How to develop your eras program signal list

The most important step in ERAS signaling strategy for the residency match is the development of your program signal list

After learning how much PDs value signals, especially in certain specialties, the next step is obvious: you need to identify the programs that you will be signaling.

This may be easy if you’re applying to Child Neurology and therefore only have three signals, which might mean you signal your home program and your two away elective programs. But if you’re creating a signal list of 30 programs, this step is going to take some time. The following rules will help you develop your ERAS program signal list, and are a critical part of the application process. 

You need to start crafting your signaling strategy in your third year

A strong strategy requires significant analysis. This means that you need to invest significant time to analyze programs across the country. That’s why you should start developing your program list and signaling strategy in your third year. 

For more on signaling strategy and geographic preferences, please see this post.

Understand that you are not considered competitive for every program

I’ve found that this rule is one that can be counterintuitive. If you’re an MD/PhD with amazing scores and research, wouldn’t every program want you? Not necessarily. A program that’s focused on increasing access to care for underserved populations may not be as interested in your basic science research.

When I say “competitive” therefore, what I really mean is aligned. For programs, it’s much more important that their residents are in alignment with the program’s interests, strengths, and goals. Given this fact, it’s obvious that no applicant will be “competitive” for every program. That’s why it’s so important to first understand your own strengths and goals, and then spend time deeply researching residency programs.

Reflect on your own interests, strengths, and goals

The most important feature of a program is that it is a good fit for you. In other words, your interests, strengths, and goals should align well with the program’s interests, strengths, and goals.

At a very basic level, this means that if you have a strong interest in reducing healthcare disparities, one of the top ranked programs in the country may not be a good fit for you if the program has a strong interest in producing basic science researchers.

Take the time to really understand what you are seeking in a program and residency training. As you begin this process, start by making a list of program features that are important to you. This may include the following factors, as well as many others:

●      Professional goals (e.g. research opportunities)

●     Professional interests (e.g. the chance to work with certain patient populations or the chance to learn certain techniques)

●      Subspecialty training

●      The mission of the program 

●      Geography: Can you see yourself living in this area for three years or more?

●     Culture: Can you see yourself working with these faculty for three years or more? Within this type of institution? 

Consider the factors important to you in your residency training, which may include the opportunity to work with certain patient populations or exposure to subspecialty training

Begin researching programs and learn which ones align with your interests, strengths, and goals

As a medical student, you may have strong knowledge of your home program, but other programs across the country can be mysteries. This is why it’s so important to start researching other programs. 

●  Start by speaking with your own residents. What do they have to say about the program at their med school? When they were interviewing, were there any programs that struck them as either particularly strong or particularly concerning? 

●  Faculty advisors are another great resource.

●  Online research is important as well, of course, and can provide key details about the program’s faculty, clinical mission, and teaching hospitals. FREIDA is the AMA's residency and fellowship database (freida.ama-assn.org), but there is also a wealth of information in Residency Explorer and on individual program websites. Spend time looking at the “in the news” or press releases sections, because these can give you an idea of recent initiatives or areas that the program is particularly proud of. 

●Many programs are now holding virtual open houses before application season, and this provides a great opportunity to learn about an individual program as well as the chance to speak with their residents and possibly their faculty.

● Virtual open houses are typically held between July and December, with many programs offering multiple dates. These events can provide information about the program, and importantly often allow for Q&A sessions with the PDs, faculty, and current residents. Many require pre-registration, so plan ahead. 

● How can you find open houses? The AAMC maintains a Google spreadsheet of self-reported residency fairs and open houses. In addition, some medical schools and organizations provide open house information for specific specialties. 

Develop a clear idea of how competitive you are for this specialty

I’ve found that applicants (especially for highly competitive specialties) sometimes don’t realize how they stack up against the competition. In fields such as Plastic Surgery, Orthopedic Surgery, Ophthalmology, and others, applicants are pretty amazing.

That’s why it’s so important to get an accurate idea of where you stand. In Dermatology, for example, it can be really hard to stand out. I’ve worked with applicants who have fantastic scores, have wonderful letters of recommendation, and have even honored all their clinical rotations, but they have not developed a specific area of excellence, or have only written a few case reports and review articles. These applicants are going to make wonderful physicians, but they may not be able to stand out in a field of highly productive applicants. Knowing how competitive you are for this particular field will help you choose the programs that are more likely to look at your application favorably.

For IMGs, this is an especially important topic. Certain states and programs are more friendly to IMG candidates than others. Within this group, factors such as year of graduation and Step 2 scores may be used to screen applicants–and if you don’t meet their published criteria, and lack any specific connection to the program, this is likely not the program for you. Our blog features posts on IMG-friendly states for each specialty, as well as the top IMG-friendly residency programs in each of the top states (for selected specialties.)

Identify your top programs: which programs align with your interests, strengths, and goals, and where are you competitive?

This is where all of your research will be so important. As you identify programs that fit with your considerations, you need to determine if you are competitive for these programs. This is where the insight and expertise of your faculty advisors and mentors will be so important.

 

Rotate at your top choices, if you can 

The research you’ve done to date is critical. You might think that it’s a great idea to do a rotation at Harvard Neurosurgery, but if you don’t have a realistic shot at being accepted, then it may not be the best choice from a signaling strategy standpoint. It might be a great choice if it affords you the opportunity to work in a particular clinical area or with a particular faculty member, but most of the time we recommend that applicants rotate at programs where they have a realistic chance of matching. (If you’re a highly competitive applicant in a less competitive field, this is obviously easier to do.) 

You may also be limited in how many away rotations you can do. There are certainly financial and time considerations, but your specialty society may also recommend limiting away rotations. For example, the Association of Professors in Dermatology states that students should limit their away rotations to two total, due to concerns about equity (as not everyone has the resources to fund multiple away rotations).

Conclusion

Although program signals are a relatively new addition to the residency application, they have quickly become one of the most powerful tools available to draw the interest of programs. Developing your program signal list therefore deserves careful thought and attention to maximize your chances of securing as many interviews as possible. Best of luck to you-we are cheering you on!

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Dr. Rajani Katta is the creator of The Residency Interview 101, the online course that helps applicants quickly and confidently prepare for their residency interviews. She is also the co-author of The Successful Match: Rules to Succeed in the Residency Match and served as Professor of Dermatology at the Baylor College of Medicine for over 17 years.

Dr. Samir Desai is the author of The Successful Match: Rules to Succeed in the Residency Match and is co-founder of MD2B Connect, the most trusted and highest-rated provider of hands-on clinical experiences for IMGs in the U.S.