The Personal Statement for Residency Application: Review and Guidance

All applicants to US residency programs are required to write a personal statement. Recent reports of plagiarism and homogeneity in these freeform essays suggest the need for better guidance in this process. The authors review the historical and current role of the personal statement and provide a practical framework for writing a unique and effective personal statement, which will help both applicants and residency directors to maximize their chances of a successful match.

Keyword: education

J Natl Med Assoc. 2011;103:439-442

INTRODUCTION

The personal statement is a required component of every medical student's residency application. It is a freeform essay meant to describe the medical student as an individual beyond the lists of experiences and accomplishments recorded elsewhere in the application. Residency directors use personal statements to select candidates for interviews and to guide interview questions. They may also predict future performance, though research on this topic has shown mixed results.1,2

Some have argued that the personal statement has become homogenous and does not allow residency directors to effectively distinguish between candidates due to the availability of online guides and sample statements, as well as a common perception that personal statements must conform to certain rigid criteria to achieve success.3,4

At the same time, the freeform nature of the personal statement may render it an easy medium for stretching the truth. A survey of family medicine residency programs found that, among application materials, 56% of perceived acts of deception (defined as active misrepresentation or omission of facts about one's qualifications, background, or abilities, including choice of specialty) were found in personal statements.5

There is also growing concern about plagiarism.6 One study used specialized software to compare 4975 essays submitted to residency programs at a large academic medical center to Internet pages, published works, and other essays. The authors found evidence of plagiarism (defined as a match of >10%) in 5.2% of statements across specialties and medical schools.6 As of recently, guidelines for the Electronic Residency Application System (ERAS) address plagiarism and warn students against using uncredited information from sample personal statements posted on Web sites, noting that this meets the definition of plagiarism.7

The results of Segal et al and the difficulty in assessing an applicant's true contribution to a written work have prompted some to propose that the personal statement be eliminated as a form of evaluation.3 However, as this suggestion is unlikely to be implemented in the near future, there is a great need to promote the creation of original, effective personal statements that serve their intended purpose.4

Though the work of writing a personal statement distresses thousands of students each year, the medical literature contains little guidance on how to write a cogent essay. ERAS instructions simply note that the statement is limited to 28 000 characters (approximately 8 pages).7 As a result, students might resort to costly online editing services or approach willing but inexperienced faculty members to review their drafts.3 There are few online resources that offer generic advice.8,9 Some medical schools are beginning to offer handbooks or workshops to help address this issue, but these efforts have not been standardized.

In response to student requests, Harvard Medical School began to offer a formal personal statement workshop in 2006. The session provides general do's and don'ts as well as personalized feedback on statement drafts. As instructor for this workshop, one of us (C.A.) has reviewed hundreds of personal statements for a variety of residency programs. The other author (I.G.) is a journalist and resident physician in the Massachusetts General Hospital Internal Medicine/Primary Care Program.

The objectives of this manuscript were to review the role that the personal statement plays in the residency application process, to provide a framework for writing an effective personal statement, and to address the common misconceptions and challenges associated with this exercise in order for both students and residency directors to maximize their chances of a successful match. This academic project was exempt from institutional review board approval.

THE MEDICAL STUDENT'S PERSPECTIVE

The medical student's goal in writing a personal statement is to weave a lucid and favorable depiction of his or her personality, activities, and aspirations. Major impediments to this goal include lack of time or focus due to clinical responsibilities, studying for the US Medical Licensing Examination (USMLE) Step 2 board exams, and indecision regarding choice of specialty. Medical students often struggle to create a cohesive narrative out of their pursuits, especially if they must prioritize among a long list of extracurricular activities, research projects, international experiences, and leadership positions. On the other hand, students with a dearth of such experiences may be more likely to plagiarize their essays.6 Nonnative English speakers often worry about grammar, word choice, and transitions. The study of personal statements found that non-US medical students and applicants indicating fluency in a language other than English were more likely to show evidence of plagiarism than US students.6

While college and medical school applicants have incentive to maximize their number of acceptances, it is in the residency applicant's best interest to represent him or herself honestly in order to match with the program that fits him or her best. However, there remains strong incentive in a competitive job market to boost credentials.10 On the whole, students tend to overestimate the importance that residency directors assign to the statement, which varies widely between programs and specialties.

