Today’s inane image of the day:
Introduction
It’s getting to the time of year where medical students across the country have interviewed [though, this is a weird interview season with the pandemic and the virtual format and all…] and are starting to ask themselves: Where do I see myself living/being/working for the next 3-7 years?
I still remember the feeling of utter exhaustion from interviewing, but also this sense of impending doom about how I was going to navigate the waters surrounding sending a love letter to my top program, how I would rank programs, and whether ranking SEVENTEEN programs would be enough to match [remember, I was in the INAUGURAL CLASS of a BRAND NEW MEDICAL SCHOOL that everyone assumed was in California]. Now that I’m a few years out, have sat on recruitment committee meetings, and have heard the advice from other program directors surrounding these exact questions, I feel that I’m in a place to provide some insight and advice to all of you.
Love letters [vs. letters of intent]
The first question you’re going to ask is: Did you send a love letter or letters of intent?
Yes. I sent a single letter of intent to my No. 1 program [MGH anesthesia, of course] and no other letters.
But the question you care more about is: Did it matter?
Probably not in my case. But that’s not always the case.
Frustrating answer, eh? Let’s dive deeper.
Send only ONE letter of intent
Whatever specialty you’ll be entering into will be surprisingly small as you delve deeper and deeper [yes, even medicine]. People talk. People network and know one another. Sending a letter that says “You’re my top choice” to MULTIPLE PROGRAMS will not bode well. One senior anesthesiologist I know remembers every single individual that sent him a love letter that was ranked to match on his program’s list but LIED and did not rank his program #1. You better bet if this anesthesiologist encounters this individual through another application for a committee position or even job at their institution that they will speak up.
So, if you plan on sending a letter that says you’re my TOP CHOICE, only send one. Some smaller programs or programs at your home institution where you have a good relationship with the residency program leadership may appreciate your letter of intent to confirm their suspicion and interest in you. Basically, the impact of the letter of intent depends on the situation and program type.
What about love letters?
There is a gray area around sending multiple letters to programs saying, “I like you a lot, so you’re highly ranked.” On one hand, it says, “You’re not my #1″ but on the other hand it indicates that you’re interested in their program. There are definitely instances in which smaller programs may be influenced by love letters [i.e. you could move up on the rank list]. I think the best kind of love letter is more of an update letter that includes some sort of meaningful update to your application [e.g. Step 2 scores, new publications, new awards] AND lets them know why you’re a good fit and why you love their program so much. In general, love letters to large, competitive programs, do not influence your ranking.
So, what’s the best way to move up on a program’s rank list?
A personal call/email from someone in your specialty that knows the program director/residency leadership and can speak to your positive attributes. A random person making a call doesn’t usually help. That individual must have a personal connection with BOTH you and the residency program’s leadership to make a difference. Otherwise, it’s kind of a toss up on whether it will actually help.
Okay, thanks for the advice. Now how do I write my letter?
Without typos. With respect. With specific examples of why a program is a good fit for you and you might be a good fit for it.
I dug back into my archives and found the letter that I sent way back in 2015:
Thank you for the opportunity to interview with the MGH Department of Anesthesia, Critical Care and Pain Medicine Residency Program on December 9, 2014! Overall, I was impressed by the broad clinical exposure, collegial environment and support for numerous academic interests, which is why I am ranking the program #1.
During your presentation, I identified with the program’s emphasis on high-quality patient care, approach to education and use of two-way feedback for continual improvement. The rigorous training environment at MGH appeals to my learning style. Expert faculty members within the program will undoubtedly serve as unparalleled resources for my current and future career interests. Throughout the 2-day interview experience, I couldn’t help but feel like the program fit the bill for everything I was looking for in residency training.
As I flipped through the January ASA Newsletter, I stumbled across Matthew Gertsch’s description of the “First Call” experience and was reminded by all of the reasons MGH is my #1 choice for residency training. Regardless of the Match outcome, I appreciated the chance to share my experiences and learn more about the program.
Warm regards,
My letter of intent to the Program Director of my top ranked residency program.
Amanda Xi
Don’t get any ideas about using this as your template. I will send this to our program leadership so we can look for plagiarism [just kidding, but there’s some stuff in there that you shouldn’t copy because it’s dated].
Rank lists
I knew which program was going to be my first choice. But my second and third choice switched depending on the week and how scared I was about living further away from my family. In the midst of the pandemic, I cannot stress enough the importance of having a strong support system close by to help you navigate the stress and burnout of residency.
Yes, I said it. Everyone feels stress and burnout during residency. I won’t sugarcoat it. There are days, weeks, and months that really suck. Those are the moments when you’ll need to lean on your support system to keep you afloat. That, and therapy PRN [as needed].
Ultimately, your rank list is a personal decision. Really take some time to reassess your priorities, your values, and where you see yourself in 5-10 years. Recognize that life happens and that you may change your rank list based on life events [e.g. you could find love, decide to start a family, get a pandemic puppy, etc]. It’s okay not to be totally sure.
A comment on the virtual season
A lot of programs are doing open houses or second looks that are virtual to help you get to know the program better. Many of these events will not influence your rank list [unless you do something egregious], so please use them as opportunities to ask real questions that matter to you. Please recognize that every single program has its shortcomings. If you go into any residency acknowledging that there is no such thing as perfect, then you will succeed. Programs can change for better or for worse. You cannot predict how that will happen, so make an educated decision based on the information you have.
Final note on your rank list – make sure to certify it every single time you change it. Applicants have not matched because they did not properly submit their list. Do not be one of them.
Matching
All I want to say on this is that Match week was one of the longest weeks in my life [may I suggest browsing some of my recommended books or items to distract you from waiting for Match Day?]. But it still warms my heart to this day to reflect upon how incredible I felt matching at my #1 program.
I hope this helps. Take all advice with a grain of salt. I am not currently on our recruitment committee so saying nice things to me won’t help your ranking, sorry.