INTRODUCTION The residency match process for the 4th year medical student is stressful and nuanced. We have all been there. We are a multi-institutional group of surgical residents called the Collaboration of Surgical Education Fellows (CoSEF) who work together to foster peer mentorship, networking, and scholarly collaboration.1 Based on our collective experiences, we propose these 6 steps to find your perfect match for surgical residency and build your BRANDD: (1) Build a strong application; (2) Reflect on your priorities; (3) Assess your program list; (4) Navigate the interview process; (5) Detail your experiences; (6) Determine your rank list (Fig. 1).FIGURE 1.: Find your perfect match for surgical residency using this 6-step framework to build your "BRANDD".Build a Strong Application Building an application means telling your story. Step 2 Clinical knowledge scores, research productivity, clerkship grades, and Alpha Omega Alpha status are significant predictors for a successful match2; however, crafting a meaningful personal statement and obtaining strong letters of recommendation (LOR) allow you to be more than numbers on a page. Your personal statement speaks directly to programs, providing important contextual information and describing the unique qualities you will bring to a surgical program. Your personal statement should "show, not tell." Use personal experiences to demonstrate qualities that will make you a good surgeon, and let your passion for surgery shine through. Start writing as early as you can; continually edit using feedback from surgical mentors, family, and friends who know you well. However, make sure to maintain your voice through this process. If you are true to yourself, you will attract the right program for you! LORs are impactful. Most are very positive, so mediocre and impersonal letters stand out negatively. The ideal letter writer is someone who both knows you well and is well-known within the field of surgery. Set yourself up for success at the start of a rotation; ask residents to help you identify potential letter-writers and spend as much time with them as possible. If you are confident in who you will ask, let the faculty know early during the rotation that you plan on asking them for a LOR. This will encourage them to take notice of you and potentially write a more impactful letter. When asking for a LOR, confirm with the potential letter writer faculty at the end of the rotation that they feel comfortable writing you a strong letter of recommendation; this gives those who will not advocate strongly on your behalf an opportunity to tell you in advance. Follow-up with an email containing your curriculum vitae, personal statement, ERAS upload code, and due date. Despite good intentions, sometimes attendings are unable to upload your LOR in time. Be prepared and get 1 more letter than you need, just in case. Reflect on Your Priorities What does your perfect workday look like? What makes you happy? The answers are different for everyone. Surgical residency is wonderful, yet grueling, with large studies demonstrating 69% of surgical residents experience burnout.3,4 Matching at a program that maximizes your happiness and fits your priorities is critical. Do you like research? Some programs mandate 2 years. How important is geography? Do you want to live close to family? Are there direct flights home? How about a rural or urban location? Are you considering a competitive fellowship? Has this program matched residents into that fellowship? Is it important that you rotate at a VA, community site, or specialty center? Think about your days and nights off; what activities outside of work excite you? There are a million questions. Make a granular, detailed wish list of what elements your perfect match would possess. List how important each factor is to you and what you can live without. This will help you identify and focus on residency programs that best suit you. Assess Your Program List Take an honest look in the mirror—along with trusted mentors—to determine where to apply. Mentors experienced with residency applications include medical school deans and general surgery program directors. Reach out to recently matched general surgery residents; however, remember that their applications and residency goals were likely different than yours. Additional resources, such as the National Resident Matching Program's Charting Outcomes in the Match5 and Fellowship and Residency Electronic Interactive Database Access (FREIDA),6 can provide a national perspective on match likelihood. Utilize your priorities, mentors, and these additional resources to help determine where you will and will not apply, and how to allocate your signals.7 Navigate the Interview Process Do not leave interview preparation until the last minute. Work on drafting answers to classic interview questions: "Tell me about yourself," "Why surgery?," and "Why our program?" Reflect on impactful experiences as they happen and on others throughout your life; these will be perfect for answers to many interview questions. How do you want interviewers to remember you when they have their rank-list meeting? Work on crafting a cohesive narrative between your interview answers and the rest of your application. Remember you are interviewing the program as much as they are interviewing you. Look back to section "Reflect on Your Priorities": what are your priorities, what is not on the website, and what clarifications are needed? Research each program and come prepared with a program-specific list of questions. Practice interviewing! Be proactive: ask your medical school, home program, friends, and family for mock interviews. Once you are happy with your answers, the goal is to balance their delivery between "rehearsed" and "conversational." Do not forget to practice as you play; if your interviews are virtual, practice virtually: ensure a quiet environment, appropriate background, and reliable internet connection. Finally, remember why you are doing all of this; let your passion shine through. Surgery is amazing; do not get so wrapped up in 'getting the right answer' that you forget to show off your authentic self! Programs have limited, overlapping interview days. Many advertise their interview dates; try and make a calendar with these dates so when scheduling interviews, you can mitigate conflicts. Although programs should only extend as many invitations as they have interviews,8 not all programs do. Respond to interview invitations promptly both to secure an interview and select your preferred day. If you are on clinical rotations during the interview season (and possibly scrubbed in), have a trusted person monitor your email