THE PROGRAM DIRECTOR'S PERSPECTIVE

Programs evaluate residency applicants using a combination of qualitative and quantitative factors, including USMLE scores, third-year clinical grades, personal statement, and letters of recommendation. The residency director views the personal statement as one of several ways to get to know applicants and rarely bases a decision on this narrative alone. The personal statement is time consuming to evaluate, so directors value concision. The earlier in the process that the application is submitted, the more time the reviewer might have to closely review the statement.

When reading personal statements, residency program directors evaluate quality of writing in addition to content. In a survey of personal statements for an anesthesia program, applicants offered an interview had higher-ranking essays-based on characteristics such as grammar, word usage, and organization-than those who were not offered an interview. However, these quality rankings were closely associated with the applicant's file screening score, suggesting that essay quality alone may not account for this result.4

Directors look for evidence of professionalism and for signs that the applicant might be difficult to work with, such as egotistical or condescending remarks. They also look for evidence of deception: a survey of residency directors suggested that they are more likely to systematically verify personal statements for accuracy than other application materials.5 These efforts may intensify in light of reports of significant rates of plagiarism in essays.6

The personal statement carries different amounts of weight for different specialties. One survey of 2 types of programs found that family medicine residency programs considered the personal statement the second most important determinant of whether the applicant is granted an interview, second only to the dean's letter, and that 52% of these programs found it "highly useful." In contrast, obstetrics/gynecology programs ranked it sixth, with only 18% finding it "highly useful."11 The authors suggest that specialties based on the biopsychosocial model, such as family medicine and psychiatry, take more interest in the personal statement. They also suggest that less academically competitive specialties are more likely to assign greater weight to personal statements than to quantitative academic factors. However, despite an increase in match rates for family residency, this specialty has retained its emphasis on students' written philosophies about their chosen field.12 In a survey of emergency medicine residency program directors, the personal statement was ranked as the least important factor in selecting residents.13

Because residency directors read so many essays, only the stellar or poorly written statements may stick out in their minds.11 However, the value of the personal statement extends beyond the decision to invite applicants for an interview. In a survey, while only 41% of anesthesia residency directors considered the personal statement very or somewhat important for selecting interview candidates, 88% of them noted using them as topics of conversation in these interviews.4

WRITING THE PERSONAL STATEMENT

In general, students are encouraged to write a 3- to 4-paragraph statement that is no more than 1 page in length, though expectations about length vary by specialty. As a rough guide, programs that place greater emphasis on the personal statement may tolerate and even expect essays that exceed 1 page, compared to more procedurally oriented specialties. The final version should be carefully proofread by a number of people for spelling and grammatical errors, awkward word choice, and effective transition and flow.

Generally, it is not necessary to write more than 1 statement to apply to a given specialty. It is risky to name a specific program in an essay, since it may be submitted accidentally to the wrong program. Students applying to a subspecialty that requires separate application to a preliminary year may use the same personal statement for the subspecialty as long as they tailor the statement to the goals of the preliminary year and how the experience will help prepare them for the subspecialty. Students who apply to more than 1 specialty have the challenging task of being authentic in each personal statement.10

GETTING STARTED

The first step is brainstorming (Box). It is worth spending some time in honest deep reflection before setting pen to paper.10 Students often find it helpful to verbalize their stories in order to connect the dots among their past experiences, current activities, and future career aspirations.

CONTENT

Unique Personal Qualities

The applicant should highlight the personal characteristics that make him or her an ideal candidate for the specialty and the residency program. Personal stories make statements more original and compelling and may be associated with a higher likelihood of receiving an interview.4 These stories do not have to be confined to the medical context. You can write about what you do for fun. In any case, use details to show rather than tell what makes you unique. For example, rather than writing that you like music, describe your experience performing a sonata by Chopin.

Career Choice

The applicant should demonstrate a broad understanding of the specialty to which he or she is applying, including its positive and negative aspects, and show that he or she has made a thoughtful decision. For example, a structured analysis of 670 personal statements submitted to the anesthesia residency program at Brigham and Women's Hospital found that "interest in physiology and pharmacology," "enjoyment of a handson specialty," and "desire to comfort anxious patients" were discussed in the majority of essays.4 If possible, it is helpful to show a track record of commitment to the field through work, volunteer, and research pursuits.

