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A medical student offered a professor $1,000 to write their residency essay, and the reason why was not laziness. In this episode, Kathleen Muldoon, a certified coach and medical education professor, shares what she learned when she sat that student down for an honest conversation. You will hear why so many students freeze on the personal statement, why the fear is less about writing and more about who they think they are allowed to be on the page, and how this connects to a kind of burnout that looks less like exhaustion and more like identity erosion. You will also hear why AI cannot solve this, since it blends every applicant into the same voice, and what Muldoon does instead to help students find their own story. This episode is based on her article “The residency personal statement is an identity problem,” published on KevinMD. Press play to hear why the essay that decides so many residency spots is really a question about identity, and what students can do about it.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Kathleen Muldoon, coach and medical education professor. Today’s KevinMD article is “The residency personal statement is an identity problem.” Kathleen, welcome back to the show.
Kathleen Muldoon: Thanks for having me.
Kevin Pho: All right, so you open up your article with a fascinating story. Tell us about this, and then why you decided to write the article.
Kathleen Muldoon: The story is this. I work a lot with medical students and interns and people who are in their formative years of medical training, and one of the things that I do is run personal statement writing workshops. It’s group-based, and it’s very much couched in some of the things that we’ve talked about before, humanity and authenticity, not so much editing and when to use proper grammatical structures for this or that, because that’s not my area of expertise.
But the story that I opened the article with, and that prompted me to write to you about it, is that a student reached out to me and offered me $1,000 to write their personal statement for them. It really caused me to pause, and this is where I want to acknowledge my own human reaction to it, because I was annoyed.
And I said, “Why would they think that I would do this? It feels like cheating. It’s not at all what I stand for in terms of finding your authentic voice, and they totally misunderstand me.” So I practiced what I preached and I got curious, and I invited them into a meeting.
And in that conversation, I learned so much, and my initial reaction was completely incorrect. What I uncovered in that conversation was that the student wasn’t trying to cheat, and they weren’t trying to put off this very important part of their residency application. They were afraid of it. They were afraid of who they were allowed to be on the page, of what they were allowed to say. They thought they had nothing interesting to say, nothing impressive.
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And it really caused me to understand that this is more a part of some of the things we’ve already talked about, which is that medical education does a really great job at training people to be competent and answering multiple-choice questions. But when asked a question for which there is not one correct answer, or for which you have to have an honest response, we’re not doing that great. So that’s where it came from.
Kevin Pho: Now, it sounds to me that there are several steps between not knowing who you are and being afraid to put your true self on paper and offering you $1,000 to write their personal statement. So I think that there are things in between. First off, when you got that email, did you feel that this was a sincere offer?
Kathleen Muldoon: I think it was a sincere offer, yes. I’ve had other offers before that live in that gray area between coaching and advice giving, or holding hands in a way that doesn’t fit with my ethic of my role as an educator. And I did think this was an honest offer. Now, let me couch this in that this experience happened several months ago, before what we’re experiencing right now as the AI boom. So I do think, given that there are programs out there that outsource what I believe should be included in their undergraduate medical education, the first couple, the two to four years of medical training. So I do think it was honest. I know it was.
Kevin Pho: OK. So you brought the student into your office and had a conversation with this student. Tell us exactly what it was like inside that room. You did mention this earlier, but just give us a clearer picture of what exactly that particular student was afraid of.
Kathleen Muldoon: So to set the stage, I think they were afraid of me at first, calling them in to have this conversation, because I made it clear that I wasn’t calling them in to talk about the terms of the contract they were offering me, but to have a conversation about why they felt they needed someone else to write their statement.
So I think the first thing I want to call into attention is the safety that I had to create in that moment. I try to live by something I hope everybody is practicing more often, and that is, how do we offer more benefit of the doubt? Until I had a conversation with this student, I wanted to understand where this was coming from.
So given that, and that I was very clear I’m not going to write this for you, but I want to know where it’s coming from because I don’t think it’s OK. And with that set, that they weren’t going to get into trouble for the ask, and that I wasn’t recording them anywhere, which I think is a big fear for how students can experience a weaponized kind of professionalism these days in particular, I just said, “Let’s get honest with this conversation.”
And so what they said, they said those things like, “I have opened this 50 times, and I have nothing to write. There is nothing impressive about me. I want to match in a highly competitive residency program in a specialty that is also highly competitive, and I don’t think they’re going to think I’m good. I want them to think that I’m good enough. So how can I make sure that they know that without actually feeling like I’m good enough?” You know?
And I think that once I’m hearing that, my heart goes out to that, especially as I’ve done a lot of work with physicians in this. It’s almost like a garbage category now, burnout, right? And we often think of it as exhaustion, but what if it’s identity erosion? And a fear that they don’t know who they are, or they’ve lost their why, or they’ve lost touch with their story, hiding parts of themselves at work. And so my heart goes out to that.
Kevin Pho: Now, I certainly sympathize with that, and hearing the context I can understand how difficult a situation that would be to this particular medical student. Do you find it troubling that their solution was to pay you $1,000 to write their personal statement rather than perhaps other avenues?
Kathleen Muldoon: Yes, I don’t condone that behavior, right? I also know that there are students who pay for exam prep materials, and I don’t mean tutoring. But there is evidence, it’s in the literature, of the amount of cheating that happens in undergraduate medical education, and that is not OK. It’s not OK.
And at the same time, if we’re looking at this as a both/and, and offering some benefit of the doubt, what incentives are we giving them to do this? And if we stay in these fear spirals because of the system that we’re in, a system that promotes checking things off a box, and tests that have one correct answer where sometimes even the wording is not clear about what the correct answer is, especially if it’s trying to test the competencies of professionalism or ethics.
