Awesome. Well, good afternoon everybody. Happy Friday afternoon. We recognize we're kind of the last talk before the the midway party, so we'll try to keep it light and keep it moving. I'm Dr. Adam Lamb. I'm the course director for today. I'm the program director at Mary Free Bed Rehabilitation in Grand Rapids. Joined with me today are two of our co-faculty members, Dr. Haley Borgstrom, who is the associate program director at Spalding Rehabilitation Hospital and also the associate fellowship director for the sports medicine fellowship there, and Dr. Craig Revito, who is the program director at Spalding Rehabilitation, also part of Mass General Brigham. So what we want to talk about today is kind of giving a little bit of a behind-the-scenes look of resident application. For some of you recognize you're probably in the throes of it as fourth years, but we also see that there's been a growing number of first, second, and third year students here, which is also equally great. And hopefully giving you a little bit of kind of the course ahead and kind of how to prepare. So in terms of our learning objectives, we'll hopefully kind of talk about some changes and trends that we've seen, help you work on building an applicant portfolio, and identifying strategies for kind of finding your voice through personal statement writing and how to navigate virtual interviewing, which is likely here to stay. Dr. Donna Huang was unable to attend today, but she helped with some of the course creation as well. We have no relevant financial or non-financial disclosures. And before we start, I think anytime that you're talking about residency application process and people have hundreds of thousands of dollars in medical school debt on the line, I think we have to kind of start with a disclaimer that this is at least three and four people's perspective on this. This is not the end-all be-all, but we've been around a couple of times and want to share some of that. But this is in no means meant to replace any advice that you've gotten from your medical schools, other mentors, friends, family, significant others, people who are helping foot that medical debt for you, right? There's a lot that goes into it. So we'll kind of start with kind of like the state of the specialty, kind of like almost this state of the union, so to speak. And what we've seen, and this probably doesn't come as a shock to anybody, is that applying has become more competitive year-on-year. There's almost no unmatched spots at the end of match day. And that's kind of been a trend over the last, you know, five plus years at this point. Program signaling is still also relatively new. And one of the challenges for us is that the number of signals that are available to all of you changes per year as well. And so each year the data that we present is somewhat out of date because the number of signals changed and we don't have kind of the new data to show to you. They've also added geographic preference indication, region, rural versus urban versus suburban. And so there's a lot of things that have changed in the past several years that we're trying to kind of get up to speed with. We've also seen that the number of people applying to physiatry increases by year. And so this we've kind of broken down by allopathic, osteopathic applicants, and then international med grads, which is kind of the way that ERAS reports the data out. And year-on-year we've seen that there's been an increase. And that increase hasn't really, that change hasn't really, the trend hasn't really changed a lot in the past couple of years. So when we look at it in 2023 there were just over a thousand applicants. The year before was just about 1055. So it's holding relatively steady for the last couple of years, but we'll kind of have to see where things go. For contrast, this is almost double the number of applicants to the number of spots nationally in the specialty, just for some context. When we look at how many programs do people apply to, I think that this is one of the questions that kind of always comes up is, what's a reasonable number for me to choose? And we've seen kind of this increase from low 40s for osteopathic applicants and just around 40 for allopathic applicants in 2019. And that's kind of blossomed up to around 60 to 50. And we haven't really seen a ton of change in the number of programs applied to in kind of the onset of signaling. That was one of the thoughts behind signaling was, could it curtail application bloat, which becomes challenging on both sides. It's a lot of applications and communication with program coordinators on a student side. It's a lot of applications on a program director side and associate program director side that we'll talk about in the next slide. And that's kind of exactly what we see here. And so this is the battle that the three of us face every year, kind of on the other side of the battle that you face. We're seeing just around 500 applications all told per program per year. When we break it down, you know, it's around 200 to 25 of osteopathic, similar numbers for allopathic, and then just around 75 or so of international med grads. And it's still early on, but we at least kind of see that the trend has at least slowed down a little bit. That there was this growing, growing number of programs applied to by year, and signaling seems to at least kind of held the line. And it's not clear. We're still early on to know, is that a good thing? Is it a bad thing? But it at least is kind of the context of where did signaling come from. Because when we're trying to do a holistic review of applications, when you have 500 to look through it, it becomes almost an impossible task, or one that gets diluted out over so many faculty, that it's hard to ensure that faculty reviewer A is giving an application the same due diligence as faculty reviewer B. And so there's a lot of variables that get introduced when the signal, when the total applicant number gets this high. From a signaling background, we started this in 2023 as a specialty. When we think about 2023, it's the match year of 2023. So that was actually the fall of 22 application cycle with four signals, then increased to five, and then this year increased up to eight. And so the thought is that, does this almost kind of serve as like an unofficial application cap? There's other specialties that use kind of a number of signals into the 15, 20, 25 plus signals, and there there has been a marked reduction in the number of applications per program. It also then becomes almost a de facto signal, and there's kind of some some ethics and discussion about whether that should actually be or not be a thing. But that's kind of the background of where this came from. What has been consistent is that programs who receive a signal from an applicant, that applicant does have a higher rate of getting an interview than an unsignaled applicant does, and we'll show the data that kind of backs that up. So when we look at program signaling, this is kind of for the average program. You can see at the bottom that the average program is getting around 47 or so signaled applicants per program. So that takes it from, you know, each average program is getting just about 500 applications. This kind of narrows that by, you know, 90% down to a 50 or so applicants who have sent a signal. But there's a really wide range on this. There are some programs who received 170 signaled applicants last year. On the contrary, there was one program that received three. So that that mean of 47, there's a really big skew to this. And that's kind of what the data here shows. This is looking at the number of applicants, and that top is the kind of that lighter blue color, and then the number of signaled applicants by proportion is that dark blue bar at the bottom of the top graph. But what we show at the bottom using ERAS available data is the proportion of applicants that a program received who signaled, right? And we see for some programs it's more than 20% of their applicants sent them a signal. And then there's this kind of tail that goes all the way down to, you know, almost 1% or less of signaled applicants at some of the other programs. And so what this says to us is that it becomes really hard for us as program directors and APDs to tell you, like, how much is a signal going to matter? Because it's going to change by program. My program gets a certain number of signals. Their program almost certainly got a different number than mine. And it's going to vary based on region, how prestigious is that program, how many spots does that program have. Bigger programs tend to get more applicants because people feel like they've got a better better shot there. And so there's a lot of dynamics that go into this. But I think in terms of using one of my least favorite terms as a med student, kind of high yield slides, I think this is one of them. And what this shows is your likelihood of getting an interview by sending a signal versus not sending a signal. And when we look at it from 2022 to 2023 match cycles, it stayed very similar. Around 48 to 53% of signals converted to an interview. On the contrary, only about 12% of non-signaled applications converted to an interview. So there's kind of a fourfold increase in your likelihood of getting an interview by sending a signal to a program. We'll talk a little bit more about some of the challenges of that and there's almost a little bit of game theory that goes into who do you send a signal to and who do you not that we'll kind of get into later. But I think if there's a program that you really want to maximize your odds of getting an interview at, that's a program to send a signal. And that's kind of what that slide says to me. It's not a guarantee but it definitely boosts your odds. There's also a lot of dual application that happens. If we exclude kind of TY and prelim programs out, those numbers look a lot lower. But out of about a thousand applicants, about a quarter of them also dual applied to internal medicine. Varying numbers kind of in the 50s for ER, anesthesia, neurology, ortho, psychiatry, diagnostic radiology. And so when you look at the match statistics you have to keep this in mind that there's people who are dual applying and they match somewhere else. And so the true match rate for applicants is different than if you look at what's the match rate for people who wanted PM&R and got PM&R versus people who applied to two or three different specialties and matched one of the three, regardless of whether it was their first choice or not. When we look