Career Planning

With a mind for the safety of applicants, many hospital systems have canceled audition rotations for the fall of 2020. Programs have offered online sessions in which current residents are available to interact with prospective applicants. Additionally, the programs have added video tours of the facilities since applicants are not able to visit the program in person.

For interviews, programs are conducting virtual interviews. It is anticipated that even if COVID-19 resolves, virtual interviews may persist into future residency application/interview cycles. ICOM will monitor the situation as the current residency application/interview season unfolds, and will keep ICOM students apprised of what can be expected for their residency cycle.

The Electronic Residency Application Service (ERAS) is an online platform used by most residency and fellowship programs. Components of ERAS for applicants includes a MyERAS page for the information typically found on your CV. It also provides the space to upload your photo, personal statement(s), MSPE, medical school transcript, letters of recommendation, and the ability to release your COMLEX-USA transcripts. You will use the ERAS program to apply for programs and in many cases, to communicate with programs, including scheduling interviews.

You will receive a “token” in the spring of 2nd year to access a portion of the ERAS system. You will enter some basic identifying information about yourself and then have the ability to set-up letter slots for the LoRs you collect during third year rotations. In June of third year, you will be allowed to fully access the ERAS website.

You will upload the information that goes into your MyERAS page, your professional photo and personal statement(s). Links in ERAS will take you to the pages to pay for and release your board scores. Your MSPE and ICOM transcripts will be uploaded by ICOM. Your requested LoRs will be uploaded by the letter writer with the confidentiality of the letter maintained, e.g. you will not see what a letter writer has written.

Letters of Recommendation (LoRs) are used by program directors to make decisions about which applicants they will offer an interview. After board scores, LoRs from the specialty are the 2nd most important influencer in the interview selection process. And, in the program director’s decision for where to place an applicant on the program’s rank order list, LoRs are fifth in importance. It is advisable to obtain LoRs not only from your preferred specialty but from other specialties as well since this could reaffirm your knowledge and skill set to the program directors reading your LoRs. While most programs require three LoRs, most will accept four. You may collect as many LoRs as you wish because you will designate which LoRs should be shared with which program. This practice allows you to focus the LoRs to the program or specialty to which you are applying.

The Medical Student Performance Evaluation (MSPE) is an objective assessment prepared by the school to indicate your overall performance during medical school. It includes an assessment of preclinical performance, grades and comments from third year core rotations, and an overall summary of your preparedness for residency. You will contribute to the introductory portion of the MSPE, providing a brief list of unique characteristics. Your advisor will assist you in that task.

The personal statement is a one-page narrative that you will write to show your interest and ability in your preferred specialty to program directors. If you apply to more than one specialty for residency, you will prepare a personal statement for each specialty. Our best advice will be for you to write a personal statement when you have a core rotation in a specialty that resonates with you. ICOM will guide you through the writing process and provide helpful edits as you prepare your personal statement(s). You may send a draft of your personal statement(s) to careerwriting@icom.edu to have the Learning Specialists provide suggested edits.

In November of second year, you will be instructed in registering for the COMLEX-USA Level 1 to be taken in May/June after second year classes finish. Upon successful completion of the OSCEs in the Clinical Preparations course as well as receiving a passing score on the COMLEX-USA Level 1, you will be approved to register and schedule the COMLEX-USA Level 2 PE between December of third year and August of fourth year. In November of third year, you will be instructed in registering for the COMLEX-USA Level 2 CE to be taken in June/July after third year rotations finish.

Several online sites provide information about accredited residency programs; AMA Freida (ama-assn.org), ERAS and residencyexplorer.org. The Match Prism is an app that allows medical students to research programs and record relevant information about each program. Many residency programs will also sponsor websites describing their program and providing information for interested applicants. Current residents are a resource for their residency program and some programs will share important information at ICOM’s annual residency fair.

Each person researching residency programs may have different priorities for what constitutes a good residency program. In general, you are advised to seek out residency programs which have a regularly-scheduled didactics program with plenty of time for patient care. You’ll want to ask about the variety of patient cases you’ll see and what the typical resident schedule looks like. As an osteopathic physician, you are advised to look at how many DOs are listed amongst their residents and attendings. Having other DOs as role models during the residency years is helpful in advancing your own sense of osteopathic philosophy. When talking to the residents, how do they report being treated? Are they happy in the program? Do you sense any burnout? You’ll want to know how often a resident is terminated or does not have a contract renewed. Of course, you’ll likely consider geographic location when selecting programs to which you’ll apply. And, as best as you can determine, you’ll seek the answer to whether or not the program will give you the skills you need to be the kind of caring and compassionate physician that you want to become.

