By Aaron Michelfelder, MD; Joel Heidelbaugh, MD; Cristen Page, MD, MPH, and Eva Bading, MD
Read the response to this blog post, Too Much of Anything Is Bad: Advising Students on the Number of Programs to Apply to.
As matching into all specialties has become more challenging in the last few years for US medical students, it is important to provide the most timely and accurate advice to those considering family medicine.
Several confounding factors contribute to a more challenging match into family medicine as a primary specialty choice:
- Medical school class size has increased, and new schools have been formed without any increase in residency positions.
- There is an increase in US citizens who are international medical students and who are entering the residency Match pool.
- Medical specialties are becoming more competitive, and students at risk of not matching into their primary specialty choice are creating parallel plans.
- Fourth-year medical students apply to two or three different specialties, which results in more students applying to family medicine, many of whom are highly competitive and have high USMLE scores.
- Students who in the past would have been offered many interviews are being offered fewer due to the influx of parallel plan students flooding the family medicine applicant pool.
- Programs are placing a higher emphasis on USMLE scores as a method of predicting the possibility of passing the ABFM board exam.
- National Residency Matching Program All In Policy means that more residency slots are filled during the Match, and fewer are available for the Supplemental Offer and Acceptance Program, or SOAP (formerly called “the scramble”).
We recently hosted lecture-discussions on matching into family medicine at the 2014 Society of Teachers of Family Medicine Conference on Medical Student Education and the 2014 Association of Departments of Family Medicine Conference and have collated the thoughts and recommendations of these national discussion participants with advice to students wishing to match into family medicine as listed below.
1) Students should pass and perform well on USMLE Step 1 on the first attempt. It is better to delay clinical clerkships and graduation than to fail Step 1. Some residency programs use the average Step 1 score (around 220) as a cutoff for interview invitations.
2) Students should work hard and perform well on clinical clerkships. International medical students understand that performance on clerkships can help with getting a residency spot, so US medical students can sometimes be overshadowed by very capable and hard-working international medical students. US medical students are competing more than ever against many talented and competitive US and international medical graduates.
3) Students should pass and perform well on USMLE Step 2 Clinical Knowledge (CK)and Clinical Skills (CS) on the first attempt, and take CK as early as possible. Students should prepare for Step 2 clinical knowledge, take it in the summer of their fourth year, and release their scores as soon as possible to residency programs. Residencies prefer to see a passing Step 2 CK score prior to ranking applicants. Similar to Step 1, it’s better for students to delay graduation than to fail or perform poorly on Step 2.
4) Students should perform audition electives. Program directors report that audition electives can improve a student’s chances for a match.
5) Students should apply to more residency programs. Most clerkship directors recommend students apply to 20–40 programs to increase interview offers.
6) Students should upload and release applications to family medicine residencies at the earliest possible date.
7) If a student lacks 8–10 interview offers by Thanksgiving, then an intervention should occur. Students and advisors should connect in November, and advisors may help with interventions as noted in recommendation 8.
8) Advising faculty should use contacts with residency programs to increase chances for interview offers for students choosing family medicine as their primary specialty.
9) Letters of recommendation and personal statements should comment on commitment to family medicine as a career choice. Letters of recommendation should highlight those who are selecting family medicine as their primary specialty choice.
10) Students who do not see themselves thriving as family physicians should not apply to family medicine residency programs. Advisors should screen out those who may use family medicine as a stepping stone into a different specialty.
11) Residency program directors should converse directly with advisors about applicants prior to the Match.
12) Students applying for family medicine who are at risk of not matching should consider applying to surgical preliminary programs in the regular Match as a parallel plan. A student who matches into a surgical preliminary slot can gain clinical experience and prepare for Step 3, while applying again for family medicine in the regular Match the following year. Students should be honest with surgical programs regarding plans for future training.
13) Advisors should meet with students at risk to not match prior to the SOAP. Students and advisors should jointly develop a plan prior to the SOAP and prepare for discussions initiated by residency program directors.
14) Program directors and medical school advisors should share contact information prior to the Match. Residency program directors need easy access to advisors at medical schools.
15) Unmatched students at the end of SOAP should continue clinical work, delay graduation if possible, and consider taking USMLE Step 3. If a delay in graduation is possible, the student could take more clinical electives to bolster knowledge and gain stronger letters of recommendation. Although clinical competence is a key factor for residency selection, obtaining an additional degree such as an MPH or completion of a research project may be helpful as well. Passing Step 3 is encouraging evidence of the possibility of passing specialty boards.
16) Family medicine advisors should dialogue with the other specialty advisors both locally and nationally. As students cross specialties with their applications, advisors from all specialties need to work together to increase the chances of students matching into a good fit for their career in medicine.
These 16 recommendations are based on conversations with people at all levels of medical education and are general recommendations. Students should receive individualized advising, and these recommendations can serve as starting points for the conversation.
So the challenge for all of us is to be more active, aggressive, and engaged in medical student advising, while helping our residency programs to select the best candidates for family medicine training without becoming overwhelmed with the noise of so many parallel plan applicants.