Guide to the Radiology Match

These are the opinions of the Program Director at The University of Texas Medical School at Houston, Sandra A. A. Oldham, MD, FACR.

So you have decided on Radiology as your career!

Congratulations! Making that decision after two or three years of medical school is a difficult task and you are to be congratulated on your choice. The coming months are very important as you begin the application process for the NRMP "Match".

There is a lot of misinformation out there on the internet and on the interview trail – hopefully this handbook will help you with the Match process.

The goal of our residency program is to provide excellence and innovation in the training of students, residents, fellows and physicians in a compassionate, individualized and academic environment.

The secret to success is early decision making, early preparation, good grades, and good advice. I don't like it when the medical school faculty advises its medical students that "everyone will graduate", and that "the top student will be valedictorian, everyone else will be MD". If you are interested in Radiology, the message you must hear, and the sooner the better, is that you must do very well in medical school, average is not good enough. You must be in the top half of your graduating class, at least (preferably the top quartile), and do very well in the USMLE Step I exam. Make sure you don't have any marginal passes or failures. If you do, get ready to explain them to me. Just because I believe you, however, won't mean someone else reading your application in another residency program will. There are so many applicants for each residency position, most program directors will simply not interview anyone with questionable transcripts or grades.

Applying to a Radiology residency is a numbers game. You need terrific medical school grades and USMLE scores just to apply. Most residency programs do establish a cut-off point for grades, USMLE scores, etc, below which they will not interview. You may think this is unfair, but with so many applicants, grades are one easy way to compare applicants.

Radiology is a very competitive and scientific specialty. It requires its practitioners to know an abundance of medicine from pediatrics to geriatrics, anatomy, surgery, physiology, physics, computers, statistics, and more. In order to become Board certified in Radiology, a resident must pass two difficult sets of examinations . The Core Exam will be taken 36 months after the beginning of radiology residency training. In 2013, the first such exam will be given. It will be an image-rich, computer-based exam administered at a central location in the nation. The 1 ½ day exam will test knowledge and comprehension of anatomy, pathophysiology, all aspects of diagnostic radiology, and physics concepts important for diagnostic radiology. Eighteen categories are included on the examination, all of which must be passed. The categories are: breast, cardiac, GI, musculoskeletal, neuroradiology, pediatric radiology, thoracic, reproductive/endocrine, urinary, vascular, CT, interventional radiology, MR, nuclear medicine, radiography/fluoroscopy, US, physics and safety. Physics questions will be integrated into each category. The Final Certifying Exam in Diagnostic Radiology will be taken 15 months after completion of diagnostic radiology residency. It, too, will be an image-rich computer-based exam administered at a central location in the nation. The exam will emphasize synthesis of information, differentials and patient management. Aspects of physics and basic sciences important in imaging will be included. The exam will include five modules. Two are required: Noninterpretive skills and Essentials of Diagnostic Radiology. Three modules willl be in clinical practice areas selected by the invdividual based on training, experience and practice emphasis.

No matter what a nice person you are, no matter how interested you are in Radiology, if you do not have the numbers, you will have a very difficult time matching into a Radiology residency program. So, the sooner you hear this message and start getting great grades in medical school and studying and passing the USMLE Step I exam with a fantastic grade, the better your chances of matching to the program of your dreams.

If your grades are poor and your Step I score is low, I will be asking you whether there is anything else you would like to do in medicine other than Radiology. That sounds very tough, but it is tough love. I have had several applicants not match in Radiology because of low grades and that is a very sad situation for them and for me. Do not count on the post match scramble for a position in Radiology – they are few and far between.

As Donna Magid, MD, MEd, my counterpart at the Johns Hopkins School of Medicine, says "Only the academically extremely strong should even think about this [Radiology]. USMLE scores must soar well above 230s/mid 90s, transcripts groan under the weight of A's, Honors and applause; accepted publications bend your mailbox from sheer volume; whole communities praise you as their savior; and your letters must make you appear likely to qualify for instant sainthood. On top of that, you must present a sparkling and error-free ERAS, a compelling Pulitzer-level Personal Statement, and project the vivid and charismatic presence of a talk-show host. A successful, articulate one."

The following specialties usually have a 100% fill rate in the Match: Diagnostic Radiology, Radiation Oncology, Dermatology, Pedi ER medicine, Medical ER, Physical Medicine & Rehabilitation (PM&R), Pediatric PM&R and Psychiatry/Neurology.

