A residency application is a key step on your way to practicing medicine in the US. It determines the first impression you make on program directors (PDs) and inevitably affects your chances to match.
We’ve made a list of 10 common mistakes IMGs—and not only IMGs—make when applying for residency that our Blueprint residency counselors often see. Don’t worry, we’ll follow up each mistake with some tips to proactively correct them and set yourself up for residency success!
1. Lower than specialty average USMLE/COMLEX scores and/or multiple attempts
I’m mentioning this first because it’s so common, and not only limited to IMG applications. Lower than average scores on standardized exams often lead to program directors passing on your application outright.
Let’s briefly take a look at the numbers: there are often hundreds if not thousands of applicants applying for a select few spots at a residency. There’s no way to efficiently review every individual application, so filters are often used as a screening tool. One of the first, easiest, and most objective filters is your standardized exam score.
Not all hope is lost, however, as applicants with lower than specialty average scores and/or multiple attempts on exams may be given a chance to interview—but only if their application makes it through the filter. And then, it’s up to the applicant to really impress PDs during their interview. Keep in mind that programs will certainly need a good explanation for the applicant to have a chance at matching.
The fix?
There was a time when you could retake a USMLE Step exam in hopes of earning a higher score. But now, Step 1 is completely pass/fail, and for Step 2, your score is locked in the first time you pass the exam (at least for seven years).
Work with your score and strengthen other aspects of your application such as having more research publications, leadership, or other awards that showcase your academic prowess. This will help minimize your low score and allow you to shine in other aspects.
Furthermore, be sure to address and explain a low score in your application, personal statement and interview if possible. If your Step 2 exam score was low and likely the reason you didn’t match this cycle, take your time to study hard and conquer Step 3/COMLEX Level 3 for the next application cycle. A strong score on the first attempt will demonstrate your improvement with standardized tests to PDs.
2. Errors on ERAS (intentional or unintentional)
When filling out your ERAS application, it’s tempting to embellish a role or accomplishment to make yourself stand out. For example, stretching the truth about being the treasurer of a club you only briefly assisted during your MS1 year may seem harmless.
However, exaggerating or falsifying accolades and experiences can severely damage your credibility. While residency Program Directors (PDs) review thousands of applications each cycle, inconsistencies or vague descriptions won’t go unnoticed. Exaggerations or falsehoods can lead to uncomfortable questions during interviews or, worse, disqualification. Programs value honesty and integrity over overstated accomplishments.
Common Pitfalls to Avoid
Overstating
Claiming you “led or founded a groundbreaking research project” when your role was primarily bench work.
Vague Descriptions
Writing “actively involved in volunteering” without specifying your exact role, responsibilities, or the impact of your contributions.
Falsifying Achievements
Listing awards, positions, or activities you didn’t actually earn or participate in or don’t even exist.
The fix?
Start Early
Begin drafting your ERAS application well in advance to allow ample time for reflection and editing.
Be Honest and Specific
Describe each experience accurately. For example:
Instead of: “Managed a large research project”
Write: “Assisted in data collection and analysis for a study on Type 2 diabetes, contributing to a publication in NEJM.”
Or consider:
Instead of: Vaguely mentioning “volunteer work”
Write: “Organized weekly health workshops for underserved communities, educating 50+ attendees on nutrition and preventative care.”
Don’t take the application lightly, and don’t falsify or exaggerate information. Take your time to review every aspect of it, from the personal statement to the extracurriculars. Have an experienced set of eyes—your mentor, attending or medical school dean—review it. (We are also here to help!)
3. Unexplained Gaps
Gaps in your medical training or work history can raise concerns for programs. Whether it’s time taken off for research, family commitments, health, or personal reasons, leaving these periods unexplained in your application may lead to doubts about your commitment or readiness. However, gaps themselves aren’t the only issue—it’s how you address them that matters.
PDs value applicants who are honest and proactive. Gaps left unexplained may lead them to speculate about your professionalism, reliability, or preparedness for residency. A well-addressed gap, on the other hand, can highlight your resilience, how you managed to push through adversity and show your dedication to personal and professional growth in the field of medicine.
Common Pitfalls to Avoid
Ignoring the Gap Entirely
Leaving a year or more unaccounted for without any mention or context.
Being Too Vague
Writing “engaged in personal development” without elaborating on specific activities or outcomes.
Omitting Relevant Experiences
Not including meaningful volunteer, clinical, or educational work done during this time.
The fix?
