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Matching into a competitive specialty, especially many of the top surgical specialties, is extremely difficult and nerve-racking—particularly when you are unsure of the steps needed to maximize your chances. Often, medical students don’t know what residency directors look for in applications. The purpose of this article is to inform you about what matters and to provide guidance on how to become the strongest applicant possible. To do this, I interviewed Dr. Chad A. Wiesenauer, a pediatric surgeon at Ascension St. Vincent, and Lisa Stuart, the residency director for the general surgery program at Ascension St. Vincent.
A foundational theme emphasized by both interviewees is the importance of strong academic performance, particularly on standardized board exams. Residency directors, of course, want to see that you did well in school, but they also need a way to level the playing field across many different schools that may have varying standards.
With COMLEX and USMLE Step 1 now moved to pass/fail, much more emphasis is placed on COMLEX and USMLE Step 2. Residencies use exam scores as a first screening tool: there are far too many applications to review in depth, so many programs use scores to filter the applicant pool. Dr. Wiesenauer noted that a high COMLEX and Step 2 score is now essential to even “get your foot in the door.” While these scores are very important, a high score alone is no longer sufficient; they serve as the foundation and initial screening criterion for strong applicants.
Beyond academics, early and sustained engagement in meaningful extracurricular activities is critical. During the first two years of medical school, students should focus on mastering the coursework while also pursuing research or leadership opportunities that distinguish them from their peers.
These activities demonstrate initiative and help build a cohesive narrative for residency applications. Start early and choose activities that align with your genuine interests and, when possible, your intended specialty.
Clinical performance during third- and fourth-year rotations is another pivotal factor. Dr. Wiesenauer emphasized the importance of excelling in rotations and utilizing resources such as surgery handbooks to strengthen clinical knowledge and learn how to be most helpful to the residents and attendings you will work with.
Achieving strong clinical evaluations and developing professional relationships is as important as letters of recommendation in the application process. Consistently demonstrating competence, reliability, and teamwork during rotations can make a major difference.
A major component—if not the most important, especially for osteopathic students—is the audition (away) rotation, particularly for competitive specialties. Both interviewees highlighted the importance of these rotations in demonstrating clinical ability, work ethic, and interpersonal skills.
At institutions like Ascension St. Vincent, which operate as smaller, community-based programs, applicant “fit” is especially important. Residents and attendings closely evaluate students’ teamwork, attitude, and adaptability, and current residents often provide direct input into ranking decisions. Students are encouraged to actively contribute during rotations, help residents without overstepping boundaries, and seek opportunities to stand out positively and professionally.
To secure audition rotations, students must use both formal and informal strategies. While many programs utilize the VSLO (Visiting Student Learning Opportunities) platform, students are also encouraged to contact program directors or faculty directly, so the program recognizes their name when the application arrives.
Dr. Wiesenauer advised that many smaller programs may require additional materials, such as a personal statement paragraph and exam scores. Lisa Stuart also noted that reaching out to request information or to express interest can be beneficial and is generally well received.
Another critical element of residency applications is finding ways to differentiate yourself from other applicants. While there are baseline qualifications every student should have, residencies want to see what makes you unique.
Differentiators can include research in your area of interest, unique extracurricular involvement, or a compelling personal story. Even smaller programs like Ascension St. Vincent receive over 1,000 applicants for just three positions, so standing out matters.
ERAS signaling has become an important tool, allowing students to demonstrate genuine interest in specific programs. Because many programs prioritize applicants who have signaled them, it is important to research each specialty’s number of signals and to use them strategically.
Research programs ahead of time and signal programs that are a good fit for your interests and likelihood of a match, rather than signaling only the most competitive names.
Both interviewees emphasized professionalism and cultural fit. Showing up to auditions in unprofessional clothes or unprepared can negatively impact your chances. Treat every day of an audition as another day of interviews—a chance for the program to get to know you and for you to get to know them.
Residency programs are selecting not only capable clinicians but also individuals who will integrate well into their teams over the next several years. This is particularly important in smaller programs, where close working relationships amplify the importance of interpersonal compatibility.
Matching into a competitive specialty requires a multifaceted approach that includes strong board scores, meaningful extracurricular involvement, strong clinical performance, strategic audition rotations, and intentional relationship building. By combining professionalism with self-directed growth, medical students can significantly enhance their chances of successfully matching into their desired specialty.
Kapil Reddy is a second-year medical student at the Marian University Wood College of Osteopathic Medicine. He is passionate about orthopedics and, in particular, sports medicine and trauma; however, he has an interest in many areas of medicine. He currently serves as the Co-Executive Chair for the Near West Free Clinic and would love to continue serving the medically underserved population throughout his career. Feel free to email him if you have questions.
Discover the voices of Marian University's health professions students through "Franc Notes", a vibrant, student-led blog that embodies our Franciscan commitment to community, reflection, and compassionate service. Inspired by the rhythm of "SOAP notes," it features weekly insights—from "DO Diaries" interviews with physicians to summer reflections and program spotlights—fostering collaboration across disciplines."
