Preparing for Residency

The road to residency starts in M1. Here’s how to begin navigating it.

Brendan Murphy , Senior News Writer

AMA News Wire

The road to residency starts in M1. Here’s how to begin navigating it.

Jul 10, 2024

As incoming medical students will be reminded—from their white coat ceremony through graduation, the goal of medical school is to make each student the best doctor possible. Finding the right residency program, through the Match process, is another crucial step toward that goal.

Michael Kavan, PhD, is associate dean for student affairs at Creighton University School of Medicine in Omaha, Nebraska. Each year, he offers a presentation to incoming medical students about the small but meaningful steps they can take as M1s to bolster their Match bona fides. As a new batch of medical students begins training, Kavan offered this advice about approaching your education with residency in mind.

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Academic performance—including one’s USMLE Step 1 and Step 2 performance, clerkship grades and feedback contained in the medical student performance evaluation (or MSPE, formerly called the dean’s letter)—is the most important factor in students earning residency slots. That said, grades earned during M1 year are unlikely to be given the same weight as other stages of training.

What does that mean for M1s?

“We emphasize the importance of passing all your courses,” Kavan said. “And if you do for some reason have a failure, it can be overcome. What is troubling to residency programs is a pattern rather than a single glitch. A major problem is having to repeat an entire year. That can certainly impact your matching.”

Although the majority of medical schools are strictly pass-fail, with no honors in the pre-clerkship phase, Creighton uses a pass-fail-honors grading system. Only about 10% of students earn honors distinctions. Kavan cautioned against putting too much emphasis on getting into that elite tier every time.

“We do tell them that we have a lot of students who do very well in the residency match without ever honoring a course,” he said. “So don't panic if you don't.”

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At any stage of the physician journey, unprofessional behavior can be a danger to patients and an impediment to a doctor reaching their full potential. Considering that, professionalism is paramount even in the preclinical stages of medical school.

Medical students, in Kavan’s experience, generally avoid the major professionalism red flags—mistreatment of others or ethical lapses such as academic dishonesty. But they may make unforced errors that are related to a lack of punctuality and excessive procrastination.

“We have students starting medical school that are perennially late in these early months,” Kavan said. “Another common thing is if students start school, and they don’t have their immunizations done on time or they fail to sign the attestation in the student handbook on time.”

“If these things add up, one of our faculty or course directors can write up an early concern notice. Then the student will meet with them and talk about it. These notices don’t go in the MSPE unless they continue to happen and go unaddressed. A little glitch, just like a course failure, will not get held against you. But students really need to make sure that they aren’t developing bad habits since a pattern of professionalism glitches often portend problems as a physician.”

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Kavan said that medical students are going to want to show residency programs they are well rounded. One way to do that is filling what he terms “buckets.” These buckets are likely to include leadership, community and university service and research.

The first year of medical school is about looking for ways to get involved while maintaining focus on one’s coursework, he said.

“Initially I always tell the students tread lightly,” Kavan said. “It's a big adjustment to medical school. Everybody's heard the analogy that medical school is like drinking from a fire hose, and that is true, it is not easy academic material. So, when we talk about these other areas of involvement it’s not a good idea to jump in, full body, into leadership service or research activities.”

If medical students do find that they are doing well academically, Kavan recommended pursuing an extracurricular that is going to require less bandwidth—running for a less-intensive class officer position or volunteering at a student-run clinic were two examples he offered—then ramping up your involvement if you continue to succeed in the classroom.

“It’s important to get involved in some sort of activity that first fall semester,” he said. “One, it looks good on your dossier, but two, getting involved with one’s classmates and the community is very important. It gives students a better understanding of the culture of their medical school, and it immerses them in their community and the profession of medicine.”