Home > Last Exit: 4th year, the Match, and Residency��

Last Exit: 4th year, the Match, and Residency��

A D.O. Student��s Guide to Residency  

Where Does It End? 

Draion M Burch, DO

Council of Interns and Residents

American Osteopathic Association 



  • The goal of this lecture is not to persuade any osteopathic medical student to pursue any particular specialty, residency program or D.O./M.D. postgraduate training. The purpose of this lecture is to help you make an informed decision. The information in this lecture is subject to change!


  • 2nd year
      • CV
      • Portfolios
      • Research
      • Academic File



  • 3rd year
    • Unique Rotations
    • Evaluations on Rotations
    • Choosing a specialty
  • 4th year 
    • Budgeting
    • Scheduling and Applying for Elective Rotations
    • ��Audition Rotations�� and Acting/Sub-Internships



  • 4th year (con��t)
    • Boards- (COMLEX Level 2/ USMLE Step 2)
    • Tips for selecting a residency programs (AOA vs. ACGME)
    • Preparing to Apply for Residency
    • Electronic Residency Application Service (AOA vs. ACGME)
    • Residency Interviewing Skills
    • The Match and Scrambling Processes (AOA vs. ACGME)
    • Requirements to Start Residency (AOA vs. ACGME)



  • Post-doctoral
    • Medical Licensing/Board Certification (AOA vs. ACGME)
    • Osteopathic Approval of ACGME Postdoctoral Training Programs -Resolution 42



2nd year  


By the end of your 2nd year 

  • Update Curriculum Vitae
  • Start Portfolio
  • Conduct Research
      • Student Researchers are more desirable to competitive residency programs!
  • Review Academic File
      • Make copies of items in your academic file for your portfolio!


Curriculum Vitae Essentials 

  • Identification Information
  • Education
  • Work Experience
  • Leadership
  • Research
    • Publications, Poster Competitions, Presentations
  • Professional Experience
  • Professional Affiliations
  • Military
  • Volunteer Activities
  • Honors & Awards
  • Special Skills
  • Hobbies & Interests
  • References

Portfolio Essentials 

  • Title Page with identification information, objective��
  • Table of Contents
  • Curriculum Vitae
  • Personal Statement
  • Evaluations
    • Clinical evaluation summary, recommendation letters, etc��
  • Honors
    • Top 10% letters, Scholarship Awards, Certificates, etc��
  • Research
    • Publications, Posters, Protocols, Papers not published, etc��
  • Lectures
  • Public Relations
    • Newspaper articles



3rd year  


Unique Rotations To Consider  

  • Research Rotation
  • International Rotation 
  • International Research Rotation 

Do a research rotation at a residency program of interest! 




Evaluations On Rotations 

  • During your clinical years, you will receive grades per rotations.
  • Try to earn HONORS on all of your clinical rotations- especially in your specialty of choice.  


By the end of 3rd year  

Time to Choose a Specialty 

  • You should have narrowed down your choices of specialties to 1-2 .
    • You can apply to more than one specialty via ERAS!
  • If not, don��t worry��yet! The earlier you decide, the easier this process will be for you.   
  • Once you have decided on a particular specialty,  apply for out rotations/electives in either this field or in one of its subspecialties.  



4th year  



  • Expenses during 4th year include:
    • Boards USMLE Step 2 &/or COMLEX Level 2
    • COMLEX Level 2 Physical Examination/Clinical Skills + Travel expenses to testing site
    • Elective Rotations
      • Application Fees, Travel expenses
    • ERAS application
      • The number of programs you are applying to
      • The number of specialties you are applying to
      • Transcripts (COMLEX/USMLE and Medical School)
    • Interviews
      • Travel expenses such as flights, hotels, rental cars, meals
  • Costs can range from ~$100-$5,000


Elective Rotations 

  • Visit potential residency programs by applying to do elective rotations or acting internships (AI)/Sub-internships (Sub-I).
    • Try to rotate in these residency programs between July-Dec. Try to interview while you are rotating there!
  • Pursue a well-rounded medical education��this is your last chance to truly see anything and everything before you begin your residency or internship.  


Elective Rotations 

  • Elective rotations are just what they say. You get to choose what you want to do.
  • Complete rotations that will help you get a well-rounded education.  
  • Use this time to see various residency programs.  
    • If a program director is in a specific subspecialty, do an elective rotation in that subspecialty!


Elective Rotations 

  • Check hospital websites for:
    • Intern and residency programs (Graduate Medical Education Links)
    • Application requirements and deadlines for elective rotations
    • Student (Extern) Rotation Application Form- may be an online application process.



Elective Rotations 

  • Apply for elective rotations 3-6 months in advance.
  • Hospitals will fill these rotations with their home medical school students before they place students from outside schools. 
    • However, if you apply early you will be on the top of the ��outside�� school pile. 
  • Some hospitals charge an application fee  
    • $20-250


Elective Rotations 

  • Some hospitals do not provide housing, travel expenses, or meals.
  • Apply to 2-3 rotations for the same month.  
    • You may be rejected from an elective rotation.
  • Cancel a rotation if you have another scheduled that you plan on completing so other students can have the same opportunities as you.   


