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How to Prepare for Your Residency Application During Each Year of Medical School

Congrats, you’ve gotten into medical school! Your dreams are coming true!

Finally embarking on your medical training is a momentous occasion, worthy of celebration. Still, for many new students, it’s normal to feel a bit overwhelmed as the reality of the journey ahead starts to sink in. During your first day of class, as you and your classmates discuss your desired specialties, you may have a voice in the back of your mind wondering what you need to do now to set yourself up for success in your dream specialty.

Especially during your M1 year, it’s not always easy to discern the right steps to take. Your email may be flooded with opportunities to get involved in extracurriculars, and you may see your classmates excelling at national conferences or launching international nonprofits. Meanwhile, you may feel like you’re struggling just to keep up with your daily lectures.

As I went through this process, I often thought, “What do I really need to be doing? What should I prioritize?” Because I certainly didn’t know what mattered (and what didn’t) when it came to landing a residency!

If you find yourself thinking the same thing, don’t worry. This article will serve as a step by step guide for how to craft that ever elusive competitive residency application, from M1 all the way to M4!

Pro tip: Bookmark this page and come back to it throughout medical school if you need extra tips for each individual year!

Understanding the Residency Application Process

The Basic Components of Your ERAS Application

Let’s begin with an overview of the current structure of the Electronic Residency Application Service (ERAS). While it’s an ever-changing beast, it’ll still serve as a good starting point for our discussion.

The ERAS application includes these major sections:

1. Personal Information

This section includes membership in honor societies and medical school awards—pretty straightforward.

2. Personal Statement

Your ERAS personal statement is an amazing opportunity to infuse your personality and passions into an otherwise metric-heavy application. One way to prepare for writing it is to keep a “professional journal” throughout medical school.

Whenever you have an impactful clinical encounter or experience, jot down the details of what happened and any thoughts you have regarding it. This will help you build a narrative of your medical school journey, which you can use to craft a thoughtful personal statement. (You can also use your journal notes to pick a specialty, prepare your residency application, and get ready for interviews.)

3. Experiences

This section is currently limited to 10 “impactful experiences” from before and during medical school. The major categories include work, research, hobbies, volunteer work, and education/training.

4. Publications

Here you’ll include peer-reviewed journal articles/abstracts that you’ve written. (Once a manuscript/abstract has been submitted for publication, it can be included in your application.)

You can also mention poster presentations, oral presentations, and non-peer reviewed online publications (like the article you’re currently reading).

5. Letters of Recommendation

Acquiring great ERAS letters of recommendation can be a daunting task, especially when you’re not sure what field you’d like to go into and your time with each attending is limited. It’s always better to have “too many” options than too few, so view each faculty member you build a relationship with as a potential letter writer. 

Once you identify someone you think may write a recommendation, be sure to stay in touch with them. For example, if you formed a bond with a faculty member during M1 or M2, reach out during M3 and let them know how you’re doing. 

If you decide to go into their field, get some clinical experience with them and express your desire for a letter. Relationships built over time are almost certain to have more weight than a letter from someone you had one rotation with during M4. 

Nevertheless, fourth year does provide a great opportunity for getting strong letters since you’re at the top of your game, have decided on a specialty, and get to function at an intern level. If you identify a potential letter writer during M4, express your desire for a letter early on and ask them “What can I do during this rotation to shine and earn a strong letter?”

Again, make sure you keep in contact and send a follow up email with specific examples of how you exceeded expectations and demonstrated qualities a residency program would find appealing in an applicant.

6. Medical Student Performance Evaluation

These vary by school but generally include your academic history, any leaves of absence, and any disciplinary action that’s been taken against you. It’ll also contain a review of your performance on each third-year clerkship. 

Make sure you’re aware of your school’s grading system for clerkships, including what you need to score on your shelf (and any evaluations) so you can achieve your target grade.

 7. USMLE Transcript

Because programs may use filters to exclude students based on their USMLE performance, it’s an extremely important part of your application. In fact, failing Step 1 or getting a low score on Step 2 may make it difficult to find programs that will fairly evaluate you as a candidate.

Always prioritize performing well on exams, and reach out for extra support if you’re having trouble preparing for them. 

Program Priorities

Next, we’ll list the elements of your application that program directors pay special attention to when they’re deciding if they want to interview you. According to the 2021 survey of program directors, the five most important parts of your application are:

  1. USMLE Step 1 score
  2. Medical Student Performance Evaluation (MSPE)
  3. Letters of recommendation in specialty
  4. USMLE Step 2 score 
  5. Personal statement


Program directors prioritize strong academic achievement during medical school and strong relationships, displayed through letters of recommendation and evaluation comments in your MSPE. Although they are becoming increasingly important with a pass/fail Step 1, volunteer/extracurricular experiences are ranked 16th, and research is ranked 30th. 

How to Set Yourself Up for Residency Success During Each Year of Medical School

M1 Year

With these priorities in mind, here are some ideas for how to build your application during all four years of medical school:

1. Make school your top priority. 

Many students who have been successful their whole academic career struggle during M1. Make sure you are building a strong foundation and reach out early to your school if you’re falling behind.

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2. Determine your school’s ranking system.

While a lot of schools are pass/fail, many include quartiles or some type of rank in your MSPE letter. It’s good to know this as early as possible, especially if you’re shooting for a competitive specialty.

3. Determine how you can be eligible for Alpha Omega Alpha and the Gold Humanism Honor Society.

These both have a positive impact on your residency application and each school differs in how they select members.

4. Find a mentor.

A mentor during med school doesn’t necessarily need to be in the field you end up choosing and could be a senior student, a resident, or an attending.

