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Clerkship directors are often a source of advice for students applying to internal medicine residency programs. During the 2004 CDIM National Meeting, Tayloe Loftus, MD, Donald Bordley, MD, and Lawrence Smith, MD, facilitated a workshop on this topic. From their notes, responses to questions posted on the CDIM listserver, and the experiences of the authors, the following is a summary of common questions asked by students.
Student’s Question: Are internal medicine residency programs rated? How do I pick a “good” one?
Advisor’s Answer: There are no official rankings of internal medicine residency programs. Programs are evaluated by the Accreditation Council for Graduate Medical Education’s Residency Review Committee for Internal Medicine and are given the
following accreditation standings: full accreditation, continued full accreditation, provisional accreditation, and probation. Each program is unique; therefore, what may appeal to a student interested in a researchoriented program would not necessarily appeal to a student interested in pursuing a private practice. It’s important for the student to research the program. The student should know the accreditation status of the program and the pass rate for the American Board
of Internal Medicine examination scores. Students should talk to the residents at the program of interest and alumni of their medical school at the program of interest (e.g., what do you enjoy or dislike about the program, would you select the program again, etc.). In addition, students should consider the differences between residency program size and affiliations in order to maximize educational opportunities and match professional goals and future aspirations.
Student’s Question: How many applications should I submit?
Advisor’s Answer: Most students with good records and appropriate mentorship should match with one of their top choice programs if they interview at approximately 10 programs. Good records include solid grades with a transcript or a Dean’s letter that includes the grades, high scores from the United States Medical Licensing Examination Step 1, and strong Applying for Residency: Providing Advice to Medical Students letters of recommendation. It is suggested that if the student does not do well on Step 1, then it is important to pass Step 2 and send the scores to the programs of interest before residency program ranking. It is important to note that many students apply to residency programs in more than one discipline. Try to dispel any myths or rumors surrounding residency application, such as “early application improves chances of selection.”
Student’s Question: Should I consider an acting internship (AI), such as a sub-internship, or senior elective at my first choice program?
Advisor’s Answer: It is important to weigh the risks and benefits of providing a stellar performance at a program and the strength of each student’s application. If the student has a good to strong application, then they should pursue an AI. However, if they do not perform well during the AI, this may hurt the students’ chances of getting into their top choice
program. Generally, students with a good to strong application should only pursue a senior elective as a means to explore the program. However, a senior elective may also be good advice if the student wants to enter a competitive program. In this case, the student is seen as competitive, but not placed in a high-risk situation; therefore, a senior elective can
provide the competitive edge. If the student shines during AI and his or her application is mediocre to poor, than the internship can help improve the student’s application. However, if doubts arise about whether the student can shine during AI, ask the student to consider a lower risk rotation, such as a senior elective. This will give the student an
opportunity to become known in the program of interest.
Student’s Question: What advice can you provide about letters of recommendation?
Advisor’s Answer: Letters of recommendation should be from faculty members who have worked with the student and who can provide concrete information about skills, knowledge, and professionalism. It is especially helpful if the letters
come from experienced educators. Letters from mentors outside of the student’s discipline can be helpful, demonstrating broader experience. Never recommend sending a letter from a personal friend or family member, regardless of how prestigious that person may be. It is seen as disingenuous. Chair letters are important if they can provide concrete information about the student. If appropriate, suggest including a letter from the students’ research mentor if the student can speak about the research project during the interview. If the student is applying to more than one discipline, reiterate the importance of sending the appropriate letters to the appropriate discipline.
Student’s Question: What advice can you give me about my personal statement?
Advisor’s Answer: The student should be sincere, honest, and truly reveal why he or she chose a particular discipline. Contrary to popular advice, cute, funny, or dramatic opening statements are often a turnoff to prospective programs. Again, being sincere and honest is key. Suggest that students address weaknesses in their record, such as poor grades or
leaves of absence, early in the personal statement. This is an opportunity to explain situations that may be seen as negative. For example, “this experience helped me mature professionally and enhanced my learning in the following ways...” Students can also use books or websites that offer advice when constructing personal statements. However, students are tempted to copy ideas, phrases, and paragraphs from sample statements and most programs can recognize these plagiarized statements. Stress that it is important for students to write the statement with their own words and tone.
Alice Speer, MD
Clerkship Director
Department of Internal Medicine
University of Texas Medical Branch at Galveston
Neera Khilnani, MD
Program Director
Department of Internal Medicine and Pediatrics
University of Texas Medical Branch at Galveston
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