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ERAS Supplemental Application Guide

ERAS Supplemental Application Guide:
During the month of Aug, a new application system was introduced by the ERAS to help the programs identify the most relevant and most suitable candidates out of thousands. Since then, a lot of confusion has been noted and I have received many questions regarding its methodology, filling of questions and the impact upon the interview and the ranking. The following review is an extract of detailed review of the ERAS manuscript with recommendations for an IMG about how to answer the ERAS supplemental application questions.
PART A: Few FAQs:
  1. Why was ERAS Supplemental application introduced?
Statement from AAMC:
“We focused on this early stage because directors reported struggling to identify which applicants are genuinely interested in their programs when deciding whom to invite for interviews,
Before we know how to fill in the questions, we need to focus why would ERAS introduce yet another portal? In addition to ERAS CV and Personal statement, ERAS supplemental application is yet another folder to review a candidate. Every year each program receives thousands of applications especially in Internal medicine and Surgery. They send interview invites to one candidate out of 10 applications received. This new portal is to help the programs to best select their candidates out of those thousands of the applications. Using this information, programs can send interviews to the most relevant candidates and chance of “pick and choose” will be eliminated. This is in addition to all those filters (scores, year of graduation etc) that each program has set up for itself.
  1. Is ERAS supplemental application optional?
Yes. So called optional. But it is paradoxical. Ironically, if you do not want to answer these specific signaling questions, you are indirectly telling the PDs that they can send invites to those who are specific about their geography, type of training and type of the program. So, even it is optional, it becomes a mandatory application so that you would not be considered “a mass random application”.
  1. Are all the programs participating in this portal?
Answer is no. Not all the programs of IM, dermatology and general surgery are participating in the ERAS supplementary portal. You will automatically come to know if a program is participating or not when you will save the program. (ERAS will send you a “supplemental application link” if the program is participating).
  1. Timeline of the Portal:
If you submit the supplemental application between 1st Sep to 19th Sep, programs will review it by 29th Sep.
If you submit it between 20th Sep to 30th Sep, they will review it by 6th Oct.
Please note that this is different from MY ERAS application that cannot be reviewed by the programs before 29th Sep as this is when they will start downloading “my eras applications
What does it imply?
You must be very narrative in your ERAS supplemental application, and you cannot say “please refer to my ERAS application for details” or “as I wrote in my ERAS CV”. It is possible that they may not have your My ERAS CV downloaded by the time they will be reviewing your ERAS supplemental application responses.
  1. What is the difference between my ERAS and ERAS supplemental application?
If you read the whole manuscript, you will know the differences. My Eras talks about your whole CV in general. ERAS supplemental application is more specific regarding what are the 5 most “meaningful” or “impactful” experiences out of all the experiences based upon which you are choosing medicine and this program. Moreover, the candidates also must talk about their geographic preference and the work settings (rural / urban) in ERAS supplemental portal. In other words, in my ERAS, you present all the bricks you have collected throughout your career. But in ERAS supplemental portal, you have to stack those bricks in a specific and promising way to build a particular house so that the PD can buy that house. I will explain this further when I will write how to fill in the application.
  1. What is the difference between Ranking programs vs Signaling 5 programs?
This is the most frequent question I got.
  1. Signaling is done before Interviews to get the Interviews. It is done based upon objective and realistic facts that consider “Your strength, career goals and the nature of the program”. I would signal Montefiore knowing it is an IMG friendly New York Program; often takes candidates without extensive research and does have GI fellowship (my future career goal). That is realistic and objective. More likely, I would get call from Montefiore as they also like IMGs and already have residents from IMGs medical colleges. This is called Signaling.
  1. Ranking is done after interviews. It is done and should be done based on “liking” not “strengths”. Let’s say I got interviews from Montefiore (because of my signal to it) and I also got interview from Oklahoma University (even without signaling but by chance or internal recommendation). I can rank Oklahoma higher than the Montefiore based upon my liking although strength wise I may not qualify for a university program.
