Forshing Lui MD, FAAN, FRCP(E), Professor of Neurology, Neuroscience Course Director, California Northstate University, College of Medicine
The 2020 National Residency Match result was released on Friday 3/19/2021. According to data published by NRMP (1), the three most important factors in determining the success of an applications are:
- Number of programs ranked in their preferred specialty.
- USMLE Step 1 and Step 2 scores.
- Alpha Omega Alpha Honor Medical Society member.
It is important to understand that after the 2021 NRMP cycle, USMLE Step 1 will become pass/fail without a numeric score. As a consequence, the Step 2 score will carry a much heavier weight after the 2021 match cycle.
With respect to Neurology in the 2020 match cycle (2), the matched candidates ranked an average of 12.8 programs, mean Step 1 scores of 232, mean step 2 score of 245 and 14.3% are AOA members versus 5.5 programs, 223, 234 and 0% AOA members. These numbers indicate that if you rank more than 12 programs, score the national mean in step 1 and step 2, you are likely to be able to get matched. If you are an AOA member, you will not be unmatched. Among 471 US MD seniors applying for neurology, only 13 did not match.
With a separate survey sent to neurology program directors (3,4), the top factors about a candidate in their decision making are (in order of importance):
- USMLE Step 1 Score
- Medical Student Performance Evaluation (MSPE)
- Letter of Recommendation in the Specialty
- USMLE Step 2 CK score
- Personal Statement
- Class Ranking/Quartile
- Audition elective/rotation within your department
- Evidence of Professionalism and Ethics
With these available data, we may draw a few conclusions about neurology matching. Overall, it is easy to get a match in neurology. However, an applicant still needs more to get matched into a program of choice. These will include good performance academically with clinical rotation and step 2 score gaining more significance.
Now, I will walk you through step by step how you may get matched into a neurology program of your choice. It starts with the time in medical school when you decided to go into neurology as your future career. First, you need to know more about the specialty to see whether this is the right choice for you. You should join the Student Interest Group in Neurology (SIGN) at your school as a member and better as an office member. If your school does not have a SIGN chapter, you may create one for your school and you become the president. All SIGN groups may become chapters of the American Academy of Neurology (AAN) with many benefits. You should join the AAN as a student member with free subscription. By becoming a student member of the AAN, you may attend the Annual Conference for free and able to connect with many neurologists and students. You will also have access to many scholarships and awards given out every year by the AAN.
When you reach your clinical rotation year, make sure you work hard during your neurology rotation. Try to be a good team member. Do not complain about scud work. The residents in the team will reflect your performance to your attending who is usually the one contributing significantly to your clerkship scores. If you have a preceptor who you feel likes you, don’t hesitate to ask if he is willing to write you a letter of recommendation for your future residency application.
When you enter your elective clinical rotation year, try to apply for an away rotation at your future “dream” program. You better get yourself well prepared before you even started that elective or sub-internship. This is our “interview elective”! You should try to practice your history taking, neurological examination and verbal presentation skills. The best time of the year to have this elective is at the end of the year such as November or December, or January. There is a good chance that you may actually attend a real interview during your away elective at that program. Make sure you do not ruin your opportunity b not working hard or doing well during this rotation.
It is finally the time of your residency application through ERAS (Electronic Residency Application Services). Make sure you have a good personal statement and good clinical attendings or professors to write you good letters of recommendation (LoR). There are a couple of tips about who to ask for the letter of recommendation.
- Make sure the attending likes you and will write a good LoR. Sometimes, you may understand by how he graded you during your encounters.
- The attending who writes your LoR is best a professor or clinician in the field of neurology such as clerkship director, program director, or department chair. Their LoR carries more weight.
- Pick someone who is experienced in writing LoRs. A community physician may not be good authors in this aspect.
Next, try to apply for at least 20 programs. You should have a few dream programs, a few easier to get in programs as your back-up and half of the programs are those you have a good chance of getting in.
During the interview day, do not hesitate to show off your medical knowledge yet make sure your answers are correct. Admit you do not know the answer to any question and tell them you will search the correct answer or ask for help. Again, try to show your willingness to be a good team player. After the interview, it is a good practice to send a “thank you” note to the attending and residents who interviewed or met with you. Let them know you enjoyed the process and like their program. It may also be a wise move to send the program director of your dream program in early January to let him know that they are your first-choice program.