These are questions from a recent Q&A session with the excellent pre-med society at BYU-Idaho. We wanted to make sure each submitted question gets the attention it deserves.

There are essentially four pillars to help create a strong application: letters of recommendation, scores, research, and volunteer/work experience. Being a competitive applicant for residency requires a well rounded application in each of these pillars, but you can customize this based on what your interests are and what specialty you’re applying into.

The important thing is to be actively looking for opportunities from day one. You don’t have to work on everything all at once, but you should be looking and planning ahead if you dream of matching into competitive specialties.

When done right, these serve as a first hand testimony to your work ethic, knowledge base, personality, and ability to function within a team in a way that no other part of your application can.

A strong letter of recommendation should be as personalized as your personal statement–which can be hard to accomplish. Make deliberate efforts to establish relationships with your letter writers. This relationship can be formed in many different settings and ideally would be forged over an extended period of time. Mentorship is common in the medical world. Look for opportunities to establish these relationships especially within your specialty department.

When it comes to the number of letters you should shoot for, error on the side of asking too many people for letters. At the end of the day, no letter writer knows if and how many residencies their letter was sent to. If you come away with more letters than you need, you can customize where they go depending on your mentors’ ties to programs and people. Or simply select the letters you feel are likely the strongest (you won’t actually read these).

Additionally, these letter writers can personally reach out to programs they have connections with to further advocate for you. In my opinion, a strong letter is the most important of the four pillars.

Many medical schools have gone to a pass/fail curriculum, and the Step 1 exam has followed suit. But there are still a few ways that students are stratified based on their academic performance.

It’s still pretty common for clerkships to be graded on a scale of pass, high pass, or honors. Alpha Omega Alpha is the medical honor society that you can apply for. Only 20% of each graduating class of students can be selected. There’s also the MSPE Dean’s letter, where specific words are used like a code to tell programs if you are among the top performers, middle tier, or low tier students.

Essentially, there is always some scoring mechanism to set you apart. If you find yourself on the higher end among your cohort, fantastic, you’ve done great. You still need to focus on the other pillars for a well rounded application. If you haven’t been as successful, luckily this can be one of the more forgiving pillars. If you feel your academic performance has not been on par with what you hoped, dedicate extra time to the other pillars to make up the lost ground. You’d be surprised how much this can help.

You’d be hard pressed to find someone who dislikes research as much as I do.

Chart digging and literature review are not numbered among my favorite hobbies, but research has honestly been one of the most beneficial things I’ve done. Residencies want to see that you know how to identify a question, understand how to develop a project, and find an answer. Not only will this serve as a talking point during interviews, but if you’ve taken a project from the beginning all the way to publication, it shows your ability to finish what you’ve started.

In addition to all of this, research has proved to be surprisingly effective in helping me connect with excellent mentors. My strongest letters of recommendation came from my research mentors. We had the opportunity to work together for multiple years on various projects so their recommendation carried more weight.

The other good thing is that medical schools know you need research to be competitive. They should be supportive of your efforts to get involved. Make sure to ask about this support during med school interviews. You need research, so going somewhere that doesn’t make it available will complicate your life.

This is probably the least critical overall, however, it remains the best way to show programs what makes you, you.

How you spend your time helps programs get a glimpse into your motivation and what drives you. Your volunteer time outside of medical school and training should hopefully be enjoyable for you. These activities help set you apart and the interviewers should see the passion in your eyes as you talk to about something you’ve done or a cause you’ve contributed to.

Regardless of where you find yourself in your training, focusing on these four pillars can help guide your efforts. If you feel that you don’t have the best setup to excel in one of these areas, I’d challenge you to change your mindset. You should never view your current situation as a disadvantage. You have more control over the outcome than you think. Seek out opportunities for yourself. If there aren’t any, create them. These extra efforts early on will eventually pay huge dividends.