Applying for residency consists of two steps: sending an application to the selected resident programs and then conducting interviews. The application stage is your first step toward residency, so don't underestimate the significance of doing it correctly.

The initial Match in 1953 attracted 6,000 candidates. Since then, the amount has gradually increased, with a tiny decrease at the turn of the twentieth century. Since 2004, the number of residency applications has steadily increased. In 2023, it reached a record-breaking high of 42,952.

Since 2020, most MD and DO candidates have been matched using the same procedure. In 2023, 7,436 DO seniors in the United States submitted rank-order lists, with a record-breaking 91.6% match percentage for this cohort.

Data from the Association of American Medical Colleges (AAMC) and ERAS reveal that the average number of applicants varies greatly by specialty, ranging from 23 for Thoracic Surgery to 44 for Pediatrics and 66 for Urology. On average, applicants submit 102.9 applications.

It does not imply that you must apply to about 100 residency programs to be effective. We advocate submitting from 15 to a max of 30–35 programs. But how to compel a residency application that will set you apart from the competition? Let’s go into the procedure and see what it needs to produce an excellent application that stands out.

Residency Application Submission Strategy

First, pick your residency programs. Choosing where you want to train is a big decision. This period will shape your clinical skills and professional growth. To make the best choice, dig deep into the programs you’re interested in. Compare their qualifications, see how they align with your preferences, and understand their requirements.

Before applying through ERAS®, reach out to your selected programs. Check their eligibility criteria, application deadlines, licensure needs, and visa policies if applicable. Most of this info is on their websites. You can find a list of ERAS-participating programs on the AAMC’s website.

Consider your career path carefully. Research one or more medical specialties. Get advice from mentors and consult physicians in those fields. Think about what would be fulfilling for you. Look into how many positions are available in each specialty, how competitive they are, and the experiences of past international graduates from your school. You can find detailed data on the NRMP website.

residency application timeline

Once you’ve chosen a specialty, decide which programs to apply to. Factors to consider include location, hospital affiliations, accreditation status, and how well their graduates perform.

The AAMC, in collaboration with other organizations including ECFMG, offers the Residency Explorer tool. This lets you compare your profile with those of applicants who matched previously. While it doesn’t tell you where to apply, it helps you identify programs to research further.

The American Medical Association (AMA) also provides a free Residency/Fellowship Training Program Search through FREIDA™.

Exciting Updates for the 2025 ERAS Season

This season brings enhancements to the Residency Explorer tool, designed by nine partner organizations to improve your application experience. Here’s what’s new:

  • Interview Data: Compare yourself with past applicants who received interview invites.
  • Program Signals and Geographic Alignment: See interview rates for applicants using Program Signal or with geographic preferences.
  • Personalized Profile Comparison: Match programs with your career interests and needs.
  • Original Source-Verified Data: Access verified data from six national organizations, exclusive to Residency Explorer.

Understanding the ERAS Timeline

While ERAS officially kicks off in June, you should start your preparations much earlier. Begin in the spring by finding colleges you’re interested in, gathering letters of reference, and writing an appealing personal statement. Here’s a more complete timeline to help you navigate the procedure.

  • Early June

Start by obtaining your token (one-time access code) from your Designated Dean’s Office, which grants you access to MyERAS. Also, consider whether you need to take the Computer-Based Assessment for Sampling Personal Characteristics (Casper), a test used by some programs to assess non-cognitive skills.

  • June

Begin filling out your application, meticulously detailing your work, volunteering, and research experiences. Take full advantage of the ERAS Tools and Worksheets for Residency Applicants to ensure you gather all necessary information. As you compile your application, identify the programs you’re interested in and organize your documents accordingly.

residency application blueprint

  • June – August

You can only register for ERAS once, so ensure your residency application is perfect before certifying it, as it becomes unchangeable. Confirm letters of recommendation, refine personal statements, and finalize the program list. Request relevant transcripts (USMLE, COMLEX-USA, MSPE). 

  • September

Submit your ERAS application at the beginning of September. Submitting early is crucial as the site often experiences high traffic and potential crashes near the deadline. Applications are released at the end of September. To prevent missing out on first interview possibilities, don’t wait until the very last minute to send in your residency application.

