Internal Medicine Pathway:

So you want to be an Internist

August 2016

Introduction and Contents

If youre considering applying for a residency in Internal
Medicine, youve come to the right place --- youre also in
great company! Over 40% of SGU graduates train in
Internal Medicine

Contents
Overview: Internal Medicine

Internal Medicine (with Family Practice being the other) is

one of the main pathways to becoming a primary care
physician for adult patients

Assessing your competitiveness for Internal

Medicine

However, a great thing about internal medicine residency is

that it will prepare you for an incredibly wide range of
career paths that vary in the patient populations and
pathophysiology you see, potential opportunities for subspecialization, practice settings, lifestyle considerations,
and many other dimensions of what make for a rewarding
and satisfying career

Beyond the numbers: what are program

directors looking for?
Developing a smart application strategyand
the importance of a fully-developed Plan B
strategy

This document will provide an overview of some critical

things you need to know if you are applying for residency in
Internal Medicine. Please review it carefully and follow up
with advisors or mentors if you have questions.

Note: These materials are geared towards students

applying for IM programs in the US; if you are applying to
programs in Canada or elsewhere, please contact the OCG
to ensure youre also developing the right strategy for your
local geography.

Making the most of your interview

opportunities
Conclusion
2

Overview: Internal Medicine

Specialty Overview: Internal Medicine

Reasons Why You Might Choose to Train in Internal Medicine
Patient populations, pathophysiology,
and interventions

Practice settings

Internists treat patients from adolescence through end-of-life and everyone

in between; some focus on more specific issues/populations such as the
underserved or womens health
Internists manage diseases across all organ systems, including mental health
and the management of patients with surgical needs
While internists dont operate, some subspecialties tend to be more
procedurally oriented than others

Lifestyle considerations

The lifestyle and income expectations depend

heavily on the setting in which you practice and
where you are located geographically
Given the wide range of options, its difficult to
generalize

Outpatient primary care settings offer the opportunity for longitudinal

patient relationships, management of chronic disease, and disease
prevention
Hospitalist positions allow for the management of the acutely ill in the
inpatient (and intensive care) setting and shift-based schedules
Many internists also work in or augment their responsibilities in related fields
such as urgent care, occupational health, medical education
If you choose to subspecialize, each subspecialty will similarly have its own
particular practice settings to consider

Sub-specialization opportunities

Population-based: Adolescent medicine,

Geriatrics, Palliative care
Organ-system based: Allergy & Immunology,
Cardiology, Pulmonary & Critical Care,
Endocrinology, Gastroenterology, Hematology
& Oncology, Infectious Disease, Nephrology,
Rheumatology, Sports Medicine
Other: Dont forget combined IM/EM, IM/FM,
and Med-Peds residency programs!

Important trends

Some internists pursue additional academic

training in General Internal Medicine to
incorporate such issues as quality of care,
prevention of medical errors, clinical outcomes
measurement, medical education, and
population health into their careers
Similarly medical informatics continues to grow
in importance as the healthcare system rapidly
adopts new information technologies

Your challenge if you choose to accept it

Given the vast array of options that Internal Medicine training can prepare you for (the above list is NOT comprehensive), you should think carefully about what elements
inspire and attract you to the field, develop a vision for how you might like your career to unfold, and what makes you a compelling candidate to IM residency programs -- this
will evolve over time of course, but its helpful to have a vision for your career and easier to make your case with one
You will need to synthesize a complete, consistent, persuasive portrait that demonstrates not only your academic achievements, but a holistic impression of what motivates
you, the kind of person you are, the kind of employee and colleague you will make, and the contributions you will make to the field. This is your challenge as you assemble your
CV, personal statement, ERAS application, letters of recommendation, schedule and have interviews with programs, and leverage your personal and professional network in the
4
application process

Internal Medicine: Specialty-Specific Resources

As internists, our main umbrella professional organization is the American College of Physicians
(ACP)

Please visit their site there is a wealth of resources on career paths and applying for residency:
https://www.acponline.org/medical_students/career_paths/

Consider joining (for free!) as a medical student member and access the leading internal medicinespecific journal, the Annals of Internal Medicine; find a mentor through the ACP

For those internists who want to expand their horizons beyond their own patient panel, they often do so
though the SGIM. It is a national medical society of 3,000 physicians who are the primary internal
medicine faculty of every medical school and major teaching hospital in the United States. SGIM
members teach medical students, residents, and fellows how to care for adult patients. They also
conduct research that improves primary care, preventative measures, and treatment services for
patients.Our mission is to lead excellence, change, and innovation in clinical care, education, and
research in general internal medicine to achieve health care delivery that is comprehensive,
technologically-advanced and individualized; instills trust within a culture of respect; is efficient in the use
of time, people, and resources; is organized and financed to achieve optimal health outcomes;
maximizes equity, and continually learns and adapts. Explore their career center and rest of their site
for useful information on the field of General Internal Medicine. http://www.sgim.org/career-center
Visit the AAMCs Internal Medicine page for additional societies and IM-specific resources and the
AAMCs Careers in Medicine portal:

https://www.aamc.org/cim/specialty/list/us/336842/internal_medicine.html

These groups do a great job so were not going to duplicate their work,
but we are assuming you will review these sites they have important information
5

