 Hello and welcome to unmatched in radiology exploring next steps hosted by the rad room. We're here tonight to provide support for students who have gone unmatched present options that students have over the next several days as they navigate the soap and beyond and facilitate immediate mentorship for unmatched students with fellow matched applicants residents fellows and attending radiologists. The purpose of the session is to create an informative safe forum for students to ask questions, destigmatize going unmatched and find mentors to assist them to navigate a challenging week. Please remember to use the Q&A feature and not chat to submit your questions so we can get to as many as we can before the time is up. If you prefer to submit a question anonymously, there is a box in the Q&A feature that allows you to do so. The organizers and panelists are Ashley Lau, Sao Hill Patel, and Arun Marugason co founders of the rad room. Ashley, Sao Hill and Arun are joined by Dr. Carol Gear, Diagnostic Radiology Program Director at Wake Forest University, and Dr. Lulu Zhang, Interventional Radiology Program Director and Diagnostic Radiology Associate Program Director at University of Cincinnati. Additionally, Connie G and Irina Quinn are here today to share their experiences the past year. They match distrustful for students and their loved ones, and that you're faced with career defining decisions so we hope you find this webinar helpful. With that, the rad room take it away. All right, great. Thank you. Thank you for the introduction. I'm going to begin sharing our slides here. You guys, all thumbs up. Beautiful. All right, great. So we want to first off welcome you to the session on matched and radiology exploring the next steps on your journey and begin. I just want to say that I'm really sorry to hear that you're unmatched. I know how difficult it can be because I was in your shoes last year. And it's something that we at the rad room are really passionate about helping provide you guys the next step on your journey to getting matched for the subsequent year and so we really hope that the information you take away from this webinar is beneficial for not just you but for your family as you decide your next steps on your journey and we're confident. I can say personally that within radiology, there's wonderful people all willing to help. And if there's anything that we at the rad room can do, please, you know how to contact us will share that information at the end, and we really look forward to helping serve you on your journey. I just wanted to take a moment to thank MRI online. When we first have this idea and we approached them, they were so enthusiastic to show support to radiology applicants everywhere they provide an amazing educational platform we can learn about all things radiology, but they really also go above and beyond to support radiology trainings and people that are interested in radiology so I really want to give a heartfelt thank you to Ashley, Ben and Serena for all they've done to put this together. Absolutely. So, just a brief agenda on the session that I'm going to present here is pretty brief, and it just helps you explore options on provides past data, which will hopefully help inform your decision making. Then really what you guys are here for is the q amp a panel. We have experts to program directors and residents who went from being unmatched to match who are here to give you their feedback, and their lived experiences with the whole process. And then, as I mentioned earlier, in the closing we're going to provide you follow up information, access to mentorship and resources, so that as you navigate the stressful week you're not alone. So the first thing we really want to talk about here is diagnosing the cause of being unmatched. So this image is adapted or it's directly from Dr Brian Carmody. This is a YouTube video match day mail bag. What if I don't match, we requested his permission and he granted it and said we can use his images from the video in this slide deck. So this is where it's from if you want to see the primary material for it. But the big thing that we want to drive home from this slide here is that competition was definitely a factor for everybody that one unmatched radiology this past year. When you're trying to diagnose what went what was the reason for being unmatched competition surely affected everybody. Then the next couple buckets that are important to think about our known weaknesses versus unknown red flags and these are not mutually exclusive and you may fall maybe you were just a victim of competition. And that's something that you're going to have to figure out and so the most important thing looking at this is identifying what was your cause and so we highly recommend finding a mentor or someone who's intimately familiar with your participation and sitting down with them and trying to figure out what are the causes so known weaknesses examples could be a failed clerkship, a repeated board exam, having to take an additional year in medical school. You may have known this if you were going through the process with less interviews that would be in that bucket for an example, unknown red flags could be something that is innocuous as just something in your letter of recommendation that kept you from being ranked higher, or having a high interview count and maybe not executing completely during the interview process. These are all things that are important to figure out because knowing what the causes is going to help dictate your next steps so we really want to make sure that that is identified for you as you navigate the process. So the available options at your disposal right now in terms of next steps are either so delaying graduation, doing your research here, or if you're partially matched reapplying to radiology. So if you're partially matched whether it's in a prelim medicine prelim surgery or transitional year reapplying this upcoming fall for an advanced position in radiology specifically for this session. This graphic is just demonstrate also adapted from that same. What if I don't match video from Dr Brian Carmody. It's just here to demonstrate that the soap is not a high value. It's not a buyer's market. That's in his exact words. There were 13,000 eligible applicants last year, and only 16% ended up accepting positions. And if you just look under the percent of accepted positions. No seniors represented about 57 and a half percent of those accepted positions and MD seniors accounted for the about another third. So if you fall into buckets that are not in those categories, it's a harder proposition in terms of trying to rely on soap and we just want you to be aware of the data from last year. And then as it comes to pertinent soap positions for pursuing radiology, you can pursue. Sorry, I apologize. The lights kind of dimmed here, but you can see the screen. So prelim surgery accounted for the most common spots. There were transitional your spots, and then they were internal medicine prelim spots in terms of being some of the most frequent. Any one of these paths will get you to radiology. It's just the types of the different steps you're going to have to take on that path. And so we're going to highlight what that looks like. So one of the most common things questions that come around this time is soap and GME funding when you're talking about these preliminary positions. So funding for residency is provided by Medicare, and there's only one initial residency period of the IRP, okay, which is the maximum minimum. It is the minimum years required for a resident to become board eligible. And it does not change even if changing specialties. For example, if you're an internal medicine resident trying to switch to radiology, you've been pre allocated three years of funding. Those three years are represented by the three years required to complete the internal medicine residency. So if you make that switch to radiology, that would require the program to seek additional funding for the remaining two years. The same principle applies to the respective preliminary years. So what that means is a prelim medicine year prelim medicine your resident only has two more years of GME funding, unless they have matched with an advanced position at the same time. While a prelim surgery resident has four more years of GME funding because of a general surgery residency is five years. So after doing your prelim surgery or you still have four years left to go. The GME funding math does not apply to transitional years, because for them your IRP is determined by the type of residency you enter in your second year of training. This is important to be aware of because some applicants of residencies have heard from in the past that when they were not given interviews at programs they were interested in, that the reason they didn't get an interview were due to logistics behind funding. That being said, not every program