The specialties with the highest unmatched rates include: Dermatology (24% of those who apply to Dermatology do not match in any Dermatology program), Radiation Oncology (17%), Diagnostic Radiology (14%) and Orthopedic Surgery (14%).

First things first

You are thinking about Radiology. Who should you talk to about this? The members of the Future Radiologists of America (FRA), a service organization at UT Houston dedicated to medical students interested in Radiology. Find out who the officers and members of the FRA are, contact them and speak with them. They are much closer to where you are than anyone else in the medical school and they can answer your questions. Another source of information are the Radiology residents at UT Houston. They are spread out across the Texas Medical Center. No matter where you are, there probably are a number of Radiology residents nearby: at Memorial Hermann-Texas Medical Center (TMC), Children's MHH, LBJ General Hospital, MD Anderson Cancer Center, Texas Children's Hospital, St. Luke's Episcopal Hospital, Methodist and St. Joseph's. These medical students and junior Radiology residents are much more aware of the subtle nuances of residency programs than I am since they either just finished the ERAS applications process and/or the Match Game recently.

Of course, you should call my office and make an appointment to meet with me to candidly discuss your career plans. I very much like to meet potential Radiology applicants early in their medical school careers. My office number is 713-500-7640.

Since this medical school until recently did not offer elective time in the third year, use this year to introduce yourself to Radiology on each of your rotations by going to the department and talking with radiologists about your patient's imaging studies. Do this when you are on medicine, surgery, pediatrics, ob/gyn or family practice. Don't just read the imaging reports, look at the images with someone who can explain them to you. Go down to the Radiology department and observe your patient having an MRI, CT scan, lung biopsy or a barium enema. You not only will understand your patient's illness much better if you see it, but you will make yourself known to the residents and faculty of the Radiology department and also confirm whether or not Radiology is for you. You may also ask me for permission to "shadow" a resident in the ER some evening. That can usually be accommodated but must be run by me first. Then you can show up in the evening and sit with a Radiology resident. Now at UT Houston, a few third year medical students will be able to take a Radiology elective in the third year of medical school. If you can, do so. If you cannot, don't worry. Scores of successful Radiology applicants did not have electives until the senior year and they matched.

Once senior year comes around, you should take the Radiology 4.001 senior elective early – in August, September, or at the latest October. The elective will give you a broad exposure to all of Radiology and will help you decide whether or not it is for you. You will get to work with lots of residents and faculty and hopefully you can approach a faculty member for a letter of recommendation. I am happy to act as your mentor in third and fourth year, just ask.

After you complete Radiology 4.001, you may want to take another elective here or at an away institution.

At UT Houston, the other Radiology senior electives are as follows:

4.003 – Pediatric radiology

4.004 – Nuclear radiology

4.005 – Body CT/MR at MHH

4.006 – IR at MD Anderson

4.007 – Neuroradiology at MHH

4.011 – Body CT/MR at LBJ

4.012 – IR at MHH

An away elective – is one in your future?

Whether or not you take an away elective is up to you. Certainly, if you spend a month at another program doing an elective, that physical presence may help you get an interview there which you might not have received were you just "an ERAS application" without a face. However, there is no guarantee that they will invite you for an interview. Even if you get an interview, that does not mean you will be placed on that institution's rank order list. You just get interviewed.

When at an away rotation, do not repeat the basic elective….that reflects poorly on your transcript and if the away institution knows you've already done the basic elective, your knowledge won't seem so spectacular to them. Try doing an away elective in an area of interest (IR, CT, etc) with exposure to lots of residents and faculty. Impress the residents and faculty with your fund of knowledge and eagerness to look things up on the internet, journals or books.

I tell applicants that, with the exception of UT Houston medical students who take the Radiology 4.001 elective at their mother program, the great majority of our residents come to us through the NRMP Match without ever doing an elective with us. The first time we meet them is on interview day. We might see them the following year, if they are doing their internship in Houston. If not, the second time we meet them is two years later when they show up for the first day of residency.

If you have a geographical need to be someplace, perhaps an away elective there will help. For example, if you must move to Iowa for residency, then an away elective there may help. Otherwise, don't spend more time on Radiology electives than you need to make certain Radiology is for you. The rest of your senior year schedule should be decided upon to prepare you to become an MD. Your first task, after all, is not going to be Radiology but your transitional or preliminary internship year and you should be proficient at caring for patients by then.