Program directors review your ERAS application twice during the residency application process. First, they look at board scores, LoRs, the MSPE and your personal statement to determine if they’ll offer you an interview. Board scores and the GPA information on the MSPE give them an idea of your academic performance. The LoRs, preceptor comments on the MSPE and your personal statement lend insight into your interest and abilities for medicine overall and that specialty specifically. If you are offered and attend an interview, they’ll be very interested in your interaction with program staff, residents and any one else you encounter during the interview process, both in person and via email or phone. They are looking for people who can function well in a team. When it comes to where a program director places your name on their rank order list, they’ll consider your interpersonal skills as well as your aptitude for that specialty.

Competitiveness of a specialty is largely based on the number of available training spots as compared to the potential number of medical students or graduates who might choose to apply in that specialty. Specialties with fewer numbers of available training spots and a high number of applicants may use board scores and LoRs to stratify applicants prior to selecting those who will be invited for an interview. Some specialties with a high number of applicants may also stratify potential applicants during the audition rotations, giving preference to those who meet or exceed a target board score. Some specialties, primary care specialties in particular, have many residency programs with many available training spots. With so many more options, these may be seen by some as less competitive. A good perspective on this is to think of these specialties as being necessary for most patients in the general population to visit this type of provider as compared to patients having fewer encounters with some of the specialists. For example, we all need to regularly see our primary care provider and may not ever need to see an orthopedic surgeon. Every two years, the NRMP publishes several resources called Charting Outcomes in the Match with one focused on match outcomes for osteopathic medical students; www.nrmp.org. These documents can help you see how your academic performance and approach to the match compares to others who’ve previously matched into that specialty.

Choosing a specialty is a personal decision that takes into account factors most important to you. While at ICOM you’ll be provided with access to the Careers in Medicine website which has information about the specialties as well as some assessments you can take to guide you in which specialties mesh well with your personality and career expectations. Throughout your time at ICOM you’ll have the opportunity to interact with physicians from various specialties, and during your third year rotations you will be able to experience many of the specialties firsthand. Keep an open mind during the early years of your osteopathic medical education. You might be surprised what specialty resonates with you!

Partway through third year rotations you’ll need to think about audition rotations in your chosen specialty during the first half of the fourth year. When you apply to residency programs, you’ll apply to programs in your preferred specialty as well as some programs in an alternate specialty. It’s always a good idea to have an alternate specialty in mind. While we hope each student matches into their preferred specialty, some students may not. And, the outcomes for matching into any specialty are better for fourth year medical students than those who sit out for a year. So, having an alternate specialty in case your preferred specialty doesn’t work out is a good idea.

Obtaining a residency position is a competitive process that requires a well-thought out strategy and attention to timelines. Your best chances for matching into a residency program are during the fourth year of medical school. The possibility of matching into a program after you’ve been out a year is drastically reduced as compared to matching in fourth year. An alternate specialty is advised to optimize your residency options. As difficult as it is to think about not having a residency program to attend post-graduation, you have to ask yourself this question, “What is my comfort level with not having a residency program to enter right after I graduate?” Presuming that you want to see your effort to do well in medical school and have a rewarding career happen, having an alternate specialty may help you have a residency to attend post-graduation. So, the focus shifts to the idea of, “If I couldn’t do specialty ___, I could still have a happy and fulfilling career in specialty ___.” At ICOM we’ll advise you to consider what alternate specialty you could pursue. We’ll guide you through the thought process on how competitive you may or may not be for your preferred specialty. Charting Outcomes in the Match  for Osteopathic Medical Students is an online resource that can help you determine your competitiveness and strategy for pursuing specialties that interest you; www.nrmp.org.

During third year and early in fourth year, you’ll request LoRs from preceptors while on rotations. Those may be uploaded into ERAS at anytime during the third or fourth year. In July of fourth year, you’ll complete your MyERAS application, pay and submit COMLEX-USA scores, and upload your photo and personal statement(s). You’ll continue to practice your interviewing skills. In September, you’ll apply to residency programs and as interview offers come in, you’ll confirm and attend these interviews. You’ll likely be offered interviews from September through January with the months of October to December being particularly busy. Toward the end of interview season you’ll finalize your thought process for completing your rank order list. This rank order list is your designation of which program(s) you’d like to match with and in the order of your preference for matching.

Audition rotations are elective rotations that happen early in the fourth year and occur at institutions which have a residency program onsite. It is an opportunity for you to see the program firsthand as well as showcase your skills for the residents and program director to see how well you might fit in at their program. Some residency programs prioritize interviews for those who’ve done an audition rotation at their program.

Your best chances for matching into a specific specialty occur as a fourth year medical student. The rate at which applicants match post-graduation decreases significantly, so it’s advisable to seek a full residency position in your fourth year match cycle. Because residency programs are funded for the exact number of years that the residency lasts, someone entering a residency with one year of time taken with a transitional year risks not having funding for the last year of their residency. So, it’s best to try to be placed to a full program and use the transitional year option as a remote back-up plan. ICOM will advise you during the residency application, interview and matching process.