will reject you because of this and some have workarounds and additional funding, but it's just something to be aware of. So, again, we're going to talk about this at some point in the Q and the Q&A session as well. So options, other options that are available so delaying graduation is a common one we have an individual on the Q&A panel today who chose this option and its institution dependent. So if you're interested asking your home program your medical school if it's possible is certainly an option. One of the benefits for doing it is that it allows you to prevent it from being filtered out by your graduation filters that some programs may have. I do want to stipulate that this is not very commonly found in not too common in programs, especially if your year of graduation is the same year that you're applying so if you graduate this year 2023. It's unlikely that a program is going to be filtering you out because you just graduated so this is something that personal experience of reaching out to programs. I don't think I ever heard anyone saying that they filter out current year graduates so just keep that in mind for your decision making. But what is definitely certain is that it is much easier to attain away rotations as a US senior student. You're not going to be acquiring rotations as much easier when you're in school, because if you don't, if you're a graduate, you would acquire something called observerships in terms of getting clinical experience as a graduate, and observerships are a little bit less regulated, less structured, and sometimes you're going to be paying a lot of money out of pocket so it's something you want to keep in mind if that's an option you choose. So, if you pursue a transitional or you're already matching to a transitional or preliminary year, what is, you know, what are you going to be taking away from it. So, if you were someone in that bucket that we showed on the first one of the first slides we looked at about the competition known weaknesses unknown weaknesses. So, the transitional or prelim years offer you the opportunity to demonstrate your ability to do excellent clinical work, and in addition allow you to network with a home program, or local radiology program in your area. The, some of the tougher features of doing this pathway is that you're going to have less time for interviews and your application. I know arena is going to talk on a little bit later today, but when you're a resident and intern, you're going to be working a lot of hours so it might be harder to build an overall application so again, finding a mentor, figuring out what are the strengths weaknesses of your application will give you the best picture in terms of helping you decide what option to choose. Additionally, so we write wrote here it's difficult to obtain or to attend observerships, you might not have a rotation at your intern your program and radiology. So, I know anecdotally from talking to people that were in that situation. They use their weekends to go work in a radiology department that was local. It's just something you should be aware of because it might not be a streamlined as you imagine. But, you know, as we touched on the benefits are that it can really demonstrate programs that you're an excellent clinical resident, and that any doubts that may have been perceived from a first year medical student class failure are not in question anymore because you can perform well as an intern. And it allows you to get a strong so with that a strong letter of recommendation from a program director. Another option. It's not as common, not as frequent offerings but there's something called physician positions, which would allow you to complete your intern year and then join immediately into an R one physician for the subsequent year. So what that means is there's no gap year between starting your intern year and radiology residency if you were already in a T wire prelim year. So another option is a research year. And this really is, you know, not just limited to research. So we talked about your application lacks publications presentations, abstracts or just general research experience. It also allows you to demonstrate a commitment to the specialty of radiology. There are a lot of organizations such as the ACR that accept graduates onto their medical students subcommittee. So I know for me personally, I was involved in the medical students subcommittee for the ACR. And in addition to doing research, being able to augment that experience with committed interest in the specialty attending national conferences. It's really a great way to build your overall application if you feel that you might just be missing radiology extracurriculars if you want to call it. So with that, there's funded versus unpaid opportunities when you're looking at research. So with a funded opportunity, you're likely to be at one institution, working primarily just there. Whereas unpaid, it might be more flexible. Again, this is something we will touch on in the coming days to give you more answers and advice on this topic, but research years are generally more flexible than if you were doing a prelim, a prelim transitional year. And exactly so our goals, maximize output network and really just allow you to demonstrate commitment to the specialty. And so the big closing thoughts takeaways we really want to convey to you is that at the end of the day, you have to make the best decision for you. And that decision is based on factors that really only you and your mentors and people closest to you know the strengths of your application. What one person does what you do, it's only dependent based on what you've done and what you think you can improve on. And so we really recommend talking to as many knowledgeable people as you can to get that information so you can make the best decision. And in addition to that using Twitter to find opportunities and putting yourself out there. Last year, it was not something that you know at first I was reticent to put a tweet out there being unmatched, but that tweet garnered a lot of attention and responses to it ended up turning into opportunities that brought me to this position today so you know, it's understandable if you're on Twitter, but if you want to talk offline, I'm more than willing to talk to any of you about that process of getting started on social media, Twitter and finding these opportunities and even if you don't want to do that we can find you opportunities directly as well. And we want to highlight the importance of finding mentors, and that's what we're going to touch on here on this final slide here. So, we have the radio at the rad room, created a part of our website here dedicated to unmatched students. And so we have a sign up form for mentors, we already have so many generous residents fellows attendings across the radiology community who've signed up to be mentors, and they're just waiting to be paired with a mentee. So this is something you're interested in. Please go to the website, even do it now we'll put a link in the chat, and you can sign up for a mentor. And in addition, there is a link for an unmatched slack channel that's being organized by Aisha, who's a fellow student, where people can have a chat with people that are in similar situations, share opportunities I know something that I benefited benefited from so highly recommended. And with that, I would like to transition to our panel. So we want to welcome Dr. gear, Dr. Zhang, Dr. Quinn, and Connie and really thankful that you guys are willing to donate your time this evening. Great. Thank you run. And so, you know, before we start I just want to take a moment to thank the panelists again for taking time out of their busy schedules to all be here tonight. And congratulations to arena and Connie for matching today after going on match last year. I know it's a process but you guys are proof that, you know, if you really commit to radiology and this is what you want to do, you can make it happen. So our first question before we get into any specifics, or is really just a general question for all of our panelists, what overall general advice do you have for applicants and how they should approach this unexpected news they had. And overall in general. So Dr saying we'll start with you. Thank you very much everyone is pleasure to be here and thank you for the invitation. The biggest thing to for me, my advice is really find a mentor, someone who I can't emphasize enough and I run thank you so much for, you know, highlighting that, but it's really. You have to understand what is the cause of the problem for you to be able to solve the problem and also it's also just getting into the minds of how a DR PD actually or PD actually thinks, and what we do to actually look at it and use using that lens to view your application. But yeah, that will be my biggest thing. Absolutely. Dr gear anything you'd like to add to that. No, I mean I would, I would echo