Elective Rotation Paperwork 

  • Hospital Student Application Form
  • Immunization Records
  • Letter of Good Standing
  • Professional Liability Insurance Certificate
  • Copy of Transcript
  • Copy of USMLE Step 1/COMLEX Level 1
  • CV or resume
  • Criminal Background Check/Fingerprint Analysis
  • Additional paperwork specific to the hospital may be required.



Elective Rotations 

  • Most students will agree that you should try to schedule one or both of the following:
    • ICU rotation
    • Acting/Sub-internship

Elective Rotations 

  • Most students will agree that you should try to schedule one or both of the following:
    • ICU rotation
    • Acting/Sub-internship


  • You and another student are paired up for the month. The two of you equal one intern. You assume the responsibilities of an intern in terms of call, admissions, and discharges.
  • Glimpse of intern year while still having someone looking over your shoulder. 
  • Chance to shine and show a particular program what you are capable of. 
  • Great way to get a good letter of recommendation, which carries more weight. 


��Audition�� Rotations 

  • Remember: rotations at hospitals you will be applying to for residency should be considered ��Audition�� rotations.
  • Show the program why they should take you. Get your face seen and known. This way when they receive your application they will remember the impression you left.  



By now, you have completed and passed USMLE

Step I and/or COMLEX Level 1. Many students ask: 

  • Do I need to take step 2/level 2 before I apply for residency?
  • Do I need to take the USMLE to apply to an allopathic program? 


When to take USMLE  
Step 2/COMLEX Level 2?

  • You should take the your second set of boards

(including the PE) by the late summer/early fall! 


Do you need to take step 2/level 2 before residency applications? 

  • Most residency programs would like to see step 2 before they make their official rank order list.
    • Therefore you should take the boards (including the PE) by the late summer/early fall. 
  • Some programs may not rank you until you have completed both parts of step 2 (CK and PE)! 
  • Make sure to check with the programs you are interested in as these requirements are program-dependent.  


Do you need to take the USMLE to apply to an allopathic program? 
Do you need to take the USMLE to apply to an allopathic program? 

  • Answer: yes & no.
  • No program can deny your application if you just submit your COMLEX scores; however, they may choose to not consider you.  
    • This is program dependent. At some programs, your chances may be increased if you take the USMLE. 
    • Choosing to take only COMLEX depends on how competitive an applicant is and how competitive their specialty choice is!


Reasons Not to Take the USMLE  

  • COMLEX is based on the COMS curriculum while USMLE is based on the LCGME curriculum.
  • A D.O. must pass all 3 parts of the COMLEX only to be licensed as a D.O.
  • If you fail any exam and the state licensing board inquires, you must report your results- which becomes part of your permanent record that your state licensing board keeps!
  • You double the cost, preparation time, etc. by taking both exams.
  • Some ACGME programs will accept candidates with COMLEX only.


Board Preparation 

  • Common resources for Step 2/Level 2:
    • First Aid for Step 2
    • Boards and Wards- great resource for rotations
    • Crush for the Boards
    • Usmleworld.com or Kaplan Question Bank
    • OMT Review
      • Savarese
      • W. Crowe COMLEX Review
      • http://www.md-do.org/NewOMMBoard%20Review02-REV.htm   


Miscellaneous Info about Boards 

  • You can take the USMLE Step 2, without taking USMLE Step 1.
    • There is not a consensus if this is helpful, however, I would like to make you aware of this option.  




Allopathic Positions you may apply to 

  • Categorical
    • programs that begin in the PGY-1 year and provide the training required for board certification in medical specialties.
  • Advanced 
    • programs that begin in the PGY-2 year after a year of prerequisite training.
  • Preliminary 
    • one-year programs beginning in the PGY-1 year that provide prerequisite training for advanced programs.
  • Physician 
    • programs that are reserved for physicians who have had prior graduate medical education. Physician programs are not available to senior U.S. medical students.


Osteopathic Positions you may apply to 

OPTION 1 (OGME-1 Resident)= Specialty Track 

  • The first postdoctoral year will be the first year of residency. This is the same as the current specialty track model. All trainees will receive residency credit for this 1st year of training. These positions will be known as OGME-1 Resident. 


Osteopathic Positions you may apply to 

OPTION 2 (OGME-1 Preliminary)= Special Emphasis 

  • The first postdoctoral year is not included in the residency, but is a specific preliminary entrance requirement into the specialty to produce an enhanced educational opportunity for that specialty. The trainee will have been accepted into the OGME-2 specialty while a senior in osteopathic medical school. These positions will be recorded by the AOA as Preliminary interns and be known as OGME-1 Preliminary.


Osteopathic Positions you may apply to 

OPTION 3 (OGME- 1 Traditional)= Traditional

Rotating Internship 

  • This first postdoctoral year is not included in the residency, but is available in the format of a Traditional Rotating Internship. It may be utilized by any osteopathic graduate uncertain of residency plans or those who want a single year program. These positions will be recorded by the AOA as OGME-1 Traditional.




Choosing a Residency��Factors To Consider 

  • Location and proximity to family
  • Didactics
  • Volume (Surgeries, Deliveries, Procedures)
  • Fellowship opportunity
  • Program Reputation/Rankings
  • Program atmosphere (residents/attendings/facility)
  • Research opportunities
  • Night float vs. overnight call
  • Amount of scutwork
  • Board pass rates
  • Amount of autonomy


Information about Residency Programs 

  • FREIDA Online Website
    • http://www.ama-assn.org/ama/pub/category/2997.html
  • DO Online Website ��Opportunities��
    • http://www.do-online.org
  • Student Doctor Network Website
    • http://www.studentdoctor.net/
  • SCUTWORK Website
    • http://www.scutwork.com
  • Washington University SOM Website
    • http://residency.wustl.edu/
    • Great website with helpful information about residency
  • MDsecrets
    • http://mdsecrets.com
    • List of unfilled allopathic residencies


How do you know if a  
program is ��DO Friendly��?

