How to Match in Internal Medicine

The first thing to know about the IM match is that it is by far the largest applicant pool of all the residencies. This is important for two main reasons: First, if you are a solid candidate, you will get into a good program. The top ten competitive programs can afford to be extremely picky; most other good academic programs just want to fill their match list with average US medical school graduates. Secondly, if you want to match in a particular, competitive program, you need to put in some work to make yourself stand out. Most programs get so overwhelmed with applications that you need to provide yourself with some insurance that your application will not get overlooked. Decent board scores, good grades, and some flattering letters of recommendation are simply not enough to guarantee yourself a spot in the highly competitive program.

1. Getting the interview
Most IM programs first screen their applicants by a variety of criteria. This task is usually performed by program administrators and staff, alike. Programs will commonly have board score cut-offs as well as standards for clerkship grades, AOA honors, etc. If you did poorly in your IM clerkship, then you definitely want to complete (and perform better in) your medicine sub-internship prior to sending out your applications. Once past the screening process, your file will be reviewed by a committee who decides whether or not to offer you an interview. This is the point where research, extra-curricular activities, and letters of recommendation come into play.

2. Becoming a good candidate during medical school
Clerkship grades and board scores are obviously important factors. Depending on the types of programs you are applying to, research is important as well. Most academic institutions seek to train residents to become academicians like themselves. Accordingly, they want to see some degree of dedication to academic medicine during your undergraduate or medical school career. Choosing a good mentor to work with in medical school is vitally important. After deciding what area you are interested in, find out who the big names are; most US medical school have at least a few. Pay attention to their academic pedigree and prior jobs so that they can put in a good word for you down the line. Aside from research, other extra-curricular activities such as community service, tutoring, sports, etc. will help you develop a more well-rounded application. They also give your interviewer something other than medicine to talk with you about.

3. Away rotations
Away rotations are not necessary for internal medicine. But, if you have your heart set on one or two specific programs, then doing away rotations at these institutions is a great idea. Remember, your goal is to stand out from the hundreds of other well-qualified applicants. Be as smart as you can. The best book to prepare for away rotations (and look smart on rounds) is the MKSAP question book. You should also have the Pocket Medicine book in your coat at all times. For EKGs, the __ is ideal, and __ is perfect for chest X-ray interpretation, the next most commonly ordered study.
Do away rotations early in your fourth year, either before applications have been sent out or during the application review and/or interview process. As you get into late January and early February, programs are beginning to make their rank lists, and if you haven’t been offered an interview yet, then you may be wasting your time. Ideally, pick an elective in a subject that you have some prior knowledge of, or do a sub-internship if you have done enough general medicine wards to feel competent. Be aware that you will be at a new hospital with completely different charting and computer systems. By the time you are a fourth year medical student, residents are looking to you as someone who can lessen the work burden. If you choose an extremely busy service and it takes you two weeks to get comfortable with the system, then you are not providing much help to your team.

4. Letters of recommendation
You will be asked to submit three or four letters of recommendation from faculty who you seek out yourself, and your medical school will provide a department letter and a Dean’s letter. You can obtain as many letters of recommendation as you want and later decide which combination of letters to send to particular schools. We recommend two or three letters from clinical experience and one letter from a research experience if possible. It is better to seek letters from faculty who know you well and who can write a “strong” letter on you behalf, as opposed to the big fish who barely knows you. It is true, that a letter from a recognizable figure can be a huge asset, but a lukewarm and impersonal letter can be detrimental. You should begin thinking about who to ask for your letters at the beginning of your third year. Do not wait until the last minute and do not pigeon hole yourself by selecting faculty all from the same subspecialty. The department letter is usually a summary of your IM clerkship and sub-internship performance based on evaluations from these experiences. The Dean’s letter is a summary of your entire medical school performance with a focus on the clinical years. The authoring Dean can put a positive spin on anything, or they can choose to highlight any negative performances. The former is the more likely scenario; however, it cannot be stressed enough that if you find yourself in opposition with your school’s administration, you will regret it when it comes time for your school to step up to bat for you. Dean’s letters will end with a summary sentence that recommends you as an “outstanding,” “excellent,” “very good,” or “good” candidate. These Dean’s letter rankings are standardized throughout the country and reflect your percentile in the graduating class based on grades.

5. How many programs to apply to
You will get all sorts of advice on this question from your medical school administration, faculty, and peers. The simple answer is to apply to as many programs as you and your wallet feel comfortable with. Interviews are offered on a different and random schedule at each institution. You can always decline an interview invitation but you can never go back in time to apply to more programs. Getting a feel for how competitive an applicant you are is a difficult task. Talk to the IM program director at your institution as soon as you can, ask lots of questions about the process, but don’t take what any one person says as the word of God. The average number of programs applied to for IM probably lies somewhere between ten and fifteen.

6. Application timing
Do not spend too much time thinking about this. Prepare early, and send in your application when it is complete and proofread numerous times. Interviews are usually offered on some sort of rolling basis, so try to send it in sooner rather than later.
7. A few interview tips
• Know the program. If it is an academic program, then they are looking for future academicians and you may want to present yourself as such. Know the major issues going on within the department (easier said than done). Be an informed consumer. Remember, each program is selling itself just as much as you are selling yourself.

• Ask good questions. Again, easier said than done. Beforehand, come up with a handful of questions specific to that program, otherwise you will not appear to be a serious candidate. Also have handful of backup generic questions to ask if the conversation begins to slow.

• Don’t brag. Most people in internal medicine are a humble bunch. Your major achievements are documented in your application in front of your interviewer. You do not need to remind them of how great they are. Do talk about how your achievements have shaped you as a physician.

• Location, location, location. If you apply to various programs because of location it would be wise not to admit this. Interviewers are proud of their respective programs, and seek residents who will feel the same. They don’t want to hear that you applied because you love New York City for example. On the other hand, programs don’t want to highly rank someone who doesn’t seem to be a serious candidate. So if you have lived in Ohio your whole life and suddenly find yourself interviewing in California, it won’t hurt to mention why you are willing to move.

8. Post-interview contact
There are no randomized-controlled trials to prove that post-interview contact boosts your chances of matching at your desired program. However, you don’t want to be the one applicant who did not write a thank you letter to a given interviewer. Short thank you notes on nice stationary should be sent to your interviewers and to each program director. If possible, try to include something personal that you talked about so that the individual remembers you. Once you have made your rank list, ask your department chair or faculty member of equivalent status to call your number one program. Even if you don’t know your department chair well, a phone from he or she provides your top-ranked program with insurance that by ranking you highly, the spot will not be wasted.

Good luck.

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