Assessing Your Competitiveness for Internal Medicine

Competitiveness of IM for All IMGs

IMGs are International Medical Graduates This is you as a SGU graduate

Table
IM-1

The need for a visa clearly

impacts difficulty of matching in
NRMP -- U.S. IMGs have scores
meaningfully lower than their
non-US citizen counterparts

Summary Statistics
Internal Medicine
U.S. IMG

Measure
1. Mean number of contiguous ranks

Matched
(n=841)
8

Non-U.S. IMG

Unmatched
(n=753)

Matched
(n=1,690)

Unmatched
(n=1,856)
3

2. Mean number of distinct specialties ranked

1.3

1.6

1.3

1.4

3. Mean USMLE Step 1 score

221

205

231

217

4. Mean USMLE Step 1 attempts*

1.1

1.6

1.0

1.2

5. Mean USMLE Step 2 CK score

228

210

236

221

6. Mean USMLE Step 2 CK attempts**

1.1

1.4

1.0

1.1

7. Mean USMLE Step 2 CS or ECFMG CSA attempts

1.1

1.4

1.1

1.3

22

15

22

9. Mean number of years since graduation

1.7

5.9

4.3

6.6

10. Percentage who speak English as a native language

71

51

19

17

8. Mean number of months since ECFMG certification

Sources: NRMP Data Warehouse and ECFMG

*USMLE Step 1 or equivalent examination
**USMLE Step 2 CK or equivalent examination

Source:

Charting Outcomes in the Match for IMGs, 2014 by NRMP and ECFMG

For non-US IMGs, essentially you

cannot fail Step 1 or CK and only
very few will get by with a redo
on CS
For US IMGs, the situation is only
slightly better but not reliably
If you have failed any portion of a
USMLE, you need to have a
robust Plan B application strategy
for a second choice specialty.
Your Plan B strategy should be as
good as if its your first choice
and will require work to not make
it obvious that it is your second
choice.

While Step 1 is just one data point, it is an important

one and will be the first screen on your application.
Graph
IM-2
1.00

Probability of Matching to Preferred Specialty by USMLE Step 1 Score

Internal Medicine

Probability of Matching

0.90
0.80
0.70

The bar for IMGs

needing visas is
higher to hit the
same probability
of matching

0.60
0.50
0.40
0.30

Without a strong plan B, the

odds are you are more likely
NOT to match than to match if
you are below the red line

0.20
0.10
0.00

160

180

200

220

U.S. IMG

240

260

280

Non-U.S. IMG

Step 1 Score
Source: NRMP Data Warehouse and ECFMG.
Copyright 2014 NRMP and ECFMG. Copies may be
made for educational or noncommercial uses only.

Source:

Charting Outcomes in the Match for IMGs, 2014 by NRMP and ECFMG

78

Charting Outcomes in the Match for IMGs, 2014

How Competitive Is Internal Medicine to Match Into?

Quantitative Profile of SGU Students Matched into IM 2014-2016
First, some good news. From 2014-2016, over 850 SGU students have matched into categorical
Internal Medicine programs in the US via the NRMP, which makes up ~43% of all SGU matches
during this 3-year period. This percentage has remained relatively consistent from year to year in the
recent past. Here is how they did in the basic sciences and on Step 1 and Step 2 CK.

SGU US IMG Students

-1 Standard
Deviation

Mean
(Median)

+1 Standard
Deviation

+2 Standard
Deviations

2.67 / 82.17

3.12 / 86.28
(3.03/ 86.20)

3.57 / 90.39

4.00/ 94.50

Step 1

218

232.40 (232)

247

261

Step 2 CK

220

233.85 (233)

248

262

Test
Basic Science
GPA1

SGU Non-US IMG Students

-1 Standard
Deviation

Mean
(Median)

+1 Standard
Deviation

+2 Standard
Deviations

2.71/ 83.88

3.16/ 88.37
(3.16 / 88.79)

3.61 / 92.86

4.00 / 97.35

Step 1

219

235.22 (238)

251

267

Step 2 CK

221

235. 86 (236)

251

265

Test
Basic Science
GPA

Note:
Source:

(1) GPA methodology changed for 2015, so both scoring systems presented here to give a general sense of academic performance for students
who match into IM through the NRMP
9
SGU proprietary data

If you need more than one attempt for a USMLE step,

your odds of matching in IM go down very significantly.
What if I failed one or more USMLE Step exams along the way?...

Of the 850+ students who matched in IM from 2014-2016, ZERO had failed all three parts at least once (Step 1, Step 2 CK,
Step 2 CS)
Of the 800+ students who matched in IM from 2014-2016, only 2 had failed Step 1 with no other failures, while 29 failed
CK with no other failures
Of the 800+ students who matched in IM from 2014-2016, only 2 had failed any two of the three USMLE step exams
Of the 800+ students who matched in IM from 2014-2016, 57 had failed the CS in their first attempt

BOTTOM LINE
If you have failed any of the step exams, you absolutely need to have a very
strong plan B for a second-choice specialty and get guidance on your application strategy from the OCG. There are
important things you need to do maximize your chances, but you are facing an uphill battle.

