My experience/advice from the end of 3rd year rotations to Match Day:
End of Third Year Priorities: I didn’t so hot here and wasted a lot of time due to issues at home, etc. Your first priority should be getting Step 2CK done before August 15th (and before October 15th) if you want it to be a factor. It’s also best to get it done because never again will you be so full of knowledge. M4, interview season, stress, reading SDN, checking Reddit, checking your email, etc. will squeeze all the information out of you. I know no one who scored well on CK (up to their Step 1 potential) having taking it after November. Also, most importantly, you’re busy and you need an uninterrupted month for CK. It can really help get you great interviews if you score a 250 and your Step 1 was a 230. If your Step 1 was amazing as in 250+, it’s still good to have a CK and many top programs may raise an eyebrow if it’s not there but you will get solid interviews even if you don’t take CK and get a score before Rank Order List (which again I don’t recommend). Anything between 240/250 I would say take your risks accordingly. You’ll definitely pull good interviews, but you’ll miss out on some places you would have gotten assuming a repeat percentile performance on CK. The next priority is getting your sub-I done. Some places seem to put stock into the subI and having it make up for a pass/high-pass in IM, but I think that’s BS. It’s not as important a pass will still look kind of bad, an honors will help. When in doubt, look at the trends at your school because that’s what these file reviewers probably do. After that, get letters from your sub-Is, elective months, continuity clinic preceptors, IM-floor months, Family is ok, research advisors, PDs if you worked with them, etc. DON’T BE AFRAID TO ASK. The worst they can say is no. Do ask if they can write a STRONG letter, but in general people understand it’s important to do this for students and will even do things last minute. In fact, my strongest letter came from someone I worked with for only two weeks on a consult service and I asked him sometime in mid-August (last minute) when my initial IM floor person flaked, but the was brought up at many interviews.
ERAS: For the timeline, applications open September 15th and the Dean’s Letter gets sent October 1st. I say have anything ready by September 15th, but October 1st. won’t kill you. I gave on speculating which programs sent early invitations and which ones did not. The only trend I noticed was that upper tiers on the east coast specifically seemed to send all their interviews a bit later, but top Midwest programs like NW/WUSTL/UMich can send them out early. I purposefully left LORs and ERAS out of the priorities because THEY ARE NOT THAT HARD. Seriously, this is not something you should stress about. Set a deadline of August 15th to when you should have elicited commitments from your 3 letters and an IM Department Letter. These people know when the real deadlines are (even if you try to trick them into thinking it needs to be submitted September 1st) but yes, keep harassing them from time to time, but don’t let it cause a stress ulcer. As for ERAS, it’s a 1.5 page personal statement, some little blurbs about your hobbies/experiences, and some forms to fill out with data like Step 1, AOA, and lastly is where to apply which is really quick. Everything’s already been set in stone now and you can’t just like earn AOA by writing an amazing personal statement. Just get it all done but do spend a few days on it to make sure it makes you shine. Don’t lie about anything, but there’s always a best way to state things. As for your PS, do try to let them get to know YOU. Not your activities, etc. Tell a story. I’m a decent writer so it did not take me as much effort and I got numerous compliments on my personal statement at some of my higher choices. As always proof read repeatedly and get a second person to glance at it. In IM, you don’t really need your PD to really read it, even though you hear a lot of that going on, it’s more relevant for other fields. Lastly, before submitting ERAS, leave a day beforehand for enough time to FB people in your situation or meet someone like a PD or intern to make sure you’re applying to the right places. It may seem obvious but a lot of these places are confusing. For example, if you want to apply to the Albert Einstein IM program, it’s going to be the Albert Einstein Montefiore Moses/Weiler campus. There’s a ton of others Einstein Residencies. Also, watch out for affiliates. Mt. Sinai has a bunch and also watch out for programs where you apply to the wrong location. University of Illinois of Chicago (UIC) is where you want to apply to if you're looking for the midtier IM program even though University of Illinois –Urbana is the undergraduate campus. Make sure you verify the programs by looking at the city and compare the PD in ERAS to the one on Doximity. Apply broadly, do not go overboard. Also, lastly, after September 15th, check up daily on things like USMLE Transcripts, LORs, and the Dean’s Letter. If you have the opportunity to review and suggest changes to your Dean’s Letter, you better make the most of that opportunity as you know your competition will be doing the same. Reach out to faculty who you worked well with and see if they can expand on the praise they gave you in their evaluations. For one, a clerkship director told me that I tied the all-time high for my class on a shelf so later I asked her to write that statement on my dean's letter and it helps. Programs don't really see how you high passed something.