  1. A program may or may not do ranking based upon signaling. ERAS has written that they have instructed the programs not to do that. Means not to prefer the candidates during ranking process who specifically signaled them. But the ERAs did not explain any mechanism to prevent this potential bias. In my personal view. Most of the programs would send interviews to the candidates who would signal them, and then rank among them based upon other credentials (scores, research etc). Exceptions can be there when very high scorers apply to a mediocre program and do not signal them, they still can get interview and even be ranked by the program, but they would definitely get interviews from the programs they actually have signaled to, and would prefer to rank them higher. So, ranking and matching will follow the signaling ultimately.
Example: Montefiore will get 3000 applications based on their filters of scores and YOG. (Low scores, old YOG, failed attempts will already be filtered out). Out of 3000, 500 might signal to Montefiore (as you only can signal 5 programs). So, Montefiore will choose 100-200 candidates for interviews for 30 categorical seats. Those 100-200 will be likely from the pool of 500- candidates who signaled to Montefiore. Ranking will be done among those who were interviewed. It is possible that Montefiore may invite a student with 271, 270, multiple publications. That student might not have signaled Montefiore because he would like to signal a university program. He will likely get interview by the university program that he would also rank higher. So, in the end he would land there. Net result: Candidates will land based upon their strengths. Ranking will follow signaling.
  1. Will this supplemental application affect overall number of interviews?
I think Yes. It would decrease all the random and courtesy interviews, and would lead to focused interviews to the most relevant candidates. Since a candidate can only signal 5 programs, it will decrease the overall number of interviews. But it will not decrease chance of matching as each interview will be given very objectively to the most relevant applicants already considering the matching points between the applicant and the program, so in spite of overall less interviews, candidates will carry same matching chance.
  1. How will it impact IMGs?
Most IMGs apply widely in 100-150 programs in more than 20-30 states and 6-7 USA regions. They do not specify geographic preferences. As I mentioned, by being specific in geography and programs, they might get less over all interviews, but each interview will have high matching chance once they get an interview. The match/interview ratio will increase.
PART B: How to fill the ERAS Supplemental Application:
In this portion, I will try to recommend how an IMG should answer the ERAS supplemental application questions in best possible way so that he gets most matching interviews. While writing this part, I will use the guidance given by the AAMC in their articles and my own experience.
The application asks questions in FOUR major areas.
  1. Past Experiences
  1. Demographic preference.
  1. Workplace settings preference
  1. Programs Signaling.
  1. Question 1: Past Experiences: “Be meaningful”
“You should identify which of your experiences you can speak about passionately and intelligently in an interview” (AAMC)
PDs are interested in knowing the 5 most important experiences that can be pertinent to their programs. Can be Clinical, research or volunteer. You have to mention top 5 experiences in these categories chosen out of all the experiences mentioned in my ERAS Cv. But top 5 “Meaningful” experiences. (Does not have to be 5, can be 2 or 3 but can be 5 as max).
Being an IMG, I know that most of us have similar meaningful experiences. So, I will be generic while answering this part. If you notice, for an IMG, the most meaningful experiences are USCE, research, House Job, work experience (e.g. FCPS in Pak or MO ship) and Volunteer work.  Why each experience is meaningful? Think of the lines you wrote about that experience in your “My ERAS”. It is the same info they are asking in more specific way. I would mention these top 5 experiences. I will also write reason for being meaningful.
  1. Clinical Rotations in USA: (come under category “Education/Clinical training”)
Meaningful because they introduced us to US health system and gave us directions why to choose medicine. You can be specific as well why you think the rotation was meaningful with respect to the application in IM program.
  1. Second Clinical rotation in USA.
Can mention specifics of the rotation.
e.g.
Cardiology rotation: helped improve your EKG reads.
Radiology rotation: helped improve your skills to understand basic imaging etc. These are all meaningful with respect to application in IM residency.
  1. Research if you have done. Otherwise, any other USA clinical rotation. Research is always meaningful. If you have done publications, you can mention about them.
  1. House Job/ FCPS training in Pak if you have done. (Come under category “Education/Clinical training”)
It is meaningful as I learnt clinical methods working in Pakistan’s limited resources clinical environment. Doing HJ improved my clinical skills that can help me in residency.
In house job, I worked in different specialties, that helped me know my niche and future specialty.
  1. Volunteer experience. I do career counseling among the students who are preparing for USMLE. It is meaningful because it polished my leadership and counseling skills. You can also mention teaching as volunteer experience if you have done any without pay. PDs love candidates who like to teach others.