Probability of Matching to Preferred Specialty by Number of Step 1 Attempts*

Graph
IM-3

Chart
IM-6

Internal Medicine

Probability of Matching

1.00

Chart
IM-7

USMLE Step 2 CK (Clinical Knowledge) Attempts*

Internal Medicine

0.70

1,400
1,200
804

800
534

600
400

147

200

0.60

28

1,200
1,000
800

791
543

600
400

152

200

45

20

45

0
2

6 and more

Non-U.S. IMG

Non-U.S. IMG
1,800

0.10
0.00

1,200
1,000
800
600
400
133

200

20

6 and more

Not Matched

1,430

1,000
800
600
353

400
138

61

12

0
2

6 and more

6 and more

Step 2 CS or ECFMG CSA Attempts

Step 1 Attempts

Source: NRMP Data Warehouse and ECFMG.

Source: NRMP Data Warehouse and ECFMG.

Source: NRMP Data Warehouse and ECFMG.

Copyright 2014 NRMP and ECFMG. Copies may be

made for educational or noncommercial uses only.

*USMLE Step 2 CK or equivalent examination

*USMLE Step 1 or equivalent examination

Source:

1,200

200

23

Non-U.S. IMG

80

1,400

Step 2 CK Attempts

Copyright 2014 NRMP and ECFMG. Copies may be

made for educational or noncommercial uses only.

Matched

1,534

Not Matched

1,400

U.S. IMG

1,600

Matched

1,693

1,669

1,600

Number of applicants

Number of applicants

0.20

Step 2 CS or ECFMG CSA Attempts

Step 2 CK Attempts

0.30

45

0
1

0.50
0.40

Not Matched

1,400

1,600

1,000

Matched

Not Matched

Number of applicants

Number of applicants

0.80

Internal Medicine

1,600

Matched

1,800

0.90

Attempts at USMLE Step 2 CS (Clinical Skills) or ECFMG CSA (Clinical Skills Assessment)
U.S. IMG

U.S. IMG

Charting Outcomes in the Match for IMGs, 2014

Copyright 2014 NRMP and ECFMG. Copies may be

made for educational or noncommercial uses only.

SGU analysis, Charting Outcomes in the Match for IMGs, 2014 by NRMP and ECFMG

83

10

Charting Outcomes in the Match for IMGs, 2014

84

Charting Outcomes in the Match for IMGs, 2014

Beyond the Numbers:

What Are Program Directors Looking For?

11

Put on your Program Directors hat

What are Internal Medicine program directors looking for? Lets talk about what wed look for if we were IM Program Directors

Smart students demonstrated by great USMLE scores/grades? Thats a given but what else? Remember, these are busy professionals
running a program with many residents working long hours, often under stress, caring for real patients every day in a large hospital,
interacting with many other professionals/departments, mentoring more junior residents, and teaching medical students.

Personally, I would want residents who make everyone else in the program/hospital better. How do they do that?

Through hard work and attention to detail, ensuring patients get first-rate care without preventable errors or things getting missed
dont cut corners, follow up on everything youre supposed to, be where youre supposed to be, doing what youre supposed to be
doing, and establish a reputation that your word can be taken as fact

Through a positive, upbeat attitude without complaint even when things get tough, always setting a good example for others

By being a fun and interesting and professional colleague (at all times) to spend endless hours with for anywhere from 3-5 years

By having passion and a unique view on how they are going to chart their own career course based on their residency training;
they should reflect well on the program both during and after their time in the program through their daily interactions inside and
outside the hospital

By being a team player that creates an espirit de corps within the program; this helps the programs reputation among students and
helps the program become more competitive and continue to get stronger year after year

You need to make it clear that you are all of the above things in addition to whatever else sets you apart on two levels:
1

First, your personal brand: the CV, personal statement, interview performance (yes, performance) have to be carefully crafted to
persuasively make the case above. Work with the OCG and other mentors to ensure the various components of your application (CV,
personal statement, LORs, MSPE) achieve this. But you also have to become those things in substance. Why? Because

Secondly, not only does it make you a more effective physician but you need other people to say these things about you. In the LORs.
And when people ask around about you. Your reputation is impacted by each and every interaction you have both at work and outside
of work. Years of meticulous work can be undone with one lazy moment in front of the wrong person at the wrong time. By the way, that
wrong person could be the secretary, the nurse, the orderly, a student, an attending, a resident, a patient, the doorman, or anyone who
knows these people.

12

Lets invert the same problem:

If we were Program Directors, what kind of applicant would we try to avoid as much as possible? Whether its
through how the application is prepared, the LORs, the interview performance, or informal interactions, Id probably
look for:
Someone who did not pay attention to detail or demonstrate a professional work ethic, e.g. through a sloppy

application with poor grammar, spelling errors, other typos, missed deadlines
Someone who hadnt put much thought into their career or why he/she wanted to pursue Internal Medicine
Someone who was low energy, lazy, complained, lacked enthusiasm, or was just not an interesting, nice person

Someone who did not paint a clear picture of who they are where their CV, personal statement, and interview

didnt fit together or didnt demonstrate the attributes I was looking for in a great resident
Someone who couldnt be bothered to get their application in on time the way everyone else did
Someone who did not present themselves professionally (attire, demeanor, sensitivity)after all, as interns, they

would be the face of the hospital to patients

Someone who clearly wanted to do something else and chose internal medicine as a backup; especially if they

didnt bother to explore IM and do the work to make it less obvious that it was a second choice

Enough with the thought experiment, lets look at what real

program directors said in surveys
13

Academics and scores largely drive who gets an

interview, though red flags can prevent invitations.
Figure IM-1

Internal Medicine
Percentage of Programs Citing Each Factor And Mean Importance Rating for Each
Factor in Selecting Applicants to Interview
(N=194)
Percent Citing Factor