at geographic preference, by and large the majority of applicants are sending three distinct geographic preferences. To me that kind of makes sense. You get to choose up to three. You might as well. It's kind of the way that I look at it. I don't know if the two of you feel differently. But that's kind of what we're largely seeing across the board. Same for setting preference. And I think this largely has to do with PM&R as a specialty that we're largely kind of urban to suburban practices. And so there really weren't a lot of people selecting rural programs because there just truthfully aren't a lot of those out there. And that to me kind of made sense that either people said urban, suburban, or no preference. That just kind of reflects where everyone is. One of the other changes that's happened to the ARES cycle, and this was in part to fight application bloat, is maximum of 10 experiences. Because what happened before was you'd get an application, maybe somebody has 15 or 20 volunteer experiences, but it's I worked at a food bank for two hours one time and then I wrote a paragraph about it and then I did this other one activity for an afternoon. And it makes the ARES application look much longer and it's harder to get through to do that holistic review. So cutting it to the 10 most meaningful gave us more time to review those 10 most impactful activities. What we've seen some students do, and I think it's kind of a wise thing, is if you've done multiple say pre-participation exams you can make that like one activity and then list all of them underneath it. So there are some ways that you can still kind of show all of the work that you're doing. But again by and large almost every applicant is using all 10, and that to me makes sense. Most everyone here has 10 significant experiences that they want to talk about. Don't leave space blank in other words. You also get to pick your most three meaningful experiences. For the fourth years in the room this is kind of old hat, you already know this. But again almost everybody's picking three, which again kind of makes sense to me. There's a widespread over what are those most meaningful experiences and overall volunteer being really high, other extracurricular activities being another, research, the ones that you would kind of make sense I think. There weren't really a lot of surprises here for me. This I think is another one of these important slides to look at. So if we look at the number of people who entered the match, whether it's MD seniors, DO seniors, or IMGs, again we start with that 1055 number at the top. But then a number of applicants matched into a different specialty than PM&R. And so if we kind of make the the cognitive leap and from a biased physiatrist perspective say that physiatry was that person's first choice and they matched into something else, then the PM&R match rate for MD seniors is 65%. It's 52% for DO seniors and 14% for US and non-US IMGs. If we narrow that just to the people who applied PM&R only, matched PM&R only, those numbers go up to 85%, 75%, and 50%. So again, when you're seeing these numbers represented, it's important to know like what is that source using? Are they saying out of everyone who chose and wanted to apply to PM&R, how many of them matched PM&R? Or if we eliminate all of the people who didn't match, withdrew from the match because they had low interview numbers or some other reason, the match rates going to look a lot higher because a lot of the people who may not have matched withdrew. So just kind of keep that in mind when you're looking at the statistics. When we look at what are the things that increase somebody's likelihood of matching, it's the things that kind of we would expect. People who have a longer rank list because they interviewed at more places. People who had higher standardized test scores, whether it's USMLE or Comlex. This is a bit up in the air because we're still kind of grappling with the change from pass-fail on USMLE and Comlex. I think what it's ultimately doing across any specialty is putting more pressure on to step two or level two and I have mixed feelings about that because we didn't really eliminate the problem that moving step one pass-fail did. We just kind of moved the goalpost and I'm not sure that moving the goalpost was better but that's just my perspective. People who did more research also had more publications and for allopathic applicants if applicable, AOA membership. This is just kind of that slide that backs this up. I'm not going to go through the whole thing. You have that available for you. I just want to highlight a couple things here at the top. Looking at your mean contiguous rank. This is the number of different programs that you have ranked in PM&R. This was probably the strongest indicator of whether somebody was going to match or not. I bring this up hopefully not to cause anxiety for any fourth-years in the room but the matched US Seniors MD or DO had about 12 to 13 contiguous ranks whereas those who went unmatched had five. So for the US IMGs and non-US IMGs it doesn't hold as well and that's because there's a really wide variation in who those applicants are. Some of them may have been practicing physiatrists in another country for 15 years, have a very long publication record versus a IMG senior and their CVs are going to look very different. So because these numbers are small and because there's a lot of variation there's a lot of it's a lot harder to pull tendencies for the the IMG group unfortunately. Using data that the NRMP was gracious to share with us this kind of shows that same thing. If you look at what is your probability of matching on the y-axis versus the number of contiguous ranks on your rank list going into March for US MD and DOs if you want to hit kind of a 90% likelihood of matching it's 11 ranks for MDs 13 ranks for DO applicants and that includes like your your categorical and advanced program. So all of those together if your rank list hit 11 to 13 you're probably in pretty good shape. When we look at it excuse me this should be for our IMGs US and non-US IMGs again because there's just so much variation here kind of somewhere between 10 to 17 but again you want to kind of be hitting I think 12 13 is a really solid number. So when we think about kind of just the takeaways from the data obviously the process is becoming more competitive. Utilize your program signaling intelligently and have a strategy and my colleagues will talk a little bit more about that in depth. Having more meaningful publications presentations is definitely important. The talk before kind of talked about research and getting involved in research early and some strategies and so definitely take a look at those slides if you weren't able to attend and not surprisingly the more interviews you go on the better likelihood of matching. That one kind of makes sense to me. So you can use that data to kind of ballpark because I'm type A most of the people in this room are super type A you want to kind of know going into match week like all right what are my odds how am I doing that's a really good way to know. It's not a guarantee but it definitely helps. So we'll next kind of pivot to personal statements and virtual interviewing and then I'll hand it over because everyone's tired of hearing me talk already I'm sure. So holistic review has been encouraged from the AAMC for many years at this point and this is kind of with the goal of considering the applicant as a whole person not just a step number or a level number or how many publications or whether you're AOA or not and the background behind that is that it's well known that holistic review improves equity in the application process also improves diversity creates better teams who provide better care for patients and so this is kind of a win-win across the board. The pushback from program directors wasn't against holistic review but it's how do I holistically review 500 applicants right that's really where all of the signaling piece came from was we all were in agreement holistic review is excellent but it's you know I've calculated out it's about 25 to 30 pages of text per applicant so then if you multiply that by 500 applications it's you know 1,500 pages that our team has to file through each of these teams has to file through. So holistic review there's also some thought that this may help improve fit between applicants and programs I'm always a little hesitant to talk about fit because it almost always is some kind of proxy for unconscious bias in some way shape or form that whether it's certain a cultural preference that a program may have versus another and so fit I think I try to move away from and instead look at it as I want the individual who's applying to me their values and their mission to align with my program my hospital's values and mission so kind of making fit much more tangible than just kind of general vibes. So what does holistic review look like it's putting greater emphasis on other aspects of an application probably most notably the personal statement the Dean's letter or the MSPE and especially the narrative comments on how does this person do again that's a lot of text to read through but those narrative comments are super helpful I think more helpful than this person got high pass or this person got honors but this person stayed late this person identified a patient who was crashing on the floor got them the care that they needed those types of comments are really important to us. Your CV letters of rec and each one of us I'm sure if you ask the three of us we each start with a different part of the application so you know make sure that the whole document as a whole is really good because each of us is going to start somewhere different but I think the personal statement in PM&R is probably one of the most important single pages in your application it's your chance to tell us who you are and in previous years if we go back a decade or two a little more than a decade for us when we were applying this was important but probably not as important as it is today I will say and writing a really good personal statement takes a lot of time and so for those of you who are first second and third year students don't leave this until a couple weeks before it's really hard to write this and it's really hard to write a good one well and find your own voice so there's guidance about AI and you know I would say just stay away from it you you can't have AI written text in your final version of your personal statement but I would say even be hesitant to use it