  • October

Interviews take place during autumn and winter during the last year of medical school. They provide programs the opportunity to examine you beyond your residency application and allow you to analyze each program’s fit with your professional objectives and personal interests. Practice your replies to frequent inquiries, prepare meaningful interview questions, and become familiar with the nuances of each program. 

Crafting Your Residency Application

Residency programs need to know how you will fit into their team. A residency application is your opportunity to demonstrate professionalism and genuineness and assist programs in determining if you are a suitable fit for their specialization and will be a successful trainee.

Residency applications normally comprise the following:

  • CV
  • Letters of Recommendation
  • Personal Statement
  • Medical School Transcripts
  • Medical Student Performance Evaluation (MSPE)
  • Licensing Exam Transcript

Applicants are responsible for crafting the applications, CVs, letters of recommendation, and personal statements. Transcripts, MSPE, and licensure test results are provided by med schools.

residency application competitive applicant

Preparing a curriculum vitae

A curriculum vitae (CV) is a thorough, chronological summary of your accomplishments. It is important to build it correctly, to show relevant accomplishments. Applicants can list up to 10 experiences, and highlight the 3 “Most Meaningful” ones.

Programs look for candidates with essential skills like communication, emotional intelligence, and the ability to stay calm under pressure. Depending on your specialty, specific skills or experiences might be crucial. For example, research experience is vital for academic programs, while fine motor skills are crucial for surgical specialties. Highlight these in your residency application.

Possible experiences include:

  • Education or training, such as clerkships and away rotations
  • Military service
  • Membership in societies or associations
  • Research projects
  • Teaching experiences
  • Volunteer work, service projects, or advocacy efforts
  • Paid work, both clinical and nonclinical
  • Other extracurricular activities, like clubs, hobbies, and sports

Include your state medical license, board certifications, and DEA registration details. Highlight your research publications, including journal articles, abstracts, book chapters, poster presentations, oral presentations, and other articles.

Requesting recommendation letters

Recommendation letters should come from faculty who have worked closely with you and can vouch for your strengths and readiness for residency. If an attending has seen you at your best, ask for a letter right after finishing that rotation. Don’t wait until residency application season, as they will have seen many students by then and might not remember you as well.

It’s generally advised to sign the waiver agreeing not to see your letters. Not signing it might make program directors wonder if you’re hiding something.

ERAS lets you submit and store as many letters as needed, then send specific ones to each program. This allows you to tailor your letters for each program. If you’re applying to more than one specialty, you can direct the appropriate letters to each program. You can continue sending letters even after submitting your residency application, so don’t hesitate to request a letter from attendings in your fourth-year rotations.

While the required number of letters can vary by program, four to six letters is a good starting point. Try to get at least one letter from a faculty member in an advanced rotation in your specialty. For primary care residency programs, get letters from physicians in that specialty and from faculty members in other specialties related to your future practice.

Letters from attending physicians carry more weight than those from senior residents. Choose individuals who know you well enough to write a strong letter discussing your specific qualities and experiences rather than generalities. Provide them with examples of your accomplishments and skills they can use as supporting material.

Not all letters need to be from physicians in your chosen specialty. Letters from attendings in other departments can be convincing, as they show your ability to excel in different disciplines and earn respect from various colleagues.

Medical students with experience outside traditional clinical settings—such as research, professional society participation, or volunteer/international work—should consider professionals from those areas as potential letter writers.

Writing personal statements

The significance of your personal statement cannot be emphasized. While strong letters of reference and high USMLE scores are important, your personal statement is how you can make your individual case and create an impact on program directors. This is your opportunity to show program directors what makes you special. They want to know the person behind the impressive numbers. They want to see that you’ll thrive in their program, reach your potential, and have a remarkable career in healthcare.

Craft a different personal statement for each specialty you apply to. Seek feedback from advisers and instructors early, making necessary revisions. Ensure your reviewers come from various backgrounds, including the specialty you’re targeting.

residency application personal statement

Your statement should flow smoothly, conveying why you’ve chosen that specialty. Your passion, work ethic, personality, and desire to contribute positively to the field should shine through. Highlight your interest by including relevant experiences, clinical work, and research that make you unique.