This section may vary for different candidates. But think about the experiences that would impress a PD. Mostly they are Clinical, research, volunteer. I would use combination of them if possible. I would mention lines about how each experience helped guide my career preference and improve my knowledge, skills, and workflow. This is what we call “meaningful”.
Portal Details:
  1. Each Clinical experience opens many sub tabs and small questions regarding:
  • Type of the experience (Education / clinical training, research, and volunteer),
  • Location and the name of the hospital
  • work frequency (clinical experiences mostly come under daily frequency)
  • your position (mostly externee, observer).
  • Was it related to patient care (most clinical experiences are patient related)?
  • Did it require medical knowledge? etc
  1. In research, you should mention specific details such in each tabs such as:
  1. Type of research
  1. Output of research (For most IMGs, it can be a poster, oral presentation, published article in journal etc). Think of publications section in your “My ERAS”. It is the same info they are asking.
  1. Citations:
If work is published, mention link, journal names, PUBMED Ids etc.
If work is presented, mention names of conference.
  1. Your role in Research: PD wants to know specifically if you were in “lead role” or “collaborator”.
Lead: You are the one assigning duties to team. e.g. making design, collecting data, Primary investigator.
Collaborator: You are doing tasks assigned to you by the lead.
Most of IMGs as applicants do research as Collaborator. So please only mention lead role if you have done it such as poster presentation.
Same applies to the volunteer tab. They want to ask specific questions. And you want to be as specific as possible.
I would not mention local college societies in “Meaningful experiences”. Only mention professional societies and organizations if they are International (such as WHO etc). That makes them meaningful.
This completes the section on “Meaningful experiences”.
Impactful Experiences:
In addition to 5 top meaningful experiences, you can also mention “impactful” experiences. They are mostly related to your family background, some family member dying and impacting you to join medicine, some unprecedented financial hardships that you faced etc. In my view it is mostly emotional part of the application that allows you to mention some extra ordinary instances that impacted your journey. They might not be the instances that persuaded you to join Medicine in USA. They can be the hardships and difficulties that impacted you, and you still fought them enough to reach here.
Tip: Only mention the story if it is real; if it is not already mentioned in the personal statement and if it is not over dramatic. Otherwise, I would advise to keep this blank.
Don’t need to go into great detail about something like a divorce or a family member dying, but you might briefly note that it impacted your Step exam performance,” (AAMC)
Dont’s of Meaningful or Impactful experiences:
  1. Do not mention your low scores or visa refusals or attempts as impactful experiences. You have limited characters allowed. It is not wise to bring on the negative side of your application. Visa refusal as impactful experience may look like a way to gain sympathy.
  1. Do not mention being CR of your class or similar local positions in local societies as meaningful experience.
  1. Do not be over dramatic and do not go into details while explaining impactful experiences such as a divorce, disease or demise of a family member.
Question 2: Demography Preference:
As students tackle the geographic items, they plan to proceed carefully. “Let’s say a program in Idaho was thinking about interviewing you, but then they see you didn’t pick their region,” says Carrasco. “They may decide not to risk wasting an interview on you.”
(AAMC)
AAMC gave two strategies to handle this part:
  1. One possible path is for students to review their favorite programs to see if they can batch them into three geographic regions. “For many students, being able to signal three geographic areas is probably sufficient because that might cover a whole bunch of programs,”.
  1. “Other students who can’t necessarily afford to limit themselves probably should signal ‘no geographic preference’ and make sure to explain why.”
(AAMC)
Most IMGs apply in 9 regions and 50 states in USA. This part is to help the programs identify the local applicants if they otherwise qualify for the program.
  1. If you have specific preference due to spouse or family, then be specific and follow “a” strategy. Please note that only three regions can be selected. Most IMGs apply in these three to four regions:
Mid Atlantic (NY, NJ, PA)
East North Central (IL, OH, WI, MI, IN)
South Atlantic (DC, DE, FL, GA, MD, NC, VA, WV)
New England (CT, MA, ME, NH, RI, VT)
If you choose three regions, only then the programs in these regions among your applied programs will get to know your preference. You must describe reason why these regions. (I would write I have friends and relatives in NY or I like city life and have done rotations in NY etc.)
