Arsham Sheybani, MD: We probably all agree that the residency match process is more competitive and complex today than in the past. The match has changed in several ways. We are seeing yet another year of virtual interviews and virtual visits. Jay, what notable changes have you observed?

Jayanth Sridhar, MD: In addition to the virtual interview format, we have also seen a dramatic increase in the number of ophthalmology applicants. It is a great time to be in our position and reviewing applications because our field is getting some of the most talented and qualified people. It is exciting to see more students from schools without ophthalmology programs gain access to resources like YoungMD Connect and feel more emboldened to make that leap into the field. These changes are positive, but they have altered the dynamic of an already-competitive process. Now, preparation for the match must be strategic.

Dr. Sheybani: Mitch, what has changed at Baylor? How are you advising applicants?

Mitchell P. Weikert, MD: As Jay said, going virtual has increased the applicant pool. More students have been applying to ophthalmology residency over the years, and it has become more difficult to distinguish between applicants. We used to rely on score-based metrics to do so, but we now take a more holistic approach using soft metrics. This has resulted in a greater burden on residency programs because we must devote more time to dissecting each application. Whereas before we used to whittle down the number of applications we read based on score-based metrics, we must now look closely at the more descriptive elements as well. We are starting earlier, so it helps if applicants start earlier, too.

Dr. Sheybani: Rachel, have you seen a difference in how applicants are discussed by your residency selection committee and what factors are highlighted compared to before?

Rachel G. Simpson, MD: The way in which we differentiate candidates has shifted dramatically with the loss of objective data that Mitch mentioned. We no longer have USMLE step 1 scores. Many institutions are eliminating traditional, measurable objectives. The Moran Eye Center selection committee prioritizes (1) understanding who an applicant is and (2) determining the applicant’s academic performance. Addressing these points now means diving into the nitty-gritty parts of each application, whereas traditionally we could obtain some of this information from the step 1 scores. Now there is no uncritical part of the application, and our examination is extremely thorough.

AWAY ROTATIONS

Dr. Sheybani: With the sheer number of applicants, it can be hard for individuals to distinguish themselves. It seems that away rotations have become a more important part of the equation as a result. Mitch, what do you think about away rotations?

Dr. Weikert: An away rotation is a useful opportunity to introduce yourself and to explore how other programs work. They are certainly a positive now. Many programs do not provide access to substantial ophthalmic experience. As ophthalmology dwindles in medical student education, so do some of the opportunities for access. Going away to gain that access to ophthalmology is helpful, but you must be proactive and seek it out.

Dr. Sridhar: I would echo that. Direct mentorship is important. To Mitch’s point earlier about being overwhelmed with lots of applications with similar data, the personal touch has become more important in terms of knowing who to even interview.
Dr. Sheybani: Rachel, do you think away rotations help or hurt?

Dr. Simpson: They help, 100%. A known entity is five steps ahead of an unknown entity. As long as your experience is uneventful, your chance of getting an interview is exponentially higher if you complete an away rotation.

BEING A KNOWN COMMODITY

Dr. Sridhar: There are three primary pointers I share when applicants reach out for advice.

1. Identify one to two faculty members to support you, as they will be a key component of a successful residency application. There are many great mentors, but it can be hard to make a connection, especially if your institution does not have a home ophthalmology department or if you are entering the game later than your peers. Invest in thinking about who will be your mentor. A known commodity is important. If not a known commodity, at least find someone who you trust to vouch for you.

2. Away rotations are growing in importance and competitiveness. Ten years ago, away rotations were not as necessary in ophthalmology. Now, because of virtual interviews, a known commodity is valued. It is important, especially if you are a borderline applicant or are average to above average, and even if you lack a geographic predilection. However, it is also getting harder to land an away rotation. You must plan ahead and apply early. The experience is an important part of bolstering your residency application, and it may help you to lock down an interview.

3. The personal statement is a more powerful tool than ever to show your unique characteristics. Ten years ago, I would tell students that the personal statement is formulaic—99% of them sounded the same. Some were bad, some were good, but most were vanilla. It used to be OK to blend in and rely on the other strengths of your application. Now, however, we have fewer objective data points to use. We have a multifaceted personal statement that can answer multiple questions, and reviewers spend more time reading them to get to know the applicants. Arsham, what do you think about the personal statement?

Dr. Sheybani: Before there were key academic components that we evaluated, and now we are trying to figure out, what is this person about? Do they take on things and finish them? Do they have drive? Do they have passion for the field? It can be difficult to separate yourself from the pack, but, in my mind, the personal statement provides some basis for you to talk to the interviewer about yourself and to address things that you might not be able to place on the application otherwise.

Dr. Simpson: I agree. When I’m done reading your application, I want to feel like I know you, like we sat down and had a conversation. The personal statement is your chance to have that conversation.

Dr. Weikert: I spend more time reading personal statements than I used to. Actually, with the changes made, it has become easier and more enjoyable to read them.

Dr. Sridhar: It has always been important to proofread your application and to ask others to do so, too. But now that members of academia are saying that they spend more time reading these personal statements, you must seek feedback from others on your application before submitting it. Run it by a trusted friend, family member, or mentor. Read it out loud and see how it sounds.