  • Look at the programs websites and see what their specific requirements are- also look to see if there are any DO��s in the program.
    • Some programs require passage of USMLE Step 1 to apply for their residency program!
  • If they list resident contact information (email address), contact the residents especially if there are DOs.  
  • Don��t hesitate to contact the program directors or program coordinators if you have any questions! 


What if I choose not to do an Osteopathic Internship? 

  • There are five states (PA, OK, FL, WV, and MI) which require completion of an osteopathic internship in order to be licensed to practice in that state.
  • Without this internship or osteopathic approval you are unable to participate in a residency, fellowship, or practice in these five states.  


Documents Needed for ERAS Application 

  • Regardless of whether you are going to pursue osteopathic or allopathic postgraduate training there are specific documents you must have.
  • You will need: 
    • 3-4 good letters of recommendation
      • (1 from your specialty choice)
    • Updated CV
    • Personal statement
    • Dean��s Letter
    • USMLE/COMLEX Transcripts
    • Medical School Transcripts
    • Photo


Letters of Recommendation 

  • You will need at least 3-4 good letters of recommendation.
    • Don��t get them all in one specialty. Programs want to see that you are a well-rounded candidate (not only did you do well in Pediatrics, but also Surgery and Psychiatry)
  • Get an early start- ask for letters during your 3rd year!     
    • Don��t wait until a few weeks before you plan on applying on ERAS.
  • Consider completing an acting internship for a final letter of recommendation. 



Letters of Recommendation (LOR) 

  • Each LOR will be accompanied by an ERAS coversheet, which includes your information, the physicians information, and your option to waive your right to see the LOR
    • You may want to waive your right on the cover sheet. This will allow the physician to give you a fair and unbiased evaluation.


Packet for Preceptors to help  
them write your LOR

  • Curriculum Vitae
  • Personal Statement
  • Their evaluation of you during your rotation
  • Thank you letter
  • ERAS coversheet
  • Small envelope- stamped, addressed to your address in case preceptor wants to mail you a copy
  • Large envelope- stamped, addressed to Student Affairs for ERAS application



Personal Statement (PS) 

  • Don��t underestimate the importance of your personal statement!
  • Don��t procrastinate! 
    • Start writing it as soon as you choose a specialty.
  • Have several individuals review your PS-your advisors, residents in your specialty, the residency program director at your medical school! 



Websites to help you write  
your Personal Statement

  • http://u101.com/articles/med-school/residency-personal-statem.shtml
  • http://www.rushu.rush.edu/studentlife/career/medpstate.html 
  • http://www.ama-assn.org/ama/pub/category/6700.html  
  • http://www.residencyandfellowship.com/page3.html 


Medical School Transcripts 

  • Request copy of transcripts for yourself and for Student Affairs (for ERAS).



COMLEX &/or  
USMLE Transcripts

  • On MyERAS, you must release your COMLEX transcripts!
  • On the other hand, you do not have to release your USMLE transcripts! 
    • May be changing for future classes. Make sure you look into this if you took the USMLE.


Dean��s Letter 

  • Now known as the Medical Student Performance Evaluation (MSPE)
  • Your Dean��s letter is a formal institutional reflection of your academic background and achievements. 
  • It is NOT a personal letter of recommendation. 
  • Your medical school��s student affairs uses your Personal & Academic File along with your Curriculum Vitae to write your Dean��s Letter. 



What does your Dean��s Letter contain? 

  • Confirmation of good academic standing
    • Anticipated Date for D.O. degree
    • Your undergrad/grad degree
    • Degree, year, where conferred
  • Undergraduate Activities Descriptions 
    • Volunteer work, research activities, clubs, honors, teaching, etc.


What does your Dean��s Letter contain? 

  • Explanation/Description of curriculum
  • Grading system 
  • Academic achievements  
  • Activities Descriptions 
    • Volunteer work, research, clubs, tutoring, professional associations, honors, awards, fellowships

What does your Dean��s Letter contain? 

  • Facilitator Comments
  • Board Exam Completion (percentile included if in top 30%) 
  • Rotations to date, including: 
    • Positive comments from each rotation
    • Final assessment: marginal to honors
  • Closing paragraph to summarize and recommend  

Request a copy of your Dean��s Letter 

  • Request a copy in early Fall of Senior Year




  • Use a picture of you in your business attire- it looks more professional. Remember- you are interviewing for a job!





What is ERAS? 

  • ERAS is a service that transmits residency, fellowship and osteopathic internship applications, letters of recommendations, MSPEs, medical school transcripts, USMLE transcripts, COMLEX transcripts, and other supporting credentials from you and your designated Dean's Office to program directors using the Internet.