what Dr saying said and and I think as far as at least mentors this week I think it is important to talk with. If it's diagnostic radiology talk to the diagnostic radiology program director or associate assistant program director because I do think they're, you know, sort of honest, you know, look with you into the lens of what's to come I think they can give you really good advice course if it's interventional, you know, I would reach out to the interventional program directors and talk to them or both if you've applied both both ways. But I think those people's view and the lens that we look through is going to be very important to kind of talk you through, you know, what are the options. And kind of again I think getting honest answers I think program directors are pretty good about being honest and and you know our is there something in your application that is going to be really difficult to overcome. Then we need to talk through that how do we change that this coming year or you do something to make it so that that particular thing isn't such a big issue. I think you need honest feedback and I think program directors are probably the right people to go to for that. Absolutely. Connie your thoughts. Yes. So I definitely agree with everything that you're saying Dr gear said when I went on match last year, you know, after taking some time to think it through, I reached out to basically all the programs that I had interviewed at and asked for very specific specific feedback is very helpful. In addition to that I think other specific things that I kind of worked on were looking for opportunities to practice interviewing and like just being more comfortable in the virtual setting because sometimes I can throw people off and really thinking through it take a lot of time to think through your personal statement because oftentimes is the first thing that someone looks at and so really thinking through how you present yourself as a re applicant is something I would suggest. Absolutely. And arena, any closing thoughts for this question. I agree with what everyone else said as well I reached out all the programs the same thing as Connie. Something else is, you know, make sure you take care of yourself this is going to be probably the hardest week you've ever been through so make sure you're prioritizing yourself, you have a strong support system around you and you have people that are supportive and can help you through the week. And yeah. Great, thank you everyone. For our next question we're going to kind of transition to like preparing for reapplying and what that looks like so we'll start with a question for our PDs. And the first question is going to be is there any difference in programs when you're reviewing re applicants on whether they decided to do an intern or transitional year delay graduation or take your research year. And Dr gear will start with you. For and again this is kind of one program directors opinion so this, you know, program directors may have slightly different opinions on this. For me there is not. You know, a difference in the applicants. I think a lot of people can't do that research year for financial reasons. You know, a lot of sometimes paid research spots are very hard to find. And I think some people really feel like you know what I've just got to keep going I'm just going to have to start with my intern year and go that way. I really personally do not weigh one more than another. I think what program directors are, you know, when everyone's reapplying what I look at is if you've gone, you know, straight into internship and what me personally I'm okay with whatever I'm a diagnostic residency program director so I'm okay with whatever internship people do I'm fine with surgery prelim intern transitional I'm good with any of it and none of it is better than another for me. But what I would say is for the folks doing that. My advice is, you know, really work hard in July and August, and get a good letter from your internship program director, because I think most programs will directors will agree. We look for that letter and when that letter is good that's a really meaningful letter because you're someone who's actually doing the job you're a doctor you're taking care of patients you're working hard. And if a program director, you know, by September they're going to have they're going to work you're going to have been there a couple of months, sends a letter that says you know this person is all in they work hard their team player. And the patients on their, I mean, they are great and program doctors I'll tell you they will not lie either. So if you know, and so that's why we value it. And so that's, that's kind of what you're looking for for that group, the group that decides to do a research here, if you will. I agree a lot with what Arun was saying. I think focus it in radiology, whatever it is, meaning, you know, get in doing some research that's in the radiology realm, but also use it to do other things in radiology, you know, that are not just the research. So maybe there's some teaching things or outreach things like the rad rooms doing I mean, you know, I'll be perfectly honest with you, I was super impressed with the rad room. And when those applicants were coming through my pool. That was very meaningful to me I was like this is so cool what they did with this year so there you can make yourself just by getting a little more involved in the field. Program directors like to see that. So, in the folks that do a year of quote research I would say, you know, do research but do other things in the field and there's a lot of ways to do that and I think there's some folks on here can help you know, you brought up a CR the rattling there's a whole bunch of ways to get involved but I would, I would throw yourself into the field, if you will, in that year, because you'll make, you'll make mentors, and you'll do you all are smart people and really interesting things. And then, and then I would finish it with when, you know, when you are getting ready to reapply. I may be jumping the gun on a question but you know some people ask me well, do I just kind of put that out there or do I wait for the program director to figure out that I didn't match my advice is to put it up front. And as a program director, I respect that. I know it's hard to imagine this, and I know this year was very, very competitive, and the signaling thing. You know, I would say that you're going to want to really look at that I think some medical students probably, and we were we none of us had done the signaling we didn't know what to do with it. We'll probably all have learned something with that. But when you're putting together your letter. I'm sorry your personal statement. I think Connie talked with this and I agree with Connie I think having a program director kind of take a look at it with you again and you know I would be out there and say you know I applied. I really want to do this. This is what I want to do. You know something in fact you know I'm sure everybody's thinking this in your head you know I applied, I didn't match. You know, I took a step back and I do think everybody should take a step back and say okay is this the only thing I want to do is this the thing and if it is. Then you put that out there in the personal statement you say you know I thought about all these other things but this is what I want to do. And you know but and kind of go from there and then talk about you know what what either you've learned an internship. You know about this or what you're learning or doing, you know this year with the time but those are those are some thoughts I'll stop so the other people can have I'm happy to answer any other things with that. Dr, that was a very comprehensive answer so I do appreciate it I think that you packed a lot of valuable information there but Dr saying do you have additional thoughts on how programs, you re applicants, comparing the years, or just general advice of what you think applicants should do with that year and approach the year. I have 100% agree with Dr gear. Yes, the probably the if they, if the applicant decides to go do a intern year of some type. I, as an other program director I talked to I do not think they view it any differently. But the biggest and most important thing is to make sure you are known to your program director. Like, March up there on June 24, whatever the internship starts and introduce yourself and make sure you work hard and probably also very good to have a faculty in their internship that knows them well that can attest to their clinical skills because the the program director is probably not seeing you on a day to day basis what there will be commenting on is just looking at other people's like comments reviews, etc. If you there's one faculty that, you know, they can that you can click with that person will be able to say a lot more about, you know, the applicant as an individual