Take electives in what specialties are great at your medical school. My recommendation is to take an elective in dermatology because all the patients you will care for during internship will have rashes and spots on their skin they will ask you about.

The ERAS Application

The application is on line and has multiple sections, including: General Information, Examinations (USMLE), Medical Licensures, State Medical Licenses, ECFMG (if applicable), Medical Education, Medical School Awards, Membership in Honorary/Professional Societies, Higher Education (university), Medical Experience (e.g. research, worked for a drug company, worked in a medical lab), Professional Experience (e.g. volunteer work, pedagogue, charity work, chef, schoolteacher, engineer before wanting to go to med school, etc), Publications, Language Fluency (other than English), Hobbies & Interest, Other Awards/Accomplishments.

Make sure you account for all the time since college graduation. If you took a year off to study, to travel, to do research, etc. make sure you explain that in the application form. Do not leave any time gaps. Someone reading your application and seeing a gap might think "Was it research or rehab???" Attention to details is a trait much sought after in applicants. If you are attentive to details in your application and keep dates straight, you probably do the same when caring for your patients. Sloppiness in filling out your application reflects poorly on you.

Account for all your time in chronological fashion. Remember, attention to detail is something we look for in a prospective resident; it is a prerequisite.

Be honest in all of your responses. All your good work goes down the drain if you lie (or stretch the truth somehow) on your application and are then caught in the lie. For example, many applicants, under "Language Fluency" write "fluent in Spanish". Well, many Program Directors are also fluent in Spanish. If we read this on your application, perhaps we will test your Spanish during the interview just to see how fluent you really are. "Yo hablo Espanol very bueno!" doesn't sound fluent to me. And, by the way, Spanish is a common second language for many of us, but the above applies for just about any language. Do not fib – I promise, you will get caught.

The Pool of Applicants

Years ago I read an article in the Pittsburgh press by one of the Associate Deans of the Medical School who talked about applicants to residencies. She wrote that the cream of the high school crop was skimmed off and went to college. The cream of the college crop again was skimmed and went to graduate schools, including medical school. The cream of the medical school crop, once again, was skimmed and went into subspecialty training, with the cream going to Radiology, Orthopedics, Dermatology and Radiation Oncology. You, the Radiology residency applicant, have been skimmed three times, at least, and you must still fall on the toe of the bell curve to succeed. You cannot fall on the heel of that curve and still go into Radiology.

To how many Radiology programs should I apply?

There are approximately 218 Radiology residency programs in the US with approximately 890 Radiology residency positions offered each year.

Depending on your CV, grades and USMLE scores, I will make recommendations regarding which programs you should apply to. Usually I recommend you apply to several programs which would be a reach for you, a few programs that would be crazy not to take you, and the rest in the middle range of probability. Do not become upset if, after years of being "top dog" you are told that you are no longer top dog and need to apply to second or third tier programs.

What is a tier? It is my unofficial ranking of programs like the tier of bench seats at a high school football stadium. Top tier programs are superb programs – very difficult to get into, only top notch applicants need apply, and are a reach for most applicants. Examples of top tier programs include (remember, this is my unofficial ranking, my bias) Mallinckrodt Institute of Radiology, University of Chicago, Massachusetts General Hospital/Brigham and Women's, UC San Francisco, U Michigan, Ann Arbor, Duke, U Virginia. Second tier programs are outstanding programs, but not as superb as first tier programs. They are within the reach of many more applicants, and do not necessarily expect each applicant to be well versed in research. Examples of second tier programs include UT Houston, UT Southwestern, UT San Antonio, Baylor Houston, Northwestern University Hospital, UCLA, USC, Emory, U Penn, U Pittsburgh, U Wisconsin, U Indiana, Wake Forest, U Washington.

Third tier programs are programs which may be less academic, may or may not be affiliated with a medical school, do not expect you to become an academic or researcher and are generally easier to get into if you do not have a superb CV.

All Radiology programs are accredited and will deliver superb to good training to the residents. Most programs have wonderful teaching, good facilities, excellent teachers and mentors.

Most Radiology programs in the country receive between 30-50 applications per position. Last year, for our thirteen positions, we received over 600 ERAS applications. I recommend medical students apply broadly to many programs, hopefully receive lots of invitations to interviews, then decide which interviews to go to. I frequently recommend most applicants apply to 25-40 Radiology residencies and a healthy number of transitional or preliminary year programs, as well.

