I've been reading this post for a while now and I feel compelled to put in my $.02. Being a new resident and having had a couple of months of students externing at my program, I can see now why students don't match. It honestly really has nothing to do with how smart you are because honestly, you only need borderline booksmarts to get by. The biggest thing that won't get you a spot isn't where you're ranked in your class, GPA seems to be more of an interview qualifier than an actual criteria to match and obviously, the majority of programs don't want residents that didn't pass any of their boards (although Part III taken early on without passing would be an exception to the rule). The biggest reason I've seen so far as to students that externed and that have (no pun intended) shot themselves in foot is their work ethic.
Over sleeping for grand rounds = deal breaker (especially if you've already been to 2 or 3 weeks of them prior); not being able to do a progress note or pre-op H&P on a computer system that has PREFORMED TEMPLATES and smartphrases (or in general, not being able to do a basic prog note/preop H&P without a computer system) = deal breaker; After 2 days of being at the program, being in on surgery and the resident either has to STILL ask you to get the room ready or get whatever is specific for students at that program (cast bucket at mine, tourniquet, etc) or has to tell you to go write the note = deal breaker; Disappearing for 10 min every 1-2 hours without any trace (I will just say it, if you smoke, don't let us know about it) = deal breaker; Going over basic anatomy for your presentation when you have attendings who have been practicing for >25 years, going over your allotted time, not knowing ANY research that you did your topic on, having less than, oh lets say 10 citations for your topic (if you have 10 or less, that's ok, but you better know them in and out) = deal breaker; writing a prog note on an inpatient (including physical exam) without having even seen the patient and even worse, focused LE exam without even taking down the dressing (not a post-op pt) = deal breaker; not having the pts dressing taken down before the residents get there = deal breaker.
Overall, doing any one of these things in isolation isn't a big deal, it happens, own it, accept it, remedy it and move on (AND make sure it doesn't happen again), but repeatedly over and over throughout the month, it just looks bad on you.
The underlying theme to this post is COMMON SENSE. I'm going to bold this again, COMMON SENSE. You can't teach it, but if you lack it, I guarantee you will have a tough time matching and then you'll be on here whining about not matching into your top program or any program for that manner. We've all had struggles in externships and residency, God knows I'm not flawless, but the students and residents that seem to do the best are the ones that do the little things the best, they pay attention to the minutia, the details. If your goal is to make the residents day a little easier and less stressful, then you've done your job as student. There's going to be things you won't be able to do, that the resident has to take care of, that's fine, but the things you can do, just do them. Don't let me catch you bitching about it in the hallway, that's another deal breaker. We all had to be someones bitch at some point along the way, it's part of the process. Again, own it, master it, move on.
COMMON SENSE gets you a residency spot, guaranteed. Personality would be the next thing, then smarts. Although I will caveat this with at my program (which I will not name on here for aninimity purposes), you do have to have some intelligence, but as far as daily stuff with the residents go, I'd rather have someone who works their butt off than someone who can tell me all the indications and contraindications for putting in a STAR, that comes in residency.
WORK HARD and HAVE COMMON SENSE and DON'T BE A D-BAG and you'll be just fine.
Let us know.
