June 14, 2009 at 8:10 PM

By Samir P. Desai, M.D., and Rajani Katta, M.D.

Authors of The Successful Match and Success on the Wards

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Dr. Roy Ziegelstein is the Executive Vice-Chairman of the Department of Medicine at the Johns Hopkins Bayview Medical Center and a professor of medicine at the Johns Hopkins University School of Medicine. For many years, he served as the program director of the internal medicine residency program at Johns Hopkins Bayview Medical Center. Presently, he is one of the associate residency program directors there.

 

In 2007, his article ”Rocking the Match” was published. In the article, he offers sage advice “from the perspective of someone who regularly mentors students through this process and as someone with years of experience as a residency program director evaluating prospective interns.”1 Recently, Dr. Ziegelstein was able to share with us some of the wisdom gained from his extensive experience mentoring students.

 

Studies have shown that, while medical students recognize the importance of mentors, many students don’t have one.2 In your article, you write about the importance of finding a mentor and describe ways to initiate a mentor-mentee relationship. Once established, what can students do to make the most of this relationship as it relates to the residency application process?

 

I think that there are several things that can be done by students to ensure productive mentor-mentee relationships with respect to the residency application process.  The most important thing is to try to get to know your mentor(s) and vice versa.  People have limits on their time, so you may want to use e-mail for much of your communication; most faculty read e-mail regularly.  You should also schedule quarterly meetings – even if only for 15-20 min at a time – so that your mentor knows how you’re doing, what your goals are, and how he or she can help.  About six months before the whole application process starts, schedule a longer meeting to discuss specifics: what field you’re going to apply in; whether your mentor feels there are others on faculty you should also meet with; what programs you should consider applying to; whom to ask for letters of recommendation; and how to approach your personal statement.  As interviews get closer, schedule time with your mentor(s) for practice interviews.

 

In a recent survey of 71 internal medicine residency program directors inquiring about the importance of applicant selection criteria, grades in required clerkships were the # 1 academic selection criterion.3 Some have questioned the appropriateness of using clerkship grades in residency selection, citing the significant variability that exists in grading from one institution to another. How do you view clerkship grades and their role in the selection process?

 

I think clerkship grades are very important.  Whether or not I agree, I believe the findings of the study you refer to are absolutely correct.  Many program directors recognize that the grading system of some schools is much harsher than the system used in other schools, but not all program directors do.  Most faculty who evaluate applicants rely heavily on the Dean’s Letter, now known as the Medical Student Performance Evaluation (MSPE).  Often, the MSPE contains figures or charts that provide information on how the grades were distributed in the applicant’s class.  Sometimes, the MSPE indicates a class rank, or if the applicant just missed an Honors grade, it may indicate “near Honors” and indicate why.

 

It is often said that audition electives are not necessary for students applying to internal medicine. Under what circumstances should students consider doing an audition elective?

 

I think by “audition elective” you mean an elective at the program the student is applying to.  I think these are unnecessary, but they may be helpful if the applicant wants to learn more about the program or if the applicant is confident that his or her clinical performance will be impressive enough that it either reinforces an already strong application or demonstrates strengths that may not be apparent from the application alone.  I have heard it said by some students that they were advised NOT to do an elective at an institution they were particularly interested in because it might detract from their application. I disagree.  I have seldom seen an applicant hurt by an “audition elective” but I have seen many applicants helped.  I do want to emphasize that I think that the most helpful “audition elective” is a subinternship.  It allows you to really see what it would be like as a house officer at the program and it allows the program to get some sense of what you would be like as an intern or resident there.

 

In reviewing residency applications over the years, we’ve found that some letters written on behalf of excellent candidates were brief or vague. Is there anything that students can do to help their professors write effective letters that are most useful to residency programs?