If a medical student doesn't follow my advice and applies to too few programs, he/she has preliminarily narrowed the number of applications and thus will receive fewer interviews. If, from that smaller group of applications you only receive a few interviews, you must go to all of them in order to be competitive. So, apply broadly to programs before November 1 so you get as many interviews as you possibly can. Then, and only then, you can decide which interviews you really are interested in. If you receive 30 invitations to interview, that is a very good sign that you are a very competitive application. You can whittle the number of interviews you go to down to maybe 15. If you only receive 4 invitations to interview, you have to go to all 4 and hope to dazzle those on the selection committees.

Also, if it is after November 1, you cannot send your ERAS application to any new programs. November 1 is a deadline fixed-in-stone after which no applications will be received or reviewed.

A few years ago I got an e-mail in January from a senior at a northeastern US medical school. He explained that he "forgot" to put UT Houston on his ERAS application list of programs and wanted to know if we would interview him. Translation: "I didn't get enough interviews" or "I don't like the places I applied to which granted me interviews" or "I'm not as competitive as I hoped I was, so I need to expand my list of programs". After November 1, no can do. I don't know where he ultimately matched, if he matched. But he likely did not get interviewed anywhere he didn't apply to before November 1.

At UT Houston, the ERAS applications are first viewed by the Program Coordinator who filters out those I should read from the many I don't need to read. Ms. Roberts looks at several things in each ERAS application – the dreaded USMLE Step I score and grades on the medical school transcript. We set the minimum USMLE Step I score each year as the main filter for which applications move on to my computer and which do not. This year, the minimum was 235, and we deviated from this number on only several occasions.

Although the official deadline for receiving ERAS applications is November 1, in truth applications are received beginning in mid-September and the filtering and reviewing of applications process is well underway by Nov. 1. Invitations to interview are sent out by us on a first come, first served basis. We do not wait for the Nov. 1 Dean's letter (MSPE) to make our decision to invite you to apply, because the Dean's letter seldom tells us earthshaking new information about you we didn't already know. So, by Nov. 1, we may have already invited 50% or more of the total number of interviews we are going to offer for that year. After about 100 invitations are offered and accepted, we slow down or may even stop looking at applications. So be prepared with your completed ERAS application before the official September 30 deadline. A good goal is to have your portion of the ERAS application in after Labor Day. That does not mean your entire application will be complete. You probably won't have all your letters of reference in by then, and you certainly won't have the MSPE letter from the Dean in before November 1, but your portion of the application which includes your medical school transcript, the scores for the USMLE Step I and your personal statement should all be in by the first or second week of September.

To do or not to do Research

Research, it is my opinion, is something you should do if it would make you a more complete medical student, if the research will allow you to express something about yourself you otherwise cannot express in medical school. I do not believe research is for everyone. Research can add to your application in a positive manner, however, for research to mean anything, it should be accompanied by a publication or case report or presentation at a local or national meeting. Some academic residency programs want to see "research" from their applicants, especially published papers. If research, however, takes you away from studying or doing well on your rotations, then forget research and apply yourself to what you really must do and that is succeed in the medical school grade game.

Ask around for research opportunities in your medical school. The Dean's office offers summer research opportunities. Talk to different faculty members in the Radiology department. Most have on-going research projects. As a student, you can incorporate yourself on to on-going faculty research or you may come to the faculty member with your own research project ideas and ask for their mentorship.

There are many excellent programs, ours included, which are very strong clinically and which do not emphasize research at the medical school level. Once in our residency program, however, you will be asked to participate in research, especially in your second and third years.

If on the ERAS application you do list some research you have done, make sure you really did the research and understand it. You will be asked by someone during your interview about that research and you had better be knowledgeable of it. If all you did was do literature searches for the team, say that's what you did. If you claim the research, know the research. Be honest.

If on the ERAS application you do list some research you have done, make sure you really did the research and understand it. You will be asked by someone during your interview about that research and you had better be knowledgeable of it. If all you did was do literature searches for the team, say that's what you did. If you claim the research, know the research. Be honest.

Letters of Recommendation

Most programs require three letters of recommendation; one from Radiology and two which should come from the clinical year primary care rotations of Internal Medicine, Surgery, Pediatrics or Ob/Gyn.