than a program director can but definitely get the program director. Let a recommendation as well. And from a research research year. I would say do it with a little bit of caution to be honest, because the amount of time people have to actually do something of value in research between the next cycle starting is actually really short. So, sometimes you may not be able to do anything of that is substantive on your CV, especially this is kind of goes goes into kind of back to the reason why you didn't match, especially if you're the one of the reasons why you didn't match is you didn't get enough interviews. So something in your initial application is being filtered out. And if it was because you don't have enough leadership research, you may not get enough. The second time around, even if you do a whole dedicated year research is because the time that how quickly the cycle moves on, essentially. So I would just make sure that if you go if you go if you go take up a research year. They have something. You know, halfway done, or they have a massive database you can just plug and play with. Because if your research is chart biopsy. For like 150 patients, you might not have any some such a substantive by the time you actually, you know apply again so. I think that that's really insightful I don't think that people would necessarily know that going into that so I think that's really so nice that you mentioned that. Yeah. Thank you. That's all, that's all my comments. So while we're on that topic actually, let's hear from arena right now about what did she actually decide to do with her year. I think the most important thing, the week that I went on matched was I started reaching out to mentors and other people who went on match and radiology and I just heard their stories and what they did, and it kind of helped me figure out the best plan for me, I have a decent amount of research. The internship just seemed like a way for me to strengthen my app kind of like what everyone else is saying it's a way to strengthen your clinical side, you're showing your that you are you know a physician that you can work with patients and you can handle the stress of being an intern, which is something unique to medical students students don't have that so it's a very unique thing to add to your application. Additionally, just before intern year I had some research projects I finished up which I was able to present during conferences which helped my application and I did from the beginning work really hard with my PD and did what everyone was saying and got a letter from my program director which I do think really helped that was actually another feedback I did receive from program directors was to get that letter of rack update your letters of rack through throughout the year. And then Twitter was also another unique aspect of my application I got more involved, got more into the community and I think you just meet people make more opportunities. You know conferences, and it's really hard I did that all during an intern year which I don't know if that's very common but I, if you have an internship that you can work with. I found ways to make my schedule work so I could do all these things. It's very starting to get more tough because my ICU is coming up but I think if you're really determined and you want to make things work you can make the schedule work, so that you can do these extra things to strengthen your application and I did stay in touch with mentors throughout the year program directors which I think really helped as well. Thank you that makes a lot of sense. Connie, anything to add maybe in particular about what decision you made about what you want to do with your year and why. Yeah, for sure. So, I opted to delay graduation and do kind of an informal research here. So I didn't, you know apply for any kind of paid research positions things like that so instead. I think the first thing I would point out is, obviously think through this decision, one because it's important but also because people will ask you. On almost all of my interviews people asked why did you make this decision and so, you know I had a number of reasons including some personal ones as couples matching things like that. And so it all fed into this decision. What I did during this year was a lot of what's already been mentioned I did some more rotations got new letters a few new letters depending, and did a lot of research with the conferences talked with got more familiar with my program and other programs I was very interested in. And in terms of doing research I would say some pointers for finding research and being able to kind of see projects through which is what Dr saying was, I guess like touching on as a as a warning, something to be careful about. I'm very lucky to be at a like a us and the institution with a radiology program that is actually doing research so that was a definite benefit. I reached out to basically everyone I knew who was a radiologist, and I did ask specifically for projects that were either in progress or anything where. You know I would be able to collect the data because now I have all this time right so I could just sit there for all the time in this week this work week and collect all the data and analyze it and write it up. And it wasn't dependent on, you know, following up on a patient after a year or something. I was just asking for very specific projects, and they were readily available. Once they started reaching out to enough people. What else I was going to say so. Yeah so reaching out with some specific requests in terms of research projects and not limiting. I also reached out to some programs in my like nearby geographic region, as well. And I did have some success doing some projects with other institutions. And, yes, and also doing things not just part of the research year, which I think was also mentioned you know participating in the student organization doing like your schools radiology interest group or going to conferences and doing the ACR things like that there's a lot of opportunities and to set enough, spend enough time googling for them. Thank you that was very insightful. So our next question is for the program directors. What advice would you provide applicants on how they can evaluate evaluate reasons why they went unmatched. We know some people in the q amp a we're actually asking, is it okay for me to reach out to a program director at a program that I interviewed at and ask if there's a specific reason why I went unmatched. So Dr saying we'll start with you on that question. Yes, I would say it's definitely okay to reach out to the program directors because we probably won't remember you next year. Sorry. But it is there are the people who's going to evaluate you and the second thing is, it might not even be a bad idea to reach out to people that you signaled and didn't get an interview on. Because I think people, there are two different, you know, they're two, in my brain there's two reasons why people don't go match. They either don't have enough interviews so diagnosing why you did not get enough interviews in the first place is important. And the second is, you got enough interviews when you didn't end up matching. So that's another issue. So it could be that you're just, it could be that for some reason, there's awkwardness at the interview, you could have had a really bad connection. The laptop was too low and everybody's staring up at your nose the entire time. So it could be really silly, stupid things that could, especially in the virtual setting because we're kind of still trying to navigate that. And also just understanding why you didn't make through the screening process, because that is a big that's a big thing that you need to figure out what changed, right. And then I'm sorry, what was the first part of the question I lost my friend of thought. It was just overall about what advice would you provide happens and how do we evaluate why they want to match. I would say best advice is just talk to as many program directors as you can get a hand on and like have them, especially, especially program director who like interview you they done they look through your applications already and they have opinions. Already, so. Yeah, absolutely. Thank you for that. Dr gear anything you'd like to add to that. I agree with Dr Zang, I think, you know, kind of the first thing is just is to talk to your home program director, and say okay, I need you to be honest with me what why do you think I didn't go matched. And, you know, because it's, I think folks have asked about so in it, it's going to depend a little bit in in my experience over the years and I have had applicants who had interviewed at our program who went on match I've had them reach out to me before and I have to admit the first time I was like oh my gosh, what do I say, kind of thing. But I ended up, you know, I think I ended up being helpful and I could look at