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The Most Competitive Residencies and How to Prepare

So you just realized you are interested in a medical specialty that you have heard is notoriously competitive. Now what? Speaking from personal experience and those of my friends and colleagues, there is a way to succeed and make it happen!

You may be asking yourself, is the specialty I want to pursue actually competitive?

Which are the most competitive residencies?

Traditionally, although the landscape is forever evolving, surgical subspecialties such as Neurosurgery, Ophthalmology, Orthopedics, Otolaryngology, and Urology, Dermatology, and Radiology are known to be amongst the most competitive specialties.

These specialties often require research on your application, great (often 240+) Step 1 scores, and involvement in activities outside of academics.

How to stand out when preparing for a competitive residency

1. Show your interest!

In general, successful applicants for most competitive residencies have already demonstrated their interest in pursuing a residency in that specialty before mid-way through third year so it helps to act early, even if you only have a small inkling you may be interested!

2. Be a shining star.

Your academic performance incredibly important when trying to match into a competitive specialty. This is an often controversial topic; some people say pre-clinical grades do not matter and some say they do.

The way I would look at it is that, it cant hurt, so do your best! Clinical rotation comments and grades definitely can be helpful and USMLE scores are highly looked at. Many programs may have cutoffs for board scores when they screen applicants.

After all, when a program gets many more applicants than spots, there has to be a way to weed people out.

If your Step 1 score isn’t all that you want, then try to take Step 2 early and do well! Step 2 is starting to be more highly considered in many fields and it would be to your best advantage to hit it out of the park to overcome a suboptimal Step 1 score.

3. Do your research.

While grades matter, sometimes connections can help you move passed that one poor rotation or pre-clinical grade and can go a long way. What does this mean? If you’re getting involved in research, make sure to meet deadlines and produce good work.

You want to show that you are reliable and willing to put in the work, even if you have pressures of coursework or clinical duties.

Try to do an elective with key people in your home department early on and if you are interested before third year, set up shadowing opportunities.

When you’re on your sub-internship either at your home institution or another, remember to be helpful and proactive. Try not to be in the way and always try to anticipate the teams needs. Prepare for all of your patients and cases and offer to stay late to help out.

What are away rotations and why do they matter?

For competitive specialties, away rotations can be quite helpful. They can make your residency match or they can hurt you based on how you perform and how you mesh with the other residents.

If you’re interested in a certain region, definitely consider doing one in that region. There are many different reasons for choosing a certain program to do an away rotation at, but amongst them are opening up a new region of the US, showing dedication to a particular program, or to look at programs that are different from your home rotation and get a feel for what you’re looking for in your advanced training.

Why are research, home rotations, and away rotations so important?

Aside from setting a good impression and getting valuable experience within your specialty, ultimately, some of these fields are small and many attendings know each other. A good connection with an individual at one institution can help you get your foot in the door at another or a few even.

In addition to this, when applying to residency you will need letters of recommendation and the more personal your mentor can make it, the better it will speak to your ability to perform as a resident.


Now with all these details what should you do?

Try to do well academically first year and maybe get your feet wet with some shadowing. In the summer between first and second year, do some research in the field and create a good bond between you and your research PI.

When you have time, continue to work on research and during third year, try to take advantage of any electives you have to get more clinical experience in the field you are hoping to pursue. When it comes time to apply, have people read your personal statement and look over your application. Ask for letters from people who you believe to be good advocates for your potential as a future professional in the field. Lastly, before interviews, try to do mock interviews with various people! It can go a long way, especially for the earlier interviews on the trial.

Good luck on your journey!