It is best if you can get a full professor to write your letter, but that professor should really know you and not merely agree to write you a letter because he rounded with you one week while on service. If you do not feel you have a personal attachment to a full professor, how about an associate professor, or an assistant professor? After that, an instructor, a chief resident, or a resident. Never ask your friends, high school teachers or childhood neighbors to write you a letter of recommendation for residency. I once got a letter from a neighbor telling me how little Johnny always liked to play with lizards, cut their tails off and watch them twitch. That neighbor knew little Johnny was destined for a career in science. Maybe so, but unfortunately not a desirable letter of recommendation! We decided not to interview little Johnny.

Anyone can recite your CV over and over again – that is not what I want from a letter of recommendation. I want the writer's insight into you as you rotated through their service or their lab. When I look at your application, I will have your transcript so I do not need a review of your grades….I want to read about something special about you….how you came in early, stayed late, were enthusiastic, a description of an event during the rotation that demonstrated to the writer your sense of curiosity, that you knew not only your patients but your colleagues' patients, when you did not know an answer you looked it up and learned about it, how you treated a patient on your service devotedly and stayed up all night regulating their insulin doses. That is personal stuff not on your CV which makes for a very good read.

Ask the senior medical students who have matched into Radiology or the junior Radiology residents who are from UT Houston to tell you who were good letter writers for them and who were not. Some faculty members write spectacular letters of recommendation while some write atrocious, brief rehashes of your CV, with lots of grammatical and spelling errors. Avoid those references at all cost.

Ask for letters of recommendation by early summer. Don't ask someone to write you a letter just weeks before the deadline, because that could suggest to some that you aren't very serious about the application or that attention to detail is not your forte or that you are an unorganized individual, all impressions you should avoid.

Another thing about those letters of recommendation; please choose three references who understand the meaning of a deadline. Sometimes, asking the busiest person you know for a letter is less problem-a tic than asking someone who hardly ever writes a letter of recommendation. Constantly keep in touch with your letter writers (e-mail is fine) and make sure they write your letter before the deadline. You want to have EVERYTHING for the ERAS application ready by early September (Labor Day is a good day to aim for) so you can push the "send" button on your ERAS application and get ready to hear back from programs offering you an interview.

The personal statement

This is perhaps one of the toughest parts of the entire application process. Many of you tell me you are unaccustomed to writing about yourselves, that it is embarrassing to self promote, etc. Well, get over it and write a short statement worthy of a Pulitzer Prize in Literature. In that statement, please do not regale me with how much you like Radiology – I like it too and don't need convincing about how great a specialty it is – you would be preaching to the choir. Do not recount your grades, your USMLE scores, because I will have that information elsewhere on your application. What I need from you on the personal statement, like from the letters of recommendation, are glimpses into your personality, what makes you tick, things not on your CV. Tell me a story about yourself or your family that gives me a glimpse about your true self. Tell me about things that have happened in your life that demonstrate your enthusiasm, curiosity, resilience, ability to be a team player, ability to be a team leader. Tall order? You bet, but it's a tough residency to get into and putting a lot of thought into the personal statement can make the difference. Mind you, we seldom get to the personal statement until you have been screened for grades by the Program Coordinator. But once you have "acceptable grades" and have an USMLE score above our "bar", the personal statement is the next item on the agenda for scrutiny. After reading your statement, I should want to meet you, and I should feel that I would actually enjoy working side by side with you at the workstation – that you are an interesting and perhaps funny guy or gal! Remember, I am reading about 200 personal statements – make yours stand out. Amuse us with your personal statement, don't bore us with it.

One of the benefits of an ERAS application is that may write only one personal statement which ERAS will send to all programs you are applying to. You may question whether or not to personalize all or some of your personal statements. This is very time consuming, but you might want to think about doing that, particularly if there are one, two or three programs you are particularly interested in and you want that program to know 1) you are interested, 2) you have done your research of the program, and 3) you took the time to personalize the statement. Perhaps all you need to write are one or two lines saying "I particularly would like to match to your Program because my family lives in xxxxx , or my fiancée is moving to yyyyy or because I really think it would benefit me and you if I were your resident".