USMLEStep1/COMLEXLevel1score
Lettersofrecommendationinthespecialty

4.1
73%

3.8

MedicalStudentPerformanceEvaluation(MSPE/Dean'sLetter)

90%

4.3

USMLEStep2CK/COMLEXLevel2CEscore

89%

4.2

PersonalStatement
GraduateofU.S.allopathicmedicalschool
Gradesinrequiredclerkships
Gapsinmedicaleducation
Honorsinclinicalclerkships

66%

3.3

79%

4.0

70%

4.1

65%

4.0

51%

4.0

64%

Personalpriorknowledgeoftheapplicant

64%

4.4
3.8

Auditionelective/rotationwithinyourdepartment

54%

Leadershipqualities

53%

Honorsinclerkshipindesiredspecialty

57%

Gradesinclerkshipindesiredspecialty

59%

AlphaOmegaAlpha(AOA)membership

58%

Perceivedinterestinprogram
Consistencyofgrades
Otherlifeexperience

3.6
3.8
4.1
4.2
4.3
3.7

47%

4.0

55%
3.4

46%

3.5

38%

3.8

45%

Demonstratedinvolvementandinterestinresearch

3.5

28%

Visastatus*

4.9

44%

Interestinacademiccareer

3.5

21%

Honorsinbasicsciences

3.2

24%

GoldSocietymembership

29%

Awayrotationinyourspecialtyatanotherinstitution

9%
31%

Fluencyinlanguagespokenbyyourpatientpopulation
50%

Youll also notice that anything that even

slightly suggests unprofessionalism, match
violations, or a lack of ethics will disqualify you

3.7

40%

ApplicantwasflaggedwithMatchviolationbytheNRMP

USMLE/COMLEXStep3score
100%

This is the perspective of real program

directors, some of whom are going to
reviewing your application this fall

3.9

75%

Volunteer/extracurricularexperiences
GraduateofhighlyregardedU.S.medicalschool

3.7

74%

Evidenceofprofessionalismandethics

PassUSMLEStep2CS/COMLEXLvl2PE

So if youre less competitive on these

dimensions, you need to apply to more
programs to give yourself a chance of
landing enough interviews to generate a
healthy Rank Order List

4.1

73%

Perceivedcommitmenttospecialty
Classranking/quartile

Eyeballing the % citing factor and the average

rating, its obvious that Step 1, MSPE (often a
proxy for GPA and class standing), CK, and CS
drive invitations

Average Rating

92%

21%
0% 1

4.0
3.1
3.7
2

3.5
3

Ratings on a scale from 1 (not at all important) to 5 (very important).

* International Medical Graduates only

NRMP Program Director Survey Results, 2014

Source:

39

NRMP Program Director Survey Results 2014

14

Developing a Smart Application Strategy and the Importance

of a Fully-Developed Plan B Strategy

15

How many programs do I need to apply to?

Answer: More than you think you do. Each application adds an incremental expense and that may be a real
concern. However, for a properly prepared application, more applications means a greater likelihood of interview
invitations provided youve targeted realistic programs. Your odds of matching are directly related to the number of
interviews invitations you receive and then how you perform in the interviews. If you consider how much youve
already invested in time, energy, and money towards your medical education, it does not make a lot of sense to put
all of that on the line for a relatively tiny percentage of your overall investment
While the number of applications is important, its equally important to be smart and realistic about the programs you
apply to. Research the programs to understand whether youre competitive, whether they take non-US IMGs if
applicable, and where you might be able to leverage your network and audition rotations
Since everyones situation is different, its hard to pin down a specific number of applications in terms of general
guidance but we are hearing successful students applying from ~ 80 to as many 300-400+ programs (including your
plan B specialty applications). As well show you later on, your goal should be to get at least a dozen or so interview
invitations to have a very strong chance of matching. Again, targeting the right programs is also important.
If youve failed Step 1, CK, or CS, wed suggest at least 300 programs (including your plan B applications) and
emphasize how important your plan B specialty strategy is.
For everyone, but especially for this last group, its also essential that you are proactively building and working your
personal and professional networks to increase your chances of matching. This means audition rotations, getting to
know people at programs you are interested in and that seem to take SGU students, including program directors,
associate program directors, and current residents both through formal and informal channels.

16

Plan B considerations: There is not only one right answer!

Unfortunately, medical school can make you feel like life is a multiple choice exam and that there is only one right answer. While it may be true
of the USMLE, its not true of your choice of specialty.
The reality is that the overwhelming majority of medical students can build profoundly satisfying, stimulating, and rewarding careers from one of
several different specialties that suit them. The key is to reflect on what inspires YOU and drives YOUR satisfaction? Is it working with certain
patient populations? Is it the procedural aspect? Is it the high-acuity environment? Is it shift-based work or longitudinal relationships? Is it the
intellectual/diagnostic challenge? Is it working with cutting edge technology? We all enjoy different aspects of the job and there are many other
dimensions to think about.

Depending on what drives you, a number of other fields can serve as excellent Plan Bs if your application may not be very competitive for IM.
Conversely, IM can be a fantastic choice for those of you who may be looking for a Plan B for another specialty

Every year, over 100 SGU students match into IM who either are non-US IMGs or for whom IM is not their first-choice specialty

What might be a good plan B for IM?

