When Lauren didn't receive any interview invitations for residency positions 2 weeks after she submitted her application, she started to feel uneasy.
By the first week of October, interview invites were rolling in for many of her peers. Lauren (whose name has been changed to protect her identity) worried about her application, but reminded herself that she was a strong candidate and it was still early.
But then a program director from one of her top choice institutions reached out to alert Lauren that her application was incomplete. The program director only received one letter of recommendation (three are required) via the Electronic Residency Application Service (ERAS), and asked if Lauren planned to complete her application.
Lauren immediately went into ERAS to check for herself, even though she was certain that she submitted four recommendation letters. But there it was: of the approximately 30 programs Lauren applied to, all of them received just a single letter of recommendation.
Terrified that she wouldn't get any interviews, Lauren contacted her medical school administrators. She learned that two other students experienced a similar issue.
In mid-October, Lauren and her administrators reached out to ERAS and the Association of American Medical Colleges (AAMC), which runs the system, to notify them of the tech glitches, according to documents shared with MedPage Today. After the ERAS team investigated her account, however, it concluded that the missing letters of recommendation were not attached to programs when Lauren submitted her application at the end of September.
Although Lauren was still confused about where she went wrong, programs had now received her letters and it seemed like the case was resolved. But she soon realized her experience wasn't unique. At the end of October, other residency candidates took to social media to express concerns about what they believed to be an ERAS glitch.
"Incredibly distraught," one applicant wrote on Twitter, but subsequently deleted the post. "Just found out some programs haven't been seeing the LORs I assigned to them in ERAS."
MedPage Today spoke to several residency applicants who believe they experienced ERAS tech issues when submitting their applications. A majority of these applicants requested anonymity due to fear of retribution.
While many say a potential bug is not surprising, students are frustrated that they cannot pin down when their documents went missing -- and whether or not it jeopardized their chances of matching with some programs.
In each case, the glitch is almost identical: an applicant's letters of recommendation (or other documents) were uploaded to ERAS, and the applicant was certain they assigned the right materials to each program before they hit submit. But weeks later, applicants checked the platform to see that these documents had never been assigned nor delivered to the right programs -- rendering their applications incomplete.
One ophthalmology applicant interviewed by MedPage Today submitted an application to 24 preliminary programs. By the middle of October, the only residency program they heard back from was their home institution. Upon checking their ERAS account, the applicant found that their United States Medical Licensing Examination (USMLE) transcript, photo, personal statement, and all three letters of recommendation were missing for half of the programs they applied to. The other half were missing one letter of recommendation.
In another case, a medical student who applied to some 50 family medicine residency programs noticed that one of their top choice programs hadn't gotten back to them. Believing they were a competitive applicant, the student reached out to the program director -- only to learn that this program and a few others hadn't received their USMLE transcript, personal statement, or letters of recommendation.
Another student applying to internal medicine heard that their application was incomplete through a friend who already had a slot in their top choice residency program. The friend asked her program director about the student's application -- only to learn that the program director never received their board scores.
Gabrielle Campbell, chief services officer at the AAMC, said in an initial statement to MedPage Today that the organization is aware of social media reports from applicants stating that their letters of recommendation were not transmitted to program directors. But Campbell added that "these reports of ERAS technical issues related to [letters of recommendation] are unsubstantiated."
"The AAMC IT team has conducted an assessment of MyERAS and the Letter of Recommendation Portal and confirmed that there is no evidence of any systems-related errors," Campbell said last Friday. She added that the organization performs daily data integrity checks for submitted documents, and encouraged applicants to "carefully review" the letter of recommendation processes in ERAS.
ERAS posted an identical statement on its Twitter account.
In an additional statement to MedPage Today, Campbell said that "the ERAS team has reached out to the small number of applicants who reported an issue to assist and ensure resolution," and that internal investigations continue to show that letters are being delivered to programs they are assigned to.
"We conducted extensive analyses across the ERAS systems and databases and were able to confirm that as of today, Friday, November 5, all letters of recommendation have been successfully delivered to the residency and fellowship programs as assigned," Campbell stated. "We continue to monitor the ERAS systems daily to ensure they are working properly. If a system issue is identified at any point, we will notify the ERAS community immediately."
Farzana Arab, an international medical graduate applying for a pathology residency slot, checked her ERAS account after hearing about other students' experiences on social media. Arab, too, found that all 74 of the programs she applied to only received two letters of recommendation.
"I understand where [the AAMC] is coming from when they say the applicants need to make sure that they are attaching all the documents properly," Arab told MedPage Today. "But when we have paid thousands of dollars, trust me, we make sure, 100 times we check."
Bryan Carmody, MD, associate program director of the pediatrics residency program at Eastern Virginia Medical School and an advocate for medical education reform, said that the persistence and consistency of accounts regarding the potential ERAS glitch is "troublesome."
"I do think that there's been something that's affected at least a small number of people," Carmody told MedPage Today. He added that because program directors may filter out incomplete applications to ease workload in the review process, they may not even have identified a glitch. And applicants, on the other hand, would have never received a review.
There is a possibility that all of the applicants did just make a mistake. But Carmody said there are still valid questions, even if all of the applicants who say they were affected by this issue were actually just affected by their own human error.
"Even if you believe that, it still sort of begs the question of why does the system allow you to make that mistake?" Carmody said. "Why take someone's money, and then allow them to submit? You can't order something online and leave your address blank, you know."
Applicants interviewed by MedPage Today said they were frustrated by an inability to identify why their documents were missing. All were certain they completed the residency application process thoroughly and correctly, as they have anticipated this moment for years.
"I went through my application countless times," the family medicine applicant said. "We have been crazy meticulous about our applications, because they are probably some of the most important applications we will ever do in our lives."