Waiting for and soliciting Interviews: Get a Gmail, download the app on your phone, and set a unique alert. I don’t know why everyone wants to get into speculation about whether the school’s email is 100% reliable. Gmail works, period. Also, you don’t want get palpitations every time your schools decides to spam you. In regards to importance of punctuality of scheduling interviews, people simultaneously overestimate and underestimate. Especially early on, if you got an interview invite, there should be time (as in a day) for you to schedule…no problem but of course there is the chance that spots will be filled and you’ll have to click on filled dates and the scheduling program will put you on a waitlist for those days. Later on, interview invite batches get smaller and tend to depend more on timing. Stay vigilant. One of my top 5 choices invited me on a Sunday and there was one spot left. As for the time course, there are one wave for AMGs. It is between September 15th to October 15th. They’ll start coming in slowly a few days after September 15th, they will hit a relative peak on October 1st (got multiple that day) and then they’ll come at a healthy pace until the middle of October where your rejections will start outnumbering your acceptances. I actually got the place I was happy to match at after this period but they traditionally send interviews a little later. Also keep in mind the upper tier places especially on the east coast start a bit later from what I’ve noticed too. I would say the time for letters of interest for interview season are after October 15th -ish. I thought this was overkill and so do many people on SDN, but people did this and were successful. November 1st isn’t too late for letters of interest either. For this, don’t be shy again. Ask your PD or someone well-known at your school straight up to put in a word on your behalf. Match lists are like a big deal every year and faculty know their institution will get judged by it so they’ll do everything within reasonable ethical bounds to help you even if you think they don’t necessarily like you that much. Also, accompany that with an LOR. Mention your connections to the area, your frank feelings, and anything new to your application. Like many things on SDN, LOIs are simultaneously over and underrated. One thing that I have omitted is a competitiveness chart of like where you should apply to and where you’re competitive for given your school, Step 1, class rank, etc. because the Eternal WAMC forum does a good job answering all of that and I tell everyone that it’s better to over-apply so when in doubt just apply. It’s better than engaging in the time-consuming pseudo-science of guessing where you may be competitive or not. Lastly, another question that gets asked is what months are the heaviest interview months so they can take time off. I’m not sure if this was an issue in the past but the system has resolved this program. When you get an invite, dates range from late October to mid-January and you can pick a date. Make sure you don’t schedule them back to back especially with weather and unreliable flights. I personally started and had 7 in November, 8 in December, and 1 in January but I know of all sorts of variations. As a general rule (unless you want to match at your home program) go local programs first as audition interviews and then schedule the remaining interviews. The order of those don’t matter and no thought it put into when you interviewed on the programs end. Some people neurotically ask if a weight list interview is weaker and I personally don’t know. I have heard people match their dream program off a waitlist but the fact that they had to come off a waitlist also says the program valued them less despite the fact that they’ll never admit that.
