Starting in 2021, the The Electronic Residency Application Service® (ERAS®) began offering a supplemental application designed to help students share more about themselves. This was also designed to assist program directors in finding applicants that fit their programs’ setting and mission. This is especially important given that in January 2022, USMLE Step 1 went Pass/Fail, which put a new spin on residency applications. Previously, program directors were able to rely on Step 1 as a screening mechanism, but without it, they were left with one less tool to use. The ERAS Supplemental Application is an adjunct tool for program directors to choose applicants.
What Happens When USMLE Step 1 Goes Pass Fail?
The supplemental ERAS application is broken into three sections. We’ll cover all three sections here in this guide with links below.
It started with just two, but has slowly become more and more. We anticipate there maybe even more in 2024. The following specialties will participate in the ERAS supplemental application process for the 2022-23 application cycle. The table below breaks down the specialties, along with which parts of the Supplemental ERAS application they participate in. Keep in mind,
|ERAS Specialty||Supplemental Experiences||Geographic Preferences||Preference Program Signals (# of programs you can signal)|
|Diagnostic Radiology and Interventional Radiology||Yes||Yes||6|
|Internal Medicine (Categorical)||Yes||Yes||7|
|Obstetrics and Gynecology||No||No||3|
|Physical Medicine and Rehabilitation||Yes||Yes||4|
For the 2023 cycle, the deadline to submit was Friday September 16th 2022. While this deadline was present, keep in mind that the actual ERAS can’t be reviewed by residency programs until September 28th. The rationale for the Supplemental Application to be due earlier is unclear, but those are the rules that ERAS put in place!
Drawing upon a similar trend with the most meaningful experiences section of the AMCAS application, the ERAS now has a past experiences section where you can showcase up to 5 of your most 5 most important and meaningful experiences. There is also an additional essay where you can share another impactful experience that demonstrates a challenge or a hardship you faced on your journey to medicine.
The character limits of the past experiences section is only 300 characters, so you do not have a lot of space here!
You need to fill in the following information for each of the 5 meaningful experiences:
The Position title
The Organization name
Your Start and end dates
The Frequency of participation (This is always tricky, because some experiences may be daily for just a period of time. Just use your best judgement)
Setting (rural vs urban). Rural is defined as population of ≤2500 while urban is defined as population of ≥50,000
Experience type: explains what type of experience you had. The following categories are included:
Primary focus area. The following categories are included:
Key characteristic: This should demonstrate the most important characteristic you got out of this experience. The following characteristics are included:
You are only allowed to pick one experience type, one primary focus area, and one key characteristic for each of the 5 experiences.
Description of the experience (maximum 300 characters including spaces): Explain why this experience is meaningful and how it influenced you. Do NOT describe what you did in the experience as this is already mentioned in your CV.
The other impactful experiences section asks the following question:
“Please describe any challenges or hardships that influenced your journey to residency. This could include experiences related to family background, financial background, community setting, educational experiences, and/or general life experiences.”
Here, applicants have the opportunity to share any challenges they faced throughout their medical journey. Programs do not expect all applicants to complete this question as not everyone faced such a challenge or hardship. But if you faced one, it is highly recommended that you include it here. There is a character limit of 750 characters including spaces. We recommend not going overboard here. If you don’t have a truly impactful statement to write, it’s best to skip out here.
ERAS has decided to break up the residency locations into the following geographic sections:
As a residency applicant, you get to choose up to three of these nine sections. Then, with just 300 characters, you can explain each of your preferences. For example, you might illuminate ties you have to the region, such as family or ancestry in the location. Your geographic preference will only be shared with programs in that geographic area.
Unlike the geographical signaling that only programs within a region would see, all programs can view the urban/rural descriptions.
It’s totally up to you as the applicant what you’d like to include here, but you probably want to consider including research experience in the speciality you are applying into. This is important because program directors will often look to applicants research as a way to gauge interest in a speciality, as well as future potential in the field.
PS allows an applicant to send a limited number of “signals” to residency programs that they are genuinely interested in at the time of the initial residency application. These signals help programs identify genuinely interested applicants early in the application review process, providing an opportunity for a more holistic review of applicants most interested in their program.
There is a real history to program signaling. In fact, there are even academic papers that are written about it. An editorial in the Western Journal of Emergency Medicine Dec 2021 written by Alexis Pelletier-Bui et al states:
Preference signaling is a concept rooted in game theory and developed in labor economics to address the challenge of employers not being able to perform a detailed analysis of all potential applicants and aiding them with identifying high-yield employee prospects. Preference signaling allows applicants to assign virtual “tokens” to their most desired employers, providing applicants the opportunity to communicate their interest, and employers the ability to focus their attention on these most “serious” applicants.
PS is new to the residency application process, therefore there is a paucity of data available on how to best assign signals. Most advice provided in this document is based on consensus and not in evidence. The data we do have is from other specialties and best practices may differ by specialty. We do have some information on how advisors advised applicants to use their signals, and how applicants decided to utilize their signals via the ERAS SuppApp in the 2021-2022 residency application cycle, reflected in the table below, referenced from the CodeEM Applicant/Advisor Supplemental Guide
How Advisors Advised and Applicants Utilized Signals in the 2021-2022 ERAS
Because signals will be assigned in concert with ERAS submission, it is strongly recommended that applicants spend some time researching programs and reflecting on what their priorities are in a prospective training program as they are putting together their initial application. There will be more opportunity to learn and reflect in depth on programs during the interview and ranking phase of the process, but having an understanding of some basic program information and the characteristics of applicants that have been accepted in the past can go a long way to helping applicants select the programs they plan to signal. There will not be a post-interview round of signals.
Let’s consider some examples. It is likely to be low yield to use a signal if your USMLE/COMLEX scores are well below a program’s cut off for consideration or if you only have a COMLEX score and a program does not consider COMLEX scores in lieu of USMLE. If you are an IMG and a program denotes US grads only, does not sponsor visas, or has no track record of matching IMGs, using a signal with that program is likely to be low yield. Make sure to consider statistics and probabilities, realizing that the yield of your signal will be lower in these situations compared to utilizing your signals at programs with applicant/resident characteristics that may match more closely with your own
Conversely, it is not wise to use a signal on a program where you are already likely to be offered an interview, such as a home institution (although the AAMC has slightly differing advice on this, see below).
This is a question that is asked a lot. In general, signaling home institutions should not be needed because they should know you as the applicant. This is especially true if you know the program well. Most program directors will tell you this, but you should check individually with your PD to see if they want you to signal (hint, if you meet with them in person, that’s basically signaling that you are interested in their residency program).
Similar to a home institution, you probably already have a great chance of getting an interview at a place you participated in an away rotation for. For this reason, we don’t necessarily recommend signaling those programs. Instead, it maybe best to save your signal for programs where you aren’t quite as well know. That said, the AAMC has published a table where they suggest signaling home and away institutions, however our suggestion at MedSchoolCoach is to show your face with the program director instead and express your interest in person, rather than just via the ERAS.
|Specialty||Signal home||Signal away rotation programs|
|Diagnostic Radiology and Interventional Radiology||Yes, unless the home program tells you not to.||Yes|
|Internal Medicine (Categorical)||No||No|
|Obstetrics and Gynecology||Yes||Yes|
|Pediatrics||Yes, unless the home program tells you not to.||Yes|
|Physical Medicine and Rehabilitation||Yes||Yes|
|Psychiatry||Yes, unless the home program tells you not to.||Yes|
|Public Health and General Preventive Medicine||Yes||Yes|
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