportunity to kind of cool off their minds. I decided to put it over the weekends so that people can attend that hour on the rotations. Again, we'll review a lot of neurology, internal medicine, OB-GYN, psych, pediatrics, biostatistics, ethics, multi-systems processes and disorders, healthcare systems, professionalism, communications. Again, you know me. I'm not very big on giving lectures.

Almost exclusively the whole course is going to be these don't clinical scenarios and examples. And again, I'm not just going to be giving you all these facts and three facts at you. I'm going to make sure I explain pathophysiology. I'm going to make sure that I explain pathophysiology. Okay, so if you're interested in any of these courses, just shoot me an email through the website and I'll give you some more information. So now, what are some key things in no particular order? Now the first thing I will say is you need to have your recommendation letters ready. I'm telling you this, one thing people don't realize is that the residency admission process is getting more and more competitive every single year. Don't get me wrong. Can you get interviews? Can you match if you don't have your complete number of recommendation letters? You can absolutely match. You can absolutely get interviews. Not a big deal. But the thing is for a process that is competitive, you want to put yourself in a situation where you don't have anything that it can compare you like they can say, oh, I'm comparing you with this other person. Well, this other person has this little advantage that you don't have. And because of that, your application is moved lower. So I'll encourage you. The thing is really doing well with this application cycle many times. It's just about being proactive. The thing is, unfortunately, many people are not proactive. Many people are unfortunately not proactive.

You got to be proactive. So get just get your recommendation letters ready. You see some people, their request recommendation letters very late in the process. You shouldn't do that to yourself. Try to get those letters early. If in fact, if people write the letters and the upload it, and it's still like two or three months before your application can be submitted, that's fine. It's better to have that recommendation letter ready than to have it come in late or not coming at all. Because again, and another benefit of getting it early is let's assume there is this person that is a famous letter writer. Chances are you're not the only person asking them for rec letters. There's probably like 20, 30, depending on the individual 50 other people asking them for rec letters. In those circumstances, it'll be profoundly helpful if you give them a lot of notice, right? So that you don't put them under pressure as well. Oh, please generate this letter for me. Please generate this letter for me. Now, one thing I also say that is helpful if you can swing it is get a few more recommendation letters than you think you need. Get a few more recommendation letters than you think you need. Because the thing is, say for example, your discipline needs three recommendation letters. It's not about I get to get like four or five. Because the thing is you may get a sense that, hmm, man, all of these recommendation letters I got is maybe not the best recommendation letter in the world.

In those circumstances, it'll be helpful to like say, okay, I'm going to swap out this one with this other one that I have. Right? And the thing is, obviously, if there's a program you really want to go to and you know someone that can write to your personalized recommendation letter that they can upload on ear as that you can attach to your application for that specific program, that's also not a bad idea. Again, it's something in most cases you do not need to do or you can do it. Just make sure when you're doing that, that you do not attach that recommendation letter personalized to that institution to another institution. Obviously, there's going to be a huge massive issue because essentially telling them that, oh, I love this institution more than others, right? You don't want to torpedo your application in that way. So again, it's something that is really necessary for people, but it's something that will not be a bad thing to do. Okay. Now, if a person, if a letter writer says write your own recommendation letter and I'll edit and sign off on it, you should take that opportunity with both hands, right? Because again, I know many people are squirmish about writing recommendation letters about themselves, but it can give you a very good way to reflect on your strengths, reflect on your weaknesses and put them down on paper, right? So because the thing is, again, the person that is no one knows you as well as you know yourself, right?

So it may sound a little bit counterintuitive, but you're probably much better at writing recommendation letters for yourself than another person that maybe is not your parent or doesn't know you that well. Now, the next thing I want to comment on are you exclinical experiences, but I guess maybe let me say something real quick. In terms of recommendation letters, obviously, you shouldn't ask the letter writer, oh, I would like to see the letter. No, if they say, oh, I'm going to offer to let you see the letter. So you can take a look. That's fine. But you shouldn't be the one saying, oh, please, I would like to see the letter you wrote for me. You cannot, you shouldn't do that. That is just not good for you. Now, the second thing I want to talk about are US clinical experiences, right? So right now, we live in a situation, right, with COVID and everything where there are online clinical experiences and there are in-person clinical experiences. Obviously, the thing that makes the most sense to do is an in-person clinical experience. Again, I will say, especially with this cycle, if you have the ability, try to do an in-person clinical experience, right? Because they just carry more weight than an online clinical experience. But obviously, the only options you have, the only option you have is getting an online US clinical experience.

