Chiles: My program uses geography and board scores to help filter our pool of applicants down. While this approach means we could potentially miss out on some excellent applicants, we cannot spend hundreds of hours carefully reviewing all the applications that we receive. Second tier elements include looking at medical school transcripts, letters of recommendation and personal statements in more detail.

Erwin: I will first look at a personal statement, then letters of recommendation and finally USMLE Step scores. We get 400-600 applications for five spots. Realistically, programs need a strategy to get through so many applications and one of mine has been whether the first sentence of the personal statement hooks me into wanting to continue reading.

Russell: I review each and every application we receive at Brown University. I do not use filters because you can easily miss a great candidate and I firmly believe in matching and reviewing the whole applicant. I look at what schools and training programs they came from, research, life experiences and personal statements.

Virani: Applications are usually reviewed by the program director, associate program directors and a team of faculty members. Personally, I look at the curriculum vitae (CV) first with a particular emphasis on background, institutions attended for higher education and ability to take projects to completion. I then look at the letters of recommendation, particularly for assessment of an applicant’s work ethic.

Erwin: I look very closely at personal statements. Is this applicant just punching the clock with something generic or have they done something that makes me say, “I want to meet this person, know who they are and ask more about this episode they had or lesson they learned in life.” Personal statements can also tell me if the applicant is a good writer, while giving me insight on how the applicant generally communicates to patients and colleagues.

Of course, there are some stories that really catch your attention, like an applicant who said they knew they wanted to be a cardiologist when their father collapsed in front of them and they did not know CPR. However, we do not all have stories like that and that is okay (and do not make them up)! There is something in all of our lives that may not be dramatic but it is ingrained in who we are; things that develop into a passion of wanting to know as much as we can so that we can do the most for other people.

Russell: Simply put, I find that a good personal statement incorporates what it is that you want to do, how you came to know it and how have you prepared yourself to accomplish your goals. It is not disjointed facts and stories.

Virani: I do not have a preference on whether a personal statement should include information on an applicant’s background or focus on career goals. However, I think that if an applicant has something in their background that shows grit or personal attributes that they think are relevant, they can share it if comfortable doing so.

Berlacher: The first personal statement pitfall is length, whether it is too short or too long. I typically tell applicants to aim for about a page and try not to go beyond that limit. Second, your personal statement should not be a regurgitation of your CV. It is meant to allow you to expound on and go beyond what is already in your CV and should not just be a list of the research you have published in paragraph form. Tell us what you did or did not like about your research and why. Describe what you want to do in the future; is it the same or different than what you have done in the past? Tell us what other life experiences contributed to your passion for cardiology. Importantly, never make something up in your personal statement.

Virani: The first pitfall is a personal statement that is too diffuse, such as those that list a lot of items but do not provide the reader with an understanding of how those items relate to an applicant’s future in medicine or cardiology. The second pitfall is a personal statement that does not provide the reader with a clear understanding that the applicant is a good learner.

Chiles: Nobody is going to be excellent in all areas. Sometimes it is an outstanding letter of recommendation, strong personal statement, research activity, advocacy and politics, or a compelling story such as recounting hardships that people have persevered through. I like to see applicants who were “intern of the year,” chief resident or recognized for their teaching efforts. Those types of accomplishments make me think, “I would really like to have this person here.”

Erwin: I like to see balanced people; for example, those that have interests outside of medicine, are engaged in their community or have been involved in projects or organizations that have helped outside the hospital walls. It is important to see that they have completed research and I take notice when someone has been recognized by their peers, won awards or been engaged with an honor society. Seeing that an applicant rose to the top in everything they did is a good indication that they will continue that trajectory in the future.

Russell: There seems to be two classes of applicants: those that “walk on water” (publish 20 first-author original research articles) and those that have high levels of maturity and can clearly explain where they came from, how they got to where they are now and how they plan to achieve their future goals. Anyone who can tell a great story of how they are a perfect match for your program is going to merit some attention.

Berlacher: Failing USMLE Step exams, failing rotations, remediation and gaps in training are all red flags. I cannot promise that an applicant can "overcome" all of these in the eyes of a program but if an applicant has any of these in her or his CV, I would recommend addressing it in the personal statement.

Virani: A common “red flag” is too many listed projects with no production (i.e., abstracts or manuscripts), as well as an applicant’s name on many abstracts but none as first author. My suggestion would be to do fewer things but take them to completion. One can certainly get involved in long-term projects but it is important to always have a product to show from a project you participated in.

Berlacher: The best letters of recommendation are from people who know the applicant well and have had significant clinical or research time with them. I look for comments about the applicant's work ethic, response to feedback and interaction in teams – all things that cannot necessarily be gleaned from a CV or personal statement.

Erwin: Once you have been reading recommendation letters for a while, you can tell if the writer really knows who they are writing for and think highly of them or if they are just writing another generic letter of recommendation. I tell people when they ask someone to write them a letter of recommendation to always ask, “Do you feel confident and able to write me a strong letter of recommendation?” A lot of doctors are pretty bad about saying, “I will write a letter, but it will not be a good one.”

Chiles: An IMG at a U.S. residency program is realistically probably going to have the best chance of matching at their own program or a program where they have done an away rotation.

Erwin: I have a very high regard for our IMGs in the sense that many of them have already done a full residency and fellowship and then they come here and start over. I think that scores tend to be more important for IMGs since program directors may not be familiar with their medical school. A research fellowship or non-accredited fellowship may be valuable in demonstrating that they can perform with physicians at an institution the interviewers are familiar with.

Virani: Since IMGs have already done their residency in a U.S. IM residency program, the letters of recommendation provide a great idea about where an IMG stands compared to other residents in their IM program. Thus, performance during residency in both clinical settings and academic productivity are crucial. If you have something special in your background that a program would find important to consider, highlight it in your personal statement. During the interviews, always provide a good rationale for what value you bring to the fellowship program (this holds true for all applicants whether IMG or not).

Chiles: They need to articulate how the adversity is something that will make them better as a physician, person and cardiologist. I have actually told several residents that we should include “failures” on CVs; I say that jokingly, but I often think those are the situations where we learn the most. While your story may not be how you would have liked it, those obstacles have the opportunity to make you better and sometimes result in more drive and hard work.

Erwin: In terms of how they should fill their year off, it depends on what their passion is. The work should augment their CV in a way that truly reflects their interest rather than just adding in a line on their CV. It should be incorporated into their main reason for being a cardiologist.

Damp: It is always helpful to have "gap" time explained. Whether it was planned all along or taken as a result of not matching, the most important thing is to explain what was done during that time and specifically how the time was used to add to the applicant's overall qualifications (i.e., research, clinical experience). When applicants choose to address not matching directly, it is very helpful to show how that experience impacted them and perhaps shaped what they chose to do for that “gap” year. However, no matter what one chooses to do, the most important thing is to explain rationale, describe what has been learned and demonstrate productivity in the activity.