Considerations
Outpatient setting
Longitudinal relationships
Range of patient populations, ages

IM is a strong plan B for other specialties

Plan B specialty

Family medicine (even though

FM training includes
pediatrics and ob&gyn, you
can tailor your practice to
your preferences)
Psychiatry

Opportunity for procedures

Sports medicine and athletics

Family medicine
PM&R

Impact of psychosocial issues

Family medicine
Psychiatry

Diagnostic challenges

FM, Psych, but also consider

Pathology, Nuclear medicine

Specialty

Common element with IM

Emergency medicine

Hospitalists and intensivists operate in

high-acuity settings, often in shift-based
work

Surgery

Many IM subspecialties can be highly

procedural and some endovascular
procedures are now replacing what
surgeons previously used to do

Neurology

Diagnostic challenge and working through

a differential dx is a core element for both

NB: Certain programs, e.g. Neurology,

17 PM&R. Rads may require a prelim year!!

LOR Requirements for Internal Medicine

Obtain at least 4 LORs: 1 from IM core and ideally 1-2 from IM audition elective(s)
One of your letters should be from an attending who knows you well from your CORE Internal
Medicine clerkship and will write an outstanding LOR for you make sure to get this (and other)
letters soon after your clerkship so they can write in some depth and specificity what kind of student
you are
You will need at least two other outstanding LORs from faculty who know you well
But how can any attending really know you all that well?
Ideally, the attending has not only worked closely with you daily for a number of weeks, but youve
shared your CV and Personal Statement with them so they have a better idea of who you are.
Even better, youve asked to meet with them (perhaps over coffee) at a convenient time for them so
that you can tell them a bit about yourself, what your goals and aspirations are, why youve chosen
internal medicine.
It never hurts to link it to experiences that youve shared with them during your clerkship. Were all
flattered when you tell us you want to follow in our footsteps (but we can tell when youre not being
sincere).

18

Your networking strategy is a core part of your

application strategy its not optional or extra.
While much of the strength of your applications (scores, grades) is already established, the care you give
putting the application together and navigating the process in an organized way can make or break your
outcome
Do not forget that while we can get lost in numbers and scores, this is still fundamentally a process run by
and for human beings.
Establish relationships to build and augment your personal and professional networks

Turn instructors and advisors into mentors. Turn colleagues and peers into friends
Find ways to demonstrate what a great resident, colleague, and physician you are going to make.
Show them, dont tell them. Keep your closest mentors and advisors updated and continually thank
them for their investment in you
Build relationships with the people at programs you are especially interested in this includes the
support and administrative staff, the residents, the faculty, and the program directors. Dont be a

nuisance, but do be a friendly, enthusiastic presence that they could imagine at their program
Ask for help. If you think someone is in a position to offer you assistance, politely ask them for it. The
worst that can happen is that they say no

Some of you have never had to find a job before. This is just some of what it takes, not just now but for the
rest of your career. And when youre in a position to provide help to those coming after you, be happy that
youre in a position to offer it

19

Some Specific Programs You Should Consider Including as

Part of the Long List of Programs You Apply to

20

Programs where 4 total SGU students matched to

categorical IM programs via NRMP from 2014-2016
Program

SGU Matches
2014-2016

Drexel University College of

Medicine/Hahnemann University*

33

SUNY Health Science Center at Brooklyn*

SGU Matches
2014-2016

Program

11

32

San Joaquin General Hospital

Florida Atlantic University Charles E. Schmidt College
of Medicine

New York Methodist Hospital

32

Albany Medical Center*

10

Lincoln Medical & Mental Health Center*

30

Morristown Memorial Hospital*

10

Maimonides Medical Center*

26

Icahn School of Medicine at Mount Sinai*

10

10

Program

SGU Matches
2014-2016

University of Massachusetts Medical School*

Richmond University Medical Center *

Danbury Hospital
Icahn School of Medicine at Mount Sinai
(Elmhurst)

Kaiser Permanente Southern California

Cleveland Clinic Florida

AtlantiCare Regional Medical Center*

UCSF-Fresno Medical Education

Newark Beth Israel Medical Center*

24

Stamford Hospital

SUNY Upstate Medical University*

23

Alameda County Medical Center

University of Texas Health Science Center at Houston*

Nassau University Medical Center

Hofstra North Shore-LIJ School of Medicine*

Mercy Catholic Medical Center Inc.

St John Hospital & Medical Center*

Arrowhead Regional Medical Center

Mercy St Vincent Medical Center*

Medical College of Wisconsin Affiliated
Hospitals, Inc.

Atlantic Health*

Orlando Health
Indiana University Health Ball Memorial
Hospital
Seton Hall University School of Health and
Medical Sciences*
Allegheny General Hospital-Western PA
Hospital Medical Education*

Jewish Hospital of Cincinnati*

Medical College of Georgia Hospital & Clinics*

Florida State University College of Medicine

Stony Brook Medicine

22

Washington Hospital Center*

22

Icahn School of Medicine at Mount Sinai*

20

New York Medical College*

19

University of Connecticut School of Medicine*

19

New York-Presbyterian/Queens

19

Norwalk Hospital*

19

Roger Williams Medical Center*

St Barnabas Medical Center*

18

Eisenhower Medical Center

Coney Island Hospital*

17

University of Arizona College of Medicine*

University of Nevada School of Medicine*

17

University Hospital-SUNY at Stony Brook

University at Buffalo School of Medicine*

16

Woodhull Medical & Mental Health Center*

UPMC Medical Education*

14

University of Louisville School of Medicine*

13

University of Texas Rio Grande Valley*

Carilion Clinic-Virginia Tech Carilion School of
Medicine

University of Kentucky College of Medicine

Rutgers New Jersey Medical School*

13

12

Lehigh Valley Hospital

Brooklyn Hospital Center*

Yale-New Haven Hospital*

12

Vidant Medical Center

Georgetown University Hospital

Lutheran Medical Center*

St Mary Medical Center*

University of Texas at Austin Dell Medical School

6
Jersey Shore University Medical Center
11
* Program accepted a non-US citizen during the indicated timeframe. This is provided as a historical fact and is not intended
as a general statement about the programs visa policies. Please consult FREIDA Online for more information.