and helping you brainstorm because then it's not you right and that's really what we want to know is who you are and so I would say you know keep AI as far away from a personal statement as you can but that's my bias so some questions to consider when you're getting into the writing process is who are you who do you want to be what are the things that have gotten you to this point in your life in your academic career what are those things that make you tick what are those things that get you out of bed in the morning, those curiosities, those patient populations, those questions that really motivate you, that, you know, that fourth or fifth day in a row on service where you're tired, you're worn out, there's something else going on. What's the thing that still makes you excited to come into the hospital on rotation? And what are your own personal values? So, this whole thing's kind of been unsolicited advice, but this one especially. I would say try to keep it to one page wherever you can, single-spaced. It's not a deal-breaker. I think we all kind of hear these stories of program directors will stop reading at the bottom of page one, even if it's mid-sentence. I don't know that any of us do that in actuality, and I don't know where that started. I'll blame surgery for that, I guess. But I think where you can keep it to one page. You know, Shakespeare kind of brilliantly said, brevity is the soul of wit, and I think that's certainly the case in a personal statement. One that tells me a lot about you and is still a page long is really impressive, and those stand out immediately. Use caution when you're describing the specialty, because this often kind of becomes like preaching to the choir, right? So, the three of us already chose PM&R, so be really careful spending a paragraph talking about why PM&R is great. Instead, spend that time talking about how you fit into the specialty of PM&R. How do your values, your curiosities, fit into the specialty? But don't sell me on the specialty, sell me on you being a part of that specialty. And stand out from the crowd. There's a lot of personal statements that are a grandma's injury, falling down the stairs, or a personal injury. You want to do something that's unique, and I've seen ones that are done really well, and we're interviewing people with those. I'm sure both of these are as well. But my main advice to you is try to do something that differentiates you in every aspect, because the more that you can stand out positively, the better, because again, we're reviewing 500 of these. And so if you're doing something that somebody else is doing, it's harder to differentiate, and that's the last thing you want. And this is a formal process, so it's kind of like your job application, so avoid any slang, jargon, those types of things in your personal statements. So, we're using that to get to know you, and we want to ensure that your personal statement is truly you. So, don't try to be someone you're not. Don't try to be the person that you think we want you to be, because if we fall in love with that person and match you, then you either have to pretend to be someone you're not for three years, or you're not going to be happy for those three years. So, be yourself. Convey who you truly are in your personal statement, and there's more than 100 programs out there. There will be many who will fall in love with you for who you are, so don't try to be someone you're not just to get an interview, because we can kind of feel that out. There's times where sometimes we really like the person that we meet on paper. We bring that person in for an interview, and then there's this feeling of, well, that's not the person that we actually met, and you don't want that to be you. And so, my advice is, once you have your personal statement, have it read by someone who knows you well, whether that's a spouse, partner, significant other, family, friends, a mentor who's kind of followed you for years and years, because you want to make sure that when they read that personal statement, it's 100% you and who you are. Prepare your space. So, when you're virtually interviewing, we've all kind of probably have seen this one from the BBC. You want to have a private space wherever you can. Minimize distractions as able. Background noise, pets, and children's. We also recognize that life happens, and so it's not a like, well, scratching that person off their dog barked, right? But try to do what you can, because it can be also distracting to you, and I think that's almost more what I see is like the dog starts barking, and the applicant gets thrown off, and I'm like, life happens, it's a dog. You know, you can't control it. And oftentimes, you can't hear the dog unless they're like in the room. Make sure that you have a good, strong internet connection, and I will say kind of like, try to have a semi-professional background. We recognize that sometimes you may be interviewing from a hotel room, and so like, the bed in the hotel room may be behind you, and that's just life happens. Try to avoid distractions where you can. During the height of COVID, there was actually this like, rate my room account on Twitter, where they would kind of go through all these Zoom virtual interviews, and rate people's backgrounds zero to 10. We don't do that, for the record. But sometimes having a knickknack, or a photo, or sports memorabilia, like, you can kind of work that into your discussion, and be like, oh yeah, this is from my trip to the Grand Tetons, or whatever it is, and it kind of becomes a part of the conversation. And so you can kind of curate your space to control what does the conversation look like. From an apparel and appearance perspective, again, I think this is another place where bias often enters, because professional attire kind of has a Western, Caucasian bias to it, which can discriminate against other people. And so, what I would say is, dress in a way that represents you, who you want to be professionally, who you would want to be to your future employer, because you're probably going to be meeting, ideally, when you're matching to one of these programs, you'll have interviewed with your boss, and potentially, like, the department chair. So, you just want to dress in a way that reflects meeting your potential future employers, in whatever way that means to you. Dressing well has also been proven to increase personal confidence, and so if you dress well, you feel well, you perform well. During the interview itself, it should be formal, but not stiff, nor impersonal. And, I can't stress this one enough, that you should assume that you're being interviewed the entire time that you're communicating with that program. So, when you're communicating with the program coordinator, if you need to change your interview date, all of that's kind of part of the interview, because, I can speak for me, and I don't want to speak for these two, but, like, my program coordinator is, like, my work BFF. And so, if she has a bad interaction with someone, like, that immediately makes it to me, and that matters a lot, because that's my work bestie, that this person was mean to, right? So, assume that you're being interviewed the entire time, whether it's your group discussions, icebreaker, the program interview, don't fall asleep if there's a program overview going on, PowerPoint. Stay professional if there's, like, a meet and greet, but, again, make sure that you get any questions asked, the answer that you need asked, right? But, there's a way to do it. So, you could say, hey, what's kind of the overnight responsibilities, or when do you guys study, as opposed to, do you have a lot of time to hang out and party, right? So, it's just kind of like, it's asking the same question, but asking it in that kind of professional way. Treat your interviews the same as you would an in-person interview. So, try to maintain relatively good posture. We should in PM&R anyway, but I don't. Try not to fidget. As an ADHDer myself, that one's really tough. Maintain good eye contact, at least periodically, trying to look into the camera, where it's kind of the green dot or something like that. If you're looking down at the screen the whole time, it looks a little weird, and I'm sure if we don't do it, it kind of looks weird on your end, too. So, at least every once in a while, try and make eye contact with the camera itself and not just the screen. You want your answers to be thought out, yet not memorized. And so, try to anticipate kind of common questions that you're likely going to get. Like, why PM&R? Why did you choose our program? What are your strengths? What are your weaknesses? So that you can have a relatively confident answer that doesn't come off canned or rehearsed, but there's not a lot of um, and, well, or like a 15-second pause before answering. From pros and cons of virtual interviewing, we all did it in person. I probably spent $10,000 on flights and hotels. I'm sure for everyone up here, it was similar. So, that's a pro, that you don't have to spend that money financially. You potentially can participate in more interviews, which is also potentially a con, because what we see is that there are people who get 15 or 20 interviews, and those are spots that somebody else may want and kind of need. So, it's kind of a pro and a con. There's less time missed from rotations and research and things like that. So, now as a faculty, that's a pro. As a student, that's probably a con. One of the other cons is kind of difficulty assessing fit of a program or however you define fit. And there's at least been some initial studies that have shown possibly reduced applicant satisfaction with the process as a whole. And I think it's because it's just, it's a little harder to feel a connection with people through a screen. So, how do you counteract that? Come to a conference. Get to make some connections with other people. Participate in away rotations where you can. And we recognize that that's really hard to do. Sometimes your schedule and our schedules don't line up, or we don't have availability. So, it's not a like, I don't want you to read this and be like, all right, I have to do three away rotations. That's not what we're saying. But if there's a program where it's really important for you to get to see the bricks and mortar, try and arrange that where you can. Get mentorship from an academic physiatrist, which that also can be virtual. So, if you don't have a home program, reach out through AAP, AAPMNR. Find somebody who can kind of help you through that process, because there's