Overview
True insight into the application and interview process for radiology residency and fellowship is limited for most medical students and residents. The process can be clouded at times by misleading advice and rumors. Only someone on the inside can really understand what you need to know when you are applying for a radiology residency. Thankfully, you have come to the right site. I have looked at thousands of applications and interviewed hundreds of residents for positions in our program during the course of many years as associate program director. I am going to delve into the depths of the radiology residency application process and enumerate what you need to know.
The Application
There’s lots of ways to go through this. But I think the best way is to go through the different parts of the application from most important to least important so you don’t squander your energy on the small stuff!
There are few sections of the application that truly differentiates one applicant from another. Dean’s letters happen to be one of those items. The reason for that: you will actually get comments from attendings, residents, nurses, technologists, and secretaries that may say something negative about an applicant. I can’t tell you how many times we have parsed through an entire application with glowing positives until we arrive at the Dean’s letter. And, then we receive coded messages in the letter such as: was very shy during the rotation, but did see some improvement. Or, this resident was very independent, but did not seek help when presented with a challenging patient care issue. And so on, and so forth.
Additionally, the Dean’s letter may be the only document in the application other than the boards that compares the applicant to his/her classmates. Most medical schools have buzz words indicating the resident’s rank in his/her class. Each one is different, but typically it allows insight into which quartile the resident resides.
Ok, so you have your Dean’s letter written in “stone”. The institution administrators may say there is not much you can do about it. But that is not true. Every medical student applying for residency should check their Dean’s Letter prior to sending out the application. At some institutions, you can look at your letter prior to application time. If that is the case, you should certainly check it for any negative or questionable comments. And if possible, confront the department/person that wrote the comment and ask if they could redact or modify it. Obviously, if the writer is truthful, the person may decide to leave it in there. But an attempt should be made, as this one negative comment often makes the difference between high ranking, low ranking, or no ranking on a program’s rank list. It is not infrequent that an admissions committee will obsess over one questionable comment. In fact, countless painful hours have been spent perseverating over these issues.
Other times, the institution may not allow you to look at the Dean’s letter. But the school may allow your mentor or a faculty member to look at the document and possibly edit it for corrections. I can’t emphasize enough how important it is to do this to increase your odds of being accepted to the residency of your choice.
The Boards/USMLE
The importance of the boards/USMLE for getting accepted to a radiology program is merely to assess the ability of a future resident to pass the radiology certification examinations. We have noticed a strong correlation between lower board scores and difficulty passing the new core exam and the old written/oral boards. Radiology board exams are notoriously difficult compared to many other specialties, so most programs take the USMLE score very seriously. The good news is that it is often used only as a baseline cutoff measure. Once you score higher than that baseline, it doesn’t factor as much into the ranking equations. Failing and low scores, unless there are extenuating circumstances, usually place the application in the deny pile.
For those of you that are D.O medical school applicants, I recommend that you take the USMLE in addition to the COMLEX examination. Many radiology programs are unsure of the significance of COMLEX scores and don’t know how to factor the scores into the ranking equations/cutoffs. Applications with COMLEX scores alone may get thrown out of the interview pile entirely.
All this being said, there is some gamesmanship with the boards. If you have done very well on the step 1 boards, often times you may be able to get away with just sending those scores alone. In fact, you may want to delay taking the step 2 portion because those scores can only hurt you if they are lower. In addition, most programs look for/expect improvement from the step 1 to the step 2 boards, especially if the step 1 boards are borderline. So be careful and take the step 2 boards very seriously. Invest in review course if you need to.
Research
Nowadays, research can be a significant factor for getting an interview in a residency program. What is the reason for that? Simply, the graduation guidelines for ACGME accredited radiology residencies have specific radiology research requirements for each resident prior to graduating. Knowing that a resident has completed multiple quality research projects means that a resident can work more independently to complete research projects within the program, reducing the burdens upon the department. Furthermore, radiology research may demonstrate significant interest in the field and provides an avenue for discussion at the point of the interviews later on in the process. Often times, we will look at an application and we will say, it’s pretty good, but the resident hasn’t completed any research. That may take the application down a few rungs.