4 Components of ERAS 

  • MyERAS Website
    • This is where you complete your application and personal statement, select programs to apply to, and assign documents to be received by those programs. 
  • Dean��s Office Workstation (Student Affairs)
    • This is ERAS software used by staff at your designated Dean's Office. From this software they create the ERAS Token that applicants use to access MyERAS. They also use this system to scan and attach supporting documents to your application, such as photograph, medical school transcript, MSPE, and letters of recommendation. 


4 Components of ERAS 

  • Program Director��s Workstation (Hospital Graduate Medical Education Office)
    • This is ERAS software used by program staff to receive, sort, review, evaluate, and rank applications.
  • ERAS Post office 
    • This is a central bank of computers which transfers the applications. You can monitor the activity of your files in the ERAS Post Office on the Applicant Data Tracking System (ADTS).


How does ERAS work? 

  • Applicants receive an electronic Token from their assigned Dean's office, and use it to access the MyERAS Web site. 
  • Applicants complete their ERAS application, select programs, assign supporting documents, and transmit their application to programs. 
  • Schools receive notification of completed application, and start transmitting supporting documents: transcripts, letters of recommendation, photos, MSPEs. 


How does ERAS work? 

  • Examining boards receive and process requests for score reports.
  • Programs contact the ERAS Post Office on a daily basis to download application materials 



ERAS Timeline 

  • Mid June- Download ERAS Applicant Manual will be available for PDF download by chapters or in its entirety on the Web site.
  • Late June- Schools may begin to generate and distribute MyERAS tokens to applicants. 


ERAS Timeline 

  • July 1st- MyERAS website opens to applicants to begin work on applications.
  • July 15- Osteopathic applicants may begin selecting and applying to Osteopathic Internship programs ONLY. Osteopathic Internship programs can begin contacting the ERAS Post Office to download application files. 


ERAS Timeline 

  • September 1st- Applicants may begin applying to ACGME accredited programs. ACGME accredited programs may begin contacting the ERAS Post Office to download application files.
  • November 1st- MSPEs (aka Dean��s Letters) are released. 
  • December- Military Match 


ERAS Timeline 

  • January- Urology Match
  • February- Osteopathic Match 
  • March- NRMP Match results will be available. 
  • May 31st- ERAS Post Office will close to prepare for the next season. 


Application Process Guideline 

  • Step 1:Research/Contact programs of interest to find out their requirements and deadlines.
  • Step 2:Request your token from your designated Dean's Office and download your applicant manual.  
  • Step 3:Register on MyERAS. 


Application Process Guideline 

  • Step 4:Register for your Match.
  • Step 5:Obtain documents and send them to the designated Dean's Office to be scanned and uploaded. 
  • Step 6:Create your Profile and MyERAS Application.  


Application Process Guideline 

  • Step 7:Create personal statements, create a list of recommendation writers, and authorize transmission of your USMLE and/or COMLEX transcripts.
  • Step 8:Search/Select programs of interest.  
  • Step 9:Assign documents to programs. 


Application Process Guideline 

  • Step 10:Certify and submit your MyERAS application then apply and pay for programs.
  • Step 11:Check the status of your applications. 
  • Step 12:Adding programs/Updating assignments and keep your Profile current. 


Using MyERAS- Overview 


  • Profile
  • Checklist
  • Messages
  • Password


  • Home
  • Page One - General Info
  • Page Two - Education
  • Page Three - Medical Education
  • Page Four - Previous Residency/Fellowship
  • Page Five - Experience
  • Page Six - Publications
  • Page Seven - Exams
  • Page Eight - Licensure Info
  • Page Nine - State Medical


  • Page Ten - Race
  • Page Eleven - Ethnicity
  • Page Twelve - Misc Info


Using MyERAS- Overview 


  • USMLE Transcript
  • COMLEX Transcript
  • Personal Statements
  • Letters of Recommendation


  • Search Allopathic Programs
  • Search Osteopathic Programs (Visible to Osteopathic Applicants only)
  • Programs Selected
  • Programs Applied To
  • Preview Invoice
  • Apply to Programs
  • Invoice History
  • Assignments Report


ERAS Application Fees 

Number of Programs Per Specialty AAMC Fees 

  • Up to 10     $60 
  • 11-20     $8 each
  • 21-30     $15 each
  • 31 or more     $25 each

ERAS Application Fees  

  • Example 1: An applicant applies to 30 emergency medicine programs, AAMC fees are $290. (60 + (10 x $8) + (10 x $15)).
  • Example 2: An applicant applies to 20 OB/GYN programs, and 10 family practice programs. The fees are $200. ($140 for OBGYN and $60 for family residency programs). 

ERAS Application Fees 

  • Example 3: An applicant applies to 23 internal medicine programs, and 7 radiology programs. The fees are $245 ($185 for internal medicine programs and $60 for radiology programs).
  • Example 4: An applicant applies to 12 internal medicine programs, 10 emergency medicine, and 8 family practice programs. AAMC fees are $196 ($76 for internal medicine programs, $60 for emergency medicine programs, and $60 also for family practice). 


ERAS Application Fees 

  • Example 5: A military applicant applies to 5 military family practice programs, 3 military internal medicine programs, 2 military surgery programs, and 7 civilian pediatrics programs. The fees are $120 ($60 for the 10 programs consolidated under the military and $60 for the 7 civilian programs).