plenty of us out there who would be happy to do. And there's also programs that are doing second look visits, either in person or virtually. A lot of them are doing in person. Ideally, they're doing those after they've submitted their rank list, so that whether somebody shows up or doesn't, it's not going to influence your standing on the list. So, it's purely for your benefit. And I think a lot more programs are starting to do that. With that, I will hand it over. Thank you. Good afternoon, guys. Thanks, Adam. That was great. Reminds me of our resident didactics, again, when we were together. Oh, shit. Yeah. So, one thing that I did want to kind of add about the personal statement section that I know that we do as an interview committee is we take a look at those personal statements, and obviously, we want them to be unique. But something that's really important is if you feel like there's a red flag on your application, I think it's a really good time to kind of just address it head on, because you know that we're going to see it on your application somewhere. And if you have a valid and reasonable explanation or a growth process from that red flag, I think it's really important to highlight that, because that shows that you're an individual who can adapt and change. And so, I think it's a good thing to incorporate if you can. I'll try and keep this short and sweet so we can get to the Q&A portion, because I think that'll be a lot more helpful for you guys, more organic kind of discussion. But to go over some stats from 2023, suffice it to say that most applicants signaled. There was very few applicants that didn't signal. Most programs participated in the signaling process. There's very few that do not. And then talking about geographic and program signals, the signals for these typically align. Obviously, there's some times where they won't. Your geographic might not line up with your program signal for whatever reason. But for the most part, your signals are going to align as per these statistics. This might even be higher now with the recent bump in program signals. It could also theoretically be lower, depending on your geographic region. So most applications, everyone's sending out their full eight signals now. And before, these statistics, these are for the five signal applicants. So most, or the highest number of signals that programs were getting, around 100 to 120 in that range. And mind you, Adam presented before on some of the numbers regarding the number of applications that we receive in total, which aligns somewhere around the 450 to 550 range, depending on the program. So just about, like I said, just about 20% at times. That being said, there are some programs that are getting somewhere around the 2%, 3% range for applicants signaling per program. So for a practice setting, I would say, like Adam said, this is kind of a thing that we're still trying to look at and observe. But I don't know if it, at least for our program, matters all that much. Because the way PM&R works is we're mostly nested in large academic institutions, which are mostly nested in major cities. And even if they're not nested in major cities, they're still nested within somewhat larger cities. And you have access to both urban and suburban, and even some rural practice settings. So I think for the most part, I would say we don't necessarily know what to do with this, other than to say, if you exclusively put something rural, it might not be a great fit for many of the programs. So I don't know how many are exclusively just putting rural for that. But very rarely used. The meat and bones are really the division or geographic preferences in our program signals. So the division signals are really, really important. And I think these are even more important for those applicants that are opting not to send a program at program signal. I think applicants who don't signal in any way, whether that's program signal or division signal, obviously much less likely to have a chance at an interview. It's not that it's impossible. You have to have some form of perhaps communication. Perhaps you did it in a way there. Perhaps you already spoke with faculty there. But I think the division preference is incredibly important for those that do not program signal that particular place. This is also kind of a hard thing to interpret for across the board for programs. Because for us in the Northeast, we have very few programs around us. So getting a division signal for us means a lot more to us than getting a division signal, let's say, in the mid-Atlantic or something, where you're trying to signal, let's say, the New York programs, and they have three within five square miles. So I think you really have to look at the division that you're signaling and decide how are these programs going to interpret it, and how heavily are they going to weight this signal. Like I said, for those programs where there's not a lot of competition necessarily within the same signal, there's not that many, it's going to weigh a lot more than when it kind of gets diluted out and you have a ton more signals, or a ton more places to be signaled, let's say. Like I said, for the New York region, perhaps. And then one of the most important things that Adam was talking about is the program signal. I think this is, for us at least, especially with the bump in the number of signals that you guys get, I think that this becomes even more important. Because this lets us know that you want to be at our institution. At the very least, you're interested enough to want to be at our institution. And we ultimately want you guys to be happy residents. And if it's here, or at Spalding, or Mary Free Bed, or wherever, we want you guys to be happy. It's not that we are only interviewing these individuals who program signal us. We still interview those who don't program signal. But I will say it's very heavily weighted toward people getting interviews who have program signals. I think for most programs, they would probably tend to agree with this, because we want people who want to be here. And then one of the other things that is incredibly important, that we use in our interview committee, and I don't think this is like ERAS language, but we call it the double signal, where we get both a division signal, or geographic preference rate, and we also get a program signal. I think, again, depending on where you're signaling, what division you're signaling, what geographic signal you do, this can mean a lot more or a lot less. But I think the double signal, or signaling both division and a program, is incredibly important if you're really, really interested in said program. I think that goes without say. And I would say, I don't want to speak for Adam, but I would guess that he would also agree with that. And that goes into this idea of game theory, and the idea of you're going to likely get more interviews to the programs that you signal to than the programs you didn't signal to. Again, that goes back to we want residents or medical students to come into our program who want to be a part of our program, who have an interest in our program for some value reason or mission reason, to find, like Adam said, their mission fit. And so you do want to match your competitiveness to the programs that you're signaling. So if you really don't feel as though you have any shot, and you don't want to waste that signal, which is going to kind of go against what I say in a little bit. You don't want to waste that signal. Don't feel like you have to send a signal just to see if you're going to get an interview. What I would say is communication with the programs is a lot stronger many times than these signals. So if you did it in a way there, and you had strong communication with your attendings and the residents who are there, you have residents who can reach out on your behalf, you have an attending who you rotated who can reach out on your behalf, and you feel like that's going to be enough for you, I think that's fair. That being said, signaling never hurts to get that interview. The idea is, if you don't signal, you probably do have a lower likelihood. I think that that's what the data obviously shows. But you also have this feeling, if you signal and you don't get that interview, you kind of wasted it. I will say, if you feel so strongly about a program and their identity and how that kind of meshes with your own identity, I think that there is no such thing as a wasted signal. I think that you truly can overcome a lot in your application by showing genuine interest and working hard on whatever rotation that you may be on. I think that's pretty much it. You know, there are not that many true requirements. Now, you know, as you all know, and as we'll talk a little bit more about here, there are certainly a lot of nuances that come into play when you're thinking about selecting letter writers. And, you know, in terms of the actual requirements, minimum of three letters of recommendation, at least one of those should be from someone in PM&R. I think that that is highly advisable. And I would say the trend has probably been more than one letter from a physiatrist. But again, we recognize that many applicants come from, you know, programs that may not have a home PM&R, you know, program, and it's definitely not a deal breaker, but highly advisable to have at least one letter of rec written from a physiatrist. And then it's up to you, really. And you want to kind of select your letter writers based on who's gonna be able to sing your praises and, you know, kind of really speak to who you are as a person and a future physiatrist. I would say common specialties that we get letters from IM, FM, surgery, research mentors, and the list really goes on, and, you know, there's nothing wrong with, you know, having an OBGYN who, you know, you have a longitudinal relationship with, or you've done research with, or, you know, there's, the list is unlimited. I mean, you should choose someone who can really, again, speak to you as a human. You can certainly check, you know, individual program websites for any other requirements. You know, I think that those aren't too common, but, you know, nothing wrong with investigating the program and making sure that you're not missing something in terms of different letter of recommendation requirements that they may have. So in terms of selecting these letter writers, how do we do that? Really, again, like I was getting at, the primary, I think, objective is to develop a longitudinal relationship with a mentor, a research mentor, a clinical