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, as well as some tips to correct them.

1. Low scores and/or multiple attempts on Step exams

I’m mentioning this mistake first because it is so common and not just limited to IMG applications. Poor scores on standardized exams lead to PDs passing on your application outright. Applicants with borderline scores and/or multiple attempts may be given a chance to interview. Still, PDs will certainly need some explanation in order for the applicant to have a chance at matching.

The fix?

Address and explain a low score in your application, personal statement and interview if possible. If low exam scores were the reason you did not 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 to PDs.

2. Errors on ERAS

Stretching your role as the treasurer of a club you helped form in med school is one thing, but fabricating accolades and experiences is far worse. Be direct and steer clear of vagueness in your application: PDs read through thousands of applications each cycle, and no inconsistency will escape their eyes.

The fix?

Don’t take the application lightly, and don’t falsify or exaggerate information. Start the application early and 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 also are here to help!

3. Unexplained Gaps

Particularly if you are a foreign medical graduate, having large gaps of time in your application without adequately addressing them can have a negative impact. There’s nothing wrong with taking a year off for research, but you need to explain why you did so in your application.

The fix?

Tell the PDs what you did with your time off, including volunteer, clinical, or educational experiences, as these can buttress your application. Do not hesitate, shy away, or be vague.

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)

You need a minimum of three letters of recommendation, with ideally two of them coming from physicians in your specialty. PDs prefer to read letters that are positive and personalized. Generic letters hurt almost as much as negative ones, and they are far more common. Applicants often misunderstand the process and submit generic and/or unhelpful letters for their speciality.

The fix?

Check the letter assignments for each program early and carefully. If needed, make a list of​​ programs with the exact requirements for each one. Pay special attention to the amount of letters you need for each program. Keep in mind that three is a good number, but some programs may require more! Make sure to get specialty specific letters, if possible. Externship experience in the US with personalized letters from US physicians is beneficial. Furthermore, LoRs from academic institutions usually hold more weight – so plan ahead!

5. Poorly prepared personal statements

Personal statements are stories and programs definitely read them. They play an important role in how PDs see you as an individual – and how much they like who they see. Some applicants falsify their statements, whereas others lack substance and fail to convey a story. Many also write something boring and generic.

The fix?

Write a personalized, simple statement. Explain why you are in medicine and why you are applying to your particular field. This is your chance to show your passion and enthusiasm. Then, read it… and reread it again and again. Have your friends take a look at it; heck have your English teacher check it out too. Do not make grammatical errors, and pay attention to detail. Finally, have an experienced set of eyes, such as your dean or your mentor, review it and provide feedback. Your statement should be tailored to a particular specialty. Avoid applying to multiple specialities with the same personal statement.

6. Inadequate US clinical experience (USCE)

Most US programs prefer applicants with at least a minimum US clinical experience time, often mentioned on their website (for most, it is 3 months of USCE). Make sure you have the experience in the correct specialty: if you are applying to pediatrics, 3 months of radiology experience, even if theoretically commendable, will not help your application much.

The fix?

Find opportunities to get more USCE under your belt. Contact hospitals, academic centers and community preceptors to see if you can audition or rotate with them. Bonus tip: if you do well, you may gain another great recommendation letter!

7. Visa related barriers

US licensing requirements for specialties and programs vary for international applicants and so do the visa requirements. I have seen applicants perfect every aspect of their application, from personal statement to recommendation letters, but have their visa status as the singular issue that prevented them from matching.

The fix?

Diligently research your specialty and program to ensure that they will sponsor your visa. Currently, internal medicine and family medicine have larger numbers of training programs that support international grads, so you will have a better chance at a visa sponsorship if you apply within these fields. Most IMG friendly programs will have the requirements and visa sponsorship information on their websites.

8. Not casting a wide net

Many applicants with higher than average scores or those with a geographical limitation often don’t apply to enough programs. This may work out (or not!) but don’t be among those persons who didn’t match because they applied only to the top two programs in their desired city.

The fix?

Apply to more places than you think is necessary. Pick at least ten, depending on your speciality, with competitive specialities necessitating more. Even if you are a spouse of a current resident, fellow or attending, it may prove a big blunder if you put all your eggs in that city or program basket. Apply to some backup programs and treat all of them as if you’re going to attend. If nothing else, don’t forget about the SOAP!

9. Lack of communication

One of the first things you should do as you start your application is to research each program thoroughly. The next step is to reach out to programs to show your interest. Part of the process is to understand when and how to follow up with the programs and to demonstrate your communication skills. Spamming a program director with multiple emails a week is a surefire way to get yourself blacklisted.

The fix?

If your application is average or on the weaker side, it is paramount that you initiate contact with either a PD or clinical faculty. Then, follow up after interviews to demonstrate your continued interest. Emails, phone calls or letters can all work, depending on where you are in the application season and specific updates you wish to share. Don’t be afraid to ask thoughtful questions, but be tactful in your emails. Communicate well, be polite and remain humble. Touching base will improve the chance the program will notice you and will place you ahead of hundreds of applications PDs receive each season.

10. Not having research for a program that expects it

Certain specialties or programs strongly suggest that you have research experience on your CV. From publications to presentations and case report authorships, “strongly suggest” typically means “require,” and your application won’t be reviewed unless you meet this requirement. This is often the case if you apply to competitive specialties, but having research experience or authorships on your CV will be a huge benefit regardless of what you are applying for.

The fix?

Learn everything you can about every program you apply to. Reading the statistics on the NRMP® website will give you a general idea about the percentage of accepted applicants who had completed research prior to applying in the various fields. Cross check FRIEDA and NRMP data for prior years’ match results to see which programs are IMG friendly, which programs require research, and how much. Finally, get in contact with graduates who previously matched and ask if your application is competitive enough.
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 are always here to help.

Image by Steve Buissinne from Pixabay