How I Succeeded as a URM Applicant: From Medical School to My First Job and Beyond
By Aldene Zeno, MD
Over the years, I have interviewed hundreds of people for positions in residency and fellowship. Dozens of med students have worked with me as mentees in research and in clinical capacities, and I’ve given lectures to undergrads about the med school application process. I have also interviewed applicants for physician jobs and written letters of reference for physicians and med students at various points in their careers.
“URM” stands for under-represented in medicine. Being bi-racial, growing up poor and with an immigrant mother, I was not the typical applicant. However, I was taught that if I worked hard enough I could achieve anything. The implication, though, was that all successful people have worked hard for their achievements. Medical school was the first time that I was around many affluent and predominantly white people. It was during this time that I learned some people work harder than others. Quite frankly, some very successful people didn’t seem to work very hard. My mom worked 2–3 low-paying jobs at a time as a single parent in a foreign country where she had to learn the language — THAT was hard work.
I saw how some of my classmates were handed opportunities. They had their tuition covered or housing paid for with real money and not loans like me. They’d been taking test-prep classes since middle school or high school. I learned that they shared old exams with each other. They shared passwords to test banks that I couldn’t afford. They had physicians in their families, or personal relationships with some of the faculty. Now, don’t get me wrong, because I recognize medical school is challenging for everyone. But all I knew growing up was the grit people in my community had working long hours and often multiple jobs to barely make ends meet. Some people just seemed to have a “leg up” in med school.
Recognizing this, I knew that I had to work harder AND smarter. I’m not advocating for cheating, but if you don’t develop effective study skills you will drown on the path to becoming a medical doctor. However, if you cheat your way through undergrad and med school, it will catch up with you. At the end of the day, being a physician requires a strong work ethic, integrity, and a genuine love for what we do. If you’re trying to become a doctor for any other reason, you either won’t make it, or make it and burn out. Here’s how I navigated applications from med school to my first job.
Take ALL standardized tests seriously
There was an old saying in medical school for approaching the United States Medical Licensing Exams (USMLE). Since there are three exams called “Steps,” they’re commonly called the “Step” exams: Step 1— study two months, Step 2 — study two weeks, Step 3 — bring a number 2 pencil. Thankfully, I did not listen to this advice since my paranoia for failing pushed me to study much more.
I should also note that back in my day (ugh, I feel way too young to say that!) there was Step 2 Clinical Knowledge (CK) and Clinical Skills (CS), though I’ve learned they got rid of the CS part due to the COVID pandemic. For CS, I was told that it was basically a test of English proficiency, so native English-speakers didn’t need to study. I didn’t follow that advice either, and I was just as paranoid about failing that as I was the other Steps. However, I do recall it being much easier than other medical training exams.
Having confidence is key in my approach to standardized tests, and to feel confident I need to feel prepared. In taking so many standardized tests from the MCAT and now Maintenance of Certification (MOC) as a board-certified OB/Gyn, I’ve learned that being good at testing requires repetition, just like any other skill. In undergrad I could hardly afford the test prep book for MCAT, so private MCAT classes were out of the question. I can’t advocate for one company over another because I have no personal experience, but if you can afford the Kaplan course or other similar courses, it will likely help just by giving you the materials to practice exam content over and over again.
Thankfully my undergrad had an MCAT prep class. I was one of three students, and the only one to come out of that an MD. I studied how to take the MCAT for a whole semester, and I pored over my MCAT prep manual the entire summer.
With all the standardized tests, it’s unfortunately not enough to just know the content in the exams. Each exam has different strategies for time management, test-taking stamina (many of these tests are 4–8 hours long!), and a different approach for reading the questions. It’s an unfortunate part of the process, but you have to learn to “play the game,” as they say. You have to spend a good amount of time for each of your standardized tests, just learning how to approach the test in addition to learning the content.
Standardized test scores, for better or worse, are a hardline for some medical school deans and residency/fellowship directors. They receive hundreds of applications every year, and some frankly won’t even look at an application if there are test scores below a certain threshold. With that said, by virtue of test scores falling along a bell-shaped curve, the majority of test-takers will be fine. To put it another way, your exam scores will likely cluster around the mean just like hundreds of other applicants. This is where the rest of my advice comes in.
Make your personal statement pop, but in the right way
A good personal statement goes a really long way. It can guide the conversation during interviews, and it can make you stand out. Being able to write about yourself with clarity and confidence is also the foundation for future cover letters or bios that you will use for job applications and grants.
I have also read some really bad personal statements over the years. A bad personal statement can make your application stand out negatively. As a former academic faculty physician, I worry about someone’s ability to write research or even communicate in their medical documentation if their personal statement is problematic. Some simple tips for making your personal statement pop:
- Keep it short, but not too short. A good personal statement is usually 4–5 paragraphs and one page. Any more than that is frankly annoying for the reviewer. Any less than that, and I worry about the applicant’s ability to express themselves through writing.
- Make it personal, but keep it relevant. Your personal statement should communicate why you are going into medicine/your specialty/your prospective job, and what you plan to contribute. I love a good story in a personal statement, but a wandering story is ineffective. Everything in the personal statement should relate back to convincing the reader that you have what it takes to stick through the rigors of medical school/residency/your prospective job.
- The personal statement is also a good forum for explaining any issues in your application. For example, you could use it to explain gaps in your education, discuss how you rallied through a personal problem to perform better in the next class or clinical rotation, or shed light on what you’ve done to improve if you’ve applied multiple times due prior failed applications. Personal statements may also highlight positives that don’t fit the classic categories in ERAS or other CV’s. Maybe you started a side hustle or non-profit or otherwise have a non-traditional path with a previous career. This is your time to shine.
- Grammar mistakes in a personal statement are unacceptable. Use spell check.
