Pediatric Residency Application Process FAQ

Pediatric Residency Application Process - From the Peds Connect Archives

This information was shared by AAP Member experts as part of the PedsConnect project, an online panel of experts who shared their opinions on topics of interest to medical students and other trainees.  You can now submit questions and read responses in the PedsConnect Forum on the AAP Online Mentorship Program.

What are some common questions students ask during their interviews?

"What is your program looking for in an applicant?"

"What would you say is unique about the residents who graduate from your program compared to other similar programs?"

"How do residents receive feedback—formally or informally—in your program?"

"What is the greatest strength (or weakness/area for improvement) of your program?"

"Why did you choose to come here?"

"What is your process for selecting mentors?"

Does it hurt my chances of getting into a program if I am not able to make it to the pre-interview dinner?

The pre-interview dinner is an important portion of the application process and while this is unlikely to keep you from being admitted to a program, these dinners allow you and residents to have more of an organic interaction. The pre-interview dinner is a time to get to know residents in that program and residents to get to know you. It is meant as a service for the applicant to get to know the "personality" of a residency program and ask questions of the current residents.

That said, treat it like part of the interview day: be your best self. We have definitely taken applicants off our rank list because of egregious behavior witnessed by our residents at the pre-interview dinner.

Do I have to hand write my thank you cards or can I just e-mail everyone I interviewed with? Also, how quickly do I need to send my thank you cards out?

In this era of ubiquitous electronic communication, I don't think it matters which mode of communication you choose. I would make sure it's personalized, though, with at least the individual interviewer's name in the opening address. I also don't think it's an absolute must to write at all, but I would encourage it as professional courtesy. I think writing within a week is very reasonable. If that is not feasible due to travelling or other constraints, then write as close to a week as possible.

Is it important that I email the programs that I am most interested in January to let them know?

I honestly don't think this is important. I also don't see how it could hurt you if you choose to do so. Programs are supposed to rank candidates based on their individual merits and ability to fit/mesh with the existing program. We do not move residents up or down our rank list based on whether we received any notification about how much they liked us or how highly they will rank us, but it does give us the "warm fuzzies" when we hear it. It also increases excitement when we see those names end up on our Match List in March, because we know those residents are as excited to be here as we are to have them.

What attributes are you looking for in your incoming intern class?

Also going to vary by training program. We like students with a strong record of academic achievement and demonstration of other special skills, like commitment to community activities, research, education, etc. We also make a conscious effort to recruit and match a diverse group of residents from a variety of cultural, ethnic, religious, socio-economic, and experiential backgrounds.

What are some unique experiences/research/advocacy/global health opportunities you've seen in pediatric residency ERAS applications (MS4s) that impressed you? In other words, do you have any recommendations for an MS1/2 looking for something to do with his/her summer off?

I think the most important thing is to do something that aligns with your passions/interests in medicine if that is possible. For people with strong interests in research, this is the perfect focus for them. For people with a passion for global health, a global health experience might really strengthen their application. For people with a passion for the underserved, advocacy work might be a great way to make a difference and demonstrate their commitment. The most important thing is that the activities are meaningful (i.e., you really put some time and effort into something that you did) and provide a strong demonstration of your passions. It is much more memorable to have applicants whose activities really give a good picture of what is important to them and what they care the most about than those who were involved in a sampling of things in a less invested way.

What are common mistakes/red flags applicants make in their personal statements?

I think there are two most common mistakes that people make that rise to the top for me. First, some people spend too much time talking about why they want to go into pediatrics. We know that you want to go into pediatrics and that you have a passion for children because you are applying to pediatrics. What are some of the other reasons that you want to go into pediatrics? It might be good to focus on these. Second, people often do not spend enough time really letting us know who they are and what drives them. The personal statement is a huge opportunity to leave a lasting impression before we even have the chance to meet you in person. What are you passionate about? What really drives you? If you have some ideas, what do you see yourself doing after training? Answering these questions with a focus on how they will relate to why you will be an exceptional resident and pediatrician is important, but the personal statement is also a great opportunity for us to get to know a little more about your personality as well. This is important for helping to determine if you might be a good fit for the people at the program you are applying to.

What qualities/attributes make up the perfect pediatric clerkship MS3 or sub-I? What specific things make them stand out during a clinical service rotation?

I have worked with a number of medical students across a wide range of personalities, styles, and clinical abilities. Across all of these factors, the most important variables that stand out to me are:

  1. a genuine care for their patients

  2. a genuine care for their team

Genuine care for the patient can be shown in a number of ways, including staying late to help with something going on with a patient, taking extra time to make sure something a patient needs is received, and making a point to build a therapeutic alliance/connection with patients and families. If the parents know the name of the medical student and their role, that is a huge compliment! Genuine care for the team can also be demonstrated in a number of ways, including offering to help other team members out if you have your work done, and staying late when things are busy to help get the work done. Both of these things have examples that may involve staying late or coming early to be sure that excellent patient care is achieved. This can be a great way to demonstrate that you place your patients' needs in front of your own, which is one of the hallmarks of an outstanding resident and pediatrician.