mentor, someone that can really speak to you and your unique qualities and traits and your strengths. In terms of how you go about doing this, it's been touched on a little bit already from Craig and Adam, but if you don't have a home PM&R program, reach out. This is where you're at these conferences to network, AAPM&R, AAP, have so many excellent resources available in terms of pairing you with either virtual or in-person mentors in your area, and take advantage of those resources. They didn't always exist, and I think that it's incredibly useful, also to kind of get to know the field better, too, right, and kind of developing that genuine interest and understanding of the field that you are dedicating your life to, right, your professional life to, I should say. Other resources that I can think can be, that are really useful is former, maybe former medical students that have matched into PM&R programs, either from your institution or through friends of friends at other institutions, kind of picking their brain a little bit. Even using your, you know, kind of medical, like your GME, you know, like the office, and kind of reaching out through your med school kind of mentors, and trying to, like, get a list of anyone in the program who's matched to PM&R, if you're from a program that doesn't typically have a lot of medical students who go into PM&R, and seeing if it would be okay to kind of reach out to those people. There are a lot of ways to get creative about this, and just making sure that you are developing, you know, kind of relationships with people that can kind of, again, you know, speak to your strengths. In terms of, you know, you can be, you can make everything as complicated as you want to make it, right? I mean, I think that if you want to think about it in a way of, you know, if you're having three, maybe four letter writers, maybe there's, you know, one person that can speak to your clinical strengths. Maybe you have a research mentor that can kind of speak to your dedication to research and your writing capabilities, right? Maybe you have, you know, another mentor who knows you a little bit outside of medicine, and you know, you've got to know more on a personal level that can kind of comment on some of your, you know, your personal strengths, and things that are important to you outside of medicine. So, that's another way to kind of strategize who you're thinking about when you're thinking about compiling, you know, three to four letters of recommendation that are really going to communicate who you are to, you know, a panel of kind of an admissions committee. I think that, again, with, you know, step one going away, and, you know, really focusing more on holistic review, I agree. The personal statement has gotten so much more important. I start with the personal statement. That's where I start, and, you know, I would say second on my list are kind of the letters of recommendation. They really matter, you know, and so, you need to put thought into this, and you need to think about it early. You don't want to be asking, you know, two weeks ahead to kind of get a letter of recommendation. And that brings us to timeline, right? In an ideal world, you know, everyone recognizes this is not always ideal, right? But in an ideal world, I would say, you know, one to two months lead time on a letter of recommendation, if not more, if you have the, you know, if you have kind of that longitudinal relationship to ask for that. Again, we recognize that there are away schedules, and that there are other, you know, factors that may impact kind of the, you know, whether or not you can make that happen, and, you know, that comes down to a conversation with that person, and whether, you know, whether or not they can actually, you know, do what you want them to do over that time period. I would say, you know, I think that the best way to go about asking and attending to write a letter of recommendation for you is to set some time away, right, schedule a time where you're not kind of asking in between patients in the middle of a busy clinic. Maybe at the end of a clinic day, you say, hey, can we sit down and talk for a few minutes after clinic, or maybe it's during more of a formal, like a mid or an end of rotation kind of feedback session, where you're sitting there and can have a conversation. I think that that is ideal. Like I said, you want to ensure that your goals can be met, right? You've thought this through now, you've developed these relationships, and you want to make sure that the letter writer can accomplish the goal that you have in mind, and there's nothing wrong with asking for that, right? So I think that giving your letter writer clear, a clear understanding of what you're hoping to kind of accomplish is key, and having that honest conversation. So, you know, I'd love, you know, I really enjoyed working with you over this, I've learned so much, I would love if you could write a letter of recommendation for me. Do you feel like, based on our interactions over this rotation, or years, or you know, whatever, that you can write me a strong letter of recommendation, right? No one, you know, I think that, and then you should be prepared for whatever that answer is, right? And if that answer is no, I don't feel like we've had enough time to really, like for me to write you a really strong letter of recommendation. It's not because, you know, you aren't amazing, you guys are all amazing, it's just, you know, you need kind of a body of work to be able to write a strong letter of recommendation, and that's what's going to help your application most, rather than, you know, kind of a superficial, you know, we work together in clinic for a day, and I think this person's going to be a great physiatrist, right? That checks the box, but it doesn't really add to the application, and to, you know, to let us know who you are as a person. If we backtrack, you know, the kind of end of September is ideally when you, you know, like mid to end of September is when you'd like to kind of get everything in, and so if we backtrack, then, you know, that July-ish, you know, certainly by the end of an August rotation, hopefully you have asked your letter writers and have, you know, a plan, and that's kind of in the works, so that your letter writers, we're all busy, you guys, us, and we, you know, we need time to kind of get these things done. Someone may say that they can't write you a letter because they have, you know, other things going on, too, right? And so that's another factor, so ask early, be thoughtful, you know, humbly accept one way or the other whether your letter writer can kind of accomplish your goal. Nothing wrong with sending us a reminder, you know, a gentle reminder every now and then, with that in mind, again, we're all busy, but a gentle reminder, you know, a couple weeks ahead of the deadline, maybe a week ahead of the deadline can be really helpful. With all that being said, you know, if you're waiting on one, you have a couple of your letters already in, you're waiting on one last letter, you do not have to wait to submit your application on that final letter, and I would encourage you to submit if you're waiting on, you know, if you're waiting on one letter, don't wait, submit, and you can always, you know, that can kind of be added in, you know, there's usually a period of time where we're reviewing applications, and that will be automatically kind of added into your file over that time period. So, you should expect to have some butterflies in your basket, right? As you're thinking about kind of the do's and don'ts of making a rank list, I tell applicants this all the time, rank programs based on your preferences and your priorities. You come to these things, you talk to your friends, you talk to mentors, everyone has all these words of wisdom and unsolicited advice like we were talking about, you know, hear it, right, and take with you what resonates with you and leave everything else behind. We all have our own kind of priorities in our life that, you know, every kind of mentor may not be aware of, and so really you need to kind of prioritize yourself, your family, other things that are important to you as you go through making your match list. Be insightful, you know, this is kind of what we were just mentioning in terms of signaling There's nothing wrong with, you know, signaling a REACH school shooting your shot, so to speak, right? But you know, you are using one of your signals for that, and so just being insightful in terms of how competitive, you know, you feel you are as an applicant and based on conversations that you have with mentors, and trying to kind of use that to really kind of curate a rank list that you would be happy with. And then in terms of, you know, you have your rank list, right, I think this is another thing that comes up a lot is how do I communicate this? Should I communicate with this? And I think that there's varying advice. My advice would be that there is nothing wrong with honestly communicating with a program that say you are number one on my rank list, right? I want to match with you. I'll be ranking you number one. What you don't want to do is tell four programs that, right? It's a small world. We'll know. And, yeah. That happens. Yeah. Trust me. So, that's why I say, you know, just be honest in your communication. And I do think that it can, I do think it can benefit, be of benefit to you in terms of kind of reaching out to maybe that top one or two, you know, kind of programs and phrasing your language in a way that is very honest. Don't. Don't wait until the last minute to certify. You know, the internet goes down and it's just a highly, highly stressful process. Don't wait until the last minute. Don't rank programs that you don't want to go to, right? We did just talk about, like, you know, trying to hit that 12, 13, feeling pretty good, you know, from an average candidate standpoint if you hit that number. But you don't want to end up, you don't want to go someplace you don't want to go, right? And so, don't rank a program if you feel that you are not going to be happy there. And then, you know, on the flip side of things, don't rely on program communication to dictate your rank list. Again, you know, again, prioritize what you want, the program that you, you know, that fits your priorities best. I think that there is a lot of variability when it comes to communication from programs to applicants, and that is okay. It is okay to communicate. What's not okay is to kind of solicit, try to kind of get information