21

4
4
4

Other programs where 1-3 SGU students total have

matched to categorical IM via NRMP 2014-2016
Abington Memorial Hospital
Advocate Illinois Masonic Medical Center*
Alameda Health System-Highland Hospital
Albert Einstein College of Medicine of Yeshiva
University
Athens Regional Medical Center
Aurora Health Care
Aventura Hospital and Medical Center
Banner Good Samaritan Medical Center*
Bassett Medical Center*
Baystate Medical Center
Berkshire Medical Center
Beth Israel Medical Center
Brandon Regional Hospital
Bridgeport Hospital/Yale University
Central Michigan University College of Medicine
Christ Hospital
Christiana Care Health Services Inc.*
Cleveland Clinic Foundation
Conemaugh Memorial Medical Center
Cooper Hospital-University Medical Center*
Creighton University School of Medicine
Detroit Medical Center Corporation*
East Tennessee State University/Quillen College of
Medicine*
Eastern Virginia Medical School
Flushing Hospital Medical Center
Franklin Square Hospital Center*
Geisinger Medical Center
Georgia Regents University-University of Georgia
Medical Partnership*
Harlem Hospital Center*
HonorHealth Scottsdale Thompson Peak Medical
Center
Jersey City Medical Center*

Kaiser Permanente Medical Group (Northern

California)
Kern Medical Center
Legacy Emanuel Hospital and Health Center
LSU Health Sciences Center-University Hospital
Maricopa Medical Center
Mary Hitchcock Memorial Hospital*

Seton Hall University School of Health & Medical

Science*
Shands Hospital at the University of Florida
Santa Barbara Cottage Hospital
Seton Hall University School of Health & Medical
Science*
Shands Hospital at the University of Florida
St Elizabeth Health Center
Maryland General Hospital
St Joseph Mercy Health System*
MedStar Franklin Square Medical Center
St Joseph's Hospital & Medical Center*
Memorial Health-University Medical Center
St Luke's Hospital
Mercy Hospital & Medical Center
St Mary's Hospital
MetroHealth Medical Center
St Mary's Hospital & Medical Center
Monmouth Medical Center*
Montefiore Medical Center/Albert Einstein College St Peter's University Hospital
St Vincent Hospital & Health Care Center
of Medicine *
St Vincent Hospital
Morehouse School of Medicine
St. John's Riverside Hospital
Moses H Cone Memorial Hospital
Staten Island University Hospital
Mountainside Hospital
Steward Carney Hospital Inc.
MountainView Hospital
Texas Tech University Health Sciences Center at
Nebraska Health System
Lubbock
New York University School of Medicine*
Thomas Jefferson University Hospital
Orange Park Medical Center
Unity Health System/St Mary's Campus
Orlando Regional Medical Center
University Hospital & Clinics
OSF St Francis Medical Center
University Hospital & Health System
Palmetto Richland Memorial Hospital
University Medical Center
Penn State Milton S Hershey Medical Center
University Medical Center (Toledo)
Pennsylvania Hospital (UPHS)
University of Arizona College of Medicine at South
PinnacleHealth Hospitals*
Campus*
PinnacleHealth System-Harrisburg Hospital
University of Arizona College of Medicine-Tucson
Providence Hospital & Medical Center*
Raritan Bay Medical Center-Perth Amboy Division University of Arkansas College of Medicine
University of California (Davis) Health System
Rochester General Hospital*
University of California, Riverside, School of
Saint Peter's University Hospital
Medicine
Santa Barbara Cottage Hospital
University of Florida College of Medicine at
Jacksonville

* Program accepted a non-US citizen during the indicated timeframe. This is provided as a historical fact and is not intended
as a general statement about the programs visa policies. Please consult FREIDA Online for more information.

22

University of Hawaii John A Burns School of

Medicine
University of Illinois College of Medicine at Peoria
University of Mississippi School of Medicine
University of New Mexico School of Medicine
University of North Dakota School of Medicine &
Health Sciences*
University of Oklahoma College Of Medicine Tulsa*
University of Pittsburgh Medical Center
University of South Dakota School of Medicine*
University of Southern California/LAC+USC Medical
Center
University of Tennessee College Of Medicine
Chattanooga
University of Tennessee Graduate School of
Medicine
University of Texas Medical Branch Hospital*
University of Texas School of Medicine at San
Antonio
University of Texas Southwestern Medical School
University of Toledo*
Wayne State University School of Medicine
WellStar Kennestone Regional Medical Center
West Virginia University Hospital
Westchester Medical Center
Western Michigan University School of Medicine*
Western Reserve Health Education, Inc.
William Beaumont Hospital*
Wilson Memorial Regional Medical Center (United
Health Services)
Winthrop-University Hospital
Wright Center for Graduate Medical Education
Wyckoff Heights Medical Center*
York Hospital