and schedule interviews on your behalf. If you must cancel an interview, do so as far in advance as possible out of respect for the program and to allow another applicant to interview. Finally, we recommend scheduling the interviews most important to you mid-season so you are practiced but not burned out. Detail your experience Just as you are selling yourself to programs, programs are selling themselves to you. It is a "match" after all! However, most interview days will feel very similar. It is up to you to listen closely to what programs do and do not emphasize. Watch how the residents interact with attendings and with each other. Can you see yourself thriving in that environment?9 Take notes during and immediately after the interview day about program-specific answers to your questions and your 'gut instinct.' Create a tentative rank list as you interview, comparing each new program to previous ones. Do not wait to create your rank list until February, as everything blends together at that point. Know that there is no 'gaming' your final rank list; just place programs in your preferred order. The interview day should not be your only contact with a program; additional events like open houses and preinterview socials can provide useful insights. These events often allow you to meet residents in a casual setting. Attend as many as you can (and take notes!). Seek additional information about programs by reaching out to other medical students, residents, and faculty with ties to that program. Consolidate all pieces of advice, but recognize that individuals may have outdated, incomplete, or biased information. Finally, thank you notes, updates, and letters of interest are all potential, yet sometimes controversial options to consider (Table 1). TABLE 1. - Controversial Topics in Application to Residency Topic General Thoughts Thank you letters/Emails Thank you letters for interviewers and administrative staff can help you stand out, especially when referencing specific conversations. You can often obtain interviewers' emails from the interview administrator, if not otherwise given, and send them within the next 24 hours. However, we recommend respecting a program's wishes regarding thank you letters; if they state they do not want thank you letters, respect their request! Social media use Surgical residency programs are increasingly using social media. You do not need social media accounts for the application process. However, social media often provides a window into a program's day-to-day workings (resident posts/program updates/upcoming research presentations). On your end, be thoughtful about what you share on social media. For example, if you post that program X is your top choice, know that other programs will likely see that information. Letters of interest When you have not received an interview invite from one of your dream programs, a letter of interest can be a useful tool. However, such letters are most impactful if specific and thoughtful. These may take a lot of effort to write effectively in an already stressful time, and ultimately may not yield an interview. Also, consider asking a trusted advisor to reach out to the program on your behalf–it can be done concurrently and works best if your mentor has a direct connection to the program of interest. Letter of intent Sending a letter of intent to your top choice program after your interview can be a great choice. Make sure it is well written and honest, and that it explains clearly why they are your top choice. Program directors talk and if they find out you sent multiple "you are my top choice" letters, you could be removed from those programs' rank lists. Update letter If you achieve any major accomplishments during this process, you can reach out to program directors with updates to bolster your application. Only include details you feel will truly help your overall application. These updates are often best received as part of a well-written and researched letter of interest or intent. It can be sent as a generic letter to all programs but may not be as impactful. Determine Your Rank List You do not know what you do not know. Throughout this process, you will learn more about yourself and what is important to you. Programs will surprise you for better and worse. Maybe residents do not seem happy at your dream program, or you fall in love with a program you did not like on paper. Your priorities may drastically change throughout the interview process. If needed, reach out to programs with additional questions to make an informed decision. Finally, reconcile your updated priorities with program characteristics and submit your rank list! CONCLUSIONS This application process is the culmination of years of your hard work. Regardless of where you are in your journey, we hope this article provides insight into this process and empowers you to build your BRANDD while finding your perfect match for surgical residency! For further reading, Table 2 contains some additional resources that we found helpful. TABLE 2. - Additional Resources for Applicants that were Helpful to CoSEF Members Component of Application Additional Resource Build a strong application • ACS: National Professional Development Seminars for medical students10 • AAMC: resources on applying to residency11 • What factors influence the match manuscript2 Reflect on your priorities • An overview on signaling article12 • Signaling, geography, and interview offers video13 • Suggestions for applicant signaling manuscript7 Assess your program list • National Resident Matching Program (NRMP)5 • Fellowship and Residency Electronic Interactive Database Access (FRIEDA)6 Navigate the interview process General interview preparation:• Behind the knife: dominate the match14 • AAMC: interview resources for applicants15 • University of Washington: overview of the interview16 Virtual interviewing:• AAMC: preparing for a virtual interview17 Interview Questions:• STATPEARLS: interview overview and questions to prepare to answer18 • AAMC: questions frequently asked19 • ACS: questions to ask programs20 • AAMC: questions to ask programs21 Detail your experiences • AMA: recorded discussion: What to do after your residency interview22 • 5 things you need to do after your interview - bullet points to follow23 • AAMC: residency program evaluation guide24 Determine your rank list • NRMP: how the match works video25 • AMA: creating a match rank order list - avoid these 4 common missteps26 • AAMC: residency preference exercise27 AAMC indicates Association of American Medical Colleges; ACS, American College of Surgeons; AMA, American Medical Association; NRMP, National Resident Matching Program. Best of Luck, CoSEF