Interviews: I have heard nightmares for Orthopedic Surgery, etc. but they’re universally decent for IM. They just want to get to know you. The first thing they generally ask is small-talk about how you like the area, etc. and then will ask you to tell them about you. While that may seem intimidating and vague on the surface, they’re just asking you to state facts about your upbringing like where you’re from, your background, quick one-liner about why medicine, where you went to undergrad, and maybe a one-liner about interests outside of medicine. Keep it to 15-30 seconds. Then they’ll ask you maybe 1-3 questions like the “tell me about a time when you had to use xyz to resolve a conflict”. Believe it or not, that’s how tough it gets. They may ask you about any red-flags and don’t be upset, they’re not grilling you but trying to get put the red flag in context and possibly minimize it if they like you. They will ask about research if it’s a strength on your application and they may ask you about what you are interested (or why you’re interested) in their program and where you see yourself in 10-15 years. That itself is like 85% of what they’ll ask. My recommendation is to look at the previous Reddit compilations and spend like 1-2 hours before interview season starts outlining your answers to every major question they ask. After that, there’s no real need to revisit that. Just come up with 3-5 standard questions because all interviewers ask questions and it’s a bad thing if you don’t at least fake interest and ask one. No one will know if it’s the same ones. Also maybe take a quick glance at their website and maybe you’ll pick up a small talking point about why you fit, but no need to go overboard. The places literally tell you about their program before the interviews in the PD or Chief Overview. There’s usually 1-3 interviews with anyone from faculty, residents, aPDs, and PDs. If you get the list before hand, google search the person and mentally prepare, but don’t be weird about it either. Also, as a general rule (should be obvious and date back to applying to medical school) but your interview starts the moment you enter the door. Quite literally for me. I was running right on time to make my interview at the place I matched and naturally I was rushing, but I took the time to politely hold the door and gesture to a lady inside who I initially thought was random staff…but later found out she was the PD and she gave me a nice wink when she walked in to give her intro. Lastly, pre-interview dinners and whether or not to show up…some people say it doesn’t matter but it really doesn’t make sense not to make every single program you want to be at in my humble opinion. If you’re flying in or driving from far off in order to get a hotel, it works out perfectly and oftentimes they’ll pay for your hotel and have residents/transportation to and from the dinner and hospital. If you can’t make it, don’t panic and things happen but let the program coordinator (not director) know and express regrets and often you’ll hear something back like thanks so much for letting us know, things happen and this is why we have residents available at the lunch time, etc.
Post-Interview Communication: Email your #1 that they’re your #1. If you don’t have a clear #1, don’t be pressured to decide. I had a clear one, but many people were choosing between Stanford v. UCSF for example and while UCSF makes up the Big 4, all top programs have strengths and weaknesses that people have to consider. For the less competitive to above average IM applicant, it’s usually not that hard to decide. Otherwise, I don’t recommend thank you notes.
Rank Order List: Rank in the order you want to attend. The way the match algorithm works is it tries to match everyone to their number 1. If they program has ranked them, they’re tentatively matched and are bumped down as other people arrive and if they are bumped out, they are then matched to their second choice and so on. It is self-sabotage to rank a “safety” higher. Said in another way, your changes of matching MGH only depend how where they ranked (they don’t see how you ranked them) and where you ranked them. Again, ranking them #1 vs. #2 is not going to increase your chances. Lastly, as a general rule, go with the view you held for a longer time. Last minute impulses are usually wrong.
Away Rotations: There’s no reason to really. They’re expensive. They add unnecessary stress during an already stressful process. Internal Medicine doesn’t really care about auditioning unlike EM or Surgical subspecialties. It’s such a large field and if you do do an away, what happens if you screw up, lol. Better to just not give them any ammo on you. That said, if there’s place you really want to go and it would mean the world to you, apply for an away there. Another reason to would be to do one early and get a well-known person in the field you’re interested in to write you a letter some people at big places may recognize, but it’s hardly a requirement. I did no away rotations and was glad I didn’t and had no FOMO.
4th Year Electives: So don’t XICU your whole year. Do your subI early, but if you can’t get it in by application season, consider doing it near the end as that’s a good option if you are willing to give of the prospects of a vacation then and fear you’ll forget stuff. More than ICU rotations, consider consult months. Despite GI/Cards being competitive, don’t waste months on them. On Cards, you won’t even learn to read EKGs…no one ever does because it’s really a lot outside the basics. As for GI, it’s cool and I did it but it’s heavily procedural so you’ll spend a lot of time observing and it’s pretty subspecialized. The best rotations to do to prepare yourself for Intern year are a Nephrology month and an Infectious Disease month. Both are extremely useful because antibiotics are everywhere and Internal Medicine is literally nephrology (fluids, HTN, electrolytes, etc.).
Match Day to Intern Year: Don't let stupid paperwork build up. It never ends especially if you're going out of state. Lease a place early and get all your errands like license plates, buying furniture, etc. done and then go on that vacation.
***Something I didn't include***: thoughts on individual programs. If people have questions and I have experience at a place or think I have a good idea, I'll answer questions though and will try to keep my post-match bias in check for your benefit as well as mine.