Acknowledge the Gap
Be upfront about the period in question. Avoiding it entirely may make it seem like you have something to hide. Use your meaningful experience section or a portion of your personal statement to explain it.
Example: “Took a year off to care for a family member while staying engaged in clinical medicine by volunteering at a local clinic.”
Example: “Dedicated a year to completing a research fellowship in cardiology, focusing on advancements in heart failure management.”
Highlight Productive Activities
If you used the time for clinical work, research, volunteering, or self-improvement, emphasize the skills and experiences you gained.
Use this opportunity to demonstrate how the time off contributed to your development. Whether through certifications, shadowing, or personal growth, show that the gap made you a stronger candidate.
Be Honest, Yet Strategic
If the gap was due to personal reasons (e.g., illness or family commitments), provide a concise explanation and pivot to what you’ve achieved since.
Example: “Took a brief hiatus to address family obligations, during which I completed an online course in medical ethics and remained engaged by attending weekly grand rounds and presented on X topic.”
Starting your residency application can feel daunting, with a multitude of aspects to consider and the pressure to do well. If you’re applying to residency soon and aren’t sure where to start, download the FREE Residency Application Timeline to stay on track and make sure your top programs receive your very best residency application!
4. Inadequate Letters of Recommendation (LoR)
For most residency programs, you will need a minimum of three letters of recommendation, with ideally two of them coming from physicians in your desired specialty. PDs prefer to read letters that are positive and personalized.
Common Mistakes
Submitting Generic Letters
Letters that fail to highlight specific skills or experiences, reading more like a template than a genuine endorsement. Generic or poorly written letters can leave an impression that your evaluators don’t know you well or aren’t confident in your abilities. Strong LoRs, on the other hand, can provide crucial insight into your skills, professionalism, and readiness for residency.
If you’re looking for more help with IMG letters of recommendation, check out these guides from Blueprint!
Lacking Specialty-Specific Letters
Not securing letters from physicians in your desired specialty, which signals a lack of focus or preparation.
Ignoring Program Requirements
Overlooking specific letter requirements, such as needing four letters or a chair’s letter for certain programs.
Underutilizing US Experience
IMGs often miss the opportunity to secure strong letters from US-based physicians, which can carry more weight in the application process.
The fix?
Start Early
Reach out to potential letter writers well in advance. Provide them with enough time to write a thoughtful and detailed letter.
Build Strong Relationships
Cultivate relationships during clinical rotations, electives, or externships. Demonstrate your skills, professionalism, and dedication so that your evaluators have concrete examples to include in their letters.
Example: Instead of a generic letter saying, “The applicant is a good team player,” a strong letter might say, “During a complex case involving a patient with multi-organ failure, the applicant demonstrated excellent critical thinking and effectively collaborated specifically with the social worker to ensure that our medical team had a proper discharge plan.”
Track Requirements Carefully
Make a list of each program’s LoR requirements, including how many letters are needed and whether specific ones (e.g., a chair’s letter) are required.
Example: “Program A requires 3 letters, including 1 from a department chair. Program B prefers 4 letters, with 2 specialty-specific.”
Follow Up Politely
If you’ve requested a letter and haven’t heard back, send a polite reminder well before the deadline.
5. Poorly-Prepared Personal Statements
Personal statements are your opportunity to present your story to programs. They can offer insight into your personality, motivations, and fit for the specialty. Yet, many applicants fall short by submitting statements that are generic, lack substance, or—worse—contain falsifications.
PDs often use personal statements to evaluate applicants beyond their grades and experiences. A compelling statement can humanize your application, making you memorable in a competitive field, especially if you have a gap in education or lower than average score. On the other hand, a poorly written or uninspired statement may result in your application being overlooked.
Common Mistakes
Generic Content
Writing vague or cliché statements such as “I want to help people,” without providing specific examples or personal anecdotes.
Lack of Focus
Failing to explain why you chose your specialty or how your experiences align with it.
Falsified Claims
Including exaggerated or untrue stories, which can backfire during interviews.
The fix?
Focus on Clarity and Simplicity
Use clear language and avoid overly complex sentences. A straightforward, well-structured narrative is more engaging than flowery or verbose prose.
Proofread and Edit Thoroughly
Read your statement multiple times.
Have trusted friends, mentors, or an English teacher review it for clarity, grammar, and flow.
Instead of: “During my medical career, I learned teamwork is important.” (Too vague.)
Write: “Collaborating with a multidisciplinary team, from the dietician to the therapist, during my pediatrics rotation taught me the value of teamwork in improving patient outcomes.”