STANDING OUT AND SHOUTING OUT

Dr. Simpson: I came from an institution without a home ophthalmology program, and I decided on ophthalmology in April of my third year of medical school. I know how difficult it is to be in that position, but it can be done, and all of us are deeply committed to making sure that good people match into our profession. At Moran, we spend an extensive amount of time looking for diamonds in the rough. Every application is opened and reviewed thoroughly. Last year, I read more than 200 applications myself.

Above all, make sure we know who you are after reading your after application. You are the most compelling thing about your application. We want to know what makes you, you. There may be 700 applicants with research experience, but there is only one you. There are several ways to communicate this information and make your application stand out. The personal statement helps to distinguish you, but so does the section for interests and hobbies. When I look at that section, I want to see something that tells me who you are.

Dr. Weikert: That’s my favorite part of the application.

Dr. Simpson: Additionally, highlight the experiences of which you are most proud. There may not be a box to fit everything you've done in life but take advantage of the open-ended sections to note what you want to make us aware of. Say you worked on some amazing research that did not get published; turn that into a story in your personal statement and tell us what you learned. Did you gain a better understanding of the scientific process? Tell us about the life experiences that have made you someone who will be successful in residency.

Further, if you feel strongly about a specific program, reach out or shout out. Residency match is like dating: We’re more likely to take an interest in someone if we know they’re interested in us. If I see an applicant shout out to Utah or Moran specifically, I will give that application a second look. Personalize your personal questions, and acknowledge the schools that you're interested in.

When you have a personal statement that mentions your institution, does that make you look twice?

Dr. Sheybani: Absolutely. You want people who want to be there.

Dr. Weikert: Just one caveat: If you name-drop someone at an institution, you should actually know that person. I have seen this turn into a negative before.

SECURING LETTERS AND SHARING DETAILS

Dr. Weikert: Recommendation letters can be an agonizing part of the application process. In my experience, a recommendation letter from someone who knows you well trumps a letter from a well-known physician who does not know you well. It may be hard to know who writes a good letter at each institution, so consider asking around—other students may have a feel for who has this ability and who does not. If you have a strong relationship with the letter writer and they know you well, you will be in a better position than if you have someone who only casually knows you and is pulling information off your CV.

Dr. Sheybani: When approaching a letter writer, it is reasonable to ask, “Do you feel like you could write me a strong letter? Do you feel like you can speak to X, Y, or Z?” This also gives them an out if they sense that they might not be able to fully deliver.

Dr. Weikert: I agree—and ask early. If you're going on a rotation with someone and want to get a recommendation letter out of it, be up front about that. Doing so helps to set expectations and gives your letter writer ample time to prepare and execute.

Also, be strategic about the application questions you choose to answer in your personal statement. An applicant once offered not making the varsity swimming team as an example of resilience. The next application we read could be from someone who emigrated from a war-torn country. Be sure your responses are well supported. Further, if you say that you can bring diversity to a program, be sure you can explain how you will do that.

Last, round out your application as much as possible. I agree with Rachel’s suggestion to highlight research that did not get published; if you do so, you will also want to demonstrate that you made a valuable contribution to that research. For outside interests, refrain from posting a bulleted list of activities like reading, cooking, travel, etc. That tells us nothing about you specifically. If you traveled somewhere, where did you go? Why did you go there, and what did you gain from the experience? These details help us get to know you.

CONNECTING WITH PROGRAMS

Dr. Sheybani: We receive many emails about applications. There are, however, some targeted ways to send your emails that can benefit you. Many programs wait several days to 1 week after the applications are due to pull them. The applications then typically go to a committee, so every application has eyes on it. If you are extremely interested in a program, it is reasonable to email the program coordinator (not the program director) and state why you are so interested. The coordinator will be able to identify the most interested applicants and communicate it to the program director.

Also, once you are granted interviews, ask if you can speak to a current resident at each of your top five programs. You can begin to build relationships and may ultimately be able to ask a resident to put in a good word for you with the program director. Send them an email and say, “I applied and really want to go there. Can you suggest that they take an extra look at my application?” Our program does lean on our residents to share feedback. We try to maintain a certain culture, which is based largely on who is in the program. We have found that our residents can help select some of the same types of people for us to keep the program going in our desired direction. If you get to know a program’s residents, it is reasonable to have them advocate for you, especially after your interview.

Additionally, avoid generic emails—program directors are inundated with them. I once received an email with another program’s name written in the opening line, so it was clear that the applicant was just rifling off generic emails. You are better off communicating with the program coordinator or current residents if you do not have faculty connections at your programs of interest. Overall, these emails should communicate what truly interests you, whether it is the region, the people in the program, the research conducted there, the clinical setting, etc. Communicating your specific interests can make a difference.

Last, have someone from your local institution—ideally a physician who can speak directly to your strengths—send a personalized email to the program director and/or program coordinator roughly 2 to 3 weeks before the rank lists are due by that program. This may generate another look and help you to catch the attention of the committee before the final rank list is completed.

Dr. Simpson: I agree. I save all those communications. They go in a file, and when the committee sits down to make our final rank list, we review everything that was submitted. If you send a thank-you note, we print it and put it in your file. Everything gets considered.

Dr. Weikert: When people express interest ahead of time, I set their names aside. Then, when we are screening applications and trying to narrow down our list, I look at who expressed interest, and that means something to us.

Dr. Sridhar: A creative way to stand out and avoid ending up in the generic pile is to provide any additional information you can over time—say a new paper that was published. That can be a nice update to initiate an email, and that extra communication reinforces your interest in the program.