Navigating Residency Application Red Flags & Enhancing Your Reapplication Strategy

Elite Medical Prep recently held a roundtable event on residency applications. The event featured Dr. James Boothe from Johns Hopkins Department of Medicine and Dr. Sarah Godfrey, a fellow in Cardiology and Palliative Care at UT Southwestern. During the session, Dr. Boothe and Dr. Godfrey focused on residency application red flags, giving advice on identifying, addressing, and overcoming these challenges, especially for reapplying to programs.

We have published the points discussed in the session in blog format below for those who would prefer to read it or review the written format in addition to the recorded session. You can watch the recorded session above, and find all of the residency roundtable recorded sessions, including our Q&A sessions here. While we provide some important tips in this session and blog, if you believe that your application includes red flags that residency programs may notice in your application, we highly encourage you to reach out to a residency advisor or trusted mentor to discuss how you should address your specific red flags. Every situation is highly individualized and talking through your application with a trusted mentor will be highly beneficial. Schedule a complimentary consultation to learn more about Elite Medical Prep’s residency advising services.

What is a Red Flag in Residency Applications?

What are the red flags that residency programs are looking out for in applications? It’s important to consider whether your application includes any of these so that you are prepared and know what needs to be addressed. The main red flags that residency applications look for include:

• Failed Step exams
• Failed coursework, particularly failing clinical rotations
• Having to repeat any part of your training
• Disciplinary actions, expulsion, probation
• Criminal history

What is an Orange Flag?

Orange flags may be problematic, and may not be. The context is important when it comes to these cases, but they are important to consider.

• Extended time to finish medical school – This may be a negative or a positive. If you took time off for some relevant research, that could actually strengthen your application. While if you have a multitude of different issues that could affect your residency performance, that may raise some eyebrows.
• Gaps in education – While taking a gap year between college and medical school is common, it is likely that programs will ask you what you did during that time. This could bring some flavor and interest to your application, or it could raise some eyebrows.
• Pass scores in clerkships – This varies by specialty. A Pass in the field you’re applying to could easily lock you out from highly competitive programs.
• Low but passing Step scores

These do not need to be addressed directly in the application but should be considered when assessing competitiveness. While these likely will not be the deciding factor in not inviting you for an interview, you should be prepared to be asked about these factors of your application.

Where to Address a Red Flag in Your Residency Application?

There are a few opportunities provided in the updated ERAS application where you can address red flags:

• Personal statement – This is an obvious choice because you can address any red flags freely. However, it is important not to go overboard and allow your red flags to take over your personal statement completely. You should strive for two to three sentences cleverly worked in.
• “Impactful experiences” mini-essay section – This is a new section of the application that provides an opportunity to address red flags if they fit within the context of the question. For instance, if you had to take time to take care of a family member that had an illness, and that impacted your grades, this may be a good section to address that situation. This may also be a good section to address some orange flags such as having to take an extended leave of absence and having some gaps in your education. We had another roundtable session dedicated to this section and preference signaling which you can view here.
• “Was your medical education extended or interrupted?” – This section does not allow for a lot of space to describe a complex situation. However, if you have a not-so-complicated reason for extending your medical education, this is a good place to address it briefly.
• Interviews – You should make sure that you deal with any red flags upfront within your application. This will give you the best chance of being invited for an interview. However, you should be prepared to address your red flags and be asked about them during any residency interview you are invited to.

How to Address a Red Flag in Your Residency Application

• Be honest! – Don’t be dishonest by omission either. Make sure to address your red flags, and do so truthfully.
• Describe what happened
• Take ownership of your actions and adopt a very mature, humble tone
• Explain what you learned and how you grew from the experience
• Tell how this makes you a better applicant and physician-in-training now

The bottom line is, be honest and don’t try to hide anything that may be considered a red flag. Take ownership of the situation and don’t try to hide or belittle any red flags. However, be sure to highlight what you have learned and how you have grown from the experience.

Examples of Addressing a Red Flag Withing a Personal Statement

Good Example:

Here is a good example of a way to address a failed Step 2 CK score within a personal statement:

“Unfortunately, during my third year, I faced a setback when I discovered I had failed Step 2 CK. I have historically struggled with standardized tests, and I had a hard time finding the best way to study for this type of test. However, once I received this result, I worked with my Dean’s office and a tutor to develop a better study plan, and I was successful on my second attempt. Though I would have preferred to pass on the first try, this experience taught me lessons in humility, resilience, and determination that will help me overcome the sort of challenges that may come during my future training.” 

