Approaching Red Flags in Your Residency Application

Program Directors and Interview Selection Committees look for certain criteria during the application process. Similarly, when presented with a residency application, they will make note of any red flags. There are a variety of red flags for a residency candidate, but do not worry! When you are aware of what might be a residency red flag, you have the opportunity to shape how your red flag is perceived. 

What is considered a Red Flag in your Residency Application?

A red flag can be caused by many different factors in your application. It is important to note that red flags do not make you a bad candidate for residency, but they create a bit more of a challenge for the applicant. Below are some common residency red flags that a candidate may face.

  • Prolonged Time Since Graduation: One of the more well known red flags within a candidate’s residency profile is having an extended “Time Since Graduation”. This refers to the amount of time that has passed since a residency candidate graduated from medical school. Typically, residency candidates with a medical school education gap of 5 years or more are referred to as “older candidates.” 
  • Gaps in Professional Experience: A common red flag is candidates with breaks in relevant medical experience from the time they graduate from medical school until they apply for residency training. While it can be difficult to find a job in your field after graduation, going too long without medical experiences can reflect poorly on the residency candidate. This gap can cause residency Program Directors and their interview committees to question if the candidate has the up-to-date skills to move into residency smoothly.
  • Extended Interruption in Medical School Education: Another red flag is for any residency candidate who took an extended break from medical school. This can happen for any number of reasons (financial hardship, familial obligations, personal health). There will be a specific question in the ERAS application that asks about any breaks in your medical school education. While it may be a necessary break, it is important that you give a thoughtful answer as to why your education was interrupted. If it warrants further explanation, you can include details about your situation in your Personal Statement as well.
  • Multiple USMLE Exam Attempts: One of the most painful red flags any residency candidate can encounter is not passing your USMLE exams. Since the change of Step 1 to pass/fail it is more crucial than ever that you pass on the first try. Having one or more additional attempts on your USMLE transcript can add extra challenges to your residency journey. Additionally, the cutoff on the number of USMLE attempts has changed from six, to four per exam.
  • Applying Late and/or with an incomplete application: Start application prep EARLY! A red flag that is simple to avoid is applying late or with an incomplete application. Although technically residency candidates can apply to programs until the Rank Order List deadline (also keeping in mind each programs’ individual deadlines), it is important that residency candidates apply in September at the beginning of the application cycle. Do NOT certify your application until it is complete, as certification is final.
  • No US Clinical Experience: A residency red flag that is exclusive to Non-US International Medical Graduates (Non-US IMGs) is when a candidate does not have any US clinical experience. US clinical experience (USCE) means working in a US medical environment and is often a residency program requirement.

Tips for addressing Red Flags in your Residency Application

While there are no “quick fixes” in residency, there are some ways residency applicants can address their red flags to strengthen their residency applications. In addition, always be thorough with your preparation, as this will help you avoid simple mistakes.

  • Obtain US Clinical Experience (USCE): US Clinical Experience (USCE) is defined as hands-on work with patients in a US medical environment and remains the number one way to improve your residency application chances. This is vital for International Medical Graduates (IMGs) who may not have any US clinical experience when they began the process. Typically, what counts as USCE are Externships, Sub-internships, Clerkships and any clinical rotations completed in the US. USCE can be used to ensure you do not have any professional gaps in your MyERAS Application, as well as to gain new Letters of Recommendation in the US. Ideally, it is best to get experience in the medical specialty you are most interested in.
  • Network in the Medical Field: Making residency connections can be a difficult and lengthy process, but well worth it. So, how do you foster these professional relationships? A few ways to create connections are:
  1. Keep in touch with your classmates from medical school. 
  2. Join professional organizations in your specialty of interest. Most medical specialties have at least one specialty specific professional organization.
  3. Go to professional conferences with your resume, CV or a copy of your MyERAS Application in hand to meet and greet with program faculty that often attend these events.
  4. Get in touch with your local programs. This may be difficult if you live in an area with few local residency programs, but if you live in an area with even one program, it is ok for you to call them up and ask to take a look at their program or even attend their grand rounds.
  • Choose the Right Message: When a residency candidate has red flags, it is important how you frame these experiences. The goal is to make sure your entire residency application provides a clear, unified message that explains any red flags and reassures residency programs that you are the right fit. 
  • Take your USMLE Step 2 CK: Although the USMLE Step 2 CK is not a requirement for your application, it can be helpful. This is very beneficial if you have any additional USMLE exam attempts. By taking the USMLE Step 2 CK, you are telling residency programs that you are qualified and ready to train. However, it is important to note that a low score may do more harm than good so be prepared.
  • Take USMLE Step 3: An effective way to bolster your application is by taking the USMLE Step 3 exam. It is a demanding and expensive process, but these scores can reassure the residency program that you are a strong candidate even if you have a red flag. This is especially helpful for older graduates and candidates with low scores or multiple attempts.

Approaching red flags in your application in a professional and persuasive manner can be a challenge. However, we help candidates overcome such obstacles by optimizing all aspects of their application documents and putting them in the best light possible. Reach out to us today for assistance conveying the right message throughout your ERAS application! Call our experts at (858)-221-8580 or email support@residencyexperts.com.