As is the case with earning admission to medical school, landing a physician residency position is competitive. Some physician specialties, however, do register as more competitive than others.
Historically, the National Resident Matching Program (NRMP) considers the most competitive specialties to be those that match with the highest percentage of U.S. medical school graduates. To land a place in one of those residency programs, an applicant must stand out.
Clinical clerkship is generally the time when students may winnow their options and identify or confirm their passions. Still, there is much work to be done in the preclerkship phase of medical school to set yourself up to match in your dream specialty. Two medical school faculty members offered their insight on what students can do early on in their medical school training to help distinguish themselves during the residency-application process.
Emphasize academic excellence
Preparation for a competitive medical specialty begins on the first day of medical school and extends to graduation. In each of the four years of training, medical students will take different steps that will culminate in a successful match, but one theme is common across all four years: Academic excellence is a must.
Even as more medical schools move to pass-fail in the preclinical phases of learning, the legwork a student does in the early years will help set up success down the road.
“Doing well academically early in medical school is going to set a student up to do well in their clinical clerkships and their NBME [National Board of Medical Examiners] subject exams,” said Michael Kavan, PhD, associate dean for student affairs at Creighton University School of Medicine in Omaha, Nebraska. “If you excel in clerkships, you should be on track to post a high score on Step 2 CK” of the United States Medical Licensing Examination (USMLE).
Dive deeper:
- USMLE Step 2 FAQs: Study tips to help maximize your score.
- What I wish I knew in medical school about shelf-exam prep.
Keep options open
Data from the Association of American Medical Colleges indicates that about three-quarters of medical students change their career preferences during medical school. So your initial ambitions are likely to shift as you learn more about your intended specialty and others
Keeping that in mind, Kavan advised medical students with designs on a physician specialty such as dermatology, orthopaedic surgery or plastic surgery—which have traditionally been among the most competitive on an annual basis—to approach their education as if they were aiming for their most competitive specialty choice option.
If medical students “are considering one of the tougher specialties, even if it’s just one option, they should prepare like that is their plan,” he said. “You’d hate to get to your M3 year and realize you want to pursue a residency in ortho but have not done any research related to that specialty. It might certainly put you behind and at a disadvantage compared to other applicants.”
Dive deeper:
- Future physicians: When's the right time to choose a specialty?
- The 11 factors that influence medical student specialty choice.
Make contact
If you plan to pursue a residency position in a widely sought-after specialty, it is best to make sure that route is for you. To do that, Kim Templeton, MD, recommended getting exposure to the field as early as possible.
“I meet with plenty of students their first or second week in in medical school,” said Dr. Templeton. She is professor and vice-chair of orthopaedic surgery at the University of Kansas School of Medicine and Health System and previously spent almost two decades as a residency program director.
Early career medical students “might still be undergoing orientation, but they know they think they want to do orthopaedic surgery as a career. One meeting isn’t binding, and it doesn't mean that they'll stick with it as they get exposed more in-depth in ortho and to other areas of medicine, but at least they have some guidance early on.”
“To be clear, as an M1 your responsibility is to learn as much as you can and to start to develop your professional identity, but that doesn't mean that there isn't some time to do shadowing,” said Dr. Templeton, an AMA member and past chair of the AMA Orthopaedic Section Council.
Another avenue for medical students is to join a specialty interest group, which most medical schools have across most physician specialties.
The University of Kansas School of Medicine is a member of the AMA UME Curricular Enrichment Program, which enables educators to assign specific elements and receive reports on student progress, track via a dashboard, send reminder emails and customize reporting options. Learn more.
Dive deeper:
- The road to residency starts in M1. Here’s how to begin navigating.
- Mastering M2: Top questions for your second year of medical school.
- What I wish I knew in medical school about finding mentors.
Follow the road to residency
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Understand expectations
In speaking with your specialty mentors early in on in medical school, it is important to know what extracurricular activities a specialty will expect from a standout applicant.
“Once you express interest in a specialty, it can be extremely helpful to meet with a faculty member in that field,” Dr. Templeton said. “That way, we can start a dialogue and we can stay in contact through your medical school career. We can talk with you about the opportunities that are available to learn more about your specialty of interest and discuss what is needed for a competitive application These discussions- and opportunities that can result from them- can be particularly useful for students from diverse backgrounds who are interested in specialties with historically less diversity.”
In meeting with mentors, it is essential to understand what types of research opportunities are available.
“For competitive specialties in particular, you're going to need to have some research experience,” Dr. Templeton said. “It doesn't need to be—and probably shouldn't be—bench research, unless that's what you did as an undergrad and that's your area of interest and opportunities are readily available.
“You’re probably going to want to focus on clinical research that you do within the department of interest, as this will allow additional interactions with faculty and residents.” she added. “I would really emphasize pursuing research during your first and second years of medical school, because as a third year with your clerkships, you're probably not going to have time to do a lot of research. I would also emphasize the need to complete projects by bringing them to publication or presentation. It is typically better to focus on a few projects that can be completed in a reasonable period of time than taking on several projects that don’t come to fruition.”
As your residency program research evolves, no online resource contains as much information as FREIDA™, the AMA Residency and Fellowship Database®, which includes more than 13,000 Accreditation Council for Graduate Medical Education-accredited residency programs, and offers a streamlined user experience.
Dive deeper:
- Medical student research FAQ: How to find projects, showcase your work.
- 4 tips for medical students to get their start as researchers.
Don’t put prestige over passion
Just because you have the bona fides for a physician specialty perceived to be particularly competitive doesn’t make it the right fit. Following your passions is paramount, Dr. Templeton said.
“If you have to wake up at two or three o'clock in the morning to go reduce a dislocated hip and you don't like working with the musculoskeletal system, that's going to be really hard,” she said, referring to typical on-call duty in orthopaedic surgery.
“You'll drag yourself out of bed, but you're going to resent your career—and you don't want to do that. You don’t want to pursue training in a competitive specialty only because of the challenge that that presents or because you are encouraged (or discouraged) from pursuing a particular specialty,” Dr. Templeton said. “You want to do something that you enjoy, something that makes you happy, something that makes it so you look forward to every morning.”
