Common Residency Red Flags

What are Residency Application Red Flags?

Residency application red flags are any aspect of your residency applicant profile or ERAS application that may present an additional challenge when viewed by residency Program Directors and Interview Selection Committees. There are a variety of red flags a residency candidate can have in any section of their ERAS Application. Being aware of what might be a residency red flag gives you the chance to shape how Program Directors view your red flags and prepare to face the complications having each red flag can bring to your residency application experience.

Time Since Graduation

Perhaps one of the most thoroughly discussed and well established red flags within a candidate’s residency profile is having an extended “Time Since Graduation” or older “Year of Graduation.” This refers to the amount of time that has passed since a residency candidate graduated from their medical school.

How to Calculate Your Year of Graduation (YOG):

Month/Year of Graduation from Medical School to Month/Year Applying to Residency

For example, if a residency candidate graduated in June 2012, and is planning to apply in September 2018, their Time Since Graduation is 6 years and 3 months.

Typically, residency candidates with a medical school education gap of 5 years or more are referred to as, “older candidates.” An unfortunate reality of the medical residency application process is that the longer a candidate is out of medical school, the more difficult it is to obtain a residency position.

Professional Experience Gap

Another gap that can be perceived as a red flag to residency Program Directors and evaluation staff are any breaks in relevant medical experience from when a residency candidate graduates from medical school until when they apply for residency training. Sometimes, medical experience or related employment can be hard to find directly after graduating from medical school, leaving new graduates scrambling for whatever job will help them make ends meet if they do not go directly into residency.

Going too long without medical experiences can reflect poorly on the residency candidate and cause residency Program Directors and their interview committees to question whether or not the candidate has the up-to-date skills and knowledge to move into residency smoothly.

Extended Interruption in Medical School Education

A less well known, but still serious red flag is for any residency candidate who had to take any extended breaks from medical school. This can happen for any amount of reasons, but some of the most common reasons are:

  • Financial hardship
  • Family obligations or passing’s
  • Personal health
  • Disagreements or the need to transfer medical schools

For any one of these reasons, a residency candidate may have to leave their medical school for an amount of time. To complicate matters further, the MyERAS Common Application specifically asks whether or not your medical school education was interrupted, and how you answer can be very important. Your answer will shape the way programs see your leave of absence and also how you handle adversity.

Low USMLE Scores

Medical students and graduates are told over and over that their scores on the USMLE exams can make or break residency aspirations. One of the most painful red flags any residency candidate can encounter is lower-than-expected scores on their USMLE Step 1 or USMLE Step 2 CK. While this is certainly not the end of your residency application dreams, it can limit the residency programs you would like to apply to or the medical specialty you want to pursue.  

Multiple USMLE Exam Attempts

Equally or even more devastating than scoring lower than you expected on your USMLE exams is finding out you did not pass the exam at all. With the passing scores and difficulty of the USMLE exams increasing every year, it is not a surprise that more and more residency candidates are not passing one or more of their USMLE exams on the first attempt.

Having one or more additional attempts on your USMLE transcript can add extra challenges to your residency journey. Residency candidates with USMLE attempts should be aware of state requirements and program minimum requirements to do with their number of USMLE attempts.

Applying Late and/or with an incomplete application

Once residency applications open in early September, residency candidates can technically continue applying to programs through ERAS until the Rank Order List deadline in late February. However, it is a well known fact that residency candidates looking to succeed should be applying in September of the application cycle. Applying later than September or applying with an incomplete ERAS Application can make a residency candidate look disorganized and unprepared for the rigors of residency training.

➔ Learn more about Applying Late or with an Incomplete Application

No US Clinical Experience

A residency red flag that is exclusively for 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. Residency programs want to have some assurance that Non-US IMGs will be able to handle themselves in US medical environments which may be very different from their home country.

Solutions and Strategies for Facing Red Flags

While there are no “quick fixes” in residency, there are some actions residency applicants can take to improve their chances and strengthen their residency applications.

Getting US Clinical Experience (USCE) or other Experiences

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 especially important for International Medical Graduates (IMGs) who may not have any US clinical experience when they begin the process. However, it can be difficult to figure out which experience counts and what does not.

Typically, what counts as USCE is:

  1. Externships
  2. Sub-internships
  3. Clerkships
  4. Any clinical rotations completed in the US

What typically does not count is:

  1. Observerships/Shadowing
  2. Research Experience
  3. Volunteer Experience
  4. Experience in Canada or England, which is believed to be similar to the US medical system

Obtaining additional USCE has many, many benefits. Not only does continuing to obtain new experiences ensure you do not have a professional gap in your MyERAS Application, but you can also use this experience 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. For example, if you are going to be applying to Family Medicine, be sure you focus on getting Family Medicine experience to prove you are dedicated to the specialty.

Networking Within the Residency World

Like obtaining USCE, making residency connections can be a difficult process, but well worth it for the benefits. Often, when all else fails, getting into residency can come down to who you know and who knows you. Even one connection has the potential to lead you towards success or point you in the right direction. But, how do you create and foster these professional relationships? A few ways you can create connections are:

  1. Keeping in touch with your classmates from medical school. This is especially relevant for US Medical Graduates and Caribbean International Medical Graduates (IMGs) who may have classmates that get into residency before them and can provide insider information about their programs.
  2. Joining professional organizations in your specialty of interest. Most medical specialties have at least one specialty specific professional organization. By joining an organization, you can create connections with other members.
  3. Going to professional conferences with your resume, CV or copy of your MyERAS Application in hand to meet and greet with program faculty that often attend these events.
  4. Looking up and getting 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. Ask politely, and do not expect too much, but if even one program says yes, this could lead to making important connections with the program down the road.

Taking your USMLE Step 3

Although the USMLE Step 3 is not a requirement for starting residency training, it can be a nice boost to your residency application. This is especially true if you have any additional USMLE exam attempts or low USMLE scores. By taking the USMLE Step 3, you are communicating to residency programs that they will not have to worry about you needing to spend extra time studying or even failing the Step 3 during your residency training. Another benefit of the USMLE Step 3 is that it will allow Non-US International Medical Graduates to qualify for the H1-B visa, which is generally preferred to the J-1 visa.

But, the USMLE Step 3 exam is not meant to be taken lightly. It is a grueling and expensive two-day exam that combines many of the elements of the USMLE Step 1, USMLE Step 2 CK and USMLE Step 2 CS. If you decide to take the USMLE Step 3, be aware it is a commitment and should only be taken by those who are confident in their abilities to pass on the first attempt.

Choosing the Right Message for your Residency Application

When a residency candidate has residency red flags to contend with, this should have an effect on how they approach their ERAS Application and the message that comes from their application documents. It is highly important to make sure your entire residency application provides a unified and beneficial message that not only explains the red flag but also reassures the programs that you are the right fit for their program.

A common example of creating the right residency message is with regards to “older candidates.”

Myth: In order to seem more appealing to residency programs, older residency candidates with lots of experience should show off all of their medical experience to impress residency programs.

Reality: While this may seem like the right path to take, this message can actually be off putting to residency programs. Excessive demonstrations of your experience may not only look like you are arrogant but will also lead residency programs to believe you will be unwilling to learn from them. Older residency candidates or those with an educational gap should try to appear humble, excited to learn, able to work with any age group, but are still a valuable asset to the educational part of the program. Using this message will help older candidates appear the least arrogant and look the most appealing to residency programs.  

Whether you are an older candidate, or a candidate looking to smooth over USMLE attempts, having the right message throughout your ERAS application is vitally important to improving your chances to obtain a successful Match.

Get professional help with your ERAS Supporting Documents and send the right message to residency programs