like dermatology, plastic surgery, neurosurgery,  or something else highly sought after. The problem  

is that you didn't quite nail your USMLE Step  1. But don't worry, all hope is not lost.

Dr. Jubbal, MedSchoolInsiders.com.

Residencies are overrun with applicants,  as we have too many freshly minted doctors  

graduating from medical school each year, but  not enough residency positions for all of them.

Confronted with over 100 applicants  for a single residency seat,  

residency program directors need  a way to narrow down the list.  

For this reason, they use a "standardized  screening process", specific to each program,  

to reject approximately 50% of applicants.  This includes USMLE scores among other factors.

We often focus on USMLE scores as the end  all in terms of residency competitiveness.  

But upon closer examination of the data, you'll  see there were a handful of students matching into  

plastic surgery or dermatology or neurosurgery  with USMLE scores below 230. What gives?

If you've ever wondered how to get inside  the mind of a residency program director  

to figure out what they care about,  you're in luck. Every two years,  

the NRMP surveys program directors from  all residencies and publishes the NRMP  

Program Director Survey, showing what factors  are most important in selecting applicants to  

interview. And this is a big deal – after all,  only 13% of applicants are offered an interview,  

making it one of the most challenging  parts of the application process.

USMLE Step 1 tops the list in the survey,  with 94% of programs citing it as important  

with an average importance rating of 4.1. In  other words, they care about it quite a bit.  

In fact, approximately 2/3 of all  programs have a target score for Step 1.  

This cutoff score varies based on the specialty.  On average, plastic surgery, orthopedic surgery,  

and dermatology programs will have a cutoff much  higher, around 230 and sometimes even up to 240.  

On the other hand, programs like family medicine  and neurology have cutoffs closer to 200.

And if you really crush Step 1,  there are threshold scores above  

which you're almost guaranteed  an interview. For dermatology,  

that cutoff is on average 241, up to 251.  For plastic surgery, it's on average 248,  

up to 256 — the highest of any specialty.  For family medicine, it's 219, up to 223.

But wait a minute - USMLE  Step 1 is becoming pass/fail,  

therefore will this even matter?  As I've [discussed on my personal  

channel](https://www.youtube.com/watch?v=LrJ5i9afqP8),  this will largely shift the importance  

in applicant selection to other  factors, like Step 2CK. And besides,  

this video isn't about telling you why crushing  USMLE is important. You already know that. We want  

to know how else you can stand out and still match  into that competitive specialty without a 260.

If you take a step back, you'll find that the  most important factors in screening applicants  

for interviews are largely high-level broader  assessments. The top 5 most important factors are

1. USMLE Step 1/COMLEX Level 1 score 2. Letters of recommendation in the specialty 

3. Medical Student Performance  Evaluation (MSPE/Dean's Letter) 

4. USMLE Step 2CK/COMLEX Level 2CE score 5. Personal Statement

Again, these are primarily summative  assessments. Your board exam scores  

are proxies in assessing your mastery of  preclinical and clinical content. Your MSPE,  

or Dean's letter, summarizes your performance  as a student. At the end of the letter,  

they often use one of 4 keywords to indicate  the class quartile in which the student ranked,  

even at supposed unranked programs. The letters of  recommendation from physicians in that specialty  

summarize the opinions of experienced attendings  who have worked closely with you. Are you a good  

"fit" for this field? And your personal  statement reflects your story and motives.

Without understanding the perspectives and  priorities of residency program directors,  

most medical students poorly  allocate their time and energy,  

placing too much emphasis on things that don't  matter, and too little on areas with a higher ROI.

Understand that applying to residency is a  different beast than applying to medical school,  

and what matters to medical schools isn't  necessarily the same as what matters to  

residency programs. Let's take extracurriculars  for example. When applying to medical school,  

the depth of your extracurriculars are important  — do you have clinical exposure? How about  

volunteering and leadership experience? Medical  schools want to know you're well rounded, that  

you understand what medicine is about, and that  you're going into the field for the right reasons.

But when you're applying to residency, you're  already well on your way to becoming a doctor.  

Now the priority is seeing if you'll be a good  fit for that specialty and residency program.  

It's not a priority to them  if you were part of X or Y  

student group. In fact, extracurriculars and  volunteering ranked at #19 in the survey.

I'm not saying to avoid interesting organizations,  

as they can offer value outside of your residency  application. In fact, being a co-founder of the  

Future of Medicine student group at my medical  school got the gears turning in my head,  

resulting in me founding the Blue LINC biomedical  incubator that resulted in me falling in love with  

entrepreneurship and innovation. And that  led me to starting Med School Insiders and  

Memm. But none of my residency interviewers  cared about the Future of Medicine group.

Similarly, many students obsess  about their preclinical grades.  

Ask your school if the MSPE or dean's letter  is reflective of your preclinical grades.  

If so, strive to be in the top quartile. And  if your school has AOA, an honors society that  

is based on ranking, try to meet the cutoff. But  if the letter doesn't reflect preclinical grades  

or you don't have an AOA chapter at  your school, focus on just passing  

and spending extra time preparing for USMLE  or building your research publication list.

As a medical student, time is of the essence,  and it's imperative to be mindful of the  

opportunity cost of any given activity. Don't  be a robot, and don't forget to live your life.  

At the same time, understand that  time spent with a student club  

means less time on other goals that will move  the needle on your residency application.

You already know it's important to do  your best on USMLE Step 1, Step 2CK,  

and your clinical rotations. But how  did those students with sub 230 scores  

match into plastics, derm, and neurosurgery?  

It comes down to three areas that can override  score cutoffs and compensate for deficiencies.