I think that it’s worth doing both. This is not OK, and also, where is this decision-making process coming from, so that we can think about, in our spheres of influence, how do we move forward in a way that’s better than what’s happening right now in this interaction?
Kevin Pho: So tell us what happened next in this story. How did you guide this student?
Kathleen Muldoon: So I did invite that student to work with me in workshops. I said, “We do this. I can do this individually with you. I can do it my preferred method, which is in groups, so that you not only practice hearing other people’s stories and being able to reflect back to them what you hear, whether they’re landing what they want to get across, but it also strengthens, you get to hear what other people hear in your stories, and you get to hear if it sounds like your voice.”
So that’s my preferred method. So I said, “This is my approach in these situations. I believe that you are a competent and successful student up until now. So let’s help you remember your story.” And then for this particular student, I did not hear from them again.
And I work with many students in these workshops, and they write gorgeous, wonderful statements built not on something extraordinary but on their understanding of those moments that are meaningful to them, the ones that guide them into the physician they want to become. So I do not think it’s that med students have forgotten how to write. I think it’s that they’ve forgotten that they have permission to write about those parts that are meaningful to them and become the humanistic, authentic physicians that medicine needs right now.
Kevin Pho: It’s been a while since I’ve been in that medical education space. So as it stands today, just for those who aren’t familiar with applying to a competitive residency, how much weight is typically placed on that personal statement, especially in the advent of all these AI writing tools? Because I know in the undergraduate space, some are saying the essay is devalued. Is that the same when applying to competitive residencies?
Kathleen Muldoon: So from what I’m hearing, and this is based on residency directors with whom I’ve had personal conversations, several of whom have reached out to me after students I’ve worked with interview, to ask about some of the other workshops I run, like medical improv, and just to tell me that this personal statement really stood out. My feeling, not being a residency program director, is that there is a lot of weight on the residency personal statement, because this is the differentiating factor.
Especially in some of the more competitive specialty programs, where you get hundreds if not a thousand applicants, there are probably fractions of degrees of difference between them, especially in the clerkship years and the rotation scores, whether it’s honors or pass. There’s now the joined match between DOs and MDs.
And so I think that for people who are sifting through these stacks of applications, once you get through the threshold or the gate, however you want to envision it, the statement is really where people say, “OK, is this somebody I can rely on on my team? Is this somebody I want to call at three o’clock in the morning? Is there something here that shows me, not that they’re perfect, but that they’re a good match for the culture and the team that we’re building here?”
So I think the difference between essays in undergraduate courses versus one in this application cycle is that AI does in a few minutes synthesize large amounts of information and create a thesis and everything, but AI does not know who you are. And AI cannot make meaning of your experiences. And in fact, AI blends you into a voice, right? Because for large language models, that’s their job, to be predictive. And so if you want to sound like everybody else, then AI will do that. But if you want to stand out, which I think is the goal of the residency personal statement, then you will be true to yourself.
Kevin Pho: Now, I think that we’ve had this conversation in previous episodes about how we got to this place, in that medical education and the path to becoming a doctor is very results based, and that of course gives the incentive for medical students like the one that you shared in the story to provide results without going through the steps needed to provide that result. So sometimes, on the other hand though, we have the system that we have rather than the system that we want. And for medical students in the system that we currently have who may be undergoing that same situation, just tell us what kind of advice you can share with other medical students who may be struggling with their personal statement, and how vulnerable or not they should be when putting their voice on a page. What kind of advice do you have?
Kathleen Muldoon: I think that there’s a difference between being real and oversharing, right? And that difference comes from the meaning that you make of your story, which is the arc of the personal statement. And it comes from how whatever it is that you’re sharing, which is likely personal to you, factors into the kind of doctor that you want someone to read that statement and know that that is the doctor you’re becoming.
So it’s not about performing competence, because everybody at this stage is competent. If you’ve passed those, Step and Level 1, Step and Level 2, if you’re in that stage, then what’s left is, who are you? Who are you on the page? And that is something that only you can know, and I know it’s scary, because it’s not a multiple-choice test. It’s not one correct answer choice, and it feels very gray.
And the sooner you start practicing living in that uncertainty, the better. That is a clinical competency, right? Because so many people are going to be in that gray space, that fear, and this is one place where your experience of it helps you get more comfortable. That’s a soft skill that you’re going to bring with you everywhere you go, that humanity, right?
So yes, it is the system that we have, right? And they are working within the system. They are checking all the boxes. They have their CV. All of that is part of their statement, your three meaningful moments, right? The personal statement does a different job in the current system that we have. The personal statement is: Who is this person, and do I want to spend one, two, three, five years with them on my team?
Kevin Pho: We’re talking to Kathleen Muldoon, coach and medical education professor. Today’s KevinMD article is “The residency personal statement is an identity problem.” Kathleen, as always, let’s end with your take-home messages that you want to share with the KevinMD audience.
Kathleen Muldoon: I want to share that we spend years in medical education training, teaching people how to be competent physicians, and we’re good at that, right? And then there are all the qualms we might have with the current system. We don’t do a great job on self-reflection, on understanding who you are. We say it, right? Who you are matters just as much to your patient as what you know. Let’s start living it.
I see this in med students. I see it in interns, residents, attendings. And if we could just call into attention the burnout that we’re experiencing, is it really exhaustion, or is there some part of it that is also our identity eroding? Let’s protect that, and know that your story matters, no matter what stage you’re at.
Kevin Pho: Kathleen, thanks again for sharing your perspective and insight, and thanks again for coming back on the show.
Kathleen Muldoon: Thank you so much for having me.
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