As medical school graduates start applying for residency programs, they often wonder “what do residency program directors look for?” The truth is, if you aren’t targeting the right qualities in your application materials, like your supplemental ERAS application, then you can inadvertently hurt your chances of getting matched. If you know what program directors are looking for, it can give you a strategic advantage on your application. This article discusses what residency program directors like to see in applicants and the red flags you should avoid.

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What do Residency Program Directors Look for? 3 Major Red Flags to Avoid FAQs

What do Residency Program Directors Look for?

Applicants will naturally want to prioritize the components of their application that will give them the best chance of being invited for an interview. And of course, it’s normal to think that some aspects might be more important than others – but is it true? Well, according to the National Resident Matching Program (NRMP), program directors do rate some components and characteristics of your ERAS application more highly. Note that this does not mean that you can ignore lower-rated aspects; you should always aim to produce the highest quality application possible. That said, here are some of the top factors cited by residency program directors when selecting applicants to interview:

Are you applying for residency and want to know how to avoid residency application red flags?

There are a multitude of other factors, but these are some of the most frequently cited ones. Now consider some of the most important factors that residency program directors look for in more detail (in no particular order):

Perceived Commitment to the Specialty

You express commitment to your chosen specialty through your personal statements, clerkships, and research experience primarily. Let’s say that you’re applying to an internal medicine residency program; during your third and fourth year of medical school, you will complete clinical rotations, called clerkships. Your clerkships give you an opportunity to explore and solidify your choice of specialty. You need to demonstrate that your choice wasn’t random and ill-considered. You should know how to prepare for clinical rotations, because these will impact your future in residency.

How to show commitment:

In your personal statement, describe what you found stimulating about the clinical environment in your rotations. You may have had other personal experiences that were influential to your decision to pursue your specialty; state this in the introduction of your personal statement.

A personal connection can also help increase the level of perceived commitment, so an anecdote about a parental influence or mentor can enhance this quality. Keep this brief, as you don’t want to fixate as much on personal background.

The answer to the question “how important is research for medical school?” is that yes, it can significantly enhance your candidate profile. Having research publications or contributions on your resume in your designated specialty can help show commitment as well. During medical school, you can find research opportunities by asking your supervisors or professors; exposure to different types of projects like translational studies, clinical trials, retrospective analyses, or epidemiological studies can also show that you’re serious about your goals.

Strong Letters of Recommendation

Most residency programs will require three letters of recommendation. Some programs will require specific referees from certain rotations or classes, while others are less specific. Always check the residency program’s website for the ERAS letter of recommendation deliverables before making any requests.

How to obtain strong letters:

You need to choose your referees strategically. If your referees are from the department of your chosen specialty, you can substantiate your suitability for work within that field. Your letters should clarify the referee’s relationship with you and give examples of your clinical performance and aptitude for the specialty. Again, some residency programs will have specific content requirements for the letters. For example, the University of Toronto Faculty of Medicine requires a list of external and internal referees; both types have specific eligibility requirements.

To receive strong letters, you need to ask no later than 2–3 months before you submit your ERAS application. Each referee should discuss characteristics that make you unique and competent; ideal referees are professionals with whom you collaborated on a research project or clinical activity. The goal of the letter is to distinguish you from other candidates. The more time you spent together with the referee, the better. Review a CaRMS reference letter example to get an idea of what you need.

Learn how to prepare for residency application with this infographic:

Professionalism and Ethical Conduct

According to a study of supporting factors used by residency program directors to select applicants for interviews, evidence of professionalism and ethical conduct was another highly sought after trait. According to the study, unprofessional behavior was also linked to worse performance in residency, which explains why program directors probe for these qualities.

How to show that you possess this skill:

The main criterion used to evaluate this attribute is clinical rotations. The Medical School Performance Evaluation (MSPE) is intended to provide program directors with an overview of the candidate’s academic performance and clinical attributes. This document lists noteworthy characteristics, academic history, academic progress, a summary, and school information. From this report, residency program directors can discern a candidate’s level of professionalism and if there were any concerns regarding ethical conduct.

To make your MSPE stand out, you can talk to your performance evaluators or supervisors about your clinical performance. This way, you can discuss any concerns and ask for feedback to help you improve. Ideally, you should start inquiring about performance as early as possible in your third year to give yourself plenty of time to improve and ensure the MSPE you submit represents you fairly as a candidate.

Good Grades in Clerkships

An important predictor of success in residency is a candidate’s grades in their clerkships. Residency program directors will also look specifically at clerkship grades in specialty clerkships to confirm that a student can succeed in the type of work they will be performing in residency. Additionally, grades in required clerkships will also determine a student’s class rank, which program directors also consider when evaluating an applicant.

How to maintain good clerkship grades:

To do well in your clerkships, you should know the expectations of the clerkship director, residents, and attendings. Each supervisor will have a stake in evaluating your performance, so checking in regularly with how you’re performing can help you exceed expectations.

Knowing what’s on the rubric can also help you elevate your performance before final evaluations, which residency program directors will be looking at on your application. Here are some expectations set by Yale medical school to give you an idea of what program directors care about:

Being familiar with the evaluation criteria can help you succeed in your clerkships and submit grades that satisfy the standards set by residency program directors.

