For future doctors, it seems nothing comes easily. Even as the MCAT and application process grow dim in the rearview mirror, the grueling first year of medical school is rapidly rounding into view. But on top of the endless facts and figures to memorize, there are always career considerations.
Residency slots are more competitive than ever, and experts say it's never too early to begin preparing for the Match, that all-important algorithm that connects graduates with the institutions where they will spend as many as five years as residents. Test scores are important, but so are course grades, recommendation letters and extracurricular activities.
"Your match depends on a lot of factors," says Dr. Rajani Katta, a dermatologist in Houston and co-author of The Successful Match: 200 Rules to Succeed in the Residency Match. "You really have to start thinking about it from day one of medical school. You have to have a strong sustained academic performance over time, not just on the USMLE."
The Step 1 exam–the only standardized tool for evaluating medical students–is still a key way station on the road to residency. According to the results of a 2010 survey of residency program directors conducted by the National Resident Matching Program, program directors cited Step 1 scores more than any other factor when selecting applicants to interview.
The more selective the specialty, of course, the higher the score needed.
"People who match in the more competitive specialties like dermatology, otolaryngology and plastic surgery tend to score higher on their Step 1 boards," says Dr. Tao Le, co-author of First Aid for the Match. "You really need to beat the average by a good 10 to 20 points to keep all your doors open."
Still, Step 1 scores are at best only a partial predictor of who will ultimately excel in practice. This fact, coupled with increasing competition for slots, is why students must work harder– and smarter–to stand out from the crowd.
"If you have outstanding Step 1 scores, it doesn't necessarily mean you'll get in," Katta says. "Lots of people have outstanding test scores. Step 1 is important, but it's just the entryway. All sorts of attributes, including empathy and communication skills, go into being a great doctor."
Students can set about polishing their Match resume from the outset, but how to do it depends on their stage of medical school. According to Dr. Christina Shenvi, an emergency medicine resident at the University of North Carolina at Chapel Hill and co-author of First Aid for the Match, suggested that when first- and second-year students are not hitting the books, they might "consider getting involved in a research project if that is your interest, or have a major role in some other project, be it a free clinic or high-school health education." Katta adds that "preclinical years offer opportunities to participate in community services, and to hold leadership positions in student groups and in your extracurricular activities. These are important predictors for some program directors."
Entering year three, Shenvi says students should immerse themselves in "hospital culture," and seek counsel from peers and mentors.
"Talk to fourth-year students and ask them for advice about how to pre-round and how to present patients," Shenvi says. "Your presentations on rounds are often the only times you interact with an attending, so you have to do well in order for them to be able to write a good recommendation letter for you."
Students in their final year of medical school need to "be on the ball with application paperwork," Shenvi says, and talking regularly to residency directors, deans and current residents. She added that the Match itself can pose its own challenges.
"The Match is different from the application process we are used to from college and medical school, but the way that students should think about it is no different," Shenvi says. "In making a rank list, sometimes students do unwise things, like rank programs they think they'll be able to match at first, even if they don't like that program as much as others. That is not a good idea. Don't overthink the rank list."
Scott Whitaker is a freelance writer based in Washington, D.C.