Then by all means, get that online US clinical experience because for some people, that's really the only way they can get recommendation letters, right? And the thing is, one thing I've noticed, because again, I've worked with lots of international medical graduates. One thing I noticed with international medical graduates is they do more US clinical experiences than they need. You see, for example, you see a person, they have like seven observerships in the US. Let me tell you this, you're wasting your time. You don't really need many of those things. For most IM Gs, all you need are two or maximum three US clinical experiences and you are more than good to go. You have more than enough of what you need, right? So, I will encourage you, if you have international medical graduate, get a US clinical experience if you can, right? But again, don't go overboard. Doing five, six or seven, right? It's not particularly helpful. It's not particularly helpful. Okay. Now, one of the things I want to comment on from the application perspective is limit how much you write on your experience descriptions. I can tell you how many times I've seen this and this is a very common problem that I've seen with applications. You see people directing paragraph after paragraph after paragraph to describe their clinical experiences. No, you don't do that. The thing is, when you are trying to part your application, the people that are reading the application will know.

Again, I've been on an admissions committee before. When the person is trying to part an application, you can see right through it. The entire committee will see right through it. Like, for example, a very common mistake I see amongst people is you'll see them. Let's see. They did like five observations at different hospitals. They will write that hospital. They write, oh, observation in this. And then they'll write one large paragraph. And then for the next place that they had, oh, the next hospital they did an observation. You're right. They're not a large paragraph. That is the same thing. Or, unless they did like three internal medicine observations. Again, they'll write all these large, large, large paragraphs. The thing is, people will know that you're just trying to bulk up your application. Again, that thing can come off the wrong way for certain individuals. So I'll encourage you to be succinct in describing your experiences. Now, the other extreme is also the bad situation. I've seen people where they don't describe an experience. They just put nothing on them. No, right? But the key thing is try to be at least creative in your experience descriptions. You know, if you have a few sentences, that's fine. We're writing like paragraphs and tons and tons and tons of stuff is just not ideal. That's one thing I'll definitely tell you, right? So again, and if possible, try not to write the same thing for every single experience.

You see some people who don't have ten observations and is literally like a copy piece for every single one. Again, that comes off the wrong way to a residency selection committee member. Okay. Now, the next thing I want to comment on are bullet points versus just writing like a series of sentences. The thing is, there is nothing wrong with using bullet points. But there are some people in admission circles that prefer that you write out proofs, not bullet points, right? Again, for many people, bullet points is not a problem. But again, your application will be falling to the hands of the few people that don't like bullet points. The thing that in general works in more situations than not is not using bullet points. So I encourage you don't use bullet points for your application. Just go ahead and write sentences together. Okay. Now, what is the next rule I want to discuss? Make sure you take step two. Again, is taking step two absolutely necessary before the era's application is submitted? No. What is this something that can help you tremendously? Yes. The only kinds of people that I will say that they can point step two to some time down the line in the application cycle are people that have extremely high step one scores. Well, surprise surprise as you know, step one scores are now being reported as pass fail. I mean, obviously, if you took it from the January of this year. So strongly encourage you.

I'm telling you this, you are significantly shooting yourself in the foot. If you don't have a step two score before you apply for residency programs, whatever you can do to make it happen. Try to get your step two done. At least with the deadline this year, you probably have up until like the first week in September to take step two to get your scores back in time before the era's application is open for submission. Before you know, programs can start, let me not say open for submission because it opens for submission much early in the process, but like programs can start downloading the application. So again, I will strongly encourage you. I'm telling you this, even if you have a high step one score, take step two. I'm telling you this past cycle and the cycle before it. There are many people that have, let me not say many people, but a decent number of people that had high scores that did not match. Again, put yourself in every position to succeed. Like literally, the match is one of these strange processes that every year it does not get easier. Every year it gets harder. It gets harder every single year. So I will strongly, strongly, strongly encourage you if you can. Take step two and have that score in hand before you submit your application. Again, obviously, if you are not ready for the exam or your circumstances of life arise and you can take it before then, that's fine. But I will strongly encourage you if you can have a step two suitcase score in hand.

