Becoming a competitive applicant

What STEP 1 score do I need? What about STEP 2?

The integrated IR residency is too new to really know. You can see the average scores and extracurriculars for different specialties HERE. The average STEP 1 of matched and unmatched DR applicants has been ~241 and ~221, respectively. On one hand, integrated IR spots are more competitive and there are rumors that some top programs use STEP 1 cutoffs of 240+. That said, board scores are only one part of your application. There are many successful applicants with lower scores.

People tend to score ~5-10 points higher on STEP 2 CK and it has less weight. The typical advice is to take it early and study hard if you have a lower STEP 1 to show improvement. If you have a high STEP 1, you could choose to take it later and not to release it to programs. However, many of the more competitive programs require STEP 2 CS & CK, so it’s worth looking at the program websites you’re thinking about to plan out your M4 year. The average STEP 2 CK of matched and unmatched DR applicants has been ~247 and ~229, respectively.

What extracurriculars should I do?

Quality over quantity is key. When surveyed, program directors tend to rank extracurriculars as less important than STEP 1, core clerkship grades, and strong letters of recommendation. The main value of research, organization involvement, community service, conference attendance, et cetera is letting you explore and show off your interest in a field. It looks odd if you’re applying to a specialty that you haven’t explored, just as it can be off putting if you’ve done everything and come off too intense. Try to do/stick to things that truly represent who you are because you’ll be talking about these activities/experiences during interviews and away rotations.  It will be somewhat obvious when you’re discussing these things if it’s something done as CV padding/fluff versus a true passion or interest.

For more context, we suggest looking at the average number of extracurriculars for those matching into radiology and reaching out to mentors early in your career.

How important is research? What about IR-specific research?

Typically, people think of research, especially IR-specific research, as having more weight than other extracurriculars. This is likely true at top academic centers, but not everywhere. Many students do choose to get involved in research. Research can be an awesome opportunity to network, explore IR, and find potential letter writers. It also has the value of sticking on your CV for life unlike other activities. Of course, there’s a wide range of experiences from a single poster presentation to taking a year or more off to head up a larger project. We encourage you to start small with a case report or poster to at least give it a try and see how you can balance research with your academics.

Doing IR-specific research is nice because it allows you to also network and show your interest in the field. However, research in other fields is just as respected. Program directors know medical school is a time of exploration and many people change interests multiple times.

For more advice on getting involved in IR research, check out this guide as well as these RFS articles: Getting Started, Research Between M1 & M2Taking a Research Year, Is All Research Created Equal.

How do I get involved in research if my institution doesn’t have an IR program?

Take advantage of SIR’s Mentor Match Platform. It allows you to reach out to researchers at other institutions that are interested in working with students. You can also reach out to IR programs at nearby institutions, ask to work on a case report during an away rotation or get involved with projects through SIR’s Medical Student Council.

What rotations should I do?

There’s no one definite answer. You should prioritize excelling in your core clerkships and doing some DR/IR electives to explore the field. Beyond this, rotations in critical care, vascular surgery, hepatology, cardiology, and/or anesthesia may be helpful. Try to do your sub-internship(s) and radiology rotations early in M4 year to get potential letter writers.

Away rotations – should I do them? If so, how many?

Away rotations are more important for IR than DR. They are not required to be successful in the match, but many integrated IR applicants do a couple. Some institutions like the University of Washington give preference to applicants who do aways with them, while others do not. Generally, they are great opportunities to see how other institutions do things and network. You should definitely consider doing one if you have a strong preference to match at that program or region or if you do not have access to IR at your home institution.

Check out the SIR RFS Away Rotation Spreadsheet that lists various programs with application information and contacts.

How can I make a good impression on an away rotation?

Three major categories that are important to consider: fund of knowledge, effort, and networking.

In terms of knowledge, brush up on anatomy (segments of the liver, vasculature, variants). Know the clinical indications for procedures. You can look up cases for the next day to prepare and think of non-obvious questions to ask about the technique, device selection, or relevant literature if there’s an opportunity.

Regarding effort, there are few subtleties. Work hard, and remember that no task is beneath you. This includes running errands, delivering scripts to patients, wheeling the bed in and out of the IR suite, pre-rounding, getting bedsheets for the patient, etc. Basically, make yourself useful, and realize that your learning comes second to patient care. Try to your patients’ stories, labs, indications, and previous procedures before you step into the IR suite.

As for networking, try to introduce yourself to everyone and make a good first impression. Getting to know nurses and APNs is as important as knowing fellows,residents, and attendings. The techs also are very knowledgeable and can help you look good in the IR suite. Be authentic, curious, and genuine.

Also, check out this RFS article on away rotations

ERAS & Preparing your application:

What are the current training options? Is one better than others?

There are now 3 pathways that primarily differ in when you decide you want to pursue IR and how sure you are of that desire. None of the pathways are necessarily better or worse, just different. One may be better for one person while another is better for someone else, i.e., you have the option to choose the path that best suits you.

