How to apply for a residency position in the US, prepared by Dr. Nayef Chahine.

Application for residency (Nayef)

Congratulations! You finally made it through medical school and can now take a small break before moving on to the next chapter in your career, residency. At first glance, the process to apply for a residency position in the US seems complicated and intense, but once you go through the steps needed, it will all make sense. Also, by now, you need to have at least passed USMLE Step 1 and ideally Step 2 CK, but some programs are ok with just having Step 1 as long as you have scheduled Step 2. Step 3 is not essential for residency application. Step 1 scores will no longer be available starting 2022, and different programs will be using different strategies to rank applicants.

Most residency programs in the US welcome International Medical Graduates (IMGs) as they recognize that IMGs, although formed in a different country, can still bring a unique set of skills and knowledge to the table in caring for patients in the US. The application process and preparation for residency recruitment begin before selecting the programs for which you want to apply. Here we outline step-by-step guidance on how to prepare and apply for a residency position. Before we do so, here are some terms and organizations that you will encounter through the process.

1. Educational Commission for Foreign Medical Graduates or ECFMG: To even have a chance of applying for a residency spot in the US, you need to get certified by the ECFMG for your training to be validated, and up to the US standards, otherwise you run no chance of success. So make sure you visit their website to get familiar with it and begin getting certified. https://www.ecfmg.org/, The application process for ECFMG AKA OASIS, can be found at https://oasis2.ecfmg.org/

1. National Residency Match Program or NRMP: This is a private, non-profit organization established in 1952 at the request of medical students to provide an orderly and fair mechanism for matching the preferences of applicants for U.S. residency positions with the preferences of residency program directors. All you need to know about when to register for the Match, how to apply, create and submit your rank order list is found at their website, so make sure you get very familiar with NRMP (https://www.nrmp.org/ranking-residency-programs/) Match applicants MUST have an AAMC ID to register with NRMP for the Main Residency Match®. After registering with NRMP, applicants should log back into ERAS and update their profile with their NRMP ID to make it easier for program directors to identify them for placement on the program’s rank order lists. Follow this link for a step-by-step on how to register: https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2017/09/Registering_for_MRM-App.pdf. Registration typically starters in Mid September, please follow the link for an updated Match time frame https://www.nrmp.org/match-calendars/

1. Electronic Residency Application Service or ERAS: This is where you will upload all the documents needed for the application, as well as do your search and selection of those programs to which you are interested in applying. Make sure you create a login and get familiar with ERAS as soon as you think of pursuing a residency in the US as well as obtaining a token for registration. https://students-residents.aamc.org/applying-residencies-eras/applying-residencies-eras

https://students-residents.aamc.org/register-myeras/register-myeras-residency

https://www.aamc.org/cim/

1. Federation Credentials Verification Service or FCVS: FCVS is a fast and convenient way for physicians and PAs to store core credentials for multiple state medical boards. State medical boards rely on this centralized, uniform process for obtaining primary-source verified education information for those applying for licensure. You don’t have to use them, and there is a fee for their services, but they sure make your life easy with certifying documents such as medical school transcripts, diplomas, etc., to be sent to the residency programs. https://www.fsmb.org/fcvs/

How to apply:

Now that you are familiar with the terms above here is what to do next:

1. Make sure you have your Step 1 and 2 scores ready for submission

2. Make sure your CV is up to date

3. Take some time to search the programs you might be interested in either by State or specialty, which can be done through the ERAS website and NRMP website. (https://students-residents.aamc.org/apply-smart-residency/researching-residency-programs-and-building-application-strategy). Once you have selected programs that interest you, make sure you visit their respective websites to get an overall sense of the program, what kind of training they offer, what is the composition of their residents (i.e % of IMGs accepted in the program), and whether they sponsor J1 visas. H visas are becoming less and less popular nowadays.

4. Download the Match calendar (see above NRMP) to keep track of deadlines.

5. Obtain your ERAS token to begin the application process.

6. Obtain a Letter of recommendation ( at least 3, with at least one of them being from someone in the field that you are interested in applying to). Make sure you give yourself enough time for them to write it and upload it into ERAS as this process can take a while depending on how busy they are. Also, make sure you select people who truly know you and have worked with you. A generic LOR won't always help.

How many programs should I send my application to?

Unfortunately, there is no one magic number. A lot will depend on the specialty of your choice, its competitiveness, your own personal geographical preferences ( East coast vs west coast, community vs academic, North vs south). Typically, most US applicants average 10-12 programs, so you can average that as well or even higher by maybe 5 more. Remember typically this process is expensive and time-consuming due to the traveling needed to be done, although now with COVID, all programs have been asked to conduct virtual interviews so that will help you save some money now.

What should I know about the interview process?

Typically people want to get to know you as a professional and team player. Programs already know your academic background and performance, so the interview process serves now as a way of them getting to know you and you get to know the program. Remember as much as they are interviewing you, you are doing the same, and programs want you to like them because if they don’t fully match, they risk losing accreditation. Here are a few tips:

1. Show up on time, and participate in all activities put on by the program. This is a great way for you to see how residents interact amongst themselves but also for programs to assess you as a team player and your interest in the program.

2. Make sure you visit their websites. A lot of information can be found there instead of asking them about it, but if you need more clarification on something you saw on their website, then please make sure you ask. This will show great interest.

3. Make sure you have questions to ask. It is ok to ask the same question to every person you encounter, but make sure you have questions.

4. Know your audience.

5. Be prepared to talk about challenges you have had either in test-taking or during medical school.

Once you are done interviewing, go back and write down the pros and cons of the program. This will help you organize your rank list before you submit it. Also, you don’t need to rank all programs you interviewed at. It sounds scary not to do so, but you do not want to end in a program you don’t feel comfortable with, as it will make the experience difficult for the two of you, and more importantly affect your education. Programs want people who truly want to be there, and you want to be at a program you are going to enjoy and get the most out of.

Last, but not least, if you know of anyone who has gone through the process, make sure you talk to them to get more ideas and different insights on what worked for them. You are not alone in this process and those of us who have been through this want to help you.

We wish you the best of luck with the process and remember, there is a light at the end of the tunnel.