what they had in in my experience. Okay there. There's categories of okay there's there's something in the apple, you have to remember this was really competitive year I mean I'm going to tell you I've been doing this a long time since 2008. I've been running recruitment at Wake Forest. This was the most competitive year I've ever seen. And I've seen a lot of competitive years. So it was, and I don't know Dr Zang may agree with this it was unusually competitive this year. And so I think that that made it hard, plus it was the first year of signals. And I think it is, you know, I think in my experience looking back when I look at what applicants have done. There's either the group that have some kind of very red flag in their application and you know if professionalism laps and medical school would be a pretty big red flag. You know, some folks have asked about low step one scores. I feel like low step scores depending on the programs could be a flag and you have to think about how do I overcome these, you know, failing a clerkship things like this or, and so you need to kind of sit down with program directors about the large red flags and say okay do you think I can overcome this and if so let's talk about how that that's one thing then there's the group of Dr Zang sort of mentioned this. And you didn't get enough interviews or you got enough interviews and you didn't match. And when I look at that there's the group that I feel like ended up in, and I've seen this quite a few times, they're in the middle of everybody's list. They're really good applicant they're they're an excellent applicant right, but they ended up in the middle of everybody's list. So they, they didn't match. So when you look at that list and you think, oh wow that was a risky list. You know, it's, you know, I think to myself boy I hope I would match in that list kind of situation and then when they redo it the next time they change it up and and this is where I would say in the re application process. I need to work really closely with a program director, and my, you know, I think we're going to learn a lot about this signal thing. I think it's going to be a big topic and a you are this year I hope it is. Because it's, I'll be interested to see how program directors looked at that signal I think that programs I think there were a lot of programs who really use that signal, pretty heavily. And some that didn't as much so I think, you know, in the reapplication process thinking very carefully about these signals and Dr saying mentioned you know, reaching out to the people you signaled why you didn't get an interview is probably very reasonable. So I just because I was at the APDR so I got a little preview of the signal thing so I'm sure they'll have the same thing at the APDR next, next month. But program directors are reading a lot into these signals. I'm just, that's the survey data so and then geographic preference is being read to a lot. So I would say that's another thing, like, unless you have very, very explicit ties to a region. Like, the better thing to do is just not have a geographic preference. Because what the surveys tell us is program directors, if you have a geographic preference and the programs outside that person geographic preference the assumption that they're making is this person doesn't want to come here. That's what survey says. And then the signal in is so apparently what the what the data is not even the survey this is like raw data from the IRS is 90 10% of the programs got 80% of the signals. Yeah. So choose your signal a little bit more wisely. And this is a little preview we're actually going to have an even more complicated signaling system next year, we're going to have 12 signals and they're going to be six tier ones, six tier two. And God help us when we have to figure out what the heck that means. Yeah, I know that's a great you have the exact same look up I had on my face when they announced that I was like, I don't know what to do with that. I have to say, I don't know anything about that because the APDR we haven't had our meeting yet so yeah, heard that but yeah so this came out during our APDR our meeting and all of us in the room are just looked at each other was like okay I don't know what to do with that information so much. Yeah, thanks, you're asked. But yeah, I just, I would say definitely and just ask questions and be careful with your geographic references because that could burn you pretty badly. Yeah, I mean I think I definitely think applying to the right set of programs is really, really important here. Aside for maybe some things are difficult to overcome in an application I think getting yourself applied to because the nice thing about radiology, I will say this, all of the programs are really good we're really lucky. They're just aren't bad programs out there. I mean, we're very lucky specialty. So you just need to imagine any of them. And there, you know, there's so many fellowship opportunities out there they're way more fellowships and there are people so you know and and this is where I think getting advice on the signaling and what set of programs to look at and focus on that is really really important and you need to you need to use program directors I think as advisors in that process. Absolutely. Thank you both for that and thank you Dr saying for the information that you learn from the AP dir meeting. Definitely sounds like there's a lot of interesting things coming down the pipeline for sure. Yeah, it's going to be a wow wow year. Oh yeah. Well, it'd be great to actually hear from Connie and arena on how did they actually evaluate themselves after going unmatched and curiosity if they had reached out to any program directors to get any feedback on their interviews or what might have caused them to go unmatched. So Connie will start with you. Yes. So like I said I did reach out to a lot of people. And I think in addition to. So, so I think doing so is really great because you can ask for very specific things like you know is one of my letters should it could it be improved you know are there any other things like really specific things for application. One other thing that I heard that hasn't been mentioned is some people were wondering about the specific ties I had to that program or that region and like interested to hear whether or not I would be I'm like very like dedicated to going there we're very interested in being in this region or this location. So that was one thing that I try to emphasize this year for the programs that I really loved. The other thing. I guess I'm trying to think of specific things that were mentioned. I think I had a slightly unique situation since I was couples matching so there was also a lot of logistical stuff so I would say for anyone who is couples matching some quick tips I would say is I would say mixed advice on this but the approach we took was to be very upfront and transparent about it about our goals and our priorities. And so we told everybody we were couples matching and that our priority was to xyz you know be in this location and things. And I guess I worked out. So, that is the approach we took and I'm happy to answer any specific questions about that. Thank you for that perspective especially with couples matching arena anything else you'd like to add to that. So I, you know I did the same thing I reached out to all the program directors I interviewed with and a lot of them actually went through my application with me which was really helpful and detail they gave me feedback on my letters my personal statement my actual application. So I think that's a really good idea to do. Additionally, I know some there's some mention of going to your own programs or schools radiology program director I didn't have one I went to a do school we don't have a radiology department so I was at a disadvantage but I think with Twitter and if you had interviews, you just have to, you know, go out of your comfort zone and ask anyone or and everyone for advice and not be afraid. I mean I had to go out of my comfort zone but it makes you a stronger applicant a stronger person in the end of the day. And the location thing I think was really good Connie I, that was a bunch of feedback I received, you know I thought that I was emphasizing I'd want to live somewhere but I think that's really really important and the signaling aspect of applications goes with that so I think that's really important to consider to emphasize location and be really, you know transparent and clear that that's where you'd want to live and emphasize it because it might be more important than we think. Absolutely. Thank you guys for all that perspective. I wanted to mention that it would be great if we applicants can speak to going unmatched interpersonal statement. So I just want to ask how can they do this well so we'll start with Dr saying, when have you seen an example somebody does as well like does it take up their