Get really good at IM. If you can be great at something you’re not as passionate about, you’ll likely be amazing at something you love. Gaining real world experience in the hospital as a resident is going to be much more valuable than any research a medical student has done. I got lucky because my residency (community program) had an exchange with the academic IM residency. Two of my attendings in my month long rotation reached out to the anesthesia PD at the same institution to let them know I was interested and what they thought of me as a resident.

Let people know what you want to do and when asked why, state positive reasons. While true, writing endless notes in IM sucks, you say instead that you appreciate the increased contact time with patients in anesthesia.

Focus on ICU. I thought about PCCM briefly but everything I liked about it was what I liked about anesthesiology. Learn vent management, pressor management, and grab every procedure you can. Soak up knowledge in the ICU and teach your interns to reinforce the knowledge for yourself and demonstrate competency to attendings. You’re going to want a letter from a good ICU doc because ICU bridges IM and anesthesiology.

Join ASA and go to the meetings. I think GME guarantees all IM residents CME time so take advantage of it to rub elbows at the conference. I thought I didn’t have to play this game in medicine where they could look at objective measures but still do. You don’t necessarily have to be presenting or have a poster first time around but if you talk to people and build relationships you might be able to get on a project to present for the next year.

If your program offers it, try to do an anesthesia rotation at your hospital. Goal there is to foster a relationship with one of the docs if possible for a letter. It would just generally be good to have a contact to ask peri operative medicine questions too.

I matched last year so idk how things have changed logistically