The Photograph

Send ERAS a nice photo of your face. Avoid casual photos, avoid photos of you in a crowd where the Program Director will have to guess which one of you is applying to residency, avoid photos of you in beachwear. I once received a photo of an applicant leaning against a tall tree. I would have asked the tree to come in for an interview, because I could not see the applicant very well. He was not invited. Send a head and shoulders photograph where you are dressed something like you plan on dressing on interview day: with a suit and tie for men and with a nice professional looking dress or pantsuit for ladies. I have received glamour shots in the past. Don't go the Mall Glamour Shot route. I've only invited one applicant who sent a Glamour Shot as her application photo ….. we accepted her because everything else about her was outstanding, and her performance during residency was excellent, but she knows just how close she came to not being interviewed because of the feather boa! The photo you send tells the Program Director who is looking at your application how seriously you are taking this application task. One bad photo can undo 4+ years of good schoolwork.

The importance of the photo comes later, so we can recognize you the day you come for an interview and more importantly, to refresh our memories, after three months of interviewing so many applicants, "Anybody remember this applicant? What did this applicant look like? Yikes!"

Getting an Invitation to Interview

As a UT Houston medical student, you will all receive a courtesy invitation to interview with us. This is generally true of all mother programs, we interview our own young. That is NOT the case for any other program you apply to. You will not be asked to a pity interview. If a program invites you to interview, it is because your application meets all the basic requirements for a residency position at that program. A program in Washington State will not ask you to interview there unless you qualify for that Program. The interview will be for you to see the Program and find out whether this is the kind of Program you want and for them to see you and see if you are the kind of prospective resident they might want.

We only interview on Fridays from November through January. This excludes the Friday after Thanksgiving, the next Friday (when most radiologists are at the RSNA), the Friday before Christmas and the Friday before New Years. We interview from 10-18 applicants each Friday. Our invitations to interview go out by e-mail on a first come, first served basis. We invite you and give you a choice of Fridays when you can interview. You must read and respond to your e-mail promptly because once a Friday becomes filled with interviewees, you will no longer be able to choose that date. It would be wonderful if you could do tag team interviews (interview in two Radiology programs in one city on the same trip, or interview for a Radiology program and the transitional program in one city on the same trip) however, this frequently doesn't work out so expect to have to travel to Chicago twice to interview, and three trips to New York.

Program Directors know that the interview trail with all these trips/hotels/clothing are expensive for you. However, once an interview day is filled to capacity it means just that. On the day you interview, we want you to feel like you are the only person in the room, so we must keep the interview experience as personal as possible. So, don't expect a program to add you on to an already filled Friday just because you delayed responding to your e-mail invitation.

Once your ERAS application is in, check your email several times a day, every day.

What to say if you must reschedule or cancel an interview?

Manners count. If you ever want to get a second chance at a program, you had better call the Program Coordinator with a believable reason for having to reschedule an interview or cancel one. Not showing up without a phone call is not an option if you ever hope to see that Program again – whether during the interview process or later on. Even if you are a no show to a program who invited you for an interview and you did not call them to cancel, don't think that is the last time you may ever come in contact with that program. Program Coordinators have very long memories and four or five years later, when you are applying for Fellowship at that same program you didn't show up for, that coordinator might remember your name or your face and share with the selection committee that you were a no show. If you treat us like that, how do you treat your patients?

This year we had a candidate who was scheduled for an interview in January.; He did not show up. We had all re-read his ERAS application and waited for him to show up so we could start our presentation that day. We never heard from him (phone, email, anything) – he just failed to show up. The next Monday I sent an email to his medical school Office of Student Affairs as well as to the Dean stating our disappointment with this applicant's lack of courtesy, manners and follow-through. I also said that behavior lead me to wonder about all the medical students from that school I didn't think I should offer interviews to students from that school until the school got it through to its students that protocol and manners matter. Although those two gentlemen quickly wrote back apologizing profusely for that student's action, and although that student wrote me apologizing he just "forgot" because he had not put the date on his calendar, no students from that medical school will receive an invitation to interview from us for at least one year.

Of course, manners dictate you inform the schools from whom you decline an interview diplomatically, stating "I cannot make the interview due to lack of money/time/resources…..". Those same good manners need to be present when asking a Program Coordinator to reschedule an interview date.

Be polite on the phone when calling to schedule an interview or when calling to see if the Program Director has looked at your application yet or when calling to change an interview date. The secretary in the Education Office and the Program Coordinator take most of these calls and can relay any "attitude" to the Program Director in no time. Be polite and pleasant on the day you interview. We all believe this is the day you are going to be on your best behavior. Any unpleasantness on interview day gets quadrupled in our minds for the future, and you may not have a future with us.

What clothes to wear for the interview?