ERAS Application Fees 

  • Special Instructions for Osteopathic Graduates: 
    Although the ERAS 2008 fee structure is the same for osteopathic and allopathic programs, it is administered differently. For osteopathic internships, the fee is applied based on the total number of programs applied to, regardless of the specialties to which the applicant applies. Applicants applying to allopathic programs are assessed based on the total number of programs applied to within a specialty.


Miscellaneous Fees 

  • US (Allopathic and Osteopathic) and Canadian Applicants 
    The National Board of Medical Examiners (NBME) charges a flat $50 fee to US and Canadian applicants who request transmission of USMLE and/or NBME to programs, regardless of the number of transcripts requested. The NBME fee is included on your invoice and collected by the AAMC.


Miscellaneous Fees 

  • US Osteopathic Applicants 
    Osteopathic applicants may request an unlimited number of COMLEX transcripts to be sent via ERAS for $50. Applicants who request USMLE transcripts via ERAS also pay a $50 fee to the NBME for an unlimited number of electronic transcripts. Transcript fees are included on your invoice and are collected by AAMC.


Payment Method 

  • You may use your VISA or MasterCard to pay for your ERAS fees online. This is the safest and fastest way to process your application. 
  • You also have the option to pay your ERAS fees by selecting the check/money order option, printing out the invoice in the payment module, and sending your fees by check (U.S. currency only) to the address on the invoice. Your application(s) may be withdrawn if payment isn't received within two weeks.  
  • All fees are payable in U.S. funds on U.S. banks ONLY.  


Payment Method 

  • If your check is returned for insufficient funds, you submit partial payment, or there is a problem with your credit card payment, ERAS will endeavor to collect fees owed and your application may be withdrawn.
  • If ERAS withdraws your application due to nonpayment, your application will be withdrawn from each program to which you applied. 


ERAS Use During the M.D. Scrambling Process 

  • From 12 noon on the third Tuesday in March, until 12 noon on the third Thursday in March each year, there is a "Scramble" period. This is before the NRMP Match Day results are revealed.
  • During this period, applicants who did not match to a position attempt to fill remaining positions. ERAS is available to applicants to apply to a maximum of thirty (30) programs free of charge who meet the following criteria:  
    • The applicant must have participated in ERAS during the regular season. This means you must have applied to (and paid for) at least one program.
    • The applicant's account must be paid in full no less than two weeks prior to the Scramble period.


Additional ��Scramble�� Information  

  • FindAResident is a company created by the AAMC to help applicants find open residency positions.
    • http://www.aamc.org/students/findaresident
  • It is an effective resource if you wish to: 
    • Change specialties
    • Change location
    • Switch residency or fellowship programs


Osteopathic Match Application 

  • The osteopathic match occurs through the National Matching Services (NMS).
  • You will sign up in Sept. for this match after you are provided a pin number from your medical school.  
  • The initial fee is $60 to sign up for this match!  
  • http://www.natmatch.com/aoairp/ 

Always Register for the OSTEOPATHIC Match! 


Allopathic Match Application 

  • The allopathic match occurs through the National Residency Matching Program (NRMP).
  • You will sign up on Sept. 1 for this match after you receive your AAMC number. 
  • The initial fee is $45 to sign up for this match! 
  • http://www.nrmp.org/ 


Interview Schedules 

  • Interviews at osteopathic programs typically occur from Sept.-Dec.
  • Interviews at allopathic programs typically occur from Nov.-Jan. 
  • Make sure to schedule rotations and vacation time accordingly. 


Interviewing Skills 

  • Before you interview, try to go through a ��mock�� interview with a faculty member.
  • Review the list of potential questions to ask during your interview.  



Other Interviewing Tips 

  • Schedule rotations appropriately for interview season.
    • Choose rotations which have lighter schedules.
  • Cluster interviews-if within the same city   
    • i.e. CCF/Metro/UH


Other Interviewing Tips 

  • Interact with the residents during the interview day.
    • They are the best source for information. Keep in mind some residency programs allow their residents to serve on the committee so act appropriately with the residents.
  • Schedule interviews, even if its not at the top of your list. 
    • A program can feel different in person. Don��t base your decision on their website or literature provided.


After Interviews 

  • You should send a ��Thank You�� note in a timely manner.
  • This can be in the form of an email, phone call to the program director, or a hand written thank you note.  



After Interviews 

  • You can choose whomever you like to thank, but most applicants thank their interviewers and the program director.
  • Make sure to get business cards from all of your interviewers. After each interview write down some highlights from the interview that you can mention in your thank you note. This will help you stand out and will not look like a generic thank you.    


Letter of Intent 


Letter of Intent 

  • After you have finished interviewing some suggest that you write a letter of intent to your top one to three choices.
  • State why you want to be there are what this residency program offers that makes you want to train there.  



Letter of Intent 

  • Do not lie and say to all three programs that you are ranking them #1, just say ��highly ranked�� to #2 & #3
  • This is a great way to keep in contact with a program  
  • Residency programs typically rank applicants in late Jan/ early Feb.  
    • Some programs rank applicants immediately after you interview!


After Interviews 

  • After you have completed the interview season, you are now challenged to create a Rank Order List (ROL)
  • When creating a rank list remember to rank the programs that you want to go to in the order YOU want them and not based on your ��chance�� of matching there.  