Bottom line though. It won’t take you completely out of the running for getting a spot, but can be a big assist in some situations.
Extracurricular activities
There are two big red flags when you are completing this section of your applications. Those people that have participated in every extracurricular activity under the sun and those people that have participated in almost nothing. A resident that participates in everything suggest that the person has a lack of focus, never investigating or accomplishing tasks in depth. On the other hand, a resident that participates in nothing but school, tends not to be well rounded and may not have outlets to disperse their frustrations during their 4 years of training.
So what are some activities that impress the admission committee? Interesting extracurriculars that show leadership potential, activities that demonstrate depth of involvement, and activities that demonstrate an ability to handle stressful situations and function independently. Some of the special extracurriculars that stand out in my mind that meet this criteria would be: a student that started a Subway franchise successfully from scratch and made it into a big business, a student that participated in the Olympics, a student that was heavily involved in the congressional lobbying, etc. These are people that tend to climb the rank list higher because their extracurriculars were memorable.
What are some extracurriculars that don’t really add much to the application? Those activities that everyone else does and do not suggest leadership potential. In radiology, those would include participating in a radiology club (Big deal!), participating in health fairs (Every medical student does it), and teaching inner city kids (We see it all the time as part of medical school curricula!) Not that these activities are bad, but they don’t add much at all to your application. My recommendation is find something you enjoy, hopefully something unique, and stick with it during your 4 years of medical school training!
Recommendations
Admissions committees like to make a big deal about recommendations. You’ll certainly hear that you need a great recommendation to get into a great program. But honestly, if you ask someone for a recommendation, it is unusual that you will find someone who is going to write you a bad letter of recommendation. It is obvious that students are going to ask attending physicians that like them. This statement brings us to the one of the few ways that recommendations change the acceptance equation. It is a rare but major red flag to see a “bad” recommendation. It often means the resident that obtained the recommendation has a poor emotional intelligence quotient or couldn’t find one attending that liked them- both major issues!!!
It is also the rare recommendation that raises the application within the pile to higher rank or from no rank to rank. Usually, this type of recommendation comes from a well known entity that wants the person in their own program or a close colleague that the radiology admissions committee implicitly trusts.
So therefore, recommendation rank fairly low in the application influence equation.
The Personal Statement
Finally, I would like to talk about the thing that medical students often perseverate on but has very little influence in the residency application process- the personal statement. The personal statement almost never helps an applicant and can occasionally hurt an applicant. After having read over a thousand of them, there are very few standouts. And, all of those that stood out were somewhat disconcerting. I still remember an essay that emphasized a dead rabbit and did not have have any correlation to radiology whatsoever. I was concerned about mental illness in that student. That same person had the possibility of a radiology ranking immediately terminated!!!
My basic advice for personal statements is be cohesive and relevant to your future career as a radiologist. Also, watch out for typos because typos suggest an inattentive personality, not a characteristic you want in a radiologist. Other than that, don’t fret too much about this part of the application.
Summary
Applications for radiology are an arduous process with multiple pitfalls. Make sure you concentrate on those items that you give you the most bang for your buck and will send your application higher on the rank list. Make sure to put particular emphasis on the Dean’s letter. Check it if you can. Correct it if need be. Otherwise, make sure your application doesn’t stand out too much. Don’t be that student with marginal board scores, no research, with dull or no extracurriculars, with bad recommendations, and with a personal statement that stands out too much. If you follow these guidelines, you should get into a great residency, hopefully one of your top choices.
Barry Julius, MD
Radiology Attending
This post was written by Barry Julius, MD, the associate radiology residency director at Saint Barnabas Medical Center, and was used with permission. More of his work can be found at his website, Radsresident.