First, it's a matter of who you know, and who is  in your corner. It's no surprise that students  

pursuing a competitive specialty have the highest  odds of matching into their home program. It's  

simple human psychology and risk assessment —  you'll have a higher degree of direct interaction  

with faculty and your program director,  including the opportunity to rotate there.  

Assuming you exhibit strong performance and  impress them through clinical rotations,  

research, and perhaps supporting them  on their side projects or initiatives,  

chances are they'll take a strong  liking to you. Comparing two candidates,  

they'll favor the one who they know  personally and has a proven track record.

You can still do this with faculty  at other programs, too. This is most  

traditionally done through away rotations.  In 2020, that's going to be less common,  

but you can still make connections outside the  formal rotation setting. For example, say you find  

a faculty's clinical interests from their website  and reach out to them to assist with case reports  

or research articles remotely. If you're part of  a national organization committee, this is another  

worthwhile opportunity to interact with faculty  committee members and build a relationship.

Beyond that, having faculty in your corner who are  willing to bat for your at application time can  

massively influence your outcomes, particularly  if you're applying to a smaller specialty where  

most faculty more or less know one another.  When you apply, they'll reach out to their  

contacts in residency programs to specifically  vouch for you and help you secure an interview.

These faculty advocates are most impactful when  they have significant direct contact with you.  

After all, it's much more meaningful when a  faculty member has worked with you closely on  

research for 18 months and can speak to your  amazing skills and how any program would be  

lucky to have you. This isn't something you  can simply figure out at the last minute.  

Rather, you'll need to begin working  on this earlier during medical school.  

A great place to start is simply pursuing  research projects or interest groups in your  

particular specialty to find a faculty mentor.  You can also ask medical students and residents  

who may offer more insight as to which faculty  members would be more receptive and helpful.

Next, it should be no surprise that being prolific  with research can transform your application.  

Looking at the NRMP official match data, you'll  find that for many competitive specialties,  

there is a large difference in the total number  

of research items between those  who matched and those who didn't.

Research is attractive because it  demonstrates initiative, work ethic,  

curiosity, and the pursuit of knowledge. Perhaps  more importantly, it helps programs look good  

when their residents and faculty publish  frequently, and it helps them secure funding.

Standing out in research is often  a key differentiating factor.  

I have 65 publications and abstracts primarily  in plastic surgery, and at every institution,  

interviewers loved talking about how I was  able to be prolific with research at such an  

unusual level. Some even told me they were  excited to have a future resident like me  

to help them push through various  projects they've been working on.

Ever since [the video on my personal  channel explaining my research  

experience](https://www.youtube.com/watch?v=H9aMenyBdkk),  I've had a large number of students asking  

for specifics on how they can do the same. There's  a great deal of complexity and nuance to it,  

much more than a single video can encompass, so  I'm considering making a course. To gauge interest  

and see if it's worthwhile, drop a comment below  if you'd like me to work on a research course.

Lastly, a highly compelling ERAS application and  personal statement can make a huge impact on your  

competitiveness. But this is much easier said than  done. Many applicants write a personal statement  

or have other components of their ERAS application  that holds them back in some way. Others write an  

application that doesn't hurt or help them much.  And only a small minority are able to craft an  

ERAS application and personal statement that  truly serves as an asset to improve their chances.

Your application should make the reader want  to meet you, while also highlighting the  

aspects of your application that would  make you a great fit at their program.  

Depending on your experiences and the program's  priorities, this can be anything from specific  

research interests to advocacy work,  and anything between. We have some  

example personal statements on the Med School  Insiders website that show a range of essays.  

One was so strong that the applicant was  told their essay was the main reason they  

were offered an interview at MGH and a few other  elite programs, despite having weaker USMLE scores  

and minimal research. You can sign up at the  link in the description to receive your free  

copies of those essays, including commentary  explaining the essays' strengths and weaknesses.

Getting into your dream specialty can be  overwhelming - I was there not too long ago.  

But by intelligently approaching your application  and prioritizing your energy and efforts based on  

relative yield, you should be able to better  position yourself for a successful match.  

Keep in mind your stage in training too. In  your preclinical years, focus on optimizing  

for USMLE Step 1 performance and dip your toes  into research. In your third and fourth year,  

prioritize clerkship grades, because those matter,  and set yourself up for success on Step 2CK.

If you need help with any step of the  process, from USMLE and shelf tutoring  

to optimizing your research to fine tuning  your personal statement or interview skills,  

visit us on MedSchoolInsiders.com. Our Insiders  are superstars in their respective fields,  

representing almost every specialty, from  plastic surgery and neurosurgery to derm, ortho,  

anesthesia, radiology, psych, and much more. When  building out our services, we found a common issue  

plaguing other companies in the industry – lack  of consistency and expertise. One student may  

get assigned a great advisor or tutor, and the  next may get unlucky. That's simply not fair.  

Just as I obsess about my personal systems,  we obsessed over creating the best tutoring  

and advising experience for aspiring future  doctors. We've shaken things up, innovating  

with systems that offer a consistently  elevated and high quality experience,  

with results that speak for themselves. And unlike  others, we have the experience and expertise to  

back up our claims. These are the same systems  that helped me score in the high 260's on USMLE,  

secure 65 research publications, match into  plastic surgery in Southern California,  

while also starting multiple profitable  companies. We'll teach you the methods and  

help you achieve your version of success.  Visit MedSchoolInsiders.com to learn more.

If you enjoyed this video, check out my video  on securing 65 research items or this video  

comparing medical school and residency.  Much love, and I'll see you guys there.