The Integrated IR Residency: Apply during medical school. Generally, 1 year internship, 3 years of primarily DR, 2 years of primarily IR, 6 years total. End with certification and ability to practice in both DR and IR. Programs vary in how, when, and which clinical rotations they incorporate. Common ones include rotations in the SICU and vascular surgery. This is a great option for medical students who are pretty confident that they want to pursue a career in IR. Some programs also allow DR residents to fill these spots if vacant. Click HERE for up to date information on this pathway and participating institutions. Click HERE for our spreadsheet comparing programs’ curricula.

Early Specialization in IR (ESIR): Apply during DR residency. Generally, 1 year internship, 3 years of primarily DR, 2 years of primarily IR, 6 years total. End with certification and ability to practice in both DR and IR. Again, programs vary in how many spots they offer, how they select for these spots, and their exact schedules. They must allow you to complete at least 12 IR rotations and 500 image-guided procedures prior to PGY 6. Consider reaching out to program directors for more specifics about their programs. This is great option for trainees who could see themselves practicing either IR or DR and want to explore radiology more before making a final decision. Click HERE for up to date information on this pathway and participating institutions.

Independent IR Residency: Apply at the end of DR residency. 7 year total with 1 year internship, 4 years DR residency, 2 years IR residency. End with certification and ability to practice in both DR and IR. This is a good option for trainees who become interested in a career in IR later in residency. It is also a good option if they want to do their IR training after a complementary DR fellowship, e.g., MSK, neuro, etc. Click HERE for up to date information on this pathway and participating institutions.

Can I still practice DR if I complete an integrated IR residency? Will my DR training be affected?

Yes, all 3 pathways end with certification in both DR and IR. Generally, the integrated IR pathway is not detrimental to your DR training. However, the other pathways may be better if you think you might want to complete a DR fellowship instead of or in addition to IR.

What programs are currently offering the IR/DR residency? ESIR?

Click HERE for up to date information on the integrated IR residency and participating institutions.

Click HERE for up to date information on ESIR and participating institutions.

What is the selection process for ESIR?

This is still being worked out and will likely be institution dependent. Consider reaching out to program directors for more specifics about their programs.

Who should I contact at a program to get more information about their plans regarding ESIR, the independent IR residency, et cetera?

The head of IR (chief of staff or program director) is likely going to be the most informative individual.

How can I compare programs?

The program website and reaching out to mentors/trainees at the programs. U.S. News & World Report, Doximity, and Aunt Minnie rankings are helpful to some people, but remember these are all biased. The best program for one person is not necessarily the best for someone else.

How to apply?

Essentially all IR and DR residency programs use the Electronic Residency Application Service (ERAS) and participate in the National Resident Matching Program (NRMP). The application opens in May and is not submitted to the selected programs until September 15th.

What should I do for internship? Surgery, medicine, TY?

Most programs are not categorical, so you can do your internship in whatever you choose. However, some require (or strongly suggest) certain internships. Most recommend a general surgery internship, but there are exceptions. UCSD encourages applicants to apply to their internal medicine program. Doing your intern year at the same institution as your residency can be helpful for networking with colleagues who will later be referring to you. However, many opt to do their internship elsewhere. Overall, the jury is still out on this one. Look at the websites on the programs you’re interested in, talk to some mentors, and go with what feels right for you.

How many programs should I apply to?

The answer to this depends heavily on the strength of your application and the region/institutions you’re interested in. The goal is to rank ~10-15 programs with a range of competitiveness. Past panels of programs directors and residents have recommended applying to 30-50 radiology programs and ~10 preliminary surgery/medicine programs or 20+ transitional years that tend to be more competitive. Applicants with a strong application, regional ties, and a desire to stay in the midwest, for example, can safely apply to less than applicants with red flags, international/foreign graduates, or those couples matching. We suggest taking some time early in M4 year to look at your CV with some mentors to get an honest sense of the strengths and weaknesses of your application (we all have both)!

Letters of recommendation – Who? How many?

Most programs ask for 3 +/- a 4th if you’ve done significant research with someone. Of the core 3, some programs require no one than 1 be from a radiologist. Thus, a good strategy for IR/DR is one surgeon, one internist, and one radiologist +/- an additional close mentor.

Like many things in life, quality trumps quantity. A letter from someone who knows you well is generally going to serve you better than a big name that hardly knows you and writes a generic letter (it’s easy to tell the difference). That said, if you happen to have a big name that knows you well, that recommendation can go a long way. Radiology, especially IR, is a small world. Having someone well-regarded in the field write you a letter and, better yet, make some calls for you can have a lot of weight.

Personal statement – How to market yourself?

As mentioned above, spend some time early in M4 year reflecting on your strengths and weaknesses. What are the top 3 interesting things about you? What makes you unique? Where have you struggled or what aspects of your application may raise concerns? Draft this early and ask for lots of feedback from many different people.