When two individuals, for personal reasons, decide that they wish to pursue residency in close proximity to each other, they will identify themselves as a couple for the match. The residency specialty that each member of the couple pursues may be the same or different. When the matching algorithm occurs, their rank order lists will be considered together. This adds complexity to the process with special considerations for the couple to think about. Couples matching works best in larger cities which have many residency programs, and couples are advised to apply to more programs than they might have applied to if applying as a single. ICOM will assist those students who indicate their interest in pursuing a couples match.

For the 2020 Match, osteopathic applicants applied to an average of 80 programs. The actual number you might apply to will depend in part on your competitiveness for the preferred and alternate specialties you choose, geographic location and personal considerations.

This number will vary for each applicant. Generally, being more competitive for a specialty lessens the number of interviews. Plan to interview at a minimum of 10 programs. Most students will interview at 15 with some interviewing at 20 or more. If programs consider you competitive for that specialty, the interview offers should happen readily. Once interviewing season begins, you are advised to accept every interview offered until you reach a personal limit. Then you can become choosier about which interview offers you accept. If you receive more interview offers for your alternate specialty than your preferred specialty, it is likely that program directors see you as less competitive than average for that preferred specialty. ICOM will work with you during this process and will likely advise you to accept every interview in your preferred specialty while you also redirect your focus on the alternate specialty.

Every student will pay a one-time fee of approximately $60 to release COMLEX-USA scores. You’ll also pay to apply to programs. The cost for each program application increases as the number of programs applied to increases. Estimating the cost of the average number of applications for the 2020 graduate, 80 applications, totals to approximately $1,800. Applicants are also responsible for interview expenses; travel, lodging and meals. This may add $5-10K to the budget for the fourth year. Sometimes applicants will group interviews geographically or coordinate housing with friends or stay with relatives in the area.

Every residency program has a program coordinator who will contact you for interviews. This individual may contact you via your ICOM email or via the ERAS website. It will be important for you to respond promptly and should your plans change, to inform the program as soon as you know that you will not be able to attend the interview.

Once selected for an interview, the impression you make on the program director and other residency staff is the most important factor for being ranked by that program. Your interpersonal skills need to shine before, during and after the interview process. ICOM will help you prepare for the actual interview by offering mock interviews. A seasoned interviewer will provide feedback to you as you answer some common interview questions. It is advised to be prepared to answer questions like these: Why are you interested in this program and specialty? What do you know about this program? Where do you see yourself in 5 years or 10 years? What has been most rewarding about being in osteopathic medical school? What are you most proud of having accomplished? If you could improve yourself, what area(s) would you focus on? What has been your biggest challenge in your life thus far? Describe any perceived weaknesses as they pertain to board scores, GPA, rotation evaluations. Tell me how you function in a group.

Students on a military scholarship, HPSP, may elect to participate in the military match; www.militarygme.org. Students pursuing urology residency and fellowships will participate in the urology match; www.urologymatch.com. Students pursuing ophthalmology, plastic surgery, neurotology and certain fellowship programs will participate in the San Francisco match; www.sfmatch.org. Most students will participate in the National Residency Matching Program; www.nrmp.org. Each match has different timelines and may have different requirements for application. ICOM will assist students as they determine which match service is appropriate for them.

Every two years, the NRMP publishes outcomes from the Match. Their most recent publication focused on osteopathic medical student outcomes may be found by clicking here.

After you have completed your residency interviews, you’ll take some time to consider which program is your number one choice, which is your number two choice, etc. This will become your rank order list (ROL). You are advised to only list programs on your ROL at which you would be comfortable attending for your residency training because once “matched,” it is a legally binding commitment. You will electronically rank the programs at which you interviewed, verify the ROL and submit the ROL within the timeframe required by the National Residency Matching Program (NRMP). While you are preparing your ROL, program directors are also preparing a ROL for the spots available in their program. After the ROL deadline, a computer algorithm will compare ROLs and “match” you at the program highest on your ROL that also ranked you high enough for a spot.

On the third Monday in March of fourth year, you will receive email notification of whether or not you matched to a residency program from your NRMP rank order list. If the news on that Monday is not as anticipated, ICOM will assist any student needing to pursue residency placement through the Supplemental Offers and Acceptance Program (SOAP). This is a process through which unmatched seniors may apply for remaining open positions at the residency programs. The SOAP is a schedule-driven process with specific rules and timelines that must be followed.

By virtue of your participation in a residency match, you are legally committing to be bound by the outcome of the match. It is important to seek guidance during the residency application and rank order process to be sure that you are making choices suitable to your personal goals for your career.

Established in 1965, the Centers for Medicare and Medicaid Services (CMS) provide funding for most residency programs.