Most of you get this right, but many of you show up in monochromatic black, dark grey or navy suits. Interview day looks like a funeral director's convention. But that's all right. A suit is very acceptable for men and women. A splash of appropriate color would be nice. Be clean, groomed and well dressed. Avoid trendy fashion statements and cleavage. Cut and clean your nails. Avoid excessive makeup and jewelry. Don't wear your hair in a funky spiked do. You aren't applying for American Idol, you are applying for a professional position in a medical school/hospital environment and we don't want you to scare the patients or the faculty.

Every other year, some applicant on the interview trail loses their luggage which doesn't get delivered to them in time for their interview. These unlucky folks show up to the interview in the clothes they were traveling in. You know how many of us dress for air travel. When you come to your interview, you will need to explain to the Program Coordinator what has happened so she can feel sorry for you instead of thinking you just don't know how to dress for an interview. During interview season I recommend you travel with your interview suit in a carryon luggage you won't be separated from. Wear nice comfortable shoes. My daughter wore high heels the day of her residency interview and the tour took them outside where construction was going on and the ground was not level. She did not enjoy walking in those heels.

The Day of the Interview

Get a good night's rest because most interviews last from half a day to a full day and involve not only sitting, having conversations and answering questions but also walking and touring.

Be very nice to the secretaries, residents and faculty you meet. Don't be rude to a secretary or to anyone else. Remember, we are already a family. You want to join our family. I look at interview day as a courtship and I expect you to behave your very, very best on that day. If you behave anything less than nice, that information will make its way back to the selection committee and your name will not likely appear on our rank order list. We have too many excellent candidates with good manners to have to worry about a rude person, even if he/she is AOA.

On interview day, you will probably listen to a small presentation about the residency program. The presentation will give all the interviewees some general information about the residency and may answer a lot of your questions about the program. After that presentation, the individual one-on-one interviews begin. At UT Houston, a candidate interviews with three faculty members of the Residency Executive Committee or two faculty members and a chief resident. Usually at the end of each interview, the interviewer asks "Do you have any questions for me?" and they really want you to have questions. It is not good to say "No, I don't have any questions. Everything I wanted to know was answered in your presentation." Make sure you still have questions to ask of your individual interviewers.

Do your homework before going to Program Y. Read up about the program on their website, Google the program, etc. When you come interview and show you know about program Y, that tells program Y that you are interested, resourceful, unafraid of doing a little bit of work and background checking, etc. Never be caught asking "How many residents do you take per year?" or "Who is your chairman?". That is stuff you can readily answer for yourself and should already know before taking the trip to Program Y.

Make eye contact with the person speaking with you. It is disturbing to talk to someone who is looking over your shoulder at your bookcase or who is looking at his/her lap throughout the entire interview. Stop twitching and wringing your hands. That makes us uncomfortable.

Breaking bread on Interview Day

Many of the places you go for an interview will either treat you to lunch on the day of the interview or take you out to dinner with a group of candidates the night before. Be on your best behavior during those times. We are watching to see if you know which fork to use.

I will give you a true example of a lunchtime mishap which occurred over 18 years ago, but which I remember as though it happened just last winter. I was Program Director at another medical school then, not at UT Houston. We would have lunch catered in our brand new conference room. This particular Saturday, we were having Chinese food. The food was placed atop two long tables covered with white tablecloths. There were two fried rice platters, one with shrimp and one without shrimp, two Lo Mein noodle platters, a tofu vegetarian platter and a chicken with wild mushroom stir fry platter. Dishes and cutlery were on a side table which also had the desserts as well as a selection of water, tea, coffee or soft drinks. On each side of the tables there were candidates and faculty lining up to serve themselves. People were seated haphazardly throughout the room, talking and eating. I had noticed that a young man (I'll call him Gus, not his real name) had a mountain of fried rice on his plate and he was hovering over the plate shoveling forkful after forkful into his mouth. Must be tasty, I thought. All of a sudden, Gus began to cough, and cough and wheeze, and look distressed, and emit such horrible sounds that have stayed with me to this very day, etc. What probably lasted two minutes felt, in slow motion, like an hour. Finally, one of the candidates darted across the room and gave Gus the Heimlich maneuver. Heidi (her real name) stood behind the choking victim, vigorously compressed his subxyphoid region several times with her two clenched fists, and at last Gus expelled a piece of chicken from his trachea, immediately followed by vomiting onto our new rug. We were all in shock, we felt so bad for Gus. What a thing to happen on his interview day. My Program Coordinator asked him if he cared to freshen up in the bathroom. Someone came to clean away the vomit. Most of us stopped eating. Gus returned in approximately 15 minutes, went back to the table, served himself another mountain of fried rice and proceeded to shovel more food into this mouth.

