Residency Interviews: Why Didn’t You Match?

Many interviewers will suspect you didn’t match based on your CV, even if you don’t tell them outright.

Any time you are applying or re-applying with a gap since medical school, interviewers will be curious about why you made the career decisions that you did.

Did you apply for residency and fail to match? Did you choose not to pursue residency for some reason?

They are interested in understanding how committed you are to residency — and how prepared you are to be successful.

This is true for all applicants, but the gap in time may raise additional questions because you didn’t take the most traditional route to residency.

Re-applying isn’t unusual.

There are many reasons why a strong candidate might fail to match. The matching process is extremely competitive, in some specialties even more so than others.

Every year, thousands go unmatched.

And yes, sometimes it’s a poor showing in the interviews that puts someone out of the running.

But the good news is that many of these unmatched candidates dust themselves off, put in the effort to improve their applications and their interview skills, then re-apply and match.

Every year, we work with many coaching clients who are re-applying for residency.

Many are seeking coaching because they realize, in retrospect, that their lack of interview skills held them back from matching last time.

Some felt they did okay in their interviews and were shocked when they didn’t match. They want help understanding what they can do differently this time around.

And we’re happy to say that we have lots of success stories from these clients — and the match is even sweeter when it happens after disappointment.

No doubt you have spent time thinking about this question and have a sense of what you could have done differently.

Now you must prepare to speak about it in a way that shows the experience only motivated you to become a stronger applicant.

It’s a delicate subject because you want to come across as open and candid — but without disclosing too much that could be perceived negatively.

You want to be realistic without being too self-deprecating. And you want to use this opportunity to reinforce your continuing commitment to medicine and your specialty.

You also want to keep it concise and simple. Don’t over-complicate it by listing 3 or 4 possible reasons and sounding unsure.

Let’s take a moment to talk briefly about the most common reasons for not matching, beyond the competitive nature of the process.

You’ll want to think about which of these issues were factors for you — and which ones you want to talk about in your interviews.

You don’t need to be 100% candid if you fear some details could make you look bad.

The main goal is to demonstrate that you learned from the experience, working on your weaknesses, whether real or perceived and are now even more prepared to excel as a resident.

Often, those who don’t match can’t pinpoint one clear reason. It may have been a combination of factors.

So if you’re not sure which to talk about, focus on issues that you’ve been able to actively improve upon since last time.

Let’s go through some ideas:

1) Weak supporting documents:
Maybe your supporting documents — like your Personal Statement or Letters of Recommendation — were not compelling enough.

Perhaps your Personal Statement was not well-written. More commonly, some people have decent personal statements and letters of recommendation, but the documents are too general, they don’t really convey the applicant’s passion and ability clearly.

2) Application strategy:
Some people apply too late due to waiting for scores or other issues. Some don’t apply to enough programs to give themselves good odds. And others don’t apply to the RIGHT programs — they aim too high or don’t look closely enough at the fit.

3) Weak interview skills:
Many of you are reading this because you fear your interview skills were part of the problem. Most applicants don’t prepare properly for residency interviews— mostly because they don’t have interview experience and don’t fully understand how the process works until it’s too late.

It is the interview that is the final hurdle.

A good interview is what separates you from all of the other candidates with solid scores and a great CV.

The good news is that weak interview skills can be improved much more easily than most of these other issues.

4) Lack of US clinical experience:
For International Medical Graduates, it can be a challenge to gain enough US clinical experience to demonstrate your comfort with the US medical environment.

Limited US clinical experience can lead to doubts about your abilities and comfort level, even if you’ve got great clinical experience in your home country.

If you suspect this was an issue for you in a prior match, you’ve likely been working on gaining more experience since then. You want to make sure you talk about this additional experience in the interview — talking up the value of any observerships and other US experience.

5) USMLE Exam scores:
You are well aware that exam scores matter a lot when applying to residency programs. Programs often screen for minimum scores before they even review other application materials. Attempts can also play a role to some degree.

If you made it to the interview round, your scores were clearly not dealbreakers. But in a competitive process, a minor difference in scores can make a difference between two good applicants.

You can’t improve on these scores after the fact, so don’t necessarily highlight this reason unless the scores are low enough that you know they’re already thinking about it.

6) Choice of Specialty:
Some specialties have special requirements and some are just more competitive than others. If you applied for a competitive specialty, you may have lost out even as an excellent candidate. We have seen this a lot with surgery and especially orthopedic surgery.

Some candidates are strategic enough to pick a back-up specialty but then have difficulty “selling” their interest for their Plan B in the interviews. No program wants to be your fall-back option.

These are all common issues that can lead to a failure to match.

If you didn’t match, you should be prepared to talk about it.

Maybe they won’t ask, but there’s a good chance they will.

It’s a tricky question because it requires you to talk about failure and weakness.

Not only is that difficult to do for anyone, but it can also be risky. If you reveal too much, come across as too negative or self-deprecating, it can raise red flags with your interviewer.

Remember: You want to come across as confident and committed.

Here’s a basic 3-part approach to help you address this awkward question:

If they don’t ask you this question outright, should you volunteer the information?

In some cases, I think it can help you to bring up this awkward topic.

If you feel it’s obvious that you are reapplying and you have made significant improvements in your application since last time, it can be helpful to draw their attention to your additional experience and dedication.

Some interviewers have a negative bias against those re-applying, even if unspoken.

They may be wondering if there’s something “wrong” with you — totally unfair given the competitiveness of the match, but it happens.

If you can explain well and speak eloquently about how you’ve become a stronger candidate, that can counteract many unspoken concerns.

There are some other common residency interview questions that provide good openings to bring up how you’ve improved. Pick and choose of course, as some of these only work well for discussing certain issues:

1) Weakness Questions.

“Tell me about a weakness.” Variations include: “What is your greatest weakness?,” “What is the weakest part of your application?,” and “What could you improve in?”

See our blog post on discussing your weaknesses which talks about which weaknesses to bring up and how to talk about them.

2) Behavioral Questions.

And then you have a number of common behavioral questions that could relate, including:

• Tell me about a time when you failed.
• Tell me about an obstacle you had to overcome.
• What was the most challenging part of medical school for you?
• Tell me about a mistake you made and what you learned from it.

Some interviewers like to ask about what you would do if you didn’t match for residency.

This comes up for those going through the match for the first time — and even more frequently for those re-applying.

This question can throw you if you haven’t prepared for it.

Nobody wants to think about not matching — especially if you’ve already been through this disappointing experience.

So why do they ask the question?

They’re likely looking to evaluate your confidence and your dedication here.

This is particularly true for those who have taken some time off after medical school before applying or re-applying for residency.

They want to understand how committed you are to a residency at this stage. Do you have the drive to succeed in their residency program?

Your answer should reflect confidence in your readiness and also clearly demonstrate your commitment.

So perhaps say something like:

“I would be very disappointed if I didn’t match because I am eager to begin residency and I am confident I am ready, after spending the last several months focusing on gaining more research experience to make me an even stronger candidate.

However, I would certainly not give up as I am passionate about pursuing a career in neurology. I would analyze where I could improve and focus on gaining even more research and clinical experience to prepare me for residency.”

That sums up everything you need to know about discussing re-applying and failure to match in an interview.

It’s a sensitive topic and one that comes up fairly frequently. But if you’re prepared, you can address it with confidence and maybe even use it to highlight your drive and commitment. We’re rooting for you!