Rank Order List (ROL) 

  • The Rank Order List (ROL) is your preferred rankings for the residency you are pursuing.
  • For the D.O. match, your ROL is created on the AOA Intern/Resident Registration Program website 
    • www.natmatch.com/aoairp/
  • For the M.D. match, your ROL is created on the NRMP website 
    • www.nrmp.org/



  • You can rank as many or as little programs as you like. The rankings are free for programs 1-30, after which you will be charged a fee for additional rankings.
  • Applicants will have a greater chance of matching if they rank more programs. 
    • You can only rank programs you interviewed at.


Match Algorithm 


At first look it may seem like a foreign language, but with careful observation the match really gives the applicant the advantage.  

Not the real match algorithm!

The Match Algorithm 

  • The match favors the applicant!
  • Here are the websites explaining the algorithms: 
    • M.D. 
      • http://www.nrmp.org/res_match/about_res/algorithms.html
    • D.O. 
      • http://www.natmatch.com/aoairp/  (click on ��match process��)


Match Algorithm Example 

  • If your number one ranks you highly (ex. if they have 12 spots and you are within the top 12) you will match at your number one.  
  • However, what happens if you are number 16 and the first 12 applicants all have this hospital ranked as their number one. Then you don��t match there and you continue to your number 2.  




Match Algorithm Example 

  • If your number 2 has you listed highly (again if there are 12 spots, and you are listed within the top 12) you will match.
  • Note: Even if the 12 spots are filled by other candidates you can ��bump off�� the last candidate if you are ranked higher.  


The Match Algorithm 

  • This is why you should always rank your list based on where YOU want to go.
  • You can find another example involving several theoretical applicants at: 
    • http://www.nrmp.org/res_match/about_res/algorithms.html 


Osteopathic Match Timeline 


  • Beginning in June, students can download the Agreement form for participation in the AOA Intern/Resident Registration Program (the "Match") from this web site. To register for the Match, each student must return a signed Agreement to National Matching Services Inc. accompanied by the appropriate registration fee.


  • Students must apply to programs independently of the Match (via ERAS). Programs receive applications and interview students independently of the Match. Application deadlines for programs vary, therefore students should check with programs regarding their deadline dates.


Osteopathic Match Timeline 


  • Each institution offering osteopathic internship positions beginning in 2007 must provide to National Matching Services Inc. information on the program(s) being offered by the institution in the Match.


  • Recommended date by which students should return their Agreements and registration fees to National Matching Services Inc.


Osteopathic Match Timeline 


  • By this date, a Listing of Programs participating in the Match will be available on this web site.


  • By this date, instructions for submitting Rank Order Lists and obtaining Match results will be provided to registered students and programs.


Osteopathic Match Timeline 


  • Final date for submission of student and program Rank Order Lists. No Rank Order Lists or Agreements can be accepted after this date.


  • Results of the Match are released to all participants in the Match (students and institutions), as well as to the colleges of osteopathic medicine.


Osteopathic Match Timeline 

  • Institutions must complete an institutional contract for each matched student, and send it within 10 working days after receipt of the Match results to the student for signature. Each matched student must sign and return the contract to the institution within 30 days after receiving the contract from the institution.


Allopathic Match Timeline 

Mid August  

  • Applicant registration begins at 12:00 noon eastern time.

September 1

  • Institution / program registration begins at 12:00 noon eastern time.

December 1

  • Applicant registration deadline (Note: Applicants may register after this deadline by paying an additional late registration fee of $50.00 when registering after 11:59 PM eastern time.)


Allopathic Match Timeline 

Mid January

  • Rank order list entry begins. Applicants and programs may start entering their rank order lists at 12:00 noon eastern time.

Late January

  • Quota change deadline. Programs must submit final information on quotas and withdrawals by 11:59 PM eastern time.

Late February

  • Late registration deadline.


Allopathic Match Timeline 

Late February

  • Rank order list certification deadline. Applicants and programs must certify their rank order lists by 9:00 PM eastern time. CERTIFIED applicant and program rank order lists and any other information pertinent to the Match must be entered in the R3 System by this date and time.

Early March (3rd Monday in March)

  • Applicant matched and unmatched information posted to the Web site at 12:00 noon eastern time.


Allopathic Match Timeline 

Early March (3rd Monday in March)

  • Filled and unfilled results for individual programs posted to the Web site at 11:30 am eastern time.

Early March (3rd Tuesday in March)

  • Locations of all unfilled positions are released at 12:00 noon eastern time. Unmatched applicants may begin contacting unfilled programs at 12:00 noon eastern time.

Mid March (3rd Thursday in March)

  • Match Day! Match results for applicants are posted to Web site at 1:00 pm eastern time.


Allopathic Match Timeline 

Mid March

  • Hospitals send letters of appointment to matched applicants after this date.
  • Note: Any contact between programs and unmatched applicants (or their designees) prior to 12:00 noon eastern time Tuesday, March 13, 2007, is a violation of the Match Participation Agreement. Contact between programs and matched applicants prior to the general announcement of 2007 Match results at 1:00 pm eastern time Thursday, March 15, 2007, also is a violation of the Match Participation Agreement. 


Can you participate in both matches? 

  • YES. As a D.O. applicant you can choose to apply to both the D.O. and M.D. match, the D.O match, or the M.D. match. The D.O. match occurs before the M.D. match.
  • If you apply for both matches and you match into an osteopathic residency program you will automatically be withdrawn from the match. This match is a binding contract. Therefore you cannot break it to try to match in the M.D. match. 
  • If you don��t match at a D.O. spot, and you applied to both matches, you will then be entered in the M.D. match.   