Additionally, US MD seniors are favored in the Match. If you attend a different type of school, it’s very important to find a mentor from your academic background that has succeeded in your chosen specialty.

5. Get involved.

If you’re comfortable with your academic performance, get involved with one or two things. Volunteering at a free clinic or hopping on a research project are great options. Remember though, you can include up to 10 things from your pre-med years and four years of medical school on your application. Getting involved with five things during M1 will likely not be fruitful.

6. Decide if you’re “gunning for” a highly competitive specialty or a highly regarded academic program for residency.

While sticking with the basics outlined here will lead the majority of applicants to be successful in securing a desired residency position, it’s important to note that some specialties or programs require you to stand out from the pack.

If you’re applying to one of these programs, you’ll need to excel academically, have strong relationships with mentors in the field, show a commitment to leadership, and have multiple publications by the time applications are due.

7. Work on a research project between M1 and M2.

Publications can take years to come to fruition and the earlier you get involved, the better. So it’s a good idea to get started on a project early, if you’re inclined to do so.

Of course, getting involved with research can be an overwhelming task if it’s on top of everything else we’ve mentioned. So make sure it’s something that’s to your benefit.

My philosophy with research was always “help me, help you, help me!” In other words, remember it’s supposed to be a mutually beneficial relationship between you and the research team. So keep your best interests in mind, and find something you think will improve your residency application.

As to how you go about getting started on research between M1 and M2, be enthusiastic and explore different opportunities until you find the right fit. Don’t be afraid to walk up to a lecturer after class and have a conversation about what they’re working on, or email a multitude of physicians to express your interest in their research.

Conversely, if you know you’re not interested in a research-heavy field, feel free to use the summer between M1 and M2 to explore other interests such as volunteering, teaching, etc. Those are also things that’ll look good on your application!


M2 Year

1. Incorporate Step 1 preparation into your studying.

Struggling during your Step 1 dedicated period can lead to taking time off or, worst case scenario, failing the exam. Consider maintaining a Step 1 Anki deck throughout the year and prioritizing board study materials over your school’s materials.

2. Maintain extracurricular activities or get involved for the first time. 

Thankfully, medical students love extracurriculars, and you’ll often be able to find groups that focus on things you’re interested in. Your email inbox is a great place to learn about activities and meetings, so keep an eye on it. 

If you’re having trouble finding a group you’re interested in, talk to other students or reach out to faculty. Sometimes a group exists, but has gone dormant. Maybe you can revitalize it. Or, if you just can’t find one that focuses on your particular interests, show initiative and reach out to a faculty member about founding a new group! 

3. Continue research projects or get involved in one.

See #6 from the M1 section above!

4. Pass Step 1 on the first attempt. 

This is the most important part of your application thus far. Don’t hesitate to reach out to your school for help, postpone your date, or seek outside tutoring.

If you’re just starting your USMLE exam prep, download this FREE Hero’s Guide to Defeating the USMLE, a 38-page master class from the experts that will save you time and ensure your success when you reach the final boss and face your exam!


M3 Year

1. Make it a point to be present and engaged on rotations.

This will help you gain confidence in your specialty choice and set yourself up for great evaluations in your MSPE letter.

2. Stay consistent with shelf exam studying.

Always think about shelf studying as studying for Step 2. Even if you don’t do as well on the shelves as you had hoped, you’re still setting yourself up for Step 2 success!

For help with shelf exam studying, check out these other posts:

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3. Build connections.

If the relationships you nurture are in your chosen field, they’re invaluable when residency application time comes around. For those applying to residency in September, be sure to ask any mentors for your letter of recommendation in May or June!

4. Always think about research opportunities.

Case reports of unique patients you see during third year are a great way to spearhead a project. Use your time working with attendings to express your interest in their research. 

5. Give presentations to the various departments you’re rotating with. 

These can be included on your application under publications.


M4 Year

Think ahead! Putting your best foot forward on your application requires meticulous planning. Luckily, the steps you’ve been following since M1 year have set you up for success!

Finalizing Your ERAS Application

Let’s revisit your “professional journal” that you started during M1 year to help you write your ERAS personal statement. While keeping this journal is a great way to prepare for writing your statement, you may still struggle with how to actually go about doing it.

To get started, consider using the following outline, with these suggested paragraphs:

  1. Introduction 
  2. Why [insert specialty]?
  3. Experiences that solidified your interest and show your strengths
  4. Personal characteristics that’ll help you succeed in the specialty and contribute to the program
  5. What you’re looking for in a program
  6. Future goals and plans

residency counseling

For extra help with putting together your residency application, you may consider working with a residency counselor who can help you draft your personal statement, give personalized feedback on your application, conduct mock interviews, and more. Schedule your free consultation today!

Approaching Match

Congratulations, you’ve officially applied for residency!

Once your application is submitted, you’ll want to (first, take a breath, and then) start preparing for interviews and thinking about your rankings for programs. For extra support with this step, check out these other posts:


You’ve worked hard leading up to this milestone. Enjoy this year, and trust that your efforts over the past four years will pay off!

Further Reading

I hope this article allows you to prioritize where you invest your energy throughout medical school. Don’t worry if you’re not writing textbook chapters or involved in the “coolest,” most time-consuming extracurriculars. By sticking to the basics described here, you’ll set yourself up for success!

Looking for more (free!) content to set yourself up for residency success? Check out these other posts from Blueprint tutors on the Med School blog:

About the Author

Erin is a fourth year medical student at The Ohio State University College of Medicine and is applying into Obstetrics and Gynecology. She has a Bachelors in Science from Sewanee: The University of the South, where she competed on the varsity soccer team. Her professional interests include improving access and quality of healthcare for people with disabilities, women's healthcare for survivors of cancer, and preventive medicine.