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Adjusting to Medical School: An Short Overview

Tino Mkorombindo is a third year MD/MBA candidate at the University of Louisville School of Medicine/College of Business. You can follow him on instagram, twitter, or linkedin.

Congratulations! You’ve decided to embark on a unique but rewarding journey! Here, we want to give a general overview, which includes what exams needed to obtain your degree and licensure, where to find residency program information, where applications are submitted, and matching programs. 

Medical school as we know it will no longer be the same. We’ve decided to focus on the factors that we do not foresee changing and will continue to adjust as new findings occur. 

We will be discussing standardized medical school exams, matching, grades, and research. 

  • M.D. Students/Graduates:
    • M.D. Students must pass Steps 1, Step 2 Clinical Knowledge, and Step 3 Clinical skills to progress to residency.
    • Step 1 has transitioned to a pass/fail system, but other metrics such as percentiles are likely to be heavily considered. 
    • M.D.s must also pass all Steps (1, 2CK, 2CS, 3) to obtain their license to practice medicine
  • D.O. Students/Graduates
    • COMLEX:
      • D.O. Students must pass Levels 1, Level 2 Performance Evaluation, and Levels 2 Cognitive Evaluation to progress to residency.
      • D.O.s must also pass all levels (1, 2PE, 2CE, and 3) to obtain their license to practice medicine
    • USMLE:
      • D.O. may use this exam in most states
  • International Medical Graduates (IMGs):
    • Must pass USMLE Step 1,2CK, & 2CS for the Educational Commission For Foreign Medical Graduates (ECFMG) certification, which is required for licensure
    • A visa is required for non-US citizen/permanent resident IMGs
Residency information:
  • Navigating the residency application can be intimidating, but the following resources exist to help give clarity:
    • FREIDA online (AMA)
    • AOA Opportunities database
    • Individual programs’ websites and printed materials
    • Specialty websites and online-residency catalogs

Application submission services:

  • Most residency programs utilize the Electronic Residency Application Service (ERAS)
  • The San Francisco Match utilizes the Central Application Service (CAS).
  • Individual program applications (Often Universal application) used by some residencies and many fellowships

Existing “Matching” programs:

  • National Residency Matching Program (NRMP)
  • NRMP Specialty matching program
  • Canadian Residency Matching Service (CaRMS)
  • AOA Match (National Matching Service) is NO LONGER ACTIVE as of 2019
  • SF Match Residency and Fellowship Services
  • Urology Match

Military Match

  • Health Professions and Scholarship Program (HPSP) and Uniformed Services University of Health Sciences (USUHS) student can submit applications to both the Military Joint Service Graduate Medical Education Selection Board (JSGMESB) and ERAs

No Match:

  • Option available to contact programs individually
  • This is used by “off-cycle” applicants, some residencies, and many fellowship programs.

There is so much to do in so little time; you need to invest in what will pay off. Though board scores (USMLE and COMLEX) are very important (do not let anyone tell you otherwise), there are other components to your application that residency program directors must look at. These include:

  • Grades on required core clinical clerkships
  • Grades on specialty electives
  • Reference letters
  • MSPE/Dean’s letters
  • Awards your receive

Therefore you need to put as much effort as possible into maximizing your results while playing on your personal strengths to determine what areas in which you will excel.


Most medical schools grade clinical clerkships with a pass, fail, or honors; some institutions also give “High Honors,” “High pass,” “Outstanding,” or “superior.” These high marks are essential for distinguishing yourself from your classmates and other applicants. However, it is very rare that someone receives all Honors, or even majority!

Therefore, you should place your focus on particular courses and clerkships where you can earn “Honors” and be content with lower but passing grades on the other passes. 

If your school is strictly pass-fail, then you may have a lower chance of matching into the most competitive residency positions. However, you can place your focus on receiving other awards, achievements, and exceptional reference letters to set you apart.

The key to achieving clinical honors is simple: Effort + Effort + More effort! INCLUDE LINK TO HONORING CLINICAL CLERKSHIPS

  1. Know the rotation and what you are getting into
  2. Be present! Round early and stay late
  3. In your own time, do focused, in-depth self-directed learning
  4. Be respectful and friendly with EVERYONE
  5. Control your emotions, as they are the only thing you can likely control during your clinical rotations
  6. Show enthusiasm
  7. Study well for the shelf exams

The most important grades that you can receive through medical school are in the following order of importance (most to least): Third-year required clerkships > senior year specialty clerkships > preclinical courses > senior electives. 


The impact of research on your residency application is variable based on the specialty you choose to pursue. As a rule of thumb, the more competitive specialties (orthopedic surgery, neurosurgery, dermatology) tend to place a higher value on prior research experience. The same is also true for institutions with a higher ranking or are research-oriented. If you have the option, we highly suggest that you attempt at least one project. Still, if you have no interest in research, do something else you are passionate about. 

General tips for research:

  • Make your experience meaningful. This means looking for a project where you can have something to show for it. Try to present a poster at a conference or assist in creating a manuscript for publication. 
  • Clinical research tends to be easier to publish than basic science research. Therefore, we recommend exploring clinical research. If you have a keen interest in a particular field, try to do research there. 
  • Make sure your project is doable. This means you want to make sure you can complete the project AND that you like the project enough to complete it. Also, make sure that the project is something you can do in the time you have available. School is still your primary responsibility, and you can’t get into residency if you can’t pass classes
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