entire personal statement is it just a couple of sentences. What does that kind of look like when somebody addresses it effectively in their personal statement. The best ones I've seen is kind of approaching it like an adversity. And how you overcame the adversity because that's kind of the big thing we always want to see. And the truth of the matter is, this is a horrible time and getting through it and learning from it is really what you guys all successfully have done. So address it head on there's no reason to hide it. And you can't hide it like it's going to come out like it. It's very obvious on the application so don't cry. And, and just, I've really I've seen it, most of the time is just like address head on and say either. Yes, I did a match. And, but I still really want this specialty. I'm willing to work for it and these are all the things I've done in the year. sense that time to really, you know, put myself out there prove myself essentially. And just, yeah, like really use it as an adversity essay and especially if you do it residency year internship year that at least from definitely from the IR perspective since I can really speak to the IR guys. It's a big deal for me. Someone who has proven themselves in residency, just because from the IR perspective. The person that's going to link on the very bottom of my list is going to be the person that says they, the reason they want to go into this is the lifestyle. And I'm just like, you did not apply to the right specialty you think what I do is easy I'm in scrolls right now so. So, and that's kind of like the kind of the big thing like if you do if you do a really good job during your clinical year and you, you know, prove to yourself that you care about the patient and work for the patient. That is a huge statement and you write that in your personal statement is like you know I took that time and, you know, really showed myself as a physician as a doctor and I showed that care about my patients. That's a good I really like to hear how welcoming the radiology community is to adversity. I think it's amazing I really speaks volumes doctor you do you have anything else to add about how applicants can showcase this showcase as well in their personal statement. Yeah, I mean I don't have a lot to add to Dr saying is statement I completely agree with her. You need to just I don't think you need to spend your whole statement on it, but I would put it out there in front and usually what I what I, when I'm talking through with someone about this. I'll say okay let's let's just say what actually happened, you know because it's happening to you all right now and what'll happen, you know when you're starting to rewrite a personal statement. It's a story unfolded in March, basically, and you're going to think back you're going to have reflected you're going to have thought about different things and then if you're reapplying in radiology you're going to say, and I decided to reapply because blank. It's going to be a little story to tell. I don't think you need to spend a long time on it, but I really respected it also kind of shows this person's really committed to this. You know, and they're they've really thought put some thought into it. And then whichever you decide to do for whatever reason whether you decide to go on with the internship, or decide to do a, you know, research radiology sort of extra curricular year. And for me I'm okay with either one. But, you know, you, then you delve into that. You can say, you know, you know, recharge to, you know, to do this, and an internship but you know you'll be you'll have something to talk about by the time you get to, you know, sort of the end of the year you're going to have been an intern for a couple years you can talk about, you know, as an intern and doing this I've really even better seen how radiology that kind of, you know, you're going to have something to talk about. Or if you're doing sort of a research year and you've gotten involved you can talk about that project you know this is going to turn out to be a good thing I'm going to get to spend a year, kind of maybe developing some things I might take, you know with me to residency. So you kind of just sort of take what was a negative and you turn it into a positive for your career and you know people can can read can give you feedback on that but that'd be my advice. I love that I think this is spoken so well because arena and Connie or people that I am inspired by and seeing how they gracefully handled so much this last year I think I as a fellow applicant was so inspired by them. Same as the hill in a room just seeing people face it head on and address it head on, and then say this is what I'm doing now about it I think I personally was so inspired so I definitely agree with this. And then I'm not know will start with Connie, how did you address it in your personal statement. I think I addressed it exactly how Dr gear and Dr saying have described I believe I started with like an illustrative story of how I got interested in radiology, and then I said that I didn't match and some reasons why I think I didn't match. And then I had a paragraph of what I've been doing and how that has made me you know, like a better applicant more interested in radiology more dedicated radiology. I did include a paragraph of other things I've been doing this year. So, you know, like something, and kind of talked about how like just a different aspect of myself as a person so not just the academic radiology stuff but some of my other interests and how that makes me a better clinician. And I think that was it does like for four or five paragraphs. What about you arena, how did you address it in your personal statement. It's very similar to Connie I had an illustrative story about radiology in the first paragraph and then I explicitly said like I did not match. And then I went on to talk about how internship kind of solidified radiology was the right field for me and then went on to talk about what I did I didn't want to dwell on it too much and talk about maybe why I didn't match just to avoid negativity. It's, it could be a good way to address it. But that that was my approach. And one more thing I just remembered was, I've heard this advice before but for some programs that I was like very interested in or had some connection or tied to to the region or the program I did kind of include that in my concluding concluding paragraph, just a sentence or two about why I was specifically interested in that program. I think that's really helpful advice and hopefully reapplicants will feel more comfortable telling that story being truthful and I think that helps because I'm sure come to find interviews and just helping yourself with that story will be helpful so it's good to know they can start on their personal statement. Fantastic. So I know we talked to a little bit already about program signals and there's a lot of changes on the pipeline. But it would be curious to hear from program directors on what you would recommend for applicants as far as what you think, or how you think they should use signals next year. You know there's a lot of talk on you know you should use some signals for reach programs a few signals on programs you think you're an average applicant for, and then a few signals on safety programs. So it'd be great to hear your perspectives on how you would advise a reapplicant to use their signals. Dr. Gary will start with you. I can, I would not use a single seat signal on a reach program. I would get put all of my signals into programs that are going to are kind of the right fit for what my application looks like, you know, knowing, you know, upfront, I promise you, all these programs are really good. They they're there aren't bad programs out there they're just not. They're different they have some slightly different setups so maybe have a little bit more research opportunities and others but the end of the day if you're reapplying. You just need to get in one of these programs. I would not use a single signal on a reach. I would use all of them on programs that are very likely to interview me and that I have a very good chance of potentially matching in no reaches, no middle either. Only use them and this is, I'm saying this now that I've seen it that is not how I advised last year I did not know what to do with this. I've seen it. I that's how I'm going to advise. I don't know if Dr saying feels differently but no reaches no middle just programs where you have a good chance of matching. That's what you that's where you go. I 100% agree. The other thing is you guys have to remember what the signals are used for. Those are used for screening out for interviews. So, if you, if they're going to interview you just because you signal them, and you were, you were not going to be a good person. That is not a signal that you should waste. Right, like you only have. Well, last year six now 12. Really is