about where someone is going to fall on a rank list, right, either a program or an applicant. So it is okay to communicate as long as it, you know, is not kind of crossing those boundaries. In terms of match day, try to stay calm, you know, use your outlets, go, you know, get outside, get some fresh air, go on a run, you know, call your friend, call your family, you know, have a snack, have more than one snack, have ten snacks, and a pie and cake, and do whatever it takes to kind of, you know, get you through. But use your outlets, you know, use your support systems. You are absolutely not alone in this process. I think around, you know, everyone is kind of going through it. We have all been through it. No one can do this alone. And so, you know, sometimes just realizing the person next to you is just as stressed out as you are can be a very, you know, calming factor. So this is all of us on our respective match days. We have all been there. In terms of kind of just summarizing and some final thoughts, planning and organization are key. Think through your application. Think through, you know, kind of how you can promote your strengths. Find your mentors. We all need help. We all need people that can guide us and give us advice. And whether that's at your home institution or using resources, national resources, please do that early and work on understanding the field and building those longitudinal relationships. When possible, you know, aim for a well-rounded PM&R experience during medical school. That's going to give you a lot to talk about, you know, in terms of meaningful experiences in your application, in your personal statement. Not only that, it's going to make sure that you understand the field well and that, you know, you're going to be able to thrive in PM&R and that it's the right choice for you. Strategize your approach when selecting letter writers early, early, earlier is better no matter what. This is a stressful time and don't forget to take care of yourself. Take care of your classmates and look out for each other. Again, it's a small field and we're all in it together. So with that being said, I think we'll pop over just for some kind of open discussion questions and more of a panel approach. Thank you. All right. We'll open up for questions. There's a microphone over here. So if anybody has questions, probably easiest way is to just kind of head over there so that everyone in the back of the room can hear as well, and then that'll just kind of make a nice line for everyone. Hello. Thank you so much for that talk. I really enjoyed it. I just had a brief question on a letter of interest. Let's say we weren't fortunate enough to signal a program and then you write a letter of interest to that program. How is that looked upon? I think that's going to vary program to program. I don't think that it's ever going to hurt you to say that you have interest in a program. I think the key thing to it is if you're going to write it to try and make it as specific to the program as possible. And I say this not because of I think this is something you're doing, but what we see is it's I'm really interested in Mary Free Bed, and then the font is entirely different for my program. And so like it becomes very clear that that was just kind of a templated one, or it'll be like because you have inpatient and outpatient experiences in a clinic, and I'm like, yep, so do they, and so do all of the other 112 programs. And so I think it's really important when you write a letter of intent to make it like specific to that program and say I'm interested in your program because of X, Y, and Z specific things, and this is how your mission aligns with mine. I think if you do that, that's only going to help you. Is it going to be as helpful at program A as program B? That's going to vary by place. But again, kind of to that shoot your shot perspective, you know, you're not going to be hurt by doing that. I agree. A well thought out email can never hurt you. So my question is regarding letters of recommendation from non-physicians. If you have, you know, someone you're very close to, you mentioned briefly outside of medicine, is it negatively impacting your application to have a non-physician kind of write a character letter? Great question. I would say if you're going to have kind of a character, you know, letter, it should be one, definitely not more than one. And I would say it depends on who that is. Like, you know, your mom shouldn't write a letter of recommendation, obviously. But I mean, there's so many, you know, unique experiences outside of medicine, you know, from like church or religion or missions types trips, and just like unique experiences that I think that it's very reasonable if there's a kind of a unique person that can write a character letter for you to have one non, you know, kind of medical letter. What are your thoughts? I agree. I would add that it's probably best for that letter to be your fourth letter, though. And, you know, I would say in most situations, happy to just have like three letters. I don't think, you know, you need more than that. But if one of them is a character letter, I would have that be that fourth. And kind of on another note, while we're talking letters of rec, I think one of the things that I notice a lot, and this unfortunately tends to impact the students who are coming from programs that don't have a home program, is that they may rotate with like a private practice PM&R doc who doesn't have as much experience in letter writing. And what we see a lot of times is like you get that one paragraph that's like, they were on time, they were nice, my staff liked them, I recommend them. That letter is not boosting your application as much. And so if you have some options, try to kind of weigh out. If there's somebody who's in an academic program, they're probably going to know the type of letter that we're looking for a little bit more. And if you don't have that option, I think it's fair to coach that letter writer a little bit and be like, can you write a little bit about my clinical acumen or my knowledge or my physical exam skills? Or try and give them a little bit of what you want. Don't tell them what to write, but tell them like what things to write about in the letter. Help your letter writer help you, in other words, if you're in that boat. Yeah, completely agree. I think I had it on the slide, but maybe didn't mention it. Having your CV available is kind of, you should have that always available when you're asking for a letter of recommendation. If you have a personal statement at that point, or even a kind of bullet points, I think providing that can be very helpful for a letter writer. And then echoing what Dr. Lamb just said about, again, ask for what you need, ask for what you want. I think the way to say that is, I was hoping you could highlight X, Y, Z. Maybe sending a follow-up email that kind of clearly bullet points that out. Not saying this is what you need to write about, but I was hoping you could highlight these things. I think that's a good way to go about it. Hi, my name is Alan. I'm a fourth year medical student. And I think at this point in the process, as a fourth year medical student, I'm curious about the third kind of signaling. We mentioned program signaling, and we mentioned division signaling. But I'm curious about how away rotations play a role once you have an interview. So essentially, you showed a graph of the percent chance of matching, given contiguous ranks. What percent chance do you have, or from your perspective, because I doubt there's any numbers on this, what percent chance do you have of matching in the programs that you've done away rotations at, versus at the other interviews that you receive? I think that's a really good question. One of the challenges that we have in doing research about the application process is that it's siloed across three different systems. So there's ERAS for the application, there's the NRMP for match, and then there's kind of the away rotation VSLO type of system. And they don't all communicate, and so it's hard to track. And so we don't have the data to say people who do this many away rotations have a likelihood of matching to this program with certain percentage. I will say it is largely higher, would be my guess. For most programs, it's going to vary program to program. But what I've seen anecdotally from my program talking with others is that there seems to be at least one or two matched residents who tend to rotate through that program. That's going to vary place to place. But it probably does help your likelihood of matching there. Just to clarify my question a little bit more, is the interviews that you receive from programs where you didn't rotate, the chances that you match there, imagine you do equally well in all your interviews, are they a lot lower if you didn't do an away rotation there? Or are your chances just that much higher at programs that you did do away rotations there? So like in terms of where would I rank people on my list, is that? So do program directors rank students in general, the ones that rotated there, much higher than the students that didn't rotate there? That I would say I kind of have all throughout the rank list, people who rotated, people who didn't. Because away rotations can kind of go one of two ways sometimes, right? People can either do really well or really not well. And sometimes the really not well happens after we've already sent out an invite to that person. And so I think you kind of see a spread up and down the list. We matched a lot of people to my program who did rotate with us. We matched a lot of people in years who have not rotated with us. So we kind of look at that, at least in my program, of like where did all of the away rotation people sit on the list versus the non. We look at it by gender, we look at it by MD versus DO versus IMG, and we tend to see a pretty even split throughout the list. Yeah, I totally agree. It's going to be variable dependent on the individual doing the away rotation. You know, you can have medical students that show up early every single day, and you can have medical students that might show up 15 minutes, 20 minutes, hour late every single day as well. And so I think it all depends on how you perform on that rotation and the relationships that you formed on that on that away rotation, and how you like left that that rotation in terms of the feelings that you had. I think that plays a bigger role, and I think most of you guys are going to have the insight to know. I would say