There is a lot of great information on this site, and I thought I'd throw in my two cents. I went to medical school in the midwest where there is a large, established Oto program, did my residency at a well known program on the west coast and am now doing my fellowship. I had below average Step 1 scores (below average for Oto that is) but was senior AOA. I also took a year off in med school for Oto research. The way I look at the process of matching into an Oto residency is in two basic steps:
1) Getting in the door (aka Getting an Interview)
2) Sealing the deal (aka Matching)
Getting in the door
Keep in mind that programs review 200+ applications each year and have to pare that number down to 30-60 depending on the size of the program. Hence the heavy reliance on "objective" measures like Step 1 scores or AOA status. Everyone knows these are imperfect tools but you have to start somewhere. I believe that the following factors can increase your chances of getting an interview; having one or all of these factors will not guarantee an interview but will increase the chances. At the same time, not having one of these attributes doesn't preclude you from getting an interview.
- Step 1 score: Yes, the median score for Oto applicants is higher than the overall median. If you rock the test you look more appealing; if you are below 200 most programs will set your application to the side. In our program Step 2 scores didn't play a huge role, but I suppose it would be helpful if your Step 1 wasn't so great and you improved 15+ points on Step 2. But if you get the same below average score that might look bad.
- AOA status: Not all schools participate in AOA. If you are AOA then great! If not it won't kill you but you should have some other aspect of your application that makes you stand out.
- Visiting/sub-I rotation: Lots of mixed opinions on this one. I probably wouldn't have gotten an interview at my program without doing it so for me it worked out. Take a critical look at the feedback you got from your clinical rotations. If people consistently tell you that you're awesome and they want to you go into their field, chances are good that you will wow the program where you do an away rotation. Most years we matched at least 1 person who had done a visiting rotation with us. But an away rotation can also be a big hurt. There was more than one student who did a rotation with us who looked amazing on paper, but by the end of their first week none of us could stand being around them. The longer you spend with people the more opportunities there are for them to find a reason not to like you. If there is a specific place you want to match, doing a rotation there shows that you are serious about your interest in their program. If you do too many then people wonder what your deal is. See my "tips for a good away rotation" below.
- Research: Taking a year (or more) off to do research clearly demonstrates a serious interest in research and that's a good thing. Even if you did it in another field before you decided on Oto, having the experience can only help your application. After all cell cultures, gels and other basic science are research skills that can be applied to any field. A one-month research elective is a token gesture but nonetheless faculty seem to like seeing these tokens appear on applications. It lends at least a small bit of credibility to your statement that you are interested in research. ALL programs want to hear that you are interested in research. Be prepared to discuss your research; if it's obvious that you have no idea what you're talking about that is very very bad.
- Letters of recommendation: You MUST have at least one letter from an Otolaryngologist. The closer you are to your letter writers the better. My mentor must have written a great letter because I was asked about the vignettes that were apparently in that letter during many of my interviews. Most would agree that you should have a chair's letter. The dean's letter doesn't count for much because everyone knows that they are generic and are basically a summary of all of the positive comments people have left on their evaluations of your performance.
- A good mentor: If there are one or two places you really want an interview, a trusted mentor may pick up the phone and call someone they know there to say why they should interview you. Be a little cautious about broadcasting your interest in other programs in case you may want to stay at your home institution.
Sealing the Deal
You've now hopefully gotten 8-10 interviews; there really isn't any magic in the number but obviously the more interviews you do the better the odds of matching at one of them. At this point it's not as important what your scores or AOA status are. What people are most interested in is figuring out how they'd feel about spending hours upon hours with you over the next 5 years. Will you be a team player? Will you help the attendings produce some publications? Will you be teachable? Will you be pleasant to be around? Will you not kill anyone?
Your goal should be to be memorable in a good way. There may be some interesting thing about your life story, some impressive accomplishment you've achieved, some breakthrough research you did, or people may just remember that you were really fun to talk to.
Interview day:
- Be nice to EVERYONE. This includes the secretaries and residency coordinators who arrange the interview days. If you think you can get away with being a jerk to someone lower down on the chain, think again. That information gets around quick.
- Be ENTHUSIASTIC. Some people come off as being ho-hum about being at their interview. This does not make for a successful interview day. Sometimes I think this impression is formed if people are too quiet; this is unfortunate for people who are shy, but do your best to smile and ask questions.
- Spend time with the residents. Two good reasons - first to see if you like them and want to work with them. Second because of the influence they have on the rank list. Regardless of what they say the residents do influence the list, mostly in terms of the really good or the really bad applicants. Around interview season everyone talks about the applicants, and that's when the stories will come out about the stand-outs.
- Dress (and groom) for the part. As silly as it may seem, people remember these things. You don't want to be "the guy with the shaggy hair or earring" or "the girl with the really short skirt or a lot of makeup."
After the interview:
- Do send a thank you card/note. This will not make or break your application but it's the polite thing to do. And no, you don't have to send one to every single person you met. But if you had a special connection with someone, consider sending them a personal note. They could become your best advocate when it comes time to parse out the list
- Talk to your mentor. Otolaryngology is a small field and people know each other. When a program wants the "real scoop" the PD or other faculty will call someone they know at the applicant's home institution.
Tips for a good away rotation
I'm tired so this will be short. Be a team player. Be willing to help on rounds - changing dressings, removing drains, writing notes, etc. Carry supplies in your pocket. Hold hook in the OR. Don't be rude to a nurse or junior resident then turn around and kiss the attending's you-know-what. Follow the rules of hierarchy - don't try to show up a resident in an effort to score points with the attending. Act in such a way that when you leave the service the residents will wish that the next student was as good as you were. The attendings will ask the residents how a sub-I is doing, and ask what they think of you. If your school doesn't have an Oto department this could be a chance for you to find a research project or a mentor in the field. Don't brag about all the wonderful things you've achieved. People will come to realize how awesome you are without you having to tell them.
Whew! Congrats if you made it to the end of this post. GOOD LUCK with the process. Otolaryngology is an awesome field and the hard work is well worth it.