Can you participate in both matches? 

  • You can match to a D.O. intern year and then match into an M.D. program if that program requires a prelim year (i.e. anesthesia, PM&R, path). You will apply to the M.D. match for a PGY-2 spot. 
  • If you choose to pursue just the allopathic match you should withdraw from the D.O. match on natmatch.com. There is an option for withdrawal that states you will be competing in the M.D. match.  


Can you participate in both matches? 

  • There is one exception in regards to residency requirements. If you want to pursue an allopathic residency in ophthalmology, you MUST do an allopathic transitional year.
    • The Ophthalmologic board does not recognize an AOA internship year and therefore you will not be granted board certification because you failed to complete the necessary requirements.


Pre-Match Contractions? 

  • Prematches are residency position offers outside of the match.
  • Prematches are available to D.O.s and FMGs applying to the allopathic match. 
  • As a D.O., you can accept a prematch from an allopathic residency program. However, if you pursue this route, make sure you have a signed contract. Do not skip the match based on a ��verbal agreement��. 

Pre-Match Contracts? 

  • Also you may want to have an attorney look over the contract for any loopholes.
  • If you accept a prematch, you must withdraw from the match.  
  • Prematches occur before Jan. 31, which is the last day programs have until they have to notify the NRMP of the number of seats (quota) available for the match  


What if you don��t match�� 

  • If for some reason you do not match you can always scramble.
  • The ��scramble�� is a brief period of time that is set aside for those applicants who did not match. The Scramble gives applicants an opportunity to contact unfilled programs and possibly secure a position.  
  • Both matches (D.O. and M.D.) have post-match scrambles for applicants who did not match into a perspective residency program.   


Osteopathic Scramble  

  • Students who fail to match initially are provided with information on programs with available positions for them to contact.
  • Likewise, programs with available positions are provided with information regarding unmatched students to contact. Thus, opportunities to obtain a position may still exist after the Match. 
  • Unmatched students may receive emails from programs that did not fill.   

If you have to scramble, go back to your medical school in order for them

to help you! 


Allopathic Scramble  

  • Unmatched applicants who submitted a certified rank order list will be given access to the Dynamic List of Unfilled Programs at 12:00 p.m. EST on Tuesday of Match Week. Applicants may not contact unfilled programs prior to 12:00 p.m. EST that Tuesday. The list is updated by the NRMP every hour to reflect the number of remaining unfilled positions.


Allopathic Scramble 

  • If you have already applied to a program, but that program still has unfilled positions, you may contact the program and inform them that you wish to be considered a Scramble applicant. That program will not count towards your thirty (30) Scramble programs on MyERAS. Also, during Scramble, you may NOT apply to more than thirty (30) programs using MyERAS, even if you wish to pay for them.


Allopathic Scramble  

  • During this period, applicants who did not match to a position attempt to fill remaining positions. ERAS is available for applicants to apply to a maximum of thirty (30) programs free of charge who meet the following criteria:
    • The applicant must have participated in ERAS during the regular season. This means you must have applied to (and paid for) at least one program.
    • The applicant's account must be paid in full no less than two weeks prior to the Scramble period.


Requirements to Start Residency 

  • Each residency has its own requirements. There are also state requirements that must be completed for a training license.
  • When applying through ERAS, check with your residency program for the necessary requirements prior to the start of residency. 


Licensing vs. Board Certification 



(A.T. Still��s original medical license)

Licensing/Board Certification 

  • Do not get these two terms confused.
  • Your license is state dependent. 
  • Your certification is based on your residency training.  



  • You will be licensed by the state you are training in.
  • At the beginning of your residency you will be issued a ��training license�� 
  • By the end of your residency you will apply for a full practicing license.  



  • When thinking about licensure there is one special caveat all osteopathic students need to consider.
  • There are 5 states that require an osteopathic internship or its equivalent for licensure purposes. (PA, MI, WV, OK, FL)  
  • Without this internship year, you can NOT train or practice because you will be denied a license from the associated state osteopathic association.  
  • There are options, which we will get to later. 



  • Your certification is based on your residency training.
  • If you pursue osteopathic training you will be boarded by an affiliated osteopathic board    
    • (i.e. IM will be boarded by the American Board of Osteopathic Internists [ABOI])
  • If you pursue allopathic training you will be boarded by an affiliated allopathic board        
    • (i.e. IM will be boarded by the American Board of Internal Medicine [ABIM]) 
  • States have no regulation over your certification 



  • Should you choose to train in an allopathic residency program or practice in those 5 states and you are unable to complete an osteopathic internship year, you can seek to get approval of your first year of residency.


Importance of AOA Certification 

  • You can't be a COM Dean, Program Director, or DME without AOA certification!


��Resolution 42�� 

  • If you decide to pursue an allopathic residency program there is a path you can pursue to get AOA approval of your intern year. 


What is this ��Resolution��? 

  • Some students who pursue allopathic training will mention Resolution 42.
  • This is a resolution created by the American Osteopathic Association to help osteopathic physicians remain connected to the AOA. 
  • These resolutions require certain criteria to be met during the intern year.  



