Medical School - ClinicalResidency & Beyond

Components of a Residency Application

What to consider when applying to residency

By: Matt Cross

One of the most exciting parts of medical school comes when it’s finally time to apply to residency programs in the specialty (or specialties!) you’ve chosen.  You’ve worked very hard for years to prepare for this moment, now it’s time to put it all on into one centralized application, the Electronic Residency Application Service (ERAS).  There are many components of your ERAS application.  Every other year, the National Residency Matching Program (NRMP) surveys program directors across the nation to find out what factors of the ERAS application are weighted most heavily.  The most recent survey was conducted in 2018, and is available here (

Let’s look at some of the facets of your ERAS app judged to be most crucial by program directors, and talk about how you can use each one to make yourself as attractive an applicant as possible.

Step scores

No surprises here. Your USMLE and/or COMLEX scores are very important to residency directors as strong performance in these is associated with a strong chance of passing your specialty-specific board exam.  If you haven’t taken Step 1 yet, the good news is that there is a wealth of resources available to help you ace this high-stakes exam.

If you have taken Step 1 but have yet to take Step 2 CK, know that despite popular opinion that Step 2 is not nearly as important as Step 1, the data shows that over the past decade, program directors are placing more and more emphasis on Step 2 performance, possibly because of its greater clinical emphasis.  If your Step 1 performance disappointed you, really be proactive about modifying your study plan.  Analyzing what worked for you and what didn’t during your Step 1 prep is highly advisable. With regard to Step 2 CS, make sure to schedule this early!  Spots fill up very fast, and you ideally want to allow sufficient time so that if you do happen to fail the exam, you have time for a retake before programs have to make their rank lists in February.

Read More: How to effectively use notecards to study for Step 1

Clinical grades

Another hugely important component of how residency programs will assess your academic performance.  How clinical grades are assigned will vary somewhat from one medical school to another, but the majority of schools will use primarily a combination of clinical evaluations from faculty and your shelf exam scores to determine your grade for each rotation.  For determining how to earn high marks on your clinical evaluations, it is often best to talk to your evaluators directly to ascertain their expectations. Upper-level students at your medical school can also be a good resource.  The shelf exams are standardized tests, similar to the USMLE Step exams, but broken down by medical specialty, and there are many resources are available to help you prepare for these. Take time to prepare and do well on in your clerkships (especially the specialty of interest) to ensure program directors that you are ready to perform well as a resident!

Letters of Recommendation

Programs will require letters of recommendation to be written on your behalf.  In general, most residency programs will want these letters to be from clinical faculty that are familiar with your work.  You will want to look at the websites of programs to which you are considering applying so that you can see if they have any specific requirements well in advance in order to give your letter writers sufficient notice.  Some specialties will only want letters from doctors in that field, while most are okay with a mixture of letters from different departments.  The main take home points here are to do your research into what will be required (an advisor familiar with your field of interest is often a very helpful resource), and to ask for letters well in advance to allow your writers plenty of time.  ERAS will let you store an unlimited amount of letters, but you can only send a maximum of 4 to any individual program.

Personal Statement

You will be required to write a personal statement, much like you did when you applied to medical school.  There are no hard and fast “rules” for your personal statement, but in general, you will want to make clear that you understand the specialty to which you are applying, and that you have the attributes necessary to succeed in the field.  Articulating this in a genuine and compelling manner is no easy task.  Personal statements range from very pedestrian to highly creative.  You will want to proofread your statement thoroughly, and solicit many different people to critique it for you.

Extracurricular activities

These include, but aren’t limited to, your volunteer experiences, research projects, any paid work, teaching experiences, and any awards/honors you may have received.  If you still have a lot of time before you need to submit your application and you’re considering which extracurricular activities to get involved in, it’s best to get involved in things you are truly passionate about, as opposed to activities that you think will check some imaginary box.  Most residency programs would prefer to see that you have been meaningfully and longitudinally involved in something you’re passionate about, as opposed to spreading yourself thinly over many superficial activities.


Don’t neglect this section!  This is your chance to give your application reviewer a glimpse into who you are as a person outside of your academic achievements.  It’s not uncommon for a substantial amount of your interview to revolve around what you have written here, especially if you happen to share a common interest with your interviewer!

This is not intended to be a completely all-inclusive list for all specialties.  Some fields/programs will require away rotations and/or intensive research, whereas some won’t expect either of these things.  It’s always a good idea to peruse the websites of programs you’re interested in, as well as talk to your advisor(s).  Take your time with your ERAS application to try and present yourself in the best light possible, don’t let all your hard work go to waste!  Once you submit just sit back and relax, you’ll be getting initiations to interview before you know it!

Read more about med school residency

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