Program Choice

The student should demonstrate why he or she has selected a certain type of residency program-for example, one with emphasis on clinical skills, community practice, research, or education-and how it would meet his or her educational needs. In a survey, residency directors ranked compatibility with their program as the most important personal or professional characteristic used in choosing applicants.14

Short- and Long-Term Goals

The applicant should posit a clear vision of what he or she intends to do within the specialty in the short- and long-term. Examples of academic accomplishments can help support this vision.

BALANCING STRUCTURE AND CREATIVITY

The applicant should strive for a personal statement that best describes him or her as an individual by using their creative writing skills within some basic boundaries. The suggestions offered below should be viewed as a helpful starting point for applicants with writer's block and not as strict requirements, particularly in light of arguments that statements have become too homogenous.

The statement can start with a hook that will grab the reader's attention and make him or her want to read more. One effective way to do this is through a personal or patient story that can be referenced throughout the narrative. In the study of statements written by applicants to an anesthesia program, more than 30% of statements discussed a case from medical school, while 17.2% mentioned a personal illness or that of a friend or family member.4 The story can be developed quickly within the first paragraph. By the end of this paragraph, the reader might also learn which specialty the medical student has chosen.

In the second paragraph, the applicant can use examples to demonstrate why he or she chose a given specialty. Here, he or she might describe a particular clinical experience or an interest developed in childhood. The third paragraph can focus more on what the medical student hopes to do in the future within the specialty-such as clinical practice or teaching. If the student is unsure, it is perfectly reasonable to state this or to mention seeking faculty mentorship to help him or her develop a niche. The essay might end with a strong and positive statement that ties together recurring themes in the essay and looks toward the next phase of the student's professional career.

EXPLAINING RED FLAGS

The personal statement may be an appropriate forum to explain major deficiencies in a student's record such as academic suspensions, expulsions, and failing USMLE step scores that are sure to be brought up during interviews. Students should discuss how to handle such circumstances and any other unique situations, such as medical disabilities, with mentors who know them well.

AVOIDING PLAGIARISM

It is important to not copy the work of others, whether it is found online or in print.15 ERAS now has a dedicated investigations team to detect evidence of plagiarism (ERAS support staff, October 22, 2010). ERAS guidelines note that

Any suspected acts of plagiarism will be investigated by ERAS. Any substantiated findings of plagiarism may result in the reporting of such findings to the programs to which you apply now and in subsequent ERAS seasons.

CONCLUSION

The personal statement is a freeform essay required of every medical student applying to residency programs in the United States. Personal statements remain an important component of the decision-making process for residency programs and help guide the tone of applicants' interviews. The goal of this framework for writing an effective personal statement is to help both medical students and residency directors maximize their chances of a successful match.

[Sidebar]

Box. Questions for Brainstorming

* What experiences have shaped you?

* What influenced your decision to go into medicine?

* What are you passionate about within medicine?

* What are you passionate about outside of medicine, and how does this relate to your professional pursuits?

* What do you do for fun or to maintain balance in your life?

* Why did you choose this particular specialty?

* What theme or theme(s) connect your activities?

* What qualities set you apart from other students?

* What type of residency program would you thrive in and why?

* What are your short-term and long-term goals?

* How would you summarize your story in a 2-minute elevator pitch?

[Reference]

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15. Trip G. Plagiarism Lines Blur for Students in Digital Age. New York Times. Aug. 1, 2010; A-1:1-2.

[Author Affiliation]

Christian Arbelaez, MD, MPH; Ishani Ganguli, MD

Author Affiliations: Harvard Affiliated Emergency Medicine Residency Program and Harvard Medical School (Dr Arbelaez), Office for Multicultural Careers Brigham and Women's Hospital (Dr Arbelaez); Department of Medicine, Massachusetts General Hospital (Dr Ganguli), Boston, Massachusetts.

Correspondence: Christian Arbelaez, MD, MPH, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (carbelaez@partners.org).