Making the Most of Your Interview Opportunities

23

If you get to the interview, it seems like a level playing

field once again, but now you must perform!
Figure IM-2

Internal Medicine
Percentage of Programs Citing Each Factor And Mean Importance Rating for Each
Factor in Ranking Applicants
(N=194)
Percent Citing Factor

Interactionswithfacultyduringinterviewandvisit
92%
Interpersonalskills 95%
Interactionswithhousestaffduringinterviewandvisit
82%
Feedbackfromcurrentresidents
73%
USMLEStep1/COMLEXLevel1score
83%
Lettersofrecommendationinthespecialty
65%
USMLEStep2CK/COMLEXLevel2CEscore
86%
MedicalStudentPerformanceEvaluation(MSPE/Dean'sLetter)
79%
Perceivedcommitmenttospecialty
55%
Evidenceofprofessionalismandethics
64%
Perceivedinterestinprogram
55%
Leadershipqualities
55%
Personalpriorknowledgeoftheapplicant
59%
Classranking/quartile
71%
GraduateofU.S.allopathicmedicalschool
69%
PersonalStatement
52%
Auditionelective/rotationwithinyourdepartment
47%
Gradesinrequiredclerkships
55%
PassingUSMLEStep2CS/COMLEXLevel2PE
71%
Honorsinclinicalclerkships
51%
Honorsinclerkshipindesiredspecialty
52%
Gapsinmedicaleducation
54%
Gradesinclerkshipindesiredspecialty
52%
AlphaOmegaAlpha(AOA)membership
51%
Otherlifeexperience
36%
Consistencyofgrades
46%
Volunteer/extracurricularexperiences
29%
Demonstratedinvolvementandinterestinresearch
27%
GraduateofhighlyregardedU.S.medicalschool
40%
Otherpostinterviewcontact
21%
Interestinacademiccareer
21%
Visastatus*
36%
ApplicantwasflaggedwithMatchviolationbytheNRMP
36%
28%
Fluencyinlanguagespokenbyyourpatientpopulation
GoldSocietymembership
25%
Honorsinbasicsciences
17%
Secondinterview/visit
13%
Awayrotationinyourspecialtyatanotherinstitution
7%
USMLE/COMLEXStep3score
24%
0% 1
100%
50%
Ratings on a scale from 1 (not at all important) to 5 (very important).
* International Medical Graduates only

Source:
NRMP Program
Director
Survey
NRMP Program
Director Survey
Results,
2014 Results 2014 40

Interactions with faculty (both in and outside the

interview), interpersonal skills (with everyone), and
interactions with current residents seem to dominate
how programs rank candidates that they interview --you need a good offense..its not a win for you
simply if nothing goes wrong

Average Rating

4.7
4.7
4.6
4.4
4.1
3.7
4.2
4.2
4.0
4.6
3.9
3.9
4.1
4.1
4.1
3.3
3.8
4.1
4.2
4.1
4.2
4.1
4.3
4.1
3.5
3.9
3.6
3.4
3.9
3.6
3.6
3.7
4.8
4.0
4.1
3.5
3.3
3.1
3.4
2

The program, i.e. the faculty, residents, and others

you meet must get a strong sense of who you are,
what you bring to the table, and it must all fit together
in a consistent way including how you groom, dress,
and present yourself
Once again, anything negative on the professionalism
or ethics front will quickly disqualify you -- they dont
need to take that risk
Do not let your guard down
Be nice to EVERYONE
Dont swear

24

Dont have alcohol at lunch; if theres a social

activity the evening before, limit your alcohol
to 1 drink if youd like they are watching you
at all times

At 5 interviews (probably discounting pure courtesy

interviews), its a coin toss on your probability of matching.
Graph
IM-1

For a US citizen, ranking 8

programs, led to a less than
80% chance of matching

Probability of Matching to Preferred Specialty by Number of Contiguous Ranks

Internal Medicine

Probability of Matching

1.00

While you dont want to

over-interpret the data, the
odds seem to tilt heavily
once you get over 10
interviews; at 11 interviews
candidates matched at ~91%
rate.

0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
0

10

11

U.S. IMG

12

13

14

15

16

17

18

19

20

Non-U.S. IMG

Number of Contiguous Ranks

Source: NRMP Data Warehouse.

Copyright 2014 NRMP and ECFMG. Copies may be
made for educational or noncommercial uses only.

Charting Outcomes in the Match for IMGs, 2014

75

Contiguous ranks is the number of

programs at the top of your rank
order list in your preferred
specialty

Source:

Charting Outcomes in the Match for IMGs, 2014 by NRMP and ECFMG

25

For non-US IMGs

(presumably needing a visa),
the situation is once again
somewhat more challenging,
though it seems the largest
hurdle has been overcome
and now odds are much
closer to their US IMG
colleagues. At 11 interviews
(or programs ranked to be
more precise), the match
rate was 89%