To start, your statement should address:

  • What draws you to medicine and your chosen specialty?
  • What qualities and skills will help you succeed?
  • What are your long-term plans as a physician?
  • What attracts you to a particular program and why would you fit?

Try to grab the reader’s attention from the very beginning. Avoid clichés and vague language. Keep it brief but detailed. Highlight aspects of you, your experiences, and your qualities that don’t appear on your CV. If you have a hobby that showcases personal growth, tell a story about it and link it to your goals.

The Texas College of Osteopathic Medicine suggests that if you want to repeat accomplishments, ensure they’re “relevant to your personal/professional growth. You want the emphasis to encourage the reader to bring this up in the interview.”

Program directors want to know you as an individual and understand what you bring to their program. Focus on your unique qualities and experiences. Quality over quantity—narrow your focus to one or two qualities and weave them into your narrative.

Avoid generic statements about your qualities. Instead, tell a story that illustrates how you demonstrated empathy or compassion. Explain why you are pursuing their program and what you hope to gain. Describe how your interests align with the program’s offerings. Discuss how your goals support their mission and what strengths you bring.

Clearly outline why you are interested in a specific specialty. Share what you have done to explore this specialty and your insights. Be detailed and specific about what attracts you to this field. Highlight achievements that show personal and professional growth. These might not be on your CV but are important for showcasing your unique attributes. Use the personal statement to delve into these distinctive details.

Maintain credibility by being honest and authentic. Don’t exaggerate or embellish your experiences. Program directors value reliability and genuineness. If there are any gaps or anomalies in your residency application, briefly explain them. Don’t dwell on them or get defensive. Show that you faced challenges and took steps to overcome them.

End your statement with a strong conclusion. Avoid weak declarative statements like. Instead, tie back to your introduction and use imagery and insights to wrap up your story naturally and effectively.

The MSPE (Medical Student Performance Evaluation)

The AAMC describes the MSPE as “a summary letter of evaluation intended to provide residency program directors an honest and objective summary of a student’s salient experiences, attributes, and academic performance.”

The Medical Student Performance Evaluation consists of six sections:

  1. Basic details about the student.
  2. Three key attributes that highlight the student’s most significant characteristics.
  3. Dates, grades, and any disciplinary actions.
  4. An overview of strengths, weaknesses, professional performance, preclinical coursework, and clerkships.
  5. May include a graphic comparison of the student to their peers.
  6. Context about the medical school itself.

Medical schools aim to present you as a strong candidate because they want their graduates to succeed. Clerkship evaluations are a crucial piece of information for program directors and are considered by many to be the most important section of the MSPE in determining applicants for interview selection and rank order list.

Students are often asked to draft their noteworthy characteristics, which can highlight achievements or experiences from any point in their life. This allows you to include information that might not fit into your personal statement or experiences section. Follow your school’s guidelines and submit your drafts early to allow time for feedback.

Residency Application Red Flags

When applying for residency, some elements of your profile may raise issues with Program Directors as well as Interview Selection Committees. These are known as red flags. Being aware of these potential pitfalls allows you to address them head-on and shape how directors perceive your residency application.

  • Time Since Graduation

One of the most frequently highlighted red flags is a long gap following graduation. This is how long it has been since you graduated from medical school.To determine this, deduct the month and year of graduation from the date of application. Generally, if you graduated five years or more ago, you are considered an “older candidate.” However, the longer you have been out of med school, the more challenging it might be to obtain a residency position.

  • Professional Experience Gap

Another red flag is any significant gap in your medical experience from graduation to the time you apply. Finding appropriate medical work soon after graduating can be difficult, prompting some to seek non-medical professions to cover their bills. Prolonged gaps in your medical experience may cause Program Directors to worry whether you have the necessary abilities and expertise to move effectively into residency.

  • Extended Interruption in Medical School Education

Taking a break during medical school can also raise eyebrows. This might happen due to financial issues, family responsibilities, personal health, or the need to transfer schools. The MyERAS Common Application specifically asks if your medical education was interrupted. How you answer this question is crucial as it shapes how programs view your ability to handle adversity.

  • Low USMLE Scores

Residency programs heavily weigh the United States Medical Licensing Examination (USMLE). While some programs have strict cutoffs, others look for improvement and growth. Significant improvement between exams can highlight qualities like self-reflection and motivation.