Very, very helpful. Now, one thing I will say that is optional. So this thing I'm going to say right now is optional. It's not something that is absolutely necessary, but it would be helpful is if you have a step three score. So if, for example, this advice, this optional advice I'm giving, and for people that are IM Gs that have graduated. If you are an IMG, and you've graduated from medical school in your home country, then you are eligible to take step three. If you can take step three, if you have the ability to take step three, there is nothing wrong with that. There is nothing wrong with taking step three. In certain select circumstances, having a step three score can actually be quite helpful to the application of an IMG. But this, again, I'm going to say this, this is entirely optional. In fact, you probably don't need to do step three, at least, you know, with your application. But again, I'm telling you this, there are certain programs that look favorably on an IMG that has a step three score in hand. They look favorably on an IMG that has a step three score in hand. Because why would some programs have this as almost like an informal requirement? Let me explain. The thing is to obtain a state license, to practice as a physician in most places in the US. You need to have a step three score.

Now, one common thing I've seen arise with many, not just IM Gs, but also like US medical graduates, that you see them being either fired from residency or being placed on mandatory leave in residency is because they are failing step three. So the thing is, if your person that has already graduated, you're eligible to take step three. And the program sees that, wow, this person has a step three score. You look to upon as a lower risk candidate than a person that does not have a step three score. But again, like I said, this is absolutely optional. I've seen many people have worked with. I mean, I'm seeing a lot of these things based on experience that I have because I work with tons of students every year, tons of people that are applying for the residency match. And again, some programs definitely. There's a program that literally will rank you just because you have a step three score. If you're an IMG, I've already graduated from medical school. So just something you want to keep in mind as you prepare your application. But again, it is entirely optional. It's not absolutely necessary. There are many more important parts to your application than a step three score. Now, the other thing I'm going to say is for people that are studying for people that are applying, right? In taking step two, I'm just putting this as like sidebar advice. Have a decent size dedicated period, right? It's really appalling. I hear this happen sometimes.

You see medical schools in this day and age, not giving their students a dedicated period to study for step two. The thing is, many medical schools don't realize that step two has gotten much harder as an exam. It's a way more intense exam. Now that step one has gone the path of pass fail. You see people that are like, man, I just took step two and I felt like I was guessing all through the exam, right? So the thing is step two is not like, let me just sit down and study for two weeks and I'm fine. No, step two is an exam that on average, again, everyone's mind needs various. I mean, there are some people where they don't even need any dedicated period and they're fine. Well, for most people in my experience, taking at least four weeks to study for step two is very prudent. Taking at least four weeks to study for step two is very prudent. Now, the next thing I want to say with applications are birialistic, birialistic, right? So if, for example, your scores are like, wow, I got a 220 on step one and I got a 230 on step two and you just applied to ortho programs. There is a very good chance that you will not match. That is just the truth. I feel like many people, unfortunately, tend to be unrealistic. You got to be realistic with this application process. So if you have mid lane scores, have backups, have backups. But here's the thing, as you're having backups, make sure you have almost like two separate applications.

You want to have separate letters of recommendation, right? Because again, you don't want to muddy things up and the thing is when you applying backups, keep those backups to yourself. You don't have to broadcast it on radio, on TV, on cable, on the internet that, ooh, I'm applying to this and I'm doing this as a backup. No, no one needs to know what you. No one needs to know what you. Again, don't muddy up your application. And again, I'm telling you this, telling you this, the match cycle because it's so competitive, it brings out the worst in people. You see people trying to sabotage the applications of others. That's why I tell people this. There's nothing wrong with being a private person. Being a private person, many times, is a smart idea for most people. Okay. Now, the next thing I want to say in terms of application, apply to a good number of programs. Apply to a good number of programs. The thing is, back in the day, I used to tell people that, oh, if you have high scores, you don't have to apply to that many programs. Just apply to a few. I mean, I remember myself, back in the day, when I was applying, I think I maybe applied to like 15 programs or thereabouts. Either 15 or 20 programs, I applied to ID, I applied to many programs at all. But if I were going through the cycle now, I would certainly not give that advice. I will certainly not give that advice.