Why is research seen as a favorable activity amongst residency programs? What qualities related to one's research activities are considered impressive to residency programs?

Findings from a survey of residency program directors published in Academic Medicine (Green, 2009) described that published research and research experience in medical school were in the top 14 important things, but they were ranked 13th and 14th. Favorable to have research experience? Yes. Most important or essential? No. Does research experience differ significantly among those who match in their specialties of choice and those who don't? No, according to the NRMP. But being involved in research is still a good thing, for a variety of reasons, and it may be an important discriminator when applicants for are similar in other ways.

Many 2nd year medical students are currently receiving or have received their Step I board scores and are beginning to think about where to apply for pediatric residency. In your presentation last October, you showed data from a national survey of program directors both from medicine and pediatrics. Step I scores were ranked as the #2 most important factor for all residency directors outside pediatrics and #8 among pediatric residency directors. Why do you think there is a discrepancy between the two? Also, do pediatric programs typically have cut-offs for how high a Step I score must be for an applicant to be considered?

I can only really comment on pediatrics and, more specifically, my thoughts concerning the Step I scores. I personally do not believe that test scores are an important factor in becoming an excellent pediatrician. Some people are better test takers than others, and some of those who are poor test takers turn out to be excellent pediatricians. With this in mind, I believe pediatric residency directors tend to emphasize other portions of the application more, as best shown by the study I cited. For example, Step II scores (Clinical Knowledge and Clinical Skills) are ranked higher in evaluating pediatric residency applicants, as they are better indicators of how proficient individuals will be as clinicians. In terms of cut-offs for Step I board scores, our program does not use cut-offs.

What other skills, experiences, etc. do program directors generally value? Are there other things that your program generally looks at more favorably in an applicant?

It depends on the individual program. As for our program, we look strongly for leadership skills in an applicant. An applicant who shows initiative and starts his or her own public health program in medical school for example, or someone who is highly involved with leadership at the medical school level is typically looked favorably upon. Showing initiative and organizational ability are two important traits for our program overall.

Referring back to the survey of national program directors, both medicine and pediatric, residency program directors ranked "Grades in Required Clerkships" as the #1 most important factor for evaluating medical students. What are your thoughts on why this is #1?

It is because the grades are standardized across the board. Clerkship directors see hundreds of students and are able to provide a direct comparison between students. We want students who have the potential to be excellent doctors, and excellent doctors are well-rounded clinicians who do well in pediatric clerkships and in Ob/Gyn, Surgery, etc.

Are there any particular elective rotations that you would recommend for medical students interested in pediatrics? For example, if a medical school curriculum is not as strong in dermatology, radiology, etc. do you think it is important for medical students to pursue these areas to be a better resident and pediatrician?

I know our program does not generally evaluate elective content for residency. I do not think there is any special formula for elective rotations that will make you a better resident and pediatrician. I would encourage every student to do what he/she wants. Most students benefit from sub-internship electives, and I would highly recommend these as they can provide evidence of efficiency in a clinical environment.

Do you have any tips for students who become interested in pediatrics later in medical school (as a 3rd year)?

I think organizing visiting rotations and sub-internships is the most important tip for those who become interested in pediatrics later in medical school. It is also very important to show commitment to pediatrics. If applicants were previously interested in orthopedics (for example), explain the change in their application. I would also encourage students to become involved in their pediatric interest group and to secure a good advisor in pediatrics as soon as possible.

Should residency applicants indicate if they are interested in a specific fellowship/specialty? What are the advantages/disadvantages of speaking with programs about their interests?

I think there are several advantages for a program and an applicant. For the applicant, it shows the program that he/she has a well-thought-out plan. For the applicant and the program, it would be beneficial so the applicant could be paired up with faculty with similar interests as soon as possible. For the program, it could help promote balance in the class. It would be undesirable for a program to have 20 residents who all want to be pediatric cardiologists.

What kinds of skills or experiences can you gain while in medical school that will allow you to become empowered residents in the future?

There are millions of opportunities while you are in medical school, from writing op-eds to newsletter submissions to engaging in local activities. All of these are things that you could add to your CV, to show that you are a person who is proficient at writing, passionate, and willing to raise your voice to take a stance about issues around you. Empowered medical students and residents are those who will get involved and get engaged. There are opportunities all around you as medical students. Don't feel like you need a large amount of experience when entering residency, instead it is our job to train you. However, the above-mentioned items are how you could get a good start that will put you ahead of the curve.

The hardest job that we have as program directors is selecting a residency class. It is an enormous task and takes a lot of work to be able to choose a small number of individuals from a huge group of intelligent people. Two things that stand out to us are being involved in those sorts of activities that indicate your passion for pediatrics and devotion to specific interests shown throughout your application. Commitment to a single area or a few areas is a great attribute to have.