Tailor It to the Specialty
Write a unique personal statement for each specialty to demonstrate your focus and dedication. Avoid applying to multiple specialties with the same statement.
Seek Professional Feedback
Share your draft with someone experienced, such as a mentor, dean, or faculty advisor. They can provide guidance on tone, structure, and specialty alignment.
6. Inadequate US clinical experience (USCE)
Most US programs prefer applicants with US clinical experience time, often mentioned on their website (for many, it’s three months of USCE at minimum).
Having adequate USCE demonstrates that you can function effectively within the US healthcare system, adapt to its protocols, and communicate well with patients and multidisciplinary teams. It also allows program directors to assess your clinical readiness and fit for their program. Specialty-specific USCE adds credibility to your commitment and suitability for that field.
Common Mistakes
Insufficient Time in USCE
Having less than the preferred duration of clinical experience in the US is an outright disadvantage that will put your application well behind other applicants.
Mismatched Experience
Completing USCE in a specialty unrelated to the one you are applying for, such as having radiology USCE while you actually plan to apply to pediatrics.
Underestimating the Value of USCE
Assuming other accomplishments can substitute for direct US clinical exposure, which is rarely the case.
The fix?
Secure Relevant USCE
Prioritize rotations, externships, observerships, or clerkships in the specialty you are applying to.
Example: If you’re applying to internal medicine, seek inpatient or outpatient experiences under internists rather than unrelated specialties like psychiatry or surgery.
Explore Diverse Opportunities
Academic Institutions: Reach out to university-affiliated hospitals offering formal externship programs. Community Hospitals: Smaller hospitals often offer hands-on experience with closer faculty interaction.
Private Practices: Community preceptors can provide valuable clinical exposure and mentorship, and can be easier to secure as there are not as many barriers to entry such as complex credentialing and training that you’d find at larger institutions.
Perform Well
Treat each USCE opportunity as a trial run for residency. Be punctual, proactive, and professional. Demonstrating excellence may earn you a strong letter of recommendation (LoR) that bolsters your application.
Start Early
USCE spots fill quickly, so plan your experiences well in advance. Ideally, complete your USCE at least a year before applying to residency to ensure your LoRs are ready.
Track and Highlight Your Experience
Clearly document your USCE on your ERAS application. Specify the type of experience (i.e. externship or observership), location, supervising physician, and duties performed.
Example: “Completed a 6-week internal medicine externship at X Medical Center, managing patient histories, presenting cases, and participating in interdisciplinary rounds with supervision under Dr. Z.”
7. Visa-Related Barriers
For IMGs, licensing and visa requirements are essential considerations in the residency application process. Even a stellar application can fall short if these elements are not addressed. Residency programs have varying policies on visa sponsorship, and some specialties are more accommodating than others.
Common Mistakes
Assuming All Programs Sponsor Visas
Not all programs are equipped to sponsor J-1 or H-1B visas, leaving some applicants ineligible despite their qualifications.
Overlooking Specialty-Specific Trends
Applying to competitive specialties with fewer IMG-friendly programs without proper research.
Not Verifying Licensing Requirements
Failing to meet state-specific licensing prerequisites, such as a required number of USMLE attempts or a certain duration of USCE.
Let me emphasize—Visa status and licensing prerequisites are non-negotiable factors for program eligibility. A lack of alignment between your visa needs and program policies can result in wasted application fees and missed opportunities.
The fix?
Research Program Sponsorship Policies
Review individual program websites for visa sponsorship details. Many IMG-friendly residency programs explicitly state whether they sponsor J-1 or H-1B visas.
Track Licensing Requirements by State
Each state has unique licensing requirements for IMGs. Some states require a minimum duration of USCE or limit the number of USMLE attempts. Familiarize yourself with these rules to avoid ineligibility.
Example: California has strict postgraduate training requirements for IMGs, whereas other states may be more lenient.
Consider Broadening Your Application Scope
Apply to a mix of academic and community programs to increase your chances. Community hospitals, in particular, often have more IMG-friendly policies. Primary care residencies also generally are more favorable to sponsoring IMGs compared to specialty programs.
8. Not Casting a Wide Net
Applying to residency programs is a numbers game as much as it is about strategy and fit. Limiting your application to only a few programs, even if you have stellar scores or specific geographical preferences, significantly increases the risk of not matching.
Have some “safety” programs to increase your interview invites and your changes at matching because residency is a competitive process with many possible outcomes. Programs assess many variables beyond scores, such as fit, interview performance, and institutional needs. Applying narrowly can leave you vulnerable to unexpected outcomes, such as being waitlisted or passed over for other candidates.