Those of us on the Selection Committee excused ourselves to go to another room and discuss the candidates we had seen that day. When we came to Gus, the three who had interviewed him that day said similar things: "He's got good grades from medical school", "He has a good USMLE score", "He seems interested and hard-working", etc. As Program Director I exercised my veto power and we did not rank Gus. Why, do you ask????? Because Gus exercised very poor judgment. If this had happened to most of us, we would have felt so embarrassed we might not have returned back into the room after cleaning up, but if we did return, we would sit and quietly sip water from a straw and eat no more. Gus went back to doing the exact thing that had caused him to choke in the first place. If he does this to himself, why should I think he would be any different with a patient. If Gus were doing a barium enema on a patient who says to him "That's enough barium, doc, I feel like I'm going to explode" do any of you think Gus would stop the flow of barium???

What if you do not get an Interview? What if you don't get THE Interview you wanted?

If the Program Coordinator has e-mailed you with a rejection, that is almost always a final decision which, if appealed, will not be reversed. If the e-mail says you are being wait-listed or that your file hasn't yet been reviewed, you can either wait or you can e-mail the PC/PD saying that you are REALLY interested in this program and would love to be asked to interview. Do your pleading with one e-mail. Do not call the Education Office on the phone. Everything is done electronically and e-mail is the way to go.

After the Interview – do I send a Thank You Note?

Emily Post and Ms. Manners would answer that question with a resounding YES! I, on the other hand, don't like Thank You Notes because they all say the same thing: "I loved meeting Dr. X, Dr. Y and Dr. Z. I like UT Houston because…… I intend on ranking your program at the top of my list." Please! If I had a dime for every generic Thank You Note I received saying "I intend to rank you highly" or some such verbiage, I'd be retired. If I cross check the list of residents who matched with us with a list of Thank You Note writers who told me they were going to rank UT Houston at the top of their list – I bet there would be no correlation. Most Thank You Note writers will be going elsewhere. Remember, "at the top of my list" doesn't say "I'm ranking you first on my list". If you have to write a Thank You Note, please send it by e-mail. Save the 44 cent postage and my eyes. Besides, some of the handwriting on those notes is awful.

This past year, we received a thank you note that topped all others. It was a folded note with the applicant's photograph on the front, courtesy of some photogallery.com. There was a bubble-like caption coming from the applicant's mouth saying "Thank you!!". Inside, was the usual "your residency program is outstanding, and this fact will be reflected on my rank order list". What does that mean????? Those of us on the Residency Executive Committee who initially had given this applicant good scores had to go back and look at the application more carefully.

I want to re-visit your Program

Occassionally, someone we interviewed asks if they can come back for a second look. The response to that request may vary from program to program, but we don't look favourably upon a second visit. We are very transparent with our program and with our residents and we made ourselves accessible to the candidates on the day you interviewed, We don't have the time to show you around on another day. But we certainly can answer any questions you may have thought of since your interview day. You can email us with the questions and we will do our utmost to answer them promptly.

Match Day

When you Match, please email me with all the information. We have been working closely for these many months, I deserve to know where you are going. Don't make me have to dig for this information. Also, send me by email your memoirs of the Match. Give me pointers for next year's crop of applicants, send me program commentaries, tell me about your great and not-so great interviews and advice you wish someone had given you.

APDR Program Director's Survey on the Match, 2008

USMLE Step 1 score required?

18%: yes, pass only

79%: yes, target score

3%: not required

If required, do you consider applicants who failed exam on 1st attempt?

50%: never 48%: seldom 2%: often

USMLE Step 2 score required?

41%: not required

13%: yes, pass only

46%: yes, target score

If required, do you consider applicants who failed exam on 1st attempt?

51%: never 48%: seldom 1%: often

Percent of Programs who offer interview slots PRIOR to the November 1st MSPE release date:

Zero offers before MSPE: 43.5%

1-24% offer before MSPE : 24%

25-49% offer before MSPE : 12%

50-74% offer before MSPE : 8%

75-100% offer before MSPE: 12%

Good luck!