History of these Resolutions 

  • These resolutions began because the number of graduates of colleges of osteopathic medicine out-numbered the available osteopathic residency positions.
  • In 1986 Resolution 65 was developed. The AOA allowed graduates from the classes of ��87-��89 AOA approval of their first year of training as long as they participated in the AOA match, but did not match and then pursued ACGME training.   
  • In 1996 the AOA replaced Resolution 65 with Resolution 22.  


History of these Resolutions 

  • Resolution 22 allowed AOA approval of the first year of ACGME training if there were ��special circumstances�� and if the applicant completed the rotational requirements of an osteopathic internship.
  • In 1998, Resolution 19 replaced Resolution 22.   


History of these resolutions 

  • Resolution 19 did not require an osteopathic curricular component for approval.
  • In March of 1999, the AOA suspended Resolution 19. 
  • In July of 2000, the AOA passed Resolution 42
  • Resolution 42 was designed to clarify the meaning of ��special circumstances��. It also required a commitment to osteopathic principles and practice and it allowed current and past trainees a route for AOA approval.    


Resolution 42 

  • Resolution 42 is the latest idea created by the AOA for approval of the first year of ACGME training.
  • Resolution 42: "Approval of ACGME Training as an AOA-Approved Internship" is a policy to grant AOA internship approval for appropriate ACGME training. 


Resolution 42 

  • Like previous training approval policies, the new "Approval of ACGME Training as an AOA-Approved Internship" policy maintains a consistent theme. That is, to be eligible for AOA internship approval of ACGME training the osteopathic physician must complete all six of the traditional rotating internship��s core rotations:
    • 2 months internal medicine, 1 month emergency medicine, 1 month family practice, and two additional core rotations (internal medicine, surgery, OB/GYN, pediatrics, family practice, or emergency medicine) so that a total of 6 months in these core rotations are completed.


Resolution 42 

  • Unlike previous policies, the new "Approval of ACGME Training as an AOA-Approved Internship" policy responds to the needs of current and past trainees who have completed their first year of training in an ACGME-accredited program.
  • Like the superceded Resolution 19, special circumstances must be present to request approval of ACGME training as equivalent to an AOA internship, as indicated in Resolution 42.  


Changes in Resolution 42 

Special circumstances has been Eliminated!

Results of Resolution 42  

  • Not everyone that applies for Resolution 42 is approved.
  • As of November of 2005, a total of 937 applicants have applied under Resolution 42.  
    • 557 (men), 380 (women)
  • 544 applicants received approval (58%) 


Resolution 42 

  • For more information regarding Resolution 42, you can call the AOA Division of Postdoctoral Training at
    • (800) 621-1773, extension 8276.
  • Bulger, J. ��Approval of ACGME Training as an AOA-Approved Internship: History and Review of Current Data.�� JAOA. Vol. 106 (No. 12). Dec. 2006. 708-713. 
  • You can also check out the AOA website : 
    • https://www.do-online.org/index.cfm?PageID =sir_postdocabtres42



So what does this mean? 

  • Resolution 42 will allow approval of an allopathic intern year to be counted as an AOA-approved internship year.
  • This will allow students to pursue training or practice opportunities in the states (PA, Fl, WV, Ok, MI) requiring the osteopathic internship.  


Additional Requirements for Resolution 42 Approval 

  • The trainee must be a member in good standing of the AOA.
  • Trainees are responsible for negotiating rotational changes with their programs. 
  • A trainee may attend an AOA annual meeting, state osteopathic annual meeting, specialty college annual meeting or prepare and conduct an osteopathic clinical presentation to satisfy the educational activity requirement. 
  • All osteopathic clinical presentations are reviewed and subject to approval or disapproval by a representative of the Program and Trainee Review Committee. 


Miscellaneous Info

Can an Osteopathic Trained Resident obtain an Allopathic Fellowship? 


Can an osteopathic physician who has ACGME Board Certification bill for treating patients with OMT? 



What to do with this information? 

  • Although it may seem overwhelming now, keep this PowerPoint presentation tucked away in a safe place until you are beginning your 4th year, which is when I hope it becomes a very valuable document.


  • The goal of this lecture is not to persuade any osteopathic medical student to pursue any particular specialty, residency program or D.O./M.D. postgraduate training. The purpose of this lecture is to help you make an informed decision. The information in this lecture is subject to change!

For more information�� 

  • www.do-online.org
    • Here you can find the list of D.O. residency programs: go to For Students then Opportunities
  • http://www.ama-assn.org/ama/pub/category/2997.html  
    • Freida online listing of M.D. residency programs:
    •  go to Residency/Fellowship Training Program Search
  • http://www.mdsecrets.com 


For more information�� 

  • www.scutwork.com
    • A peer review of residency programs
  • www.studentdoctor.net 
    • A students/resident online forum
  • Iserson, K. ��Getting into a Residency: A guide for medical students�� 
  • Desai, S. ��The Residency Match: 101 Biggest Mistakes and How to Avoid Them�� 




Contact Information 

Draion M Burch, DO

Region III Trustee

    Council of Interns and Residents

Vice Chair Intern-Resident Committee

    Michigan Osteopathic Association

Resident Representative Board of Trustees

    American College of Osteopathic Obstetricians and Gynecologists

Dept of Obstetrics and Gynecology

Statewide Campus System

Michigan State University College of Osteopathic Medicine

St John Health System Osteopathic Division

Macomb-Oakland Hospital, Macomb Center




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