What I Wish I Knew Before Applying to Residency


You may have read up on the dos and don’ts and be familiar with the process of applying to residency, but that won’t prepare you for everything.

For this guide, content contributor Austin Johnson, an upper-year medical student at Stanford University, shared what he learned applying to residency. These small details and lesser-known strategies will prepare you for the challenging residency application trail.

If you haven’t already, save our comprehensive Residency Application Guide and Residency Application Month-by-Month Timeline, which outlines everything you should be working on when.


1 | You Can Prepare Too Early

Believe it or not, there’s such a thing as preparing too early.

The residency application process is prone to regular changes all the way up until applications open. For example, for the 2023-2024 residency application cycle, there were a number of significant updates to ERAS. In particular, the number of activities you could include changed to a maximum of 10, whereas it used to be unlimited; they also required more descriptive information for each activity.

In the setting of such changes, proactively getting all of that writing out of the way to get ahead may lead to more work once ERAS announces iterative application updates.

Additionally, each program updates its requirements, including how they view signals, very late in the game. Although the deadline to submit is in September, programs might update how they use signals as late as August.

Overall, be prepared, but don’t finalize your work too much before the summer leading up to the opening of the application.

However, that’s not a blanket excuse to avoid preparing in advance. There’s still plenty you can do to organize your activities and log experience details, and since your personal statement and letters of recommendation aren’t likely to change much, there’s no reason not to start those as soon as possible—months before applications open.


2 | You May Not Be Able to Submit on Opening Day

There’s a very good chance you will not be able to submit on the day you want. For example, if you’re waiting on letters of recommendation, you won’t be able to click submit until they’re in—and you need to have every component of your application locked down before you can hit submit.

It is vital to give your letter writers deadlines and reminders. You don’t have to worry about STEP/COMLEX scores or medical school transcripts and the MSPE, but a late letter could derail your application. Notably, you cannot undo your submission!

Do all you can to be ready, but don’t sweat small delays. While not ideal, it’s not the end of the world if you submit a few days after applications open—just don’t push it too far.


3 | The Process Is Toxic and Draining

Worried or afraid - students in a park upset

Applying to residency can be very challenging to one’s self-esteem and confidence. No matter how qualified you feel you are, it’s possible to receive zero interview invites on a certain release day (if your specialty has such days). This outcome is incredibly discouraging, and it can quickly trigger powerful feelings of imposter syndrome.

What were those four or more years of medical school for anyway if you can’t even secure an interview? How is it that you worked so hard for so long and still aren’t landing the interviews that your fellow applicants are?

Stay away from crowd sourced forums or Google spreadsheets, where candidates often list how many interviews they have and provide pointed, poisoning advice. These forums are almost always anonymous, so posters can easily lie or exaggerate about their performance.

Your only true competition is with yourself, so avoid comparing yourself to others. Plus, not receiving interviews on the first day is nowhere near a clear indicator of your final results.


4 | It’s Not as Uniform as You Think

The residency application process is far from one-size-fits all. When it comes to signals, different programs use them for different reasons. On top of that, you may have additional ERAS complexity like gold and silver signals, and each program interprets them in a different way.

One school may value a signal greatly and consider it a prerequisite for earning an interview, whereas other times, you may signal a school and then read on their website that they don’t use signals at all.

Navigating interview communication, such as thank you notes, letters of interest, and letters of intent, also varies widely from program to program. Some schools explicitly state they do not accept these forms of communication at all, others state they “don’t expect anything,” and still others don’t say a thing about them at all. It’s left up to your interpretation, which can cause quite a headache.

Some specialties also require you to interview for first year programs separately from your advanced program, and these intern year programs are often handled differently than others. Since you’re interviewing for both programs at the same time, jumping back and forth while remembering the separate requirements can get complicated.

Application requirements from program to program vary wildly. Each program has its own fine print, even if they all use ERAS, and this lack of uniformity can be confusing and frustrating. It’s a great deal more random than you might expect.


5 | You Won’t Hear From Many Programs

Woman looking discouraged at a computer screen

To add to the confusion, programs often won’t tell you why you’ve been rejected. More commonly, programs won’t even notify you of a rejection, despite their ability to easily send an automated email to provide closure.

Approximately 50% to 75% of the programs that did not grant me an interview participated in this ghosting behavior, leaving me to sit in uncertainty. Will they eventually send me an invitation? Can I book a different interview for this day, or will the program suddenly get back to me and schedule me during the same time slot?

You pay money to submit an application, yet some programs ghost you even if you signaled them. It can make you feel like you’re not even good enough to warrant a rejection.

Ultimately, it’s a ruthless process that can derail your mental health if you’re not careful.


6 | You’ll Need Multiple Resources

When you apply to medical school, there’s one consolidated resource to gather data from—the MSAR, (Medical School Admissions Requirements). Unfortunately, no such unifying resource exists when you apply to residency.

Instead, information is fragmented across various organizations and forums, and it’s up to you to combine multiple sources to gather the data you need to make informed program decisions.

First, the Fellowship and Residency Electronic Interactive Database, better known as FREIDA, is the official American Medical Association (AMA) residency and fellowship program database. The platform boasts over 13,000 accredited programs across every specialty and subspecialty. Use it to gain a basic overview of the nationwide distribution of your programs (including program size, location, and reputation), explore specialties, and budget application costs.

Next, Doximity has a Residency Navigator that’s full of unique features, including STEP/COMLEX score comparisons of matched and unmatched applicants and a one-of-a-kind Couples Match tool. This platform has a useful sorting function that allows you to sort by reputation based on resident reviews, research output, program size, and percentage who subspecialize.

You’ll also need to rely on program websites for specific program details, taking a deep dive into the sections and tabs to help determine if it’s the right fit for you. This is also where you’ll find out what a program’s rules are around thank you letters or whether or not the residency program requires Casper, for example, as well as their interpretation of signaling.

We covered all of the best resources for applying to residency in more detail in this article: MSAR for Residency: 3 Resources to Systematically Select Programs.

In addition to using multiple resources to research and narrow down the programs you want to apply to, the interview process itself requires familiarizing yourself with another long list of different platforms and tools.

The Thalamus website is used by some programs for interview scheduling, and others stick to the ERAS platform. You’ll almost surely need to toggle back and forth between them, depending on the programs you applied to. This is only a small detail, but when you are already balancing medical school commitments with applying to residency, any small inefficiencies can be a huge pain.

Additionally, you’ll need to get comfortable with using the various interview platforms, including Zoom, Teams, Webex, etc.


Create a Stand Out Residency Application

Med School Insiders can help you prepare a stand out residency application that will help you match into your ideal program. We offer a number of Residency Admissions Consulting Services tailored to your needs, including personal statement editing, USMLE tutoring, interview prep and mock interviews, and overall application editing.

Reach out to our team any time to learn more about our services, and follow the Med School Insiders blog for the latest how-to advice, strategies, personal stories, and industry updates. As you progress in medical school, we have comprehensive guides dedicated to helping you conquer each of your clerkships, as well as your residency application.

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