research program and really just keep keep realistically assess your application and use your signal accordingly. And the second thing I would say and not is if there's a program that you're interested in, you're really interested in and don't fake it because it's obvious when you fake it. And actually write a personal letter record, personal personal portion in your personal statement is actually a like something like, at least when I review application I take really seriously is like oh, like, it's not in like, don't put at your last paragraph. Like, this is why University Cincinnati is my favorite like, don't that's very obvious. But if you legitimately have a reason why you want to go there. Right. Put it in your personal letter. It's it tells the program, because at the end of the day, like what programs, at least definitely for my program is we want residents who will work hard and actually happy to be here. And that's a big deal for us and on top of that I went for, I went, I went to Dartmouth as my residency, and I was also on the interview thing. And one of the big, biggest problem we had because we were rural program is, is this person going to survive in the wilds in New Hampshire for four years. Like is this person actually going to stay here for four years. And that's something that if you have interest in, you know, a more rural part of the country or a slightly like not New York City basically something worth writing about right like should address it. Because that might put your, you know, you might float to the top from the interview process. That's great advice. Thank you. So it'd be interesting to hear from arena and Connie about how they use their signals this year. So arena, if you wouldn't mind sharing. So when I met with the program directors, a lot of them told me, either to signal them or maybe don't signal them because they know I'm really interested so I kind of use that to help pick my signals. So if half of my signals went to program directors I was already in contact with, then the other half were, I did not reaches but regional programs that I didn't get interviews at last year. And just to see if maybe this would help me get them so it was kind of experimental. Really interesting perspective thank you. And Connie, if you want to share how you utilize your signals this year. I had a similar experience to arena when I reached out and talk to people some people were very explicit like, you don't need a signal me, which was great to hear. And I hate to disagree with the program directors on the panel, but I would say I did signal some reach programs and my happy ideas that I got an opportunity to interview at places. I don't know, I don't know, I don't know if I should be encouraging people to do that, but it was not all negative to do so. And this, since we're talking about the signaling. I remember it I was going to come on the geographic preference. I think Dr saying you'd recommended potentially it maybe I was misunderstanding, potentially saying that no geographic preference. I actually advised heavily not to do that because apparently a lot of people approached interviewing just by looking at the geographic preference first and so if you hadn't indicated a preference then maybe your application hadn't been reached. And so I would say if you do have any kind of geographic preference. I opted to state my top three rather than trying to say that like as an applicant I will go anywhere even though it's kind of true like I would go anywhere in the country, but rather than saying that I did opt to choose my top three and guess it was okay. I'm sorry, I should clarify. No, definitely if you actually have a place that you want to go. But if you legitimately have no preference, don't be forced to pick one. That's, that seems to be the, what the survey say. That's all that that was, I'm literally just rehashing what the survey data told me. So I was like, okay, good to know. Thank you all for that. And so I think you've kind of mentioned this a little bit that you do often re interview applicants but how does it can applicant be more likely to be re interviewed from a prior cycle. I think we've talked about a lot of growth in that year demonstrating that through a personal statement. Are there any other tips you can give for how an applicant can increase their likelihood of being re interviewed. I'll start with you, Dr. Zane. Reaching out to the program is important, honestly. And just, just, it will be interesting next month when we see what this, what the survey on the DR side demonstrated. But on the IR side, there was a lot of us who told our internal our internal applicants or applicants who done away rotations with us that they shouldn't use their signal with us in direct contradiction to what the ERAS says you should do. So that, that's something to like reach out to the program directors that you actually have connections with like to ask if you need to signal them or not. That's something that can be helpful. But really just really growth in your application and just addressing things head on it's going to be the biggest thing. And yeah, just have to get to the screening process basically. Excellent advice. Dr. Beard, do you have anything time. Um, no, I just think, you know, I would maybe if you interviewed at places that you didn't match at your, your, it's possible you'll get another interview at those places but I also might say, Well, gosh, there was something about my application at least this time that I didn't match there and I might want to look at another set, if you will, or focus on another set, because there's a lot of programs out there and I might want to focus on some that maybe I didn't, you know, interview at for whatever reason, some of which maybe, you know, I didn't signal them. And boy, they seem like they might be a good fit for my application and interest and maybe try some of that but in, in the time between now and the reapplication cycle. You all are going to do some things that are going to make your applications better it may not be finished let's say you're doing research you may not have you're not you probably won't have a new publication. But you can talk in your personal statement about Oh, I'm doing this really great project and I'm really, you know, involved or I'm, and you know doing this committee and ACR that I've never done or I'm an internship and I'm getting to take care of patients and seeing it you know there you're going to have more to talk about that is going to make your application stronger. You know, do know that everyone's gonna your application is going to be stronger just by virtue of having more time to make it stronger. If that makes sense. I think that makes a lot of sense I think you brought up a great point to a lot of times at least I felt this way when I was applying this year is that some of the programs I applied to me maybe weren't a great fit and throughout the interview season I learned that as they kind of learn like what I'm looking for in a program who's going to best support me. So maybe addressing that again with a set of fresh eyes, a great, a great piece of advice for Rena and Connie did you re interview any programs this year, and did those programs mentioned it to you or did it feel awkward or how did you go about this. We'll start with Connie. Yes, I did re interview at a number of programs I did from last year. In my experience, I re interviewed at the majority of the same programs I interviewed with last year. And it was kind of mixed bag in regards to how people addressed it. I try to think sometimes it was a little bit awkward, but it was okay. Other times, some people I think I mentioned how people did ask almost every time about the re application why did I apply again to this to radiology into this program. Any specific interests. Yeah. Okay, great. And we did have a question I'll just have you answer right now so you, you did delay graduation and you were really open about it and you advise other people to just be open about it and I think that's kind of over here from Dr. So really just be open about that and express it. It sounds like it came up for sure. And yeah, like I think I was saying I make sure you like have very specific reasons why you chose to do whichever option you choose, because that's definitely came up. And then the partner also kind of had the same thing and it came up for him as well almost every time so. Good advice is ringing now mayors now I know address that on that's good. And then arena. What about you and re interviewing how did it feel. Did you, did you get the same like mixed bag of re interviews and new interviews or how did it go. Yeah, I had a lot of re interviews. And it was a little nice because you already know a lot of the, you know the PD and some of the faculty are re interviewed with. And they can, they can see how you've grown over the year and I don't know you just know each other a little bit