Common Mistakes
Overconfidence
Believing high scores or strong credentials guarantee acceptance into top-choice programs.
Geographical Restriction
Applying only to programs in one city or region without considering alternative areas.
Neglecting Backup Options
Not including a range of programs, from dream programs to safety options.
The fix?
Apply Broadly
The NRMP recommends applying to at least 10 programs for less competitive specialties and significantly more for competitive ones. For competitive specialties like dermatology or orthopedic surgery, 40+ applications is typical.
Include Backup or Safety Programs
Select a mix of dream, target, and safety programs. Safety programs should still align with your specialty and career goals, but have less stringent criteria.
Be Strategic About Where You Apply
While it’s understandable to prefer certain locations, restricting yourself to one city or region is risky. Cast a wide net geographically to improve your odds.
Example: If you prefer living in Texas, apply to programs statewide rather than limiting yourself to Houston or Dallas.
Treat Every Program Seriously
Even backup programs deserve your full effort. Prepare tailored applications, interview professionally, and avoid signaling disinterest.
Understand Specialty Match Rates
Research the historical match rates for your specialty and adjust your application volume accordingly. Competitive specialties like plastic surgery, dermatology, and neurosurgery often require significantly more applications.
Example: Pediatrics has a relatively high match rate, so applying to 15-20 programs might suffice. For orthopedic surgery, 40+ applications would be prudent.
If nothing else, don’t forget about the SOAP!
9. Communication Issues
Effective communication with residency programs is essential, but can often be mishandled. Reaching out can highlight your interest, professionalism, and enthusiasm, but overstepping boundaries or failing to engage strategically can actually hurt your chances.
Common Mistakes
Lack of Outreach
Assuming that submitting an application is enough to convey interest.
Overcommunication
Sending multiple emails a week or bombarding program directors without significant updates.
Generic Messages
Failing to personalize communication, making your outreach appear insincere or lazy.
Missing Opportunities to Follow Up
Not reaching out after interviews or when significant updates arise.
The fix?
Research Programs Before Reaching Out
Before contacting a program, thoroughly review its website, mission statement, and faculty interests. Use this information to tailor your communication.
Follow Up Post-Interview
After interviews, send a personalized thank-you email. Mention specific topics discussed during the interview to reinforce your interest.
Provide Updates When Appropriate
If you have significant updates, such as passing USMLE Step 3, completing a major research project/publication, or gaining additional clinical experience with a new letter of rec, communicate these to the program.
10. Research Expectations
For many residency programs, particularly those in competitive specialties, research experience is more than a “nice-to-have”—it’s close to essential. Ignoring this expectation can leave your application overlooked, even if other aspects are strong.
Residency programs, especially in competitive fields like dermatology, radiation oncology, or orthopedic surgery, value candidates who demonstrate intellectual curiosity and a commitment to advancing their specialty. Research shows your ability to analyze problems, collaborate, and contribute to the field beyond clinical practice.
Common Mistakes
Underestimating Research Importance
Assuming strong clinical experience or scores can compensate for a lack of research. It cannot
Last-Minute Research
Attempting to cram research into your CV late in the application process, resulting in incomplete or superficial projects.
Misaligned Research
Having research experience that doesn’t align with the specialty or type of program you are applying to.
The fix?
Start Early
Begin building your research portfolio as early as possible during medical school. This could include basic science research, clinical trials, case reports, or literature reviews. Even small contributions matter if they demonstrate involvement and commitment.
Example: If you’re interested in dermatology, consider co-authoring a case report on a rare dermatologic condition or participating in a retrospective study on treatment outcomes.
Target Specialty-Relevant Research
Align your research with the specialty you are applying for. Programs value candidates with research that demonstrates a genuine interest in their field.
Example: For neurology, a research project exploring outcomes in stroke rehabilitation would carry more weight than a study on pediatric vaccine adherence.
Leverage Every Platform
Posters and Presentations: Even if you lack a formal publication, presenting research at local or national conferences is valuable.
Case Reports: Writing up unique or educational cases from clinical rotations can be a quick way to add research to your CV.
Ongoing Projects: Include projects in progress on your application, but clearly label them as such.
If you applied and did not match this year, closely analyze these aspects of your application. Be realistic and have someone experienced review your application in a holistic manner.
Feel free to reach out to us if you have questions! We’re always here to help.
Image by Steve Buissinne from Pixabay
