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Most Important Factors in Residency Match

Know what is important for matching to residency

One of the most important objectives of medical school is to prepare you to go to residency. Although where you went to medical school is important for your future career, most physicians would say that where you complete your residency training is most impactful. Historically, the most competitive residency programs are surgical specialties that have good work/life balance, are prestigious, and/or have good pay such as dermatology, head and neck surgery, ophthalmology, urology, neurosurgery and orthopedic surgery. With that being said, medical students will do everything in their power to set themselves up so that they can go to the best residency program in their respective specialties. Rather than focusing your efforts on factors that are not important to match residency programs, here are the most important factors that you should focus on.

Getting an interview (top 5 factors in order)
2. Letters of recommendations
3. Dean’s letter
5. Grades in required clerkships

As expected, USMLE/COMLEX Step 1 is the most important factor for getting a residency interview with 93% of program directors saying that it’s an important factor. Given the variability amongst medical schools in how they grade their students, Step 1 offers the most objective way to measure a student’s knowledge base. It’s unfortunate that so much of your career rests on one exam but as long as you prepare yourself for this exam, there is no reason why you can’t excel. You’ll also notice that letters of recommendations and the Dean’s letter are also very important factors in getting interviews. These factors are often overlooked; strong letters of recommendations can take you far, especially in small surgical fields where everyone knows everyone. In order to get good letters, you need to build strong relationships with mentors who you get along with and are willing to vouch for you. You can build these relationships by doing research with them, meeting with them regularly, and getting to know them outside of work. The Dean’s letter is also very important and essentially summarizes your performance during third year clerkships.

Being ranked highly (top 5 factors in order)
1. Interactions with faculty during interview and visit
2. Interpersonal skills
3. Interactions with house staff during interview and visit
4. Feedback from current residents
5. USMLE Step 1/COMLEX Level 1 score

Getting an interview is very different from being ranked highly. Some applicants look better “on paper” than in person and will be touted highly before the interview but drop low after a bad interview. You’ll notice that essentially 4 out of the top 5 factors in getting ranked are dependent on your interview. How then, are you supposed to prepare yourself for these all-important residency interviews? As strange as it sounds, the same factors that will make you a good doctor will also make you a good interviewer. You’ll need to work on being an effective communicator who is thoughtful and purposeful in the things you say. This is something that you will have to work on all throughout medical school. Don’t use the fact that you are not very social or that you are “socially awkward” as excuses to avoid developing these important interpersonal skills. These skills are not only incredibly important in the match process but also as a future physician. If you can’t get along with your residency colleagues and attendings, you’ll probably also have a tough time connecting with your patients as well. Medical school isn’t just about learning medical knowledge; it’s a time to grow as a person and develop social/interpersonal skills. Don’t take those doctoring classes for granted!

Edward Chang

Edward Chang is the Co-founder and Director of Operations of He graduated from the David Geffen School of Medicine at UCLA and is currently a urology resident at the University of Washington. He also attended UCLA as an undergraduate, graduating with a major in Molecular, Cell, and Developmental Biology. If you are interested in contributing to, please contact him at [email protected]. Follow him on Twitter @EdwardChangMD and Prospective Doctor @ProspectiveDr.

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