Ah, internal medicine, possibly one of the more cerebral specialties and ironically the most poorly talked about. Bad hours, never-ending paperwork, and complex casesmaybe you’ve heard it, I definitely have. All I know is that I’m hurtling cross-country towards my new life as a PGY1 IM intern at 70 mph in my dad’s black ’99 Toyota Camry and I couldn’t be more excited. If you hope to be in a similar position next year, hopefully the next couple paragraphs will help you out.


Year 3

Do well on your USMLE Step 1

Before talking about specialties it’s probably wise to mention this caveat. As much as I wanted to be a dermatologist-neurosurgeon-hybrid in space I don’t think my grades would have made the cut (not ashamed). So what are the average USMLE scores of 2014’s successful matching class?




So you can see here that the averages for IM are slightly above the average for both US and independent graduates. Naturally the more competitive programs require higher scores and programs in less desirable locations/community programs are more forgiving. There are obviously exceptions to the rule but for the most part I’d say this is accurate. If you have your eyes on a prestigious/academic program shoot for high scores and for those interested in local programs the averages can be a good benchmark. Sometimes people with lower scores ask me if I would apply in their position and I tell them absolutely. The averages you see above still follow the basic conventions of statistics (standard deviation/bell curve) so people with a wide range, both low and high land seats.

High Pass/Honor your Clinical Rotations

Your evaluations during third and fourth year of medical school are smack-dab in the middle of your ERAS application. The grades you earn as well as any comments (good or bad) are seen immediately by anyone going over your application. Do the best you can on these rotations and shoot for honors. Historically it is said that IM and Surgery grades carry extra weight. I just acted like all of them were super important and tried my best.

* Your Sub-I in Internal Medicine is important for several reasons A) It will provide you a great opportunity to ask for a letter of recommendation B) The eyes of people reading your application will probably linger on this part for a split second longer—so do well C) It provides you with experiences to talk about for your personal statement & interview

Do extracurriculars/volunteer work/research that you care about 

If you want to be a surgeon than doing a random psychiatry elective abroad—though better than nothing at all—won’t help your case as much as if you did something related to your field. This goes for all the activities you participate in outside of academics. The residency committee knows when you are padding your resume or if you are trying to do something that you believe in. Long story short, even though its never going to hurt you to participate at any level, try and be involved in activities that say something about you and mesh with your personal narrative.

*Writing was something that I enjoyed and I tied it into medicine by getting involved in narrative medicine via different websites and magazines. This was brought up at every interview I attended. The point here is I took something outside of medicine–writing–and applied it to the profession. I suggest a similar approach to your extracurriculars.

**Research is always a positive. Just be sure you know what you are talking about.

Year 4

Get great letters of recommendation

The only way to manage this is to work hard during your time in the hospital. Look up research articles; present cases; help the residents and interns; be interested (not annoying). The letters from attendings who can write personally about you are the best; letters from individuals in leadership positions (chairmen, directors, etc.) who can do the same are probably better. Medicine is a small world so letters from a physician who the reader knows can help your case.

Write a killer personal statement

I like to think of the personal statement like this. It’s the only thing in your profile which you have complete control over. What you choose to talk about says a lot about you. Are you focused on volunteer work? Educater-roles? Research? Surprisingly the measly four-paragraph essay ends up saying a lot more about you than you’d expect so make sure you put in the right things. Show yourself in a positive light and be proud of how hard you’ve worked!

Pick your programs wisely

For IMGs that means A) applying broadly B) choosing programs that accept IMGs C) Paying attention to score cutoffs.

When I applied I chose programs based on where prior graduates of my school had gained acceptance. That’s an easy way to narrow down the list of programs before diving in.

Interview Season

Ace the interview (click here)
Follow up with programs

I recently had a reader ask me what the best way to communicate with programs is. Different people say different things, but here’s my take on it:

What you should definitely do: A) Send a thank you email/letter to everyone who interviewed you. This is very important. B) Send the program that you intend to rank first an email that you are doing so and why. There are a lot of templates online for this and I think it helps because programs want residents that want to be there.

What you should do if you feel strongly about it: A) Send programs an interest email if they haven’t given you an interview yet. I’ve heard people obtain a couple interviews from doing this though it didn’t work out for me. Late October/early November is a good time.

What you should not do: Do not send emails of interest a couple weeks after ERAS opens; most programs are still receiving and going through applications. Further: Do not continuously email programs about your interest; meditate over the difference between “eager” and “annoying”.

Wrapping it up

Internal medicine has the greatest number of spots available in the US. That means there are a wide range of scores that can land you a seat. Still, to give yourself the best chance aim for the average that year (as per NRMP) and if you are an IMG it always helps to break it for both Step 1 and 2. Do well in all the other aspects of your application and apply broadly. It’s not on the same level of competitiveness as Radiology, Anesthesiology, Surgery or ER but you still need a good application if you want to attend a good program. Hope this helped, good luck future doctors!

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Dr. Barbara Edwards (Princeton)Dreamer DocLuis Hernandez Recent comment authors
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Luis Hernandez
Luis Hernandez

Thank you sir, good post, I really enjoyed and I wish you the best in your journey. Would you tell me about how the PGY-1 looks like? thank you so much!!

Dreamer Doc

Hey Luis! PGY-1 is a little different for everyone obviously depending on where you did clinical rotations in medical school and what the culture was like in that hospital. Hopefully you go to a program that caters to interns and provides them with adequate supervision and feedback — that was one of the aspects I liked at my own program. I think one of the things you notice starting off is the steep learning curve transitioning from “book learning” to actual practice where not everything you see or do is as cut and dry. It’s honestly an amazing experience though… Read more »

Dr. Barbara Edwards (Princeton)
Dr. Barbara Edwards (Princeton)

Great post! This article can help calm nerves and get organized in ones pursuit to become a doctor!