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Here’s How Residency Programs Rank Applicants

13 min



How do Residency Programs Rank Applicants? We’ll tell you!


Applying to residency can feel like playing “pin the tail on the donkey” – blindfolded applicants aimlessly wandering, hoping they are stepping closer to securing a spot in the residency of their dreams. We are here to remove the proverbial blindfold and shed important light on this seemingly mysterious process!

Disclaimer: every residency approaches this process slightly differently, with particular variation between specialties. But behind closed doors, most residency programs will rank applicants using an algorithm that contains the elements we will outline below.  



A residency program is a match to be made, not a prize to be won!

Before we start the list of factors residency programs weigh when considering you as an applicant, it is important to always remember that a program needs to match your needs just as much as you should try to match its needs. Too many applicants attempt to contort their CVs, personalities, and personal goals to seem more “attractive” to potential programs. This is a guaranteed recipe for unhappiness. Matching to a residency program will affect nearly all of the major aspects of your life for the next 3 to 7 years: where you (and your family) will live, where you will work, who your friends will be, and where you will potentially end up after residency is over. Remember that, however reputable a residency is, it must allow you to reach your personal and professional goals and it must be filled with people you are excited to work with and learn from. 

Ok– now that we have addressed this important caveat, let’s re-direct our attention back towards the factors that residency programs consider when reviewing your application.



Grades and USMLE Scores

Unfortunately, there is no way around the fundamental truth that most residency programs initially filter applicants by performance in medical school and on the United States Medical Licensing Examinations. If you attend a medical school that does not track or assign grades, then obviously your academic performance will be less helpful. At the time your application is due, there is likely not much you can do to alter these marks, so make sure you do as well as you can while you are in the classroom! Any academic honors or awards (including AOA) are also important (especially for pass/fail only schools), so be sure to seek out these opportunities when they arise.


Like it or not, Step 1 is currently an important, central component of ranking applicants for most residency programs. With the FSMB and NBME electing to change USMLE Step 1 to pass/fail starting January 1, 2022, the calculus for ranking applicants will change. Once this occurs, many believe that more attention will simply be paid to Step 2 scores, with applicants expected to complete USMLE Step 2 prior to the application submission deadline. To maximize your chances of success on USMLE Step 1 and Step 2, check out our resources on preparing for these tests or consider working with a professional tutor like me!



Rotation Performance

As important as your performance in the classroom and on standardized examinations, your performance on the rotation of your future specialty is just as critical. Most residency programs will look to see if you received “Honors” or “High Pass” on this rotation (assuming your school assigns these marks) – this is very helpful in demonstrating your interest in the field and your ability. Many programs will actually weigh your performance during this single rotation as heavily as your entire performance over the remainder of medical school, so make the most of it! To further demonstrate your success on this rotation, make every effort to identify a mentor in this field who will write you a letter of recommendation detailing your excellence (see below). 



Letter of Recommendation

Depending on the field into which you are applying, you will be asked to provide at least 3 letters of recommendation to support your application. Here are the key elements of selecting the optimal letter writers:


  • Choose someone who knows you well: it is critical to select a letter-writer who knows you well and feels strongly about making a great case for your candidacy. If you don’t even feel comfortable ask a person for a letter, this person would probably not be a great selection.


  • Choose someone who other people know well: your letter-writer should ideally be someone with experience in the field (at least 5+ years) and preferably someone who will be known by (or known of by) program directors at programs to which you are applying. As such, ideal candidates have some leadership role within the department at your medical school and/or nationally within the field. This will greatly help with the impact factor of this letter and the ability of residency programs to believe the sentiment of the letter.


  • Choose someone within the field: this final point is not absolutely necessary, but certainly helps with your application overall. However small the world of medicine may be, the world of individual specialties is even smaller. An ENT surgeon will likely give more weight to a letter coming from another ENT surgeon in support of a prospective ENT resident, particularly if the two know each other (see the point above). If you failed to identify a mentor in the field or switched into your desired specialty too late to identify a mentor, the first two categories become even more important.  



Interview Day

The 1-2 days spent with each prospective program (virtually or in-person) are extremely important to the rank list equation. Prepare for this like you would an examination: learn the names/biographies of the leaders of the program and any person with whom you will be interviewing, review the residency program website, and prepare some program-specific questions to ask. It is painfully obvious when an applicant has spent little to no time preparing for interview day, particularly when compared to other applicants who are well-prepared. Do not underestimate the importance of social visits with residents and faculty! If an applicant has a particularly negative interaction with even one member of the residency (including staff members), that applicant is at high risk of exclusion from further consideration. Ultimately, everyone is looking to confirm that they would enjoy working with you and that your personality would mesh well with the group.



Personal Statement

The personal statement is your once chance on the application to make sure your voice is heard! Take time to prepare an appropriate length (maximum 1 page single-spaced) statement that highlights your interest in the field, tells your story, and is unique. Ask many people to read your statement and tell you if the narrative voice sounds like yours and if they find it interesting. An exciting first sentence is key – if the start is boring, most people will stop reading. Check out our blog post on how to write a compelling hook for your personal statement if you need help!



“Unicorn” Features

Most programs will leave a column on the rank list that may be left empty or filled with a particularly unique feature of an applicant. Whether you are a former Division I athlete or a concert pianist, make sure you share this either through your personal statement or on interview day – or both!


That’s all! I hope this post helped provide some insight into how programs rank residency applicants. If you need additional help with your personal statement, mock interviewing, or making your rank list, be sure to check out our residency matching services!

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