Let’s say you apply a program in OK but have not given preference to this state, the program in OK will not know whether you participated in the “geography preference question or not”.
  1. If you are applying widely and cannot bunch your programs in 3 regions for being them scattered, then choose “b“ strategy: i.e. ”no preference to any state” at all or choose “do not want to communicate”, then all programs will know that you did not prefer any state.
Do not forget to explain “why”.
You may write:
“I am an IMG and to me a program strength and training is more important than its geography and location. I am open to all the states and believe that good training supersedes geography should not be restricted by the locations as there very good programs in all states of USA. “
  1. There can be a third strategy as well. You specify three IMG friendly regions but you signal 3-4 programs in those three regions and signal one or two highly IMG friendly programs outside the regions. You may get interview from that program out of the regions as well as from the programs whose regions your preferred. This strategy is recommended when you have many seniors in a very IMG friendly program such as Oklahoma University that otherwise might be out of your three IMG friendly regions.
Question 3: Workplace settings: “Be Non-specific”
In this question, you will be asked about preference to rural or urban or multiple. They would ask your interest in terms of a scale.
I would write: No preference
Reason: Each setting has its own importance. In urban settings, multitude of cases and more exposure due to population > 50,000.
In rural settings, you can see different patient populations and different clinical set up. You are committed to the patient care regardless of the locality.
Question 4: Signaling a Program. “Be realistic”
“For most students, I would say don’t use all your signals for reach programs, so you don’t waste them. “Also, make sure to signal a less competitive program, as they otherwise may not think you’re really interested in them — and to make sure you have a safety net.”  (AAMC)
I have mentioned earlier that signaling is different from Ranking. It is done based upon realistic and objective facts such as Strength of your CV and Programs features.
  1. If you signal a program, the program gets notified.
  1. Rest of the programs where you applied but did not signal, they do not know if you participated in ERAS supplemental application or not. Remember, ERAS supplemental portal is OPTIONAL.
  1. It increases chance of getting interviews from the 5 programs you signaled. In past when ENT residency chose signaling process, it was observed that 90 % of the candidates got one interview out of 5 programs they signaled. 80 % got 2 interviews out of 5 they signaled. So, we advise to signal 5 programs not based on your liking (as you would do in ranking) but based on your CV and career goals.
TIP:
  1. Do not use all signals to “reach” programs. Means the programs that are within your easy reach (less competitive) and can send you invite even without a signal. g. Bronx Lebanon, or a program, where you did rotations and have been promised an interview.
  1. Also do not signal a program that is over competitive. You will waste the signal. E,g. UMAS or MGH who are competitive and not IMG friendly.
My advice would be to signal IMG friendly universities and save signals by not signaling IMG friendly small community programs to have a fine balance explained in this rule published by AAMC.
Applied Example:
If I were applying this year, this is how I would have signaled:
  1. Oklahoma University
  1. Montefiore
  1. Abington
  1. Brookdale University
  1. Marshfield Wisconsin.
Only these programs would get notice that I signaled them. The 1-5 numbers are mere numbers not ranking by applicant. These are the programs that would match with my scores and my future career goals (Monte has GI fellowship). If signal U-MAS, I may not get call by them as I do not match with their standards, but I would miss a chance of signaling to a program that I may qualify. (as you can only signal 5 programs). So, be realistic and signal to the programs that best match with your CV and career goals.
Remember:
  1. You cannot signal to a program, where you did away elective or Sub-internship. I do not know if same rule applies to externship or observer ship or not.
Summary:
I tried to be as simple and objective as possible. I understand it is a long draft and a complex topic to understand. But basic rule is same:
  1. Be meaningful in your experiences.
  1. Be realistic in your signaling. Signal with in the three regions you chose. Avoid signaling to euther too easy programs or too competitive programs.
  1. Stack your favorite programs in 3 regions if you have any regional preference or “say no preference and explain why” if you cannot stack them in three regions.
  1. Be nonspecific in your work settings.
These are my views. People may have different views and different recommendations based upon their own experiences. Please make change sin your responses according to your individual experiences, preferences, and circumstances. We will do live session this Saturday 1 pm eastern time to further discuss this portal.
Best wishes. Always believe in Almighty because if you believe, you receive

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