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Courtesy Carol Carraccio

Scenarios for Program Director Review of Applications for Internships
 Scenario 1: September 4, 2009
 
Dr. C, program director at The Children's Hospital, downloads her ERAS (Electronic Residency Application System) Mailbox three days after it opens to applicants to find 250 applications. She needs to begin screening these applications to decide who to invite for interviews. The first order of business is to look at where the student is graduating from and the reputation of that school. The next step is to review USMLE scores to make sure that the student will actually graduate on time from medicinal school having passed the requisite national tests. These test scores also help to predict whether this student will likely be successful in passing the specialty boards, a measure used at the national level to judge the quality of a GME training program. A review of the transcript is now in order to determine whether this student had any academic difficulties which could impact or foreshadow performance in residency. If any of the above demonstrates significant reason for concern, the applicant will be placed in an inactive file. If the applicant comes from a good school, has USMLE scores above the mean and excellent grades, the student will be invited for an interview. The real challenge is in making decisions about inviting applicants whose credentials lie somewhere in-between those designated as inactive and those invited to interview at the initial screening. It is untenable to wait until the MSPE (Medical Student Performance Evaluation) becomes available on November 1st to begin the invitation process since most programs begin interviewing in mid November and travel plans must be made in advance. So for a large number of applications, any available letters of recommendation and certain sections of the ERAS application become helpful in the decision-making process that occurs during the early screening. Dr. C goes to the section in the ERAS application that asks whether "medical education/training was extended or interrupted?" This holds key information about academic difficulties or unique extracurricular experiences. This information as well as that included under the heading of "Other awards/accomplishments" will help to inform the decision of whether to invite the applicant for an interview. If these sections do not yield any significantly positive or negative information, leading to an invitation to interview or making the application "inactive, " respectively, the applicant is put "on hold" until the arrival of the MSPE on November 1st. This time intensive process must be revisited as new information becomes available with the MSPE.   

Scenario 2:  November 2, 2009
 
It's time to revisit the same applications that have been previously reviewed. The applicants "on hold" are now reviewed in the context of the MSPE. Details about any leaves of absence, academic difficulties or positive extracurricular activities can be explored in detail. Actual comments from faculty who worked with students can also be reviewed in detail. Clinical acumen and personal characteristics that are commented upon by clerkship directors carry tremendous weight.  The bottom line about where this student fits in the context of his peers is one of the most valuable pieces of information. Reviewing the MSPE can be a lengthy process, some are concise with helpful graphic representations of data and others are not.   

Scenario 3: September 4, 2014
 
Dr. C, program director at The Children's Hospital, downloads her ERAS (Electronic Residency Application System) Mailbox three days after it opens to applicants to find 350 applications. She needs to begin screening these applications to decide who to invite for interviews. The first order of business is to look at where the student is graduating from and the reputation of that school, the USMLE scores and the transcript to date. She then clicks on the link in the ERAS application to eFolio trajectory. This link provides all of the additional pieces of information needed to make a decision about whether this applicant is a good match for the program and should be invited to interview. The individual student has agreed to have program directors access this information which has been collected prospectively by both the Medical School and the individual student. At a glance it is easy to see the time spent in medical school and what experiences the student had that deviated from the traditional curriculum. To supplement the MSPE letter and formal letters of recommendation, each extracurricular experience is linked to invited assessments that the students have sought over the course of medical school to attest to their effort and performance. The ease of access, additional information, and ready understanding of the information submitted lead to greater efficiency for the program director, and less applicants receiving a status of "hold.

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