let's assume that you shine, right, on your your away, and let's assume we have two candidates that, you know, one did an away with us and they just knocked it out of the park, and another equally excellent candidate that we don't actually know personally. I think that the favor would go to someone that you do know personally, and I think that, you know, in addition to that, you have other kind of colleagues, you know, that can either send an email or, you know, have a communication and kind of reinforce the positive experience that they had working with you during that away, right? So I mean, certainly if we're assuming that you did awesome on your away rotation, I think that that's, you know, that that's gonna be helpful for you. Having that personal connection, you know, is gonna, it means a lot. Hi, I'm Douglas. Thank you guys. This is a very helpful session. I know for all of us it can feel like a very opaque and kind of murky process to go through. So I was wondering specifically on sort of the open communication point that you mentioned in being upfront with the programs, and the programs can to some degree be upfront with you. I was just wondering if you could talk more about what kind of communication can be expected in that, and where is the line in this gray area of this you can't do? But, you know, I've walked out of interviews and gone, oh it went great, and my wife's asking, oh so are they gonna pick you up? I have no idea. I don't know what to expect them to say out of those interviews. I think good, but I don't know. So I just wonder if you could speak more to that. Yeah, again, I think there's so much variability from program to program, which is why I tried to make the point that you should not rely on a program's communication with you to really impact or, you know, significantly, you know, affect your rank list. Because there are some programs that, you know, will reach out to applicants if they feel like they wanted to provide them with additional resources or information. There are some programs that don't reach out under any circumstances, you know, to applicants, and so using a program's communication to you, I think that you can't necessarily rely on that, and that there's going to continue to be a lot of murkiness there. But on the flip side, you know, you reaching out and kind of controlling, you know, the communication that you have with the program is something that you can control, and, you know, I think that you know, thank you, or, you know, like those are all very nice, and every program, again, I think has different ways that they respond to thank-you notes. Either they do or they don't, or if there was some follow-up, you know, question or issue, then there might be additional communication, right? So I'm not, in a long-winded way, I'm really not answering your question at all, but I think that what it boils down to is that you can control the communication that you have to the program, and while, and you cannot control the communication that programs have to you, and you should take all communication, I think, from the program with a little bit of a grain of salt. The boundary that you cannot cross is asking a program where they're going to rank you, and, you know, soliciting basically where one or the other is going to be ranking someone on their list. Yeah, and conversely, we can't do that to you. So no program can ask, like, you know, where are we ranked, or even kind of like, we hope that you rank us high, really kind of borders on pressuring people. Yeah, or rank to match, right? So I think all of those are kind of like, they flirt the line of what's allowed. So I know that my program, we don't do that. We respond to communication with, like, thank you for your interest. I think the key things are you can't solicit, like Dr. Borkstrom said. The other one is, like, being real explicit. Like, if you're number one program, and you want to send a number one, do it. Send it to one place. Don't send it to multiples. That's happened. And also, like, if you say, I'm ranking you high, we all know what that means. That means that I'm not number one, but maybe I'm, like, number two, three, or four. That probably also isn't going to change our ranking on our end. So I think sending, like, a number one matters a lot. I think sending a highly interested probably doesn't. I can't say that it hurts you, but it probably doesn't move you up at the same time. Hello. Along the lines of interviewing and rank lists, I wanted to ask, how much does things prior to the interview continue to play a role in terms of making your rank list? For example, let's say you have an interviewee. They were in the first batch of interview invites, and then you have someone who was fortunate to get off of the wait list. Would you say that they're on an even playing field now that they've both received an interview, or will things like signaling and geographic alignment still continue to play a role? Let's say the person didn't signal or have geographic alignment, but had a fantastic interview, versus someone who had a good interview, also signaled, had geographic alignment. I guess that one requires a nuanced response of knowing, like, who the applicants are, but I will say that it still comes into effect, at least in our discussions when we're meeting about applicants, about whether or not an applicant wants to be with us. If we have two equal applicants that we liked equally, and they have perhaps equal but diverse backgrounds, we're going to take... I think that the person who had signaled us, who said they wanted to be there, or had sent us the number one, saying, you know, we want to be a part of your program, because again, we want happy residents. Yeah, I think it depends on kind of the reason that maybe someone was on the rank list and got off. For us, there were far more qualified people than we had interview spaces, and so what I would say is that it's not a, oh, this person's came off the wait list, they've got to be, you know, if we interviewed 50 people and this was number 48, that's as high as they can go on the rank list. I think once you're in the interview, you're in. If there was something like a yellow flag or something that put you on the wait list instead of a immediate send out for an interview, that probably is going to follow you. But I would say, too, from an interview, like, if you were in interview wave one or interview wave two, because I know some programs send out in batches, mine does that, it's not a, your first tier and second tier. It's, if you got an interview invite right off the bat, you're in from that perspective. And I would say, too, a lot of the members of, you know, maybe the admissions committee and who you're meeting with don't know. Yes. And so, you know, you can kind of just, don't let that get in your head, you know. You're there, you're interviewing, and just let, you know, let your personality shine. Yeah. Thank you. Hi. Thank you so much. I had a specific question that you kind of touched on but wanted to get your explicit opinion on thank-you emails. Who would you send those to? Who would you not? Do we have to send them to everyone that we spoke to? Please, no? It's a really good question. I think you might get three different responses. I'm of, like, the mind that, like, brevity is the best thing, and I understand that you guys are thankful for getting the opportunity to interview. Like, I read that a lot, so I know that you guys are, and I see it on your faces when you interview. I don't need, like, an email to tell me that, but I, you know, I understand that there's, there probably is some, like, external pressure to do that, and I can only really speak for our program that, you know, we really do understand that you guys are thankful. Like, you don't don't feel like you have to send something. Especially, like, a five-paragraph, you know, thing that took you half a day to write, you know. Like, we, you all have lives to get back to, and if you are gonna send something, you know, something very short is very acceptable. Yeah. One of the things that, in the RFPD, so the Fellowship Program Director, that we're kind of working on in AAP is being explicit. So, so for my program, for example, at the end of the interview day, we tell you, please don't send us a thank-you email. You can always reach out to us if you want, but I'd rather you catch up on laundry, walk to your dog, do something, because your time is valuable. So, I think for the programs where it's, like, it doesn't make a difference, I think it's really helpful for us to say so, and I think more programs are trying to do that. So, it's a work in process. Thank you so much. Yep. I know that it'll vary from program to program, but as Step 1 and Comlex 1 have moved to pass-fail, is there a growing consensus about osteopathic medical students taking both Step and Comlex, or, you know, skipping Step 1 and doing Step 2? Where does, what's the consensus on that becoming? I will say, in reviewing applications, it becomes a lot more difficult to give opportunities to schools that you might not otherwise, like, know of or hear about. One of the best residents that I've ever worked with came from a school called Wayne State, and I, you know, I had never heard of it before. I had, like, you know, applied to medical school or anything, and I always think about that when I when I review applications from from Wayne State, but what I'm trying to say is, with Step 1 going to pass-fail, I think it becomes really difficult for those applications to, like, shine through and show, kind of, what they have to offer, because you all know that getting into medical school is such a crapshoot, and, you know, getting in one place, you might have gotten in there one year and not the next, and vice versa. So, I think it has a big effect on some of, perhaps, like, the smaller schools and some of the osteopathic schools, as well. Yeah, I would say that the consensus is there is no consensus. I think that doing well on it, having more data points that reflect well on you, is never going to hurt. I think that the taking USMLE Step 1 when it's pass-fail as an osteopathic candidate, I think, is less helpful, right, because I don't know if you got a 216 or a 258. So, you know, I think if you're gonna take one, probably taking Level 2 makes the most sense, but there may be some value in taking the Level 1, Part 1, so that you get a feel for what is the exam like. So, I think it's gonna vary. If you can, if you take it and you feel like you're gonna do well, that's that's only going to