Good grades complement strong test scores. Your GPA isn’t everything, but it demonstrates your ability to manage the ongoing learning necessary in medicine. Residency programs aim to see if you can handle the intensive training and regular criticism associated with the position.

  • Multiple USMLE Exam Attempts

Failing a USMLE exam and needing multiple attempts to pass is even more challenging. With passing scores becoming harder each year, this is an increasing issue. If you’ve needed multiple attempts, be aware of state and program requirements regarding USMLE attempts as this can add another layer of difficulty to your residency application process.

how to address residency application red flags

  • Applying Late or with an Incomplete Application

While you can apply through ERAS until late February, it’s widely recommended to apply in September. Applying late or with an incomplete residency application can make you appear disorganized and unprepared, which are not traits residency programs look for.

  • No US Clinical Experience

For Non-US International Medical Graduates (Non-US IMGs), lacking US clinical experience (USCE) is a significant red flag. Residency programs often require USCE to ensure you can handle the unique challenges of working in a US medical environment.

Tips and Best Practices to Master the Residency Application

Residency starts long before you craft a residency application. Be careful when choosing the right residency programs. Ask the chair and other faculty members in your department about their top residency program recommendations. Find out why they chose their training programs.

Evaluate programs based on their location, curriculum, unique rotations, elective opportunities, and community engagement, not just their name value. Different programs have different strengths. Choose the ones that align with your unique needs and goals.

Reach out to physicians in your chosen field. Ask why they chose their programs and what other options they considered. If possible, speak with students who have rotated through the program or attend the affiliated institution. They can provide objective insights.

Getting US Clinical Experience (USCE) or Other Experiences

US Clinical Experience (USCE) is critical, especially for International Medical Graduates (IMGs). It involves hands-on work with patients in a US medical setting. Here’s what counts as USCE:

  • Externships
  • Sub-internships
  • Clerkships
  • Any clinical rotations in the US

Here’s what typically doesn’t count:

  • Observerships/Shadowing
  • Research Experience
  • Volunteer Experience
  • Experience in Canada or England

Gaining additional USCE is incredibly beneficial. It prevents professional gaps in your residency application and helps you obtain new Letters of Recommendation from US practitioners. Ideally, get experience in the specialty you’re most interested in. For example, if you’re applying to Family Medicine, focus on gaining Family Medicine experience to show your dedication.

Networking Within the Residency World

Building connections can be challenging but rewarding. Here are some strategies to help you network effectively:

  • Stay in Touch with Classmates: Especially for US and Caribbean IMGs, classmates who get into residency before you can provide valuable insider information.
  • Join Professional Organizations: Each specialty has its own organizations. Joining can help you connect with other professionals.
  • Attend Professional Conferences: Bring your resume, CV, or MyERAS Application to meet program faculty.

Taking Your USMLE Step 3

While not required to start residency, taking the USMLE Step 3 can strengthen your residency application, especially if you’ve had multiple attempts or low scores on other exams. Passing Step 3 shows residency programs that you won’t need extra study time during training and qualifies IMGs for the H1-B visa, preferred over the J-1 visa.

However, Step 3 is a tough and expensive two-day exam. To strengthen your application — only take it if you’re confident you can pass on the first try.

Choosing the Right Message for Your Residency Application

If you have red flags in your residency application, address them strategically in your ERAS Application. Ensure your entire application presents a consistent, positive message.

Showing off all your experience to impress programs can backfire, making you seem arrogant or unwilling to learn. Instead, appear humble, eager to learn, and adaptable. Highlight your value while demonstrating a willingness to grow.

How to Prepare for Your Residency Interview

When you receive interview invites, arrange geographical locations and determine the amount of time you must spend traveling or recover. Some programs may demand documents prior to your interview. They should prepare agendas in advance. Please contact the program organizer if you have any queries.

  • Read all materials sent by the program and review their website. Learn about faculty interests to find common ground.
  • Develop a list of questions to learn about the program’s strengths, challenges, and focus areas.
  • Do mock interviews with friends or mentors. Consider various questions and practice your responses.

Additional Medical Residency Application Resources