Good USMLE Scores

Across all specialties and programs, USMLE scores are one of the strongest predictors of whether applicants receive an invitation for an interview.

The USMLE step 1 is a pass/fail exam that measures basic science knowledge. The USMLE step 2 CK is designed to assess applications of medical knowledge, skills, and understanding of clinical science. According to a study, almost 90% of residency program directors agreed that they will increase their emphasis of USMLE step 2 exam results, now that step 1 is pass/fail. The reason program directors care so much about these tests is because high scores correlate with better performance across all residency performance domains, according to another study.

How to increase your score:

Most applicants will take their USMLE step 1 at the end of their second year before moving into the clerkship phase of the third and fourth years. Because both exams are critical components of your application, you will need to start preparing well in advance. On another note — residency program directors also considered failed attempts at the USMLE to negatively influence an applicant’s evaluation, which means it’s important to do well on the first try.

Here are some study tips that you can employ for both examinations; also, keep in mind that a USMLE step 1 prep course can assist with each of these tips and more:

Residency Personal Statement

The residency personal statement is another significant aspect of your application that program directors look at. Most candidates have excellent USMLE step 2 CK scores, strong grades, research experience, and a competitive class ranking, which can make it difficult to distinguish them. One way — perhaps the way to stand out in the applicant pool is to have a strong personal statement. Reading residency personal statement examples can also help you get a strong grasp on what to write. Once you have a strong first draft, you will need to complete revisions; residency personal statement editing can help you catch any errors so you can confidently submit this document.

How to write an excellent personal statement:

The key to a strong personal statement is to provide evidence of your skills, goals, competencies, and motivations for pursuing your specialty of choice in a coherent and compelling manner. In terms of what residency program directors look for in a personal statement, there are several characteristics highlighted in a survey:

3 Major Red Flags to Avoid

Clichés in your personal statement

It can be easy to inadvertently insert red flags in a residency personal statement. Program directors receive a plenitude of personal statements. If applicants don’t try to personalize theirs, then it’s going to be difficult to differentiate everyone based on what they wrote. To avoid clichés, consider common tropes like using one of your experiences to advertise yourself as a hero. Doing so is needlessly boastful and betrays the neutral, objective tone needed to write an essay of estimable quality. Consider a residency prep course to help you avoid these, especially if you want to improve your residency application after going unmatched.

Not explaining gaps in your resume or grades

If you have any significant gaps in your education or in your USMLE scores, then you should provide a brief interpretation, not an excuse. If you review your application and decide that something deserves an explanation, you can address it in your personal statement or supplemental ERAS application. Unaddressed missteps are easy to identify for residency program directors, and they can use them to rule you out as a qualified applicant.

Irrelevant personalized letters of recommendation

Generic letters of recommendation don’t say anything unique about you as an applicant. Bad letters usually don’t come from the right people. As mentioned earlier, your letters should contain specific information about why you’re an outstanding applicant using examples from your clinical experience. Also, if your referees weren’t attendants in the department of your specialty choice, then their testimony isn’t as relevant as it could be.


1. Do residency programs care about volunteer experiences or extracurriculars?

Residency program directors will take any volunteer hours or extracurriculars into account, which can improve the quality of your application. However, they aren’t typically rated as highly as say, clerkship grades or leadership qualities. Review some ERAS experience section examples to see how to format these entries properly.

2. How long should I give my referees to write their letter of recommendation?

You should request your letters (you must have at least 3 and up to 4) at least a month in advance. This will give your referees plenty of time to write a good letter; if they need your help providing other documents, you can supply those as needed.

3. Is the USMLE step 2 more important than step 1?

Both scores are important, but as noted, step 1 is a pass/fail, which means program directors have almost unanimously agreed that they will be putting more emphasis on USMLE step 2 CK scores.

4. How can I exhibit leadership qualities?

Leadership can manifest in a variety of ways. A few good examples include starting or fulfilling a role in a student activity, becoming a teaching assistant, tutoring, or competing in athletics.

5. Do program directors look for research experience?

According to the NRMP, demonstrated involvement in research isn’t one of the top cited factors among program directors. However, having research experience in a relevant field can help you identify why you’re a suitable candidate for a specific program comprised of faculty members whose research interests align with yours.

6. How do I explain having more than one attempt at the USMLE?

You can offer an explanation in your personal statement, but don’t make excuses. Focus on how you’ve improved and what you learned, rather than what you did wrong in the first place.

7. Is it important to describe experiences that aren’t related to medicine in my application?

You should dedicate part of your application, specifically in your personal statement, to giving the program director a sense of who you are. However, be careful you don’t over-emphasize personal experiences because you need to have lots of space to discuss clinical experiences or research.

8. Does the rating of different factors vary depending on the specialty?

According to the NRMP, factors are usually consistent, but there are some variations you should be aware of. For example, emergency medicine residency program directors placed specialty-specific letters of recommendation above USMLE scores, which is fairly uncommon among other specialties.

To your success,

Your friends at BeMo

BeMo Academic Consulting

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