Again, I have close tabs on the trends that happen with the era cycle because I just work with a lot of people. I know a lot of residents. I know a lot of people in that space. So the thing is, apply to a good number of programs. Why? The reasoning behind that is we're going to go through another Zoom cycle. Many programs have seen how awesome it is to do interviews over Zoom. They don't have to prepare, they don't have to find a competition for people coming in, they don't have to get all the snacks and lunch for people coming in for interviews. They can be in the comfort of their office, they don't need to book a special room for this or that. So Zoom cycles are pretty much here to stay. That is just the truth. Even if COVID has eased up in the US, Zoom cycles are still here to stay. So to be honest with you, because Zoom cycles are the order of the day, people can interview at more programs than the normally interviewed at. And programs can interview more people than the traditionally interview. So if you look at it, let's say you're a program that, oh, before Zoom interviews were a thing, you could only interview like 500 people just because you didn't have that much in the way of manpower to interview more than that. But now we zoom, you're like, oh, this is easy. We can interview 2,000 people. If that's the case, you're going to have more selection ability. And because you have more selection ability, that may skew the rank list that you make up.

And that can also from the medical students perspective skew how they make their rank lists. Right? So the thing is, my belief is that these technicalities, because of the volume of interviews that programs can now do, and the volume of interviews that applicants cannot participate in, my belief is that that has skewed the NRMP algorithm. Right? Because again, these stories of, wow, this person had high scores. They did not match. I've seen it to be more pervasive last year with the era cycle. And this year with the era cycle. So I encourage you, even if you have high scores, apply to a decent number of programs. Trust me, like it's better to spend the money and match than to say, let me pinch pennies and not much. If you look at it from an opportunity cons perspective, again, I know people like it's not all about the money. But at least you need to consider the money. Because again, this is not all about the money. That is one of the things that has contributed to physicians getting mistreated really in this country. Right? So you need to consider that. Right? So because think about it, if you have to reapply in another cycle one, your chances of matching are reduced quite significantly. That's one, if you're participating in the cycle again. But two, you're also missing out on a year of a physician salary. If you're going into a discipline like internal medicine, let's say at the basis, at the baseline is like 200,000. Right? You're missing out on that one year of salary.

If you invested that money, it could turn into multiples of that. So I'll encourage you, right? It's better to spend the money. I know people will be like, wow, so many programs, how do I afford it? But it's typically prudent to put your best foot forward. Again, obviously people have financial challenges that they face. Right? But basically here's what I would say. Apply for as many programs as you can reasonably afford. Because think about it, at least, for most of the cycle, you don't have to fly. You don't have to do too many things. Right? So apply for as many programs as you can reasonably afford. Again, please take all this advice I'm giving you with a grain of salt. If I should have said this at the beginning, again, no one knows everything. I mean, be telling you wrong information here. But what I'm speaking from is based on my own experiences, based on experiences that I've had myself and on experiences from working with lots of people that have gone through this process and have been successful. Right? I've worked in lots and lots of people that have gone through this process. So again, apply to as many programs as you can reasonably afford. Right? And again, be realistic if I need your application. Right? Again, if you know your scores are really low and your application is just filled with top 10 top 20 programs, again, you're kind of setting yourself up for failure. Right? You're kind of setting up yourself for failure.

I've seen some people, I reviewed your applications and I'm like, wow, this person's application is not stellar at all. But you see the kinds of programs they're applying for. They're like, wow, what is going on here? So again, you got to be careful. Now, one thing I also want to say is for people that are going through the match, you know, let's say they've gone through the match before and they only matched into a prelim or something. I will encourage you keep an eye out for our spots. Our spots are spots that pop up all through the year. Where it's like an out of cycle spot, it opens up with a program and they can interview you rapidly and get into the program quickly. So keep an eye out for that. It's pretty common in anesthesia. It's pretty common in radiology. So keep your eye out for those kinds of opportunities. Now, for people and I want to say something for people that match with this past cycle, but it didn't match into their discipline of choice. So let's say for example, they applied into dermatology or neurology or radiology or anesthesia and you only matched into a premium program or a TY program. Let me give you some advice. Do good clinical work because many times when people match into something they don't want to go into. They're like super jaded. They're like, man, I matched into this thing. I didn't want to do. Resist that temptation. Do clinical work. Try to do well on your in training exam.