better but then it could be awkward because you're like okay, we've already answered all of the same questions last year so it's, but I think you just learned and I think, you know, after a year of experience of interviewing you've gotten better at interviewing to so you're just, you're better at talking in these situations but yeah it definitely had the same experience. And that's great to hear and really is like re emphasizing how important is to reach out to these programs because now you're like forming a relationship months of head of everybody as well and having months to grow that relationship and make sure they're a good fit for you so it definitely seems like great advice. Fantastic. So the last set of questions we have are really just targeted specifically to individual panelists based on their background. So the first one we have is for Dr Zhang. So since you have an IR background for those who may not have matched IR this cycle. Would you recommend them still trying to apply for integrate IR next year, or maybe focusing on DR since there's more spots available and then trying to pursue IR through different routes as IR, or matching through fellowship. So, I always tell people to apply to DR. It's just the reality of the numbers. If you look at the number of applicants to IR versus the available number of spots it's just it's not. It's miles apart so it's just not possible. So, I tend to what I tend to emphasize is going to keep your if you're, if you truly think you want to go into IR, put that out there, like, join as IR. You can join for free. The medical student slash RFS section of sIR is the most insanely active session ever like they, I think they put out a YouTube video like once a day it's just, it's it's craziness. I have no idea where they find the time. And, and then getting involved and really like from an IR perspective the biggest thing we want to know is if I do. If I do really understand what it means to be an IR doc, and are you going to, are you going to stick it out are you going to do it. And then the second thing is apply really broadly like look at your ESIR programs and DR, like, I highly recommend applying to DR programs to also have the ESIR pathway. I am also in the process of interviewing for the independent pathway which is the formerly fellowship pathway which is not really the fellowship that doesn't matter. You are at a far more advantage as a DR with the ESIR background than you are as a IR person as a DR person without ESIR. Just, I'm just going to every program director agrees that and that is not because we're jerks and we don't want it because there is a funding limitation. Right. As a DR person, you have four years of funding. As an IR person you have one year of funding. If you do DR without ESIR and you have to do a two year fellowship. That's an extra year of funding my I have to find. And that is not easy to do. My hospital like it's just it's just not so it's as a DR as IR person doing this matches like I really have to think about that question. And it does makes a huge difference whether or not you can, you can, you will match successfully, even as an ESIR, even if you go through the DR and then fellowship pathway. That's really great advice and like a room mentioned in his presentation about how funding can actually play a role, even with fellowships and as you mentioned with the different pathways it seems like that still plays a role, even down the line as well. Yep. So Marina, our next question is for you. And were you able to do any radiology rotations during your transitional year. Yes, I was and that is one of the big advantages if you're at a TY program that has a radiology program affiliated with it. You can kind of get in with that program work with them throughout the year I gave presentations. And I needed the PD pretty well by the end of the year so that's something to consider also if you're going to so open to one looking at programs that maybe have radiology programs they are nearby. You may be able to do like a visiting away at a nearby program if they don't have one affiliated. That's great advice. Just to round it out. Do you have any advice for people that are trying to couples match and how to navigate that. Yes, I do I'm trying to think of my most concise advice. I would say to apply very broadly and very much target places with a lot of programs in the area or multiple hospitals in the program which is basic advice. I think I still stand by my advice that is to be very transparent and upfront. I think that it helps programs understand your true like draw or ties to this area. You know if they generally believe that you want to be here with your partner for a length of time. The other advice that you hear pretty often and I think it was very effective was to reach out on behalf of your partner. And basically immediately if one of us got an interview we reached out to the program director to the programs on the other person's behalf and I found that to be very successful people very welcoming about it. And I also even did a little bit of that during interviews at the time was appropriate. And then I also did a little bit of a presentation my partners also find to DR and so if it came up. Someone asked, did we interview partner I said, no but you know, she's a great applicant, you know, putting it out there and it is a little awkward but it is. It was not a negative thing and in fact it was helpful sometimes so there's a lot of things you can do. You do have to put yourself out there as though and it can be a little bit awkward. You know, interviews are awkward for everybody so just leaning into that taking advantage of the awkwardness and just throwing on an additional across is great doctors and we're going to mention something. I was just going to say, kind of echoing on Connie's comment from the program director side. If you're a partner, especially if they are applying to the same hospital with a different residency. I mentioned that to the program directors because we kind of know everybody in the hospital, we can actually make a phone call or send an email I'll be like, hey, are you guys interviewing this person we really like this person can you can interview them please. And that actually does it can help. I definitely know like, you know, as Cincinnati obviously we have the Cincinnati Children's Hospital. And that is something that does come up quite often is like pediatric and we'll be like, we'll send a message out to the pediatric program director it's like hey, can you guys do us a favor kind of thing. That's awesome it's really good to hear from both perspectives really how this really comes together. And I like that you're, you're, you're being a sports spouse you're being a supportive period is also important in radiology so it's so exciting. So I'll just go ahead and ask it does anybody have any lingering advice, any last minute thoughts they want to share we're really fortunate to have already answered all the Q&A questions but any last thoughts for the audience today. And it's free to anybody to answer if you have something to say. I do think everybody was so comprehensive. I personally learned so much during the session. I do want to reiterate that we are so thankful for MRI online for Dr. Dr saying arena and Connie for joining us today. I think this is an invaluable session and we're so happy you shared our night with us. I also wanted to reiterate that we do have a mentor program you can sign up for on our website, and MRI online will be sending out recording shortly. They're doing so much work behind the scenes are to really keep this together. So our website here is the radiology room if you if you want to Google it just put the Radarum and you'll find it under unmatched in the future Radres section. I really encourage you to, you know, I know it's really really hard to put yourself out there but following in the footsteps of Marina and Connie and going forward and I know some people have already done that and really inspired by those are already on there. But, and just let us know how we can support you we're really happy to support you we're really happy to be with you on this journey so anything that we can do to make your life better please reach out to us through social media. Any last thoughts around or so. No, I just want to say thank you guys all the panelists and I hope you guys found this beneficial and like Ashley mentioned there's anything that we can do for you guys. Please let us know we've got a lot of mentors who are willing to provide mentorship provide advice to you guys. For those of you looking for research opportunities or just ways to be stronger applicants for the next cycle. So please take advantage of that and we're happy to do whatever we can to help you on your journey. Absolutely take care everybody. Thanks again for joining us. Thank you. I'm our online. Thank you doctor here doctor thing arena Connie. Take care everybody.