Residency application process

Pre-Med & Medical School Pre-Med Topics
21

<p>im just getting ready to enter my 2nd year, and 1st year definitely exceeded my expectations. however, i’m freaking out about the fact that i have boards at the end of the year, and that i’ve always been a decent standardized test taker (enough to get me where i’m at) but never stellar. i still am clueless about what specialty i want to enter (which i know is ok) but i worry because i do have an interest in ophthalmology and derm and ENT and other competitive specialties, and i know that board scores are insanely important for those. how early did you start studying for step 1 in your 2nd year? and is step 1 really the end-all when it comes to the make-or-break aspect of your application? (btw my school is all pass-fail grading for the 1st 2 years)</p>

<p>also, more for curiosity, but if i decide that i really want to stay in the region that i am currently in for residency, like the new england area, how possible is that?</p>

<p>any help would be greatly appreciated. and thank you all for sharing your experiences on this board. i’ve been following for a while and it’s been helpful to hear all the different perspectives on this crazy educational experience.</p>

22

<p>Data that I’ve seen on board prep timing is that there’s a significant increase in scores from week 3 to week 4, and a smaller, but still pretty sizable jump from week 4 to week 5. After that, for each additional week of studying scores go up, but the size of the jump gets much, much smaller with each subsequent week (classic diminishing return). With that in mind, my med school recommended studying for no more than 6 full weeks. </p>

<p>It’s certainly possible to stay in region. In fact most people will limit their applications to a particular area of the country (though not every body - Exhibit A right here - I applied from Oregon to North Carolina and Arizona to Virginia, though I didn’t interview quite as broadly)</p>

<p>As for the relevance of step 1 scores - the scores open doors. Get yourself acquainted with the Residency Directors Survey that is on the NRMP website (at least that’s where I think it is, maybe it’s on the AAMC site). You’ll see that, really, the 6 to 8 hours spent finishing Step 1 is the most disproportionately important time span in all of medicine, followed by the time you spend interviewing at a program.</p>

<p>Now there are plenty of stories of people with sub 200 scores getting into things like ortho or anesthesia, even radiology, the trick being that those individuals are willing to move to North Dakota or Idaho or other less desirable locations and programs in order to pursue their dreams. They are not going to big name programs, fun cities, or even ‘non-malignant’ programs. It’s taking a long shot but sometimes it pays off. But really, the take home message should be that passing is the first priority, and second is getting the highest score possible. Once you have that score, all it does is open the door. It does not guarantee you a spot, it does not make you a great third year med student, a great intern or a great doctor. Twice last month I had to help residents in extremely competitive residencies write viable admission orders - one ophtho and one neurosurg (in JUNE mind you, so these were residents who at a minimum had done an intern year and almost a complete year, if not more, in their chosen specialty and they couldn’t write adequate admit orders). The whole time I was teaching them I wanted to point out that they probably had way better grades and board scores than I did and yet they were about to fail at taking care of their patients…but I held my tongue and was nice and portrayed it as though I was helping avoid getting woken up by the nurses asking for clarification of their orders.</p>

<p>Hope that answers your questions</p>

23

<p>BRM:</p>

<p>I hate working with people who think they’re hotshots but can’t do the simplest of tasks. </p>

<p>It’s remarkable how in the span of a year I’ve learned to pick up on “good” practices versus “bad” practices. When I started third year, I was trying to soak up everything and it was hard for me to tell when things weren’t going as they should. It’s still really surprising to me when I realize that people are doing bone-headed things. I’m accustomed to thinking that I’m doing good and that I know my limits, and it’s a little odd to think that it might not be the case with coworkers or people senior to me in the hierarchy.</p>

<p>I’ve started thinking about specialty in terms of either/or. Inpatient or outpatient? All ages or a specific age group? Men, women, both? Doing or thinking? Sick or well? Primary care or specialist? Multiple organ systems, or just one?</p>

<p>So far, my answers are: inpatient, all ages, both, doing and thinking, sick with the possibility of getting well, specialized, multiple organ systems. Add the fact that I love the OR, and I think I’m justified in paring down the possibilities to general surgery and anesthesia.</p>

24

<p>Yes, I think those are both excellent options based off what you laid out. I think that now that you’ve got those laid out, the next step is deciding how important each of those things are, and that will show you the way. </p>

<p>For example, if getting to see kids is really high on the list, that might tip the scales more towards anesthesia. On the other hand if sick and wanting to be responsible for getting them better is where you’re placing your priorities, surgery is probably the answer. (Occasionally, when trying to get a rise out of my Anesthesia friends, I remind them they’re just there to help the real doctors do their jobs… :wink: )</p>

25

<p>Last day of my medicine sub-i. I’ve definitely ruled out medicine. It’s become clear to me that I’m just not as excited about medicine as my resident and the categorical intern are. They both really love what they do, and while I had a great time, I had a great time because it was new and novel and I was learning how to manage patients on the floor. I can’t see myself being very happy as a medicine resident.</p>

<p>Next up, anesthesia elective!</p>

26

<p>I’m now more than halfway through my cardiac anesthesia elective. I’ve also spent some days on general cases, too. I’m liking the general stuff better since there’s more stuff I can do than on the cardiac cases, but I’m starting to think that I might become bored as an anesthesiologist in 20 years. If I pick anesthesia, it’ll be for the lifestyle and the people, who, by the way, are generally fantastic - very into teaching and appropriately laidback.</p>