 

I would focus on three things: First, when an applicant asks for a letter, I think it’s best to say “Do you feel you know me well enough to write a strong letter of recommendation in support of my application?”  Brief or vague letters are often written because the professor doesn’t really know the applicant.  In fact, I think they are often the result of a student asking a professor at his or her school who has a well-recognized name to write a letter of recommendation thinking that it will be of great help, even though the professor really doesn’t know the applicant. I think these letters are often viewed as “prizes” by applicants, but they may, in reality, hurt the applicant rather than help.

 

Second, when a student asks for a letter of recommendation, he or she should come prepared with a complete and up-to-date CV and, if possible, with a personal statement.  Also, the student should ask the professor for a letter in a formal meeting rather than in a chance meeting in the hallway or cafeteria.  In the more formal meeting, the student can tell the professor something about his or her goals, objectives, background, etc., if the professor doesn’t already know the student well.

 

Finally, the student could offer to compose a few paragraphs about his or her background, goals, objectives, interests, etc., for the professor.  The student is not really offering to “write the letter for the professor,” but by writing a few paragraphs like this, the student may make it easier for the professor to put things in the letter that are important.  I think these “tips” should help avoid the perils of the brief or vague letter of recommendation.

 

For many students, the personal statement is often the most dreaded aspect of the residency application. As someone who has read thousands of statements, what makes a statement memorable to you?

 

I can’t for the life of me understand why the personal statement is so dreaded, but I certainly know it’s true for most students.  Remember, no one is asking you to write an essay on how the principles of the Gettysburg Address influenced politics in the Eisenhower era, and you’re not being asked to solve a complex mathematical equation.  You are being asked to write about yourself, and you should be able to do that relatively easily.  In fact, you should relish the opportunity; this is your chance to tell people something about you before they meet you and to make them look forward to getting to know you better.  If you can communicate what is special about you (without sounding overly self-promoting or arrogant) that is not already evident in your application, you have created an effective personal statement.

 

Why should I want to meet you?  Let me know in the personal statement.  Remember that the personal statement is also often used as the basis for your faculty interviews, so make it something interesting.  One important point though: a “memorable” personal statement (the word you used in your question) is not necessarily the goal.  I can tell you of many personal statements that were “memorable” because they seemed outlandish or silly or because they made the applicant appear “scary” or weird.  Please show your personal statement to others (e.g., a faculty advisor who has experience reading them and evaluating applicants) before sending it out.

 

Many surveys of program directors have shown that the interview is the most important factor used in the ranking of applicants. You’ve had considerable experience conducting interviews. Why do some applicants stand out?

 

Applicants who stand out in the interview are able to communicate confidence without arrogance; sincere interest in the program that does not appear disingenuous; good speaking and also good listening skills; and an enthusiasm for medicine.  Applicants stand out when they make me feel that the interview flew by rather than dragged.  Applicants stand out if I can envision them taking care of my patients when they need to be hospitalized and/or if the interview leaves me feeling eager to teach and work with them.  As I mentioned above with respect to the personal statement, I would advise practicing interviewing with a faculty member who has experience interviewing and evaluating applicants.

 

The quality of questions asked by an applicant is important to many interviewers. In your experience, how often are you impressed with questions asked by candidates? How can applicants learn to ask meaningful questions?

 

To me, “meaningful questions” are those that seem “meaningful” to the applicant.    Just be yourself.  Don’t ask questions because someone told you that those are the questions you should ask.  Ask the questions that are important or relevant to you.  Also, come prepared – read about the program before your interview and try not to ask a lot of questions whose answers should be known to you before you visit the program.

 

References

 

1Ziegelstein RC. “Rocking the match”: applying and getting into residency. J Natl Med Assoc 2007; 99(9): 994-9.

 

2Aagaard EM, Hauer KE. A cross-sectional descriptive study of mentoring relationships formed by medical students. J Gen Intern Med 2003; 18: 298-302.

 

3Green M, Jones P, Thomas JX Jr. Selection criteria for residency: results of a national program directors survey. Acad Med 2009; 84(3): 362-7.