In this example, the applicant acknowledges the red flag in their application (having failed Step 2). They also acknowledge the circumstances that led to it (they struggled with standardized exams). They then show the concrete action that they took to address the situation while emphasizing what they gained and learned from the experience. This applicant also highlights how this helps them in moving forward having gained humility and resilience which will help support their success as a medical intern and future physician. This example emphasizes how they have become a better applicant than they would have been previously.

Bad Example:

Here is a bad example using the same scenario:

“I ended up failing on my first attempt at Step 2 CK, but I really had a lot going on in my personal life at that time and I also feel that my medical school didn’t prepare me particularly well for the test. Most of the material that was on the test was on science-oriented topics that I feel don’t translate into clinical skills and clinical practice at all and that made it more challenging for me, but even then I was very surprised when I received my exam result. I managed to pass on my second attempt and I’m just glad at this point to have checked that box and have it behind me.”

Why is this example not ideal?

Let’s break down why this example is less likely to be viewed favorably by residency programs. Firstly, the circumstances surrounding the failed attempt are vague and non-specific. Instead of addressing the reasons as to why this applicant failed their first attempt, they say “I had a lot going on in my personal life.” While you may not feel comfortable sharing certain personal details on your application, it is important to understand that every medical student has a lot going on in their personal life and this will not be enough to persuade whoever is reviewing your application that your situation was outstanding from your fellow classmates.

The applicant then continues to shift blame onto their home institution. While your institution may have some culpability in a situation like this, it is very unlikely that this will be seen in a favorable light. No one wants to see an applicant throw their home institution under the bus. Additionally, this applicant then goes on to further blame the questions on the test. They say the exam focused on “science-oriented topics that… don’t translate into clinical skills.” This is another example of shifting blame, as well as presenting excuses that do not really explain how your situation was outstanding from your classmates. Everyone takes the same exam.

The applicant closes this section by stating that they are glad to “put it behind” them. Rather than focusing on how this situation has helped them grow and how it will inform their future success, they give the impression that they would rather forget the experience. This applicant will likely still have to complete Step 3, and take in-service exams and board exams. They would benefit from learning from this experience how to be better test-takers moving forward.

The key is to come across as a professional and mature adult. A part of that is being able to make mistakes and learn from them. Addressing a red flag in your application is a good opportunity to demonstrate that quality in yourself.

General Advice for Reapplying to Residency

When reapplying it’s important to look at your application in an objective way. This can be very difficult to do on your own. It is highly recommended that you get at least one more person to review your application with you. While you are reviewing your application and identifying weaknesses, try to separate out aspects of your application that can be changed (for example, the number of programs you applied to), vs. aspects that you cannot change (for instance, an exam failure).

Below are some of the points that you should consider when reviewing your application.

Review prior year’s application

• Ask help from at least one other person
• Consider what your weaknesses were
• Decide what you can change
• Identify what can’t be changed

Come up with a plan and decide how to address what you can change

Start by identifying if your weaknesses are more surrounding your application or your interviewing abilities. If you struggled to get invitations to interviews last cycle, you likely have weaknesses in your application that need to be addressed. Whereas if you did receive a decent amount of interviews (>10), you may need to focus on your interviewing skills. In this case, we recommend scheduling mock interviews with an advisor.

Consider Applying to a different (or more) specialty

If you applied to a difficult specialty, it may be time to consider applying for a less competitive specialty. You may also consider double applying to more than one specialty. Talking through your specific scenario with a mentor or residency advisor can help you determine what the best next steps are in your specific situation.

Apply to more programs than the year prior

• Broaden your list
  • By geography and competitiveness – did you only apply to top programs or programs in very competitive geographic areas?
• Consider not applying to programs you interviewed with in the prior year
  • Unless you have meaningful connections there
  • If you didn’t get an interview, and things have changed in your application, it may be worth reapplying to the same program

Consider Re-writing your personal statement

Include concrete details about what you’ve done since the last time you applied to:

• Improve your application
• Improve/develop clinical skills
• Show commitment and interest in your desired specialty

Consider at least 1 new LOR from someone you worked with since you last applied. This can be tricky but try to get a new letter if possible. For instance, if you volunteered in a clinical setting over the last year. See our recorded session on getting a letter of recommendation for more tips. Consider asking mentors to reach out to programs for you. If you have mentors in your home program, they may have connections in some programs you are interested in. It may be a good idea to see if they can put in a good word for you.