<p>That being said, I finally got my surgery clerkship grade back (after 7+ weeks, sheesh!) and it’s stellar. The feedback is the best I’ve gotten all year. With a grade this good, I feel almost obligated to apply for general surgery, but I have a lot of reservations about the field, mostly pertaining to specialty culture and the hours.</p>

<p>I’ve decided that I’m going to apply for both anesthesia and general surgery. I can’t see myself making a real decision until after I do my surgery sub-i, which due to scheduling issues, won’t be until the end of October, and I think it’s important to submit apps early. Once I know what I’m going to choose, I’ll either decline interviews or just not rank programs.</p>

<p>This has been really hard for me. I can’t tell what’s going to be more important to be in 5 years or 20 years. Will it be the topic (in which case, surgery is super-interesting) or the lifestyle and culture (anesthesia can’t be beat)?</p>

27

<p>Can we get an update on this? Please…</p>

28

<p>Thanks for asking, BRM. It’s taken me a while to get back to you since I’ve been traveling all over.</p>

<p>August was a tough month. Cardiac anesthesia is an intense rotation, and I was pretty stressed out because I couldn’t decide if I should double-apply in anesthesia and surgery or just apply for surgery. I spent the last two weekends of the month really thinking about myself, my interests, and my goals in life.</p>

<p>I realized that what I liked about anesthesia were not good reasons to become an anesthesiologist. The faculty and residents here in the anesthesia department are is awesome, and I realized that I wouldn’t have wanted to train in anesthesia at any other institution. I think I’d really enjoy being an anesthesia resident, but I don’t think I would enjoy being an anesthesia attending. It’s fundamentally a specialty where you work alone, and I prefer working in a team. In short, I would’ve had a great time during the 4-5 years spent as a resident and fellow, and then I’d be facing a future in a career that probably wouldn’t be that interesting to me.</p>

<p>In the end, on September 1 I submitted applications for general surgery programs only. It was a bit of a leap of faith - at that point, I knew that medicine wasn’t right for me, and I thought that anesthesia wasn’t right either, but because of scheduling trouble, I wouldn’t get to do my surgery sub-i until the end of October. If I found myself not liking that rotation, I’d essentially be screwed because I would’ve applied in a field I didn’t like without any real option to apply for something else.</p>

<p>I’m glad to say that I enjoyed my month on surgery thoroughly. Now that I have more perspective, I’m almost 100% sure that I’ve made the right decision for the right reasons. With regards to my applications, I limited myself to the northeast for personal reasons. I’m currently nearly towards the end of the interview process - I have just three places left to go on my schedule, though I’m wondering if I can realistically expect any new invites come January. I’m also in the process of starting to think about the places I’d like to take a second look at and how I’m going to arrange my rank list. There are so many things I’m trying to take into account. If you’ve got any smart advice on these things, I’d like to hear it, BRM.</p>

29

<p>Good luck on the match. Debating b/w radiology, internal med, and anesthesiology myself.</p>

30

<p>Hey, congratulations on making in through med school, I was just reading through the topic and I had a few questions (sorry if these are stupid questions)

  1. Exactly how selective are most residencies? like are there 10 spots a year? 100 spots? 500?
  2. Would you choose now if you were going to do a surgical subspecialty?
  3. Exactly what is the difference between your residency and your fellowship?</p>
31

<p>Shades:</p>

<p>Everyone’s got their reasons. You have to decide what factor is most important for you and the relative importance. I hope you’ve been keeping some sort of notes.</p>

<p>Personally I’m someone who if I’m happy at work, I figure being happy at home is just that much easier. I mean who does things they don’t like to do during their free time? It’s one of the reasons I have such a hard time understanding the draw of lifestyle fields. With that in mind, I put a premium on the program even if I wasn’t thrilled with the city. </p>

<p>In terms of my list, I had visited all my top picks by christmas. After that, it was pretty clear that I was judging the programs against the places I had already been. In the end I knew my top three really stood out over the rest, but the final order was in doubt for a long time between those and then it came down to just pulling the trigger and accepting the final result. I ended up at the program that was 3rd on my list. It was the program that I actually felt was the best fit, and ending up there removed any buyer’s remorse or putting my program higher and wondering if I would have matched elsewhere if my list was in a different position.</p>

<p>Premed4:

  1. The first question is a little tough because each specialty is different. Over 5000 US seniors will match into Internal Medicine programs, programs that range in size from 5 to 50. Pediatrics will have about 2700 US Seniors with similar ranges in size. Meanwhile a “Big” (in size) General Surgery program may have 8 residents per year. An average OB/GYN program will take 4 interns a year. A derm program may only take 2 interns a year, so it’s highly variable. Some fields like Derm or plastics or ENT are all extremely selective. But within every specialty there are highly selective programs, and sometimes there are other extenuating factors that may make it even more difficult for a particular applicant to match at their most desired program. For example, my program is very popular with the medical students at the med school it’s affiliated with. However my program leadership are very careful to have a diversity of residents. That means the students really have to prove themselves as third years and then again as 4th years during their acting intern month. If they don’t do well, if they don’t impress the residents, then no matter how much they want to stay at our program they may be entirely shut out. </p>

<p>2) If Shