Red Flags Come in Many Forms
There are no personality traits more attractive in a candidate than self-awareness, confidence and humility. And nothing makes these traits more attractive than the barriers the candidate had to overcome to obtain them.
Red flags come in many forms. For medical residency, they include low or failing Step scores, graduating from a medical school outside the United States, prior failure to match, lack of U.S. clinical experience, gaps in medical training, professionalism issues and disciplinary action. However, there is no greater red flag than the candidate who pretends in his or her personal statement that these do not exist.
The Case of the Foreign Accent and the Inappropriately Dressed Teenager
When it comes to writing residency personal statements, there is a tendency among candidates, as well as sometimes also those advising them, to believe that not discussing red flags, whose existence is always otherwise obvious, is the way to make themselves more attractive. To take a comprehensive view of this question, let us take a look at the case of the foreign accent and the inappropriately dressed woman.
Let’s start with the world-famous professor who has come to the U.S. to give a lecture in English, his third language. He speaks with such an accent that sometimes those unused to his manner of speaking have difficulty understanding him. Now let us pretend we do not know how famous he is, that he is a professor, or anything else about him.
There are two different ways he can step up to the podium. He can dive into his lecture unapologetically, creating an awkward feeling in those struggling to understand him, or, as some speakers do, he can preface his lecture by making a joke about his accent, which puts everyone at ease, including himself, and makes everyone feel comfortable as he begins.
Now let’s imagine a teenager arriving late to a 70’s-themeed party and suddenly realizing, as she sees all the bell bottom pants and big hair wigs around her, that she had never received the message that it would be a themed party. When she opens the door, everyone sees her mistake.
The teenager has two options. The first is to feel embarrassed, ashamed and to lose all her confidence. The second is to embrace the mistake and enjoy the party anyway.
With the first option, everyone would sense her embarrassment, and feel awkward and embarrassed around her. With the second option, everyone would feel excited to have her at the party and, after her candidly admitting her error, quickly forget it even existed.
In both cases the audience at the lecture and the others at the party admire the speaker and teenager more for being unafraid to show their shortcomings and display their unaffected, while still humble, confidence.
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Two Sides of the Same Coin
Every red flag is a coin with two sides. One is the dull, negative side, where you find awkwardness, embarrassment and shame. The other is the shiny, positive side, where we see the coin at its most attractive. It is where we see the coin’s personality traits of self-awareness, humility and confidence.
Why You Should Address Red Flags in Your Personal Statement
The purpose of the personal statement is for you to present yourself in the most attractive light, and the most attractive personality trait in a candidate for medical residency is the union of humility and self-confidence. Your character is what matters most, not your ability to speak without an accent.
Everyone has positive and negative attributes. The question is whether you are someone your future fellow residents, attendings and program director will enjoy being around.
The kind of person everyone enjoys being around is not the one who tries to pretend he or she has no problems.
What the ECFMG Has to Say About It
The ECFMG, like us, takes a clear view in favor of discussing red flags in a personal statement. Here is one of the “Do’s” from their Personal Statement “Do’s” and “Don’ts”:
"DO be honest. If there is a 'red flag' on your application (gap in training, disciplinary action, course failures), this is your chance to explain it. Don’t avoid the topic, and make sure your explanation is accurate and forthright."
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What Others Have to Say About It
Because of a lack of understanding of the compelling ways red flags can be presented in a personal statement, there are many who end up giving either erroneous advice or correct advice that is erroneously understood.
Here is the opinion expressed by Tao Le, Vikas Brushan and Christina Shenvi in their book, First Aid for the Match:
"Another egregious error is utilizing the personal statement to discuss application weaknesses. Drawing attention to a failed USMLE attempt or to a low clerkship score with an explanation of illness or personal distraction is rarely helpful. Describing oneself as great on the wards, but a poor test taker, is also worrisome. The personal statement should be a time to celebrate a great medical school and appreciation for an excellent education. Any experiences that reflect poorly on your school or your education should not be included. (For example, 'My shelf exam scores are low because we received no guidance on what to study.') If the interviewer wants you to elaborate on any weaknesses in your application, he or she will ask you about them. Do not volunteer the information needlessly."
"You should avoid any negativity in your personal statement. For example, if you went to graduate school and switched to medical school because you hated your time in graduate school, do not say so overtly. Focus on what you learned through the experience of going to graduate school and how it motivated you to pursue medicine. Discuss how you feel medicine is a better fit for you, but do not dwell excessively on the negative aspects of your experiences."
The reason I have reproduced the advice from this book is that many of our clients cite it when expressing concern about the ECFMG’s and our advice not to shy away from addressing red flags in their residency personal statements. Because of the way this advice is worded, our clients end up misinterpreting it and not realizing how it actually supports our position.
Take a look at the first sentence of the second paragraph: “You should avoid any negativity in your personal statement.” That is the key. Think back to the earlier story of the inappropriately dressed teenager arriving at the party. She could blame the party organizers for not telling her about the theme. She could blame her dog for eating the invitation. Or she could avoid all negativity by embracing her mistake and showing her strength and depth of character instead.
In other words every red flag has two sides: one in which the red flag can be shown to be a strength and the other in which it can be shown to be a weakness. First Aid for the Match is correct that the personal statement is not the place to showcase weaknesses. However, it is a mistake to conclude that this means not to address red flags.
Take the example of the failed USMLE attempt due to “personal distraction.” You certainly do not want to write that your reason for failing was that you were simply “distracted.” We have had clients who thought they could get away with not studying or with going out partying the night before. But we also had a client who was 8 months pregnant and started bleeding a couple of hours before her Step 2 CS, and who tried to take the Step 2 CS anyway rather than lose the money she had paid for the registration fee, airplane tickets, hotel room and rental car (she had had to fly to another city to take it). And we had a client whose father had gone into intensive care following a motor vehicle accident four days before needing to take Step 2 CK. Both clients failed those attempts. These were not “poor test takers.” Both recovered and excelled in their second attempts.
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The Erroneous Advice of Waiting for the Interview
Partly because of erroneous advice, together with how easy it is to misunderstand the medical residency application process, some candidates mistakenly believe it is better not to address any red flags in a personal statement and wait until the interview to discuss these instead. That is like a girl who has never left her house waiting at home for suitors to come see her.
Time and again, we have seen candidates refusing to address red flags in their personal statements with the belief these will be discussed in their interviews, only later not to receive any invitation to interview.
Why does this happen? Because through the rest of the medical residency application, the red flags are obvious, making even more glaring their admission from the personal statement.
How do you plan to hide the fact that you graduated from medical school in the Caribbean, for example? How do you plan to hide your low USMLE scores?
Remember the man with the accent. Remember the teenager inappropriately addressed for the party. Even if you do get an interview, do you really prefer to wait until you are put on the spot to answer the question rather than taking control of your narrative?
The Competitive Edge of Discussing Red Flags
Character is the single-most overlooked opportunity to gain a competitive edge in the medical residency application, and the only place to show it is in the personal statement.
Candidates often underestimate how great the number of others applying for the same medical residency position is. They even more frequently underestimate the number of other clients we have applying from the same medical schools, with similar scores and experience, for the same specialties and even for the same hospitals.
We read their medical residency personal statements side by side, together with their CVs, the same as the programs will.
When comparing two similar applications, which one do you think is going to appear more attractive? Is it the one from the man who makes everyone feel awkward because of his accent? Is it the one from the teenager who tries to hide how she is dressed when she opens the door to a party?
Which is the one you would find more compelling?
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Editor’s Note: This article was originally published December 4, 2016, and last updated for accuracy and comprehensiveness May 19, 2022.