- Have the personal statement read by multiple trusted mentors who are already physicians. Even better, include your personal statement with your request for letters of reference. It may help your letter writers give a more personal touch. If sent in an email, you could say, “Thank you for agreeing to write a letter of reference for me. For your review, I’ve also attached my CV and personal statement. I would greatly appreciate if you have any feedback.”
Own everything on your CV
There is nothing more annoying to me as an interviewer than finding out someone has “fluffed” their CV. If I ask you about a research project you did 10 years ago because you’ve listed it as your experience, you should discuss it with enthusiasm, just like anything on your CV.
There’s a part of me that envies those who went to well-resourced universities, or who otherwise had the personal connections to be involved in research, special projects, or publications. I went to an undergrad of 4,000 students and was the only person in my class to go directly to medical school. I’m thankful for all of my professional experiences, however, I had to scrap to find many of them. I worked as a medical secretary during the summers in undergrad because I needed the money. I didn’t have a strong research background, and I decided on my specialty later in medical school, so I wasn’t aware of how to approach research faculty in medical school for research opportunities. In residency, there was no urogynecology fellowship at my hospital, so I couldn’t sign on to ongoing research projects or grants.
Despite my shortcomings, I spent my time doing what I could within my means, and I did it earnestly and wholeheartedly. A lot of my energy went into volunteerism, advocacy, and global health — all things I’m genuinely interested in and that were supported in the programs I attended. I think my enthusiasm for each of my projects was palpable through my application and in my interviews. In addition, I met amazing, like-minded physicians in my journey, and I increasingly learned about opportunities for research, volunteerism, and publication later in my career.
To be fair, it may be hard to recall details from the research project you did 10 years ago. Be honest with your interviewer about your role in the project, and highlight the skills that you learned in the process. In addition, take time before your interviews to refresh yourself on activities listed in your CV.
Choose your mentors wisely
Mentorship is critical for young physicians. I once had an assigned “mentor” in undergrad who told me I’d be successful in my medical school application, “Because you’re a woman and…you know…” I’m assuming he meant because I was a woman of color. Thankfully, I had enough mentors along the way who recognized my true merits.
You may have assigned mentors throughout your training, which can be an asset. However, actively seek mentors who do what you want to do, or who otherwise embody the type of physician you seek to become.
Finding mentors can be challenging, and the pool becomes more limited the farther along you are in medicine. The best mentor relationships develop organically. As a student or a physician in training, you may need to remind potential mentors multiple times that you’d like to shadow or meet for coffee. In my experience, if I needed to remind a potential mentor about a meeting, it was usually because they were busy and not because they were blowing me off. Now that I’m a mentor, when someone reminds me multiple times about my meeting with them, it shows me that they are committed. I’ve never felt bothered by these kinds of messages.
When I reviewed bad applications as an academic faculty physician, my immediate thought was that the applicant likely had poor mentorship. There’s no way as an undergrad that you know what a strong med school application is, or as a medical student that you’d know how to put together a strong residency application, or as a resident that you’d automatically have a glowing fellowship or job application. A good mentor with more experience can help you get to the next level.
Get references from people that actually know you
For faculty physicians writing multiple references every application cycle, they often have templated letters. I know this not only from conversations with my colleagues in academic medicine, but also from my own experience reading letters. A letter of reference is much more compelling when a letter writer includes personal anecdotes about working with the applicant. After reviewing hundreds of applications, my eyes start to gloss over when I read non-specific letters. The worst is when the letter seems to regurgitate what is in an applicant’s CV without any personal narrative. To me, these are the tactics that letter writers use when they don’t really know the applicant.
I remember feeling intimidated asking my faculty to write a letter for me. In reality, part of our job as teachers and physicians is to support the next generation of medical doctors. It’s an honor when someone asks me to write a letter of reference. I honestly can’t remember who I asked to write my letters for medical school or residency applications. For my fellowship application, I asked someone that I’d spent a considerable amount of time with during a global health experience. She was not a university physician or someone affiliated with my training program, but she was able to provide a more personal touch with her letter.
Unfortunately, there is another element of “playing the game” when it comes to getting letters of reference. If you know somebody that knows somebody in your medical school of choice, or if you have a letter writer with some clout in your intended specialty’s national society, it can work to your advantage to get a letter from the right person. Medicine is a relatively small world. Some letter writers develop a reputation for being too generous with their praise, while others are known to be trustworthy and accurate.
I also learned more as a faculty member that some applicants use their personal connections to have emails or phone calls made on their behalf directly to program administrators. These emails or phone calls don’t necessarily have to be from your letter writers. As a URM student, I didn’t have many of these connections at first. However, if you make an effort to be personable with everyone you work with along the way, you’d be surprised who may pick up the phone for you to advocate on your behalf.
Follow Advice from Disney’s “Aladdin”: Be Yourself
If you are one of the hundreds of students gearing up for application season in medicine, congratulations! And if you’re an under-represented in medicine applicant, consider yourself among the very few, and you should be very proud. Every program has their own “formula” for how they process applications. Having done interviews for medical students going into residency as well as residents going into urogynecology fellowship, I know that some programs are more objective than others in their scoring systems. I say all of that because often times it can feel as if we’re trying our best to shine through our applications, and yet the outcomes are often unexpected. Unbeknownst to you, a program you’re applying to may put more weight on research and publications, others on standardized test scores and grades, while others are looking for non-traditional applicants who have more varied life experiences.
If we spend our time guessing what other people want all the time, we may lose sight of why we’re in this thing called medicine. Consider the application process a time for you to highlight your strengths and to think about the type of program you want. At the end of the day, authenticity is a requirement for your self-preservation in this marathon to medical doctor. Additionally, our patients deserve the best versions of ourselves.