Screening through applications can move quickly when using ERAS, in that it gives us numbers and allows us to click through experiences. The difference in those who we have chosen to accept is that they have done things that have mattered to them. Specifically, there is a difference between quantity and the longitudinal nature of activities. We are looking for things like advocacy that matter to you. Do things that make a difference to you, and in doing so you will be able to tell us what you will bring to our program.

Since applying to residency has become increasingly competitive, in that you need better board and clinical scores, it doesn't seem to lend time to extracurricular activities. How should we best manage our time and should we prioritize some activities over others?

You are right, it is becoming more competitive. But I can say that if you are a US trained medical student, then there is most likely a position for you as long as you dot your I's and cross your T's. Yet, you still need to self-evaluate and determine how competitive you are. This may not be the case as the number of medical students is growing and residency positions are not keeping pace. Yet, your question how do you get to everything in 24 hours, is a common one. It's important to remember to be who you are and do what's important to you. In doing so, this will give you energy and allow you to do more of what you love because this will improve your mood and boost your energy.

There is a distinct shifting of gears from getting into medical school to getting into residency. In applying to residency, we are looking for one or two things that you have done more deeply, shown commitment to and provided sufficient time and energy. This change of strategy is a better way to go in terms of strength in your application and also will provide better quality of life if you are doing things that you truly enjoy.

How important are letters of recommendation when reviewing applications for your residency program?

Letters of recommendation are critical. One unique thing that I advise medical students to do is to envision himself or herself as the person who is receiving their own application packet. Overall, we are looking for you to tell a story about yourself through 2-3 things such as research or community service projects. It would help if you had your potential letter writers focus on different areas of your journey as a student, thus allowing all three letters to show different aspects of you as an applicant. One thing to always ensure you ask the person is, "Do you feel comfortable writing a very strong letter on my behalf? If so, could you speak to this?" Then provide bullet points with items you would like him or her to mention in the letter. In doing this, a story will be able to come through your application. If you don't give those who are writing the letters any guidance, they may speak to the same qualities about you. Being strategic in who you choose to write your letters is very important. Someone who knows you because you have done 1-2 things longitudinally really reflects integrity, which is a quality at the end of the day that we are really looking for in our future residents.

It is easy to tell when a letter is merely a regurgitation of your CV versus when the letter writer truly knows you. With the large number of applications that we, as program directors, receive per year, sometimes less is more. For example, your personal statement and letters of recommendation should ideally be one page or less. Sometimes generating a letter from someone outside the realm of pediatrics can be very telling of your characteristics and attributes. For example, a surgeon speaking on your behalf saying that they would want you to take care of their grandkids some day is a very powerful statement.

A couple of things I can't emphasize enough, is that the people who are writing your letters should really know you through spending time with you and can write a letter that you would want to have. Letters from the chair of pediatrics at your program rarely tell us who you are as a person and so are less valuable than those that are written by someone who you have spent a lot of time with. One other very valuable point that we see when reviewing applications is you need to ask people to write letters who have experience in writing letters on behalf of medical students. For example, you may work with someone at a foundations experience or a clinic in a community setting one day a week over a period of a year, setting you up for an ideal relationship for a letter. Yet, they may not know exactly what to write or how to write it. You need to strategize along those lines.

In terms of looking at an application as a whole, how much emphasis do you place on Step 1/Step 2 scores?

These scores do matter. When reading through large numbers of applications, these scores are concrete. However, if we seem to get to know you or have an understanding of who you are as we read through your applications, it will allow us to take other things into consideration.

I love and hate recruitment season. Recruiting our future residents is one of the most important things we do as a Program Director. I love being able to bring fresh new faces into the program, yet, on the other side of the coin, I hate it because I have to, in some ways, be judgmental. We need something to discriminate applications, so one thing that we can base it on is USMLE scores. Looking at the data from last year, the average Step 1 score for a matched pediatric residency applicant was 226 versus the average score of 206 for an unmatched pediatric resident. Yet, we can take people who are not strong test takers and can help you pass the boards through training acquired in residency. USMLE scores are one piece of information to consider when weighing applicants. So if you haven't taken Step 1 or 2 yet, study hard and take it well because in doing so, it will keep doors open for you in the future. However, if it doesn't turn out how you had imagined, just know that it is not the end all or be all.

I would be lying if I said we didn't look at it. On our initial application screen- there are twelve categories and USMLE Step 1 and Step 2 scores are two out of the twelve. Thus, the scores are in there, but there are many other things to look at to get a good feel for your total application. There have definitely been instances where I have read an application that has managed to paint a picture of a journey through medical student training, yet the scores don't match up well. Yet, I have a 100% feeling in my heart that this student would be a terrific resident and work extremely hard for all three years, then the scores may not matter as much

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