thank you cards

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no, you do not have to send thank you cards. the program will pick it's best candidates just like getting a job (or the school's own students). an email to a program director at the top places you are interested in probably would help if you and a few other candidates are similarly ranked. that way they know that you are still interested in going there.. sending them not right after you interview but after you finish all your interviews might be best..
 
If there was someone you connected with or who you want to impress it can't hurt. I usually sent the program director (+ chair if I interviewed with them) a note but I have no idea if it made any difference or not.
 
I don't hold it against anyone for not writing (that is just way too many cards to write!), but I admit that I always was impressed to some degree when I got an email or note from an applicant thanking me for the interview.

I think talking to the program director if you are very interested in a program is definitely helpful! Don't BS the director, but expressing sincere interest might make the program take another look at you. However, I agree that it probably won't do much if you are not highly ranked. But if they are deciding between you and someone else, that could be the added thing that makes up their mind. Just my opinion, certainly not a rule.
 
Ditto. I never wrote one of those post-Christmas-like thank-you cards and snail-mailed it like you might to your grandmother. I did send a few follow-up emails, generally to someone I thought I clicked with or just to the program coordinator/whoever I had discussed setting up the interview with the most.

On the other side, I believe once or twice(?) we got a snail-mail card from an interviewee. It wasn't terribly cheesy per se, just a little unusual. Even as a resident myself, I got several emails back from applicants, which I generally forwarded to the program director as an FYI (depending on the nature of it - I also assumed a certain degree of privacy with such communications).

At any rate, I agree that sending a "Thank you" isn't required/expected, but some sort of follow-up communication is still probably a good idea - if you can do it without sounding forced, overly formal, or cheesy, all of which are rather subjective.
 
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