The thing is, when off cycle spots open or in like these off cycle are spots when they open, many of them will give you very favorable reception if you've done well. If you've done well from a clinical perspective at the premium program you've started, or if you've done well from an in training exam perspective, many times these off cycle spots, they'll ask you, oh, can you give us some of your evaluations you've gotten from rotations that you've done in residency? Obviously, those evaluations will be good reflections of the level and the quality of work you've done as a resident. And again, if you just matched into a premium and you're getting through the cycle again, for sure, for sure, make sure that you have a step three score. Programs are very low to look at your application favoritly. If, oh, you only matched into a premium program you didn't match into what you really wanted. And then, for whatever bizarre reason, you've not taken step three. That's a big no-no program. Again, I've worked with many people that have been through many of these kinds of scenarios. I assure you, if you just matched into a premium and you're planning to go through the match again, make sure you have a step three score. Make sure you have a step three score. And then, finally, I'll just say again, make sure you prepare a good application. I've made many podcasts on how to prepare a good application.

So just look for them on the website, or look at the spreadsheet that I have on my website on the exam topic lists. It's a spreadsheet. If you look, you'll see a part that talks about applications. I list out the podcasts that I've made for application purposes. So thank you for listening to me today. Again, as I do at the end of every podcast, I do offer one on one tutoring for all the USMN exams, step one, step two, CK, step three, preclinical medical exams, third-year shelf exams. And I also offer consulting with the ERAS application process. So like, I help with personal statements, recommendation letters, letters of interest, supplemental applications, because I know supplemental applications were a thing for internal medicine programs last year and some other residences. But more residences are beginning to embrace supplemental applications, especially for this cycle. So I help with all those things. And then I have these podcasts on Apple podcasts on Google podcasts and on Spotify, at least the most recent 150. If you want everything from episode one, all the way to episode 389, go on the websites, divineinterventionpodcasts.com. If you actually subscribe to the website with your Word Press account, you will get an email notification whenever I make a new podcast. And then also have a You Tube channel called divineintervention, USMN podcast and videos. That's where I post the videos that I make.

And then finally, I also have this new website called divineinterventionlifelessens.com. That's a website where I post Bible-based podcasts. There about, you know, many people said, oh, divine, I love the life lessons you please at the end of your podcast. So I decided to start a new website and on that website, I put a lot of Bible-based teaching. Most of the podcasts are like 10 minutes longer or less. And I address a common problem that's faced by humanity from a biblical perspective. So it's called divineinterventionlifelessens.com. If you actually go on Apple podcasts, you can actually find it as the divineintervention life lessons podcast. So thank you for listening to me. Have a wonderful rest of your day. I'll see you next time. God bless you. Thank you.

Request them early (months in advance) to avoid putting undue pressure on busy faculty members.

No; do not initiate asking to see the letter. Wait for them to offer it voluntarily.

In-person clinical experiences, as they carry significantly more weight than online ones.

Two to three; going overboard (5-7) is unnecessary and wastes time.

Writing large, repetitive paragraphs or using the exact same description for every single site.

They must use separate letters of recommendation and keep the backup plans private (do not broadcast them).

Early in the application cycle, giving ample notice to the writer.

It provides flexibility to swap out a weaker letter for a stronger one if needed.

It forces self-reflection on strengths and weaknesses, which is often better than relying solely on others' perspectives.

In-person experiences are preferred over online ones, but 2-3 total are sufficient; do not overdo it.

A Step 3 score.

Narrative sentences are generally preferred over bullet points by the majority of committees.

Early in the application cycle, giving ample notice to the writer.

It provides flexibility to swap out a weaker letter for a stronger one if needed.

It forces self-reflection on strengths and weaknesses, which is often better than relying solely on others' perspectives.

In-person experiences are preferred over online ones, but 2-3 total are sufficient; do not overdo it.

A Step 3 score.

Narrative sentences are generally preferred over bullet points by the majority of committees.