So, I’m reading Iserson’s Getting Into a Residency and it’s bumming me out. The suggestions [paraphrased] like “get honors”, “pick a specialty (but the right one!) early” and “spend your extra time doing clinical volunteering” and my favorite “come in early and leave late on your clinical rotations” are making me feel like I won’t be competitive. So, I thought a poll might make me feel better. Feel free to answer whether you are a student or a resident. If you’re like me and haven’t hit clinics yet, just say what you are planning to do.
I meant to say: feel free to answer no matter where you are in the process now. I know some of the answers aren’t optimal, but it was too hard to plan it all ahead. Sorry!
This post can also be a place to discuss choosing a specialty, a mentor, or anything else. Might liven up the Med School forum for a day or two. 
Pam
Pam, Iserson stressed me out too. Here are my golden rules:
GRADES - do as well as you can, this helps keep your options open. At some point you’ll discover what level of effort you require to get good enough grades. Dave Kelley observed this weekend that the effort required to get As instead of Bs is an “exponential difference,” and that’s a good way of looking at it. My own feeling was that I was working as hard as I could and I was NOT going to give up sleeping or talking to my family, and if that meant P=MD, so be it. But I would’ve kicked myself if I’d realized fourth year I wanted to be an ophthalmologist. So do the best you can, determining your tolerance level for work and studying.
DO WELL in your clinical rotations. Doesn’t have to be honors (in my opinion) but you want to make a good impression. Generally this means making sure the work is done, don’t whine, be helpful, a good team player. There was no way in hell I was showing up earlier than I had to. I guess maybe sometimes my interpretation of “had to” got me a little extra time, but it was because I needed that much time to pull up all the labs, write notes, whatever. I wasn’t showing up before the crack of dawn for my health, that’s for sure. Don’t be a gunner and show up your teammates. Residents see right through that crap and don’t care for it generally.
CHAT UP your attendings on clinical rotations, and at the conclusion of the rotation, ask if they will be able to write you a strong LOR for your residency application. If they agree, work out the timing - some will want to do it right away, others will tell you to get back to them later. (Corollary: get guidance from your Dean’s office on how they want to handle LORs sent in before they’re geared up to take them for ERAS.)
KEEP AN OPEN MIND about specialties. Go into third year expecting to enjoy something about each rotation, and be enthusiastic even if you’re pretty sure it won’t be your thing.
If it turns out you’re one of those folks still pondering at the conclusion of third year, arrange your fourth year schedule to expose you to more possibilities as early as possible.
Do an audition rotation.
If at the conclusion of third year you realize that you really want to pursue a field where you did kinda mediocre in that rotation (this happened to a few of my classmates), then schedule a sub-I (acting internship) in that field as early in fourth year as you can, and do a bang-up job that month so that you can get a glowing recommendation from that experience in place of your third year experience.
I’m sure there’s more but that’s off the top of my head. Volunteering during medical school - yeah, right. Actually I was stupid enough to continue helping with my daugher’s synchronized skating team until the end of my second year (this was insanity on my part) and you know what, I realize now that I didn’t even list it anywhere since it wasn’t health-care related. Oh well.
Mary
Thanks Mary,
Thanks for the help! There is lots of good info in the book, but it’s definitely written for gunners! I talked to a 3rd year about it, and she was intimidated that I had already read it. Lol.
I’m trying to arrange some clinical volunteering during my break (July). We’ll see how that goes. Other than that, I’m not going to sweat it right now (even though I start clincials in only 6 months - yikes!).
Pam
Hi there,
Iserson is a little dated in many aspects. Your best source of information on residency applications and the process will be the folks who are the year ahead of you. That being said, there are some specialties such as Neurosurgery, Derm, Optho, Ortho that you need to track early and you need to do very well in both your coursework and your USMLE Step I in order to get interviews. Neurosurgery is very unforgiving because of the low number of residency slots nationwide.
As a first or second year medical student, you can join a specialty interest group or two at your school so that you become familiar with the application process at every step along the way. You also need a good faculty advisor once you have decided on your specialty. This person should not be a department chair but an associate professor who can guide you. This person should have some solid knowledge of programs that are out there and should have a good relationship with the department chair.
Specialties such as Internal Medicine, Family Medicine, Pediatrics, and Psychiatry have many slots at excellent programs so you don’t have to stress about getting in.
Other specialties such as General Surgery, Anesthesia, Radiology etc are very program dependent and require more research into which programs are a good fit for you or if you are even competitive for these residencies.
Application for residency is very different from application for medical school. There is little difference between the person who is first in the class and the person who is last in the class as long as you pass your coursework. At this point, look to your upperclassmen for the best advice.
Natalie 
Pam,
I affectionately refer to Iserson as being somewhat of an “Application Nazi”. Some of his info is dated and some of it over the top. But, it does provide a solid framework within which you may devise your own application strategy. I found his test to select a specialty patronizing and not helpful. His format for evaluating individual programs in the interview trial was overly strict & cumbersome; however, it does prompt you to think about & seriously consider aspects of programs & cities that you may not have previously considered.
As with anything & everything you read as a physician - you must read it critically. Sort the wheat from the chaff and use the info to your advantage.