help. A high USMLE Step 2 is never gonna hurt an osteopathic candidate, but taking it, if you're unprepared and doing poorly on it, probably hurts, especially if you're, you know, your Level 2 score is like a, you know, 690 or something. You know, taking a CK and barely passing or failing probably drags that application down. So, I think it just kind of depends. First of all, thank you for this. My question is in regards to the letter of recommendations. So, I know you said to cover different aspects, be it us as a person, clinical skills, research, etc. I've been advised that if it comes to, like, a non-physiatrist, such as, like, a surgeon, a family med, you have them speak more to your clinical skills, but let's say, hypothetically, I know an anesthesiologist who can speak to me in a personal level, but I haven't necessarily worked with them on a clinical level. Do you still advise that they should, like, they can speak on me as a person, but, or would you rather have them speak to me as a, like, on a clinical skill level? Like, if you haven't worked with that person clinically? Yeah, but more so, you know, more mentorship, or they just know me more as a person, but I haven't been with them. I think that that is absolutely a good person to have write a letter, and they don't always have to speak on your clinical, you know, skills. So, like, you know, a longitudinal mentor, you know, in whatever avenue, you know, that you may have, like, that is a great person to write a letter for you, and not every single letter has to reflect your clinical skills. Did I answer your question? Yeah, that does. I only asked that because people always advise work with a surgeon, or family med, or things like that, so you can show that you cover other multidisciplinary aspects. Yeah. I was just curious about that. Yeah, I mean, I think that that's another, sure, I think that both of those things are true. I think that, you know, if you do have, like, you know, do great on your IM rotation and can have, you know, a letter that reflects your medicine, you know, clinical skills, your strengths in medicine, and or, you know, other types of exam, that that's great, but I also think that if you have a longitudinal mentor that's non-clinical, that that can be a very strong letter that's adding to your file, too. So, I think that's that time we're having the fourth letter can be really helpful, so that that fourth letter kind of becomes, like, your wild card one. Maybe it's somebody that you didn't work with clinically, but really knows you as a person and can speak to that. Maybe it's a research person, so I think in those situations, having three clinical letters with the fourth being your non-clinical is probably the way, if I were in your boat, that I would go with it, but I think if they can speak to you as a person and your character, that's what we're trying to gain from letters, and so a strongly written letter, I think it matters more, can they write you a strong letter, as opposed to what specialty they're in, or is this the department chair or a junior faculty member? Like, I think sometimes we see that, where it's like, I want to get a letter from the chair, and the chair's like, yeah, I talked with them for five minutes, they seemed cool, right? So, that's not your answering your question, but I think that's where having that fourth letter, I think that's where I would use it, if I were you. Thank you. Hi, my question's about the couples match. I'm just wondering about how your institutions, or in general, how they handle the communication regarding the couples match, if there's any communication between specialties, or if partners are reaching out on behalf of their partner, or vice versa, and how you guys handle that. Thank you. Yeah, I would reach out as soon as you can, in regard to your significant other, and their interest in, you know, your particular institution or area. And as far as our communications with other programs, we're very happy, especially for, you know, obviously interested in your application, to send in a good word to the program director, and communicate with them, you know, pretty readily. Yeah, I think from kind of like a FERPA perspective, we can't really speak too much to, like, an individual's application to another program, but we definitely, for us, we'll say, hey, we're interviewing this person, didn't know if you're interviewing their partner, but we're definitely interested in that applicant. I will say, too, there are times where, if we're trying to gauge the likelihood of an interview, we may look at the residency programs around us. And if somebody's matching in the, the couple's matching with someone in ophthalmology, and there's not an ophthalmology program within 30 miles of me, that may influence my decision on giving someone an interview or not. Because, realistically, if they're trying to stay together, they're probably not trying to come to Grand Rapids if their partner's doing optho, right? So, it kind of goes both ways. I think, too, some of the programs will communicate with the TY or prelim programs to do the same, so that they don't want to interview somebody that I'm not. I don't want to interview somebody they're not. So, I think there is some coordination. It's also where the program coordinator, surprisingly, all know each other. So, because I was like, hey, do you know this person? She was like, yep, I know them. Here's their cell phone number. I'll call them. I was like, okay. So, a lot of that happens, too, with the coordinators. Yep. Hi, my name is Queen Denise. Okay. Thank you so much for the insightful presentation. I have two questions. So, I understand the importance of submitting apps early, but is it frowned upon, frowned upon to not submit, like, applications the first day programs have access to it? That's one question. And the second question is, is there anything an applicant can do if they're on a waitlist or to secure an interview if they're really interested in a program? So, I would say you obviously want to submit as soon as possible, but I don't think it's the end of the world if you don't have it submitted the day ERAS opens. I can tell you, I was not sitting there waiting for ERAS to open to review the applications, like, right away. And even when we're doing the review of them, you know, it's, you know, sometimes 500 applications to get through. We're not getting through them in one sitting, in one night, in one weekend. These are, like, you know, a multiple week process. So, obviously, the earlier you can submit, the better. But if it's happening a day later, two days later, three days later, I don't honestly think you're losing out on anything. But my anxiety would probably force me to submit on the day. You definitely don't want to submit kind of like a half-baked application. So, if you're like, my personal statement's not where I want it to be, my CV's not done, you're better off waiting a day or two, spending the time to get it done right, and then submit. I will also say, I think this is the first year in the past five years that ERAS didn't crash the day that it was available for program directors. So, usually, like, the first day or two, we're like, that's probably just gonna crash. I'll look at it on the weekend. So, that's at least what I do. Your second question was to get off the waitlist. Is there anything you can do? Waitlist or to secure an interview if an applicant is really interested in a specific program. Yeah, I think that's where, again, a thought-out email can never hurt. So, contacting kind of the, you know, the program coordinator is probably the right thing to do. I don't know that, you know, again, it may not help you, but certainly I don't think will hurt you. Definitely lean on, like, a mentor that you have, too. If it's, you know, someone within the field that can reach out on your behalf, I think is really, really important. If they have a connection, let's say, to the program that you're very interested in interviewing at that you haven't secured that interview with, they have a connection there. They have some relationships there that they can kind of perhaps help sway things. Yeah, I think especially if you can couple it with maybe something's kind of just changed on your CV. So, I know a lot of poster acceptances for AAP and Phoenix just kind of went out. So, if you were on a waitlist and you had a poster that got accepted, I think kind of adding that in there and being like, hey, I also had this thing happen can also be a helpful thing. I agree kind of reaching out to the coordinators is probably the best way. I'm terrible at managing my inbox for email and so things tend to get lost a lot easier there, but my coordinator always stays on me and so she'll be like, hey, I got this. What did you want to do with this? So, I think emailing the coordinators because, like, they run my day. She runs my schedule. It's better for both of us that way. So, I think, like, that's who I would reach out to with that, but I think a well-thought email can always only hurt, only help you. It never hurt. Thank you. Yeah, of course. Hi, I'm Eva. I'm an M4 at FIU, so I'm in the application process right now. I think you actually just started to answer the question I was going to have, which is between the time that you interview with a program and you submit your rank list, if you were to have a meaningful experience, like having an additional publication, how is it appropriate to reach out to the program if it is appropriate? Yeah, I think it's appropriate to do. If you've had something that's changed on your CV in a appreciable way, in terms of do you reach out to the program director or the program coordinator, hopefully they've kind of given you a little bit of guidance on your interview of, like, who to contact for those things. I would say in general, probably program coordinator is the way to go. If nothing else, they'll just forward it on to us. If not, kind of pull us aside and be like, hey, did you see this person got published or something like that? Because we know that those things happen, so it'll never hurt to let us know the good things you're doing. Awesome. Thank you. Well, I think we've kept everyone long after the time, so hopefully the boat doesn't leave before we all get there, but thank you all for your attention. This was really great.

residency application

medical students

personal statement

virtual interviews

PM&R

signaling system

interview opportunities

letters of recommendation

holistic review

strategic ranking

mentorship

application competitiveness