Many people feel the personal statement is just a screen for red flags. Did you not take the time to catch a bunch of spelling/grammatical errors (not great for someone reading scans)? Do you seem arrogant, odd, or maybe unpleasant to work with for 5 years? Perhaps it is just a screen, but it can also be an opportunity to stand out and market yourself as a unique asset – what’s your story, why radiology, what makes you different? It is also a great opportunity to answer potential concerns. You might not have the luxury of answering these elsewhere if they don’t invite you for an interview. Low board score, gap in your education, applying to a competitive region, poor clerkship evaluation. Try to anticipate their questions a weave clear answers into your story.

Nailing your interview & beyond:

When are most interviews? How to schedule your 4th year accordingly?

It varies both regionally and between radiology and your internship programs. The east coast and midwest tend to interview earlier than the west coast. For example, many california programs do not send out invitations until November with most interview dates in Dec/Jan. Some TY and IM programs start interviewing in October while some surgery programs wait until February.

Try to schedule time off especially in Nov. – Jan. However, this isn’t always feasible. Other options include scheduling lighter rotations. Ask senior students at your institution for recommendations. Many attendings are understanding of needing to leave rounds to schedule an interview or missing a few days – they went through this too.

Love letters – When? How? To whom?

You may notice that much of this process is like dating. You decide who to invite, they decide if they want to meet in person. If you haven’t heard from them and know invitations have been sent out, it’s totally fine to send a brief, polite email to the coordinator and program director expressing your interest in the program. You also might be able to get a mentor to make a call for you. What’s not helpful is baraging the program with lengthy calls or emails. They are busy and this will likely annoy them.

The pre-interview dinner – Dos and Don’ts

They are “optional.” You should try your best to make them because it shows your interest in the program and is usually a great way to get a feel for the program from the residents. Have another interview the day before? Flight delayed? They understand. It’s not the end of the world if you can’t make it.

Dress nice but many are less formal. They will send you details ahead of time, so you can look up the place and plan your attire accordingly. Be a polite and interested guest. You’re not necessarily being evaluated, but some social faux pas are difficult to forget, e.g., getting obnoxiously drunk or bad mouthing other programs.

How can I prepare for the interview day?

Practice your responses to some typical interview questions (below). It can be helpful to do some mock interviews with mentors with feedback to avoid faux pas and gain confidence.

Make sure to do some research on the program before you get there. A favorite question is “why here?” Have a thoughtful answer. They will also ask you if you have any questions. Have thoughtful questions. Not questions that could be answered by looking at their website for 2 seconds.

What are IR/DR interviews days like?

They vary but generally involve some informational presentations on the program, a hospital tour, lunch with current residents, and series of ~15 minute interviews with 5-6 faculty members +/- chief residents. The DR interview day is usually a half day (AM or PM). If you are interviewing for both the IR and DR programs, many institutions will schedule it on the same day for an all-day interview. You often come a little earlier for additional presentations or hanging out in the IR suite and have additional IR interviews and a tour in the afternoon. Some programs have you attend a lecture, others have an additional social event for IR applicants, it varies so keep an eye out for interview day schedules from program coordinators.

 What are common interview questions?

Generally, both DR and IR interviews are very laid back. It’s like speed dating where both of you are just trying to get to know each other efficiently and you end up repeating yourself often.

(Common)
“Tell me about yourself?”
“How did you become interested in IR/DR?” or “Why IR/DR?” or “Why IR v. DR?”
“What’s your favorite IR procedure?”
“I see you’re interest in [hobby you listed], tell me about that?”
“I see you did [extracurricular], tell me more about that?” or “What did you learn from that experience?”
“Why are you interested in [the program]?”
“Where do you see yourself in 10 years?”
“Do you have any questions for me?” or “What can I answer for you about [the program]?”

(More difficult / less common)
“Where else are you interviewing” (technically against the rules, but it happens)
“Tell me about a challenging experience in your life.”
“Tell me about a time you failed / lost your temper.”
“What advice would you give to a first year student about how to be successful in medical school?”
“Tell me about your most challenging patient.”

Interviewing tips & common pitfalls?

Generally, try to relax, sit up straight, make eye contact, and don’t fidget. Do your best to make your answers sincere and seem spontaneous even if it’s the 10th time you’ve answered the question that week. Smiling appropriately (not incessantly) conveys trustworthiness. Try to mirror your interviewer’s body language and make it conversational. Remember your story and strengths and play to them without being arrogant. Be consistent in your self-marketing.

All of this is easier said than done, so practice with someone who can give you honest, constructive feedback.

Thank you notes – To send or not to send? How & who?

This is debatable. Some people send something to every interviewer, others only to the program director, and others not at all. If you’re going to, avoid cookie cutter thank yous. Make it brief but personal by making note of something unique you discussed with them. Most people prefer email, but there are exceptions and you can score brownie points by adjusting accordingly. If you’re going to send a thank you, consider reaching out to the coordinator about what is preferred, and don’t forget to thank them too. They are the unsung heroes of this process!