Some Perspective on Your Interview Day

Programs are evaluating you on interview days, but true that on interview days they are also using that time to
market their program. Therefore, most programs want you to leave with a good feeling regardless of how strong a
candidate they think you are. They will smile, exchange pleasantries, and offer compliments and are unlikely to use
pressure tactics or make you feel bad about yourself
Therefore, nothing going wrong is NOT the same as a good interview day. A successful interview day is if you
effectively, persuasively, and charismatically communicate to the program why you are the most compelling
candidate for their program and why they should rank you first on the list. That should be your objective.
Unfortunately, you wont have any idea if you were able to achieve that by the time you leave. If you get to the
interview and fail to powerfully make your case, you have wasted a huge opportunity.
You are trying to convey your personal brand the same one they have a sense of from your CV, personal
statement, and LORs, but now they get to see it all come to life. The bar here is very high and you need to prepare
just like you would for a test. But this isnt a multiple choice test; think of it more like a stage performance.
Remember, this is a job interview! (as opposed to trying to get into school)
Dont drop your guard in any of your interactions, whether formal or informal. Whether written, email, by

telephone, or in-person, be professional in how you greet/address others and communicate with them
See the ACPs page on interviews:
http://www.acponline.org/medical_students/residency/interviewing/keys.htm

26

So, how do you prepare for the interview?

Practice, practice, practice, then practice some more

in as realistic settings with other people as possible, wearing your interview suit, and polished shoes, with hair and makeup
as it would be that day so you can get feedback and get used to even the smallest things like whether you cross your legs or
not

Even the simplest question such as Where are you from? can be fumbled spectacularly the first time you try to answer it

Do mock interviews with colleagues, mentors, and faculty youve got a relationship with but be careful if its at a place where the
person is also evaluating you for a spot at their program
Write out what you want your personal brand to be and practice answering all sorts of questions that speak to your CV, your
clinical experiences, what is in your personal statement, and questions that try to get at all of the qualities we discussed earlier.
When they ask you about your favorite book or musician, theyre really trying to see if youre a fun, interesting person with outside
interests that would be ok to get stuck on call with (vs. a USMLE-test taking robot)
Do your homework. Research the program, the key faculty, perhaps have informal conversations with residents to learn a bit
more in advance. Have your list of questions prepared based on the research you complete. Your level of questions reveal a
good deal about the quality of your candidacy. Would you be impressed by someone who hadnt even read the website?
If youre fortunate enough to receive sufficient interview invitations, try to schedule at least one or two programs that youre less
excited about as warm-ups. That way you can get some practice for the programs you are most excited about at the same
time, dont leave those programs until the end of interview season either

27

Some Frequently Asked Questions on IM Residency

Interviews from the ACP Site
"Why do you want to go into internal medicine?"

"Briefly describe your student research project." (if applicable)

"What are your ultimate career plans? Are you planning on a

subspecialty? What field?"

"Do you plan on research as being a part of your career?"

(Note that it is perfectly acceptable to say 'I don't know' to this

question. An interest in a subspecialty is not mandatory. Internal
medicine is a broad area, and not knowing what you want to do
before you have started training is certainly reasonable. This
question is to get an idea of your area of interest and whether or
not you may be heading in a certain career direction. It is also
fine to have more than one subspecialty in mind.

"Give me some one-word descriptors of yourself."

"Tell me something about you that is not on you CV."

"What are some of your strengths/weaknesses?"
"Tell me about your hometown/college/medical school."
"Why did you choose the college/medical school that you
attended?"
"Describe the best/worst incident that you encountered in your
medical school career."

"Where do you see yourself in five years? ten years?"

"How do you feel about the practice of medicine today? What
about its future? (i.e. malpractice, insurance, reimbursements,
etc.)"

"Who is your role model? Why?"

"What is your biggest fear in the realm of medicine?" (or

questions concerning the state of medicine in general)

"What is the most recent book you've read? Tell me a little bit
about this book.

"Why do you want to come to this program?"

"What will you/can you bring to our program?

"What are some of your hobbies/interest/extra-curricular

activities?"

"Why should we want you to come to our program?"

"What makes this program appealing/special to you?"

"What do you hope to gain from our residency program?

You should be prepared - interviewers may pick something on your curriculum vitae (i.e. extra-curricular
activities, work experiences, research project, etc.), personal statement, ERAS application, etc. to ask you about.
Remember what you wrote; review these documents prior to interviewing so you are not caught off guard by
these questions.

Source:

http://www.acponline.org/medical_students/residency/interviewing/questions.htm

28

Conclusion

29

SGU Resources and Contact Information

While we have tried to provide guidance that will be useful for a broad set of students, we
also recognize that each students situation is unique. If youd like to discuss your specific
circumstance and the combination of your test scores and academic profile position you for
Internal Medicine, please reach out to our office at CareerGuidance@sgu.edu and we will
happily direct your questions.

Additionally, the clinical faculty that you encounter on the wards are an invaluable resource
leverage them if you can
Within OCG, the following advisors are Internists and could be helpful if youve got IMspecific questions
Melissa Wallach, MD (Trained in IM and Pediatrics)
John Madden, MD (Trained in EM and IM)

You should go through the same process for your plan B specialties

30

Next Steps

Review the So you want to be an Internist presentation

Research IM further through the resources listed earlier
Assess your own competitiveness
Write/refine your CV for IM and begin to establish your personal brand/story
Obtain at least 4 LORs: 1 from IM core and ideally 1-2 from IM audition elective(s)
Develop your plan B
Complete your personal statement and make sure it aligns with your personal brand and CV
Research programs and develop the list of programs you will apply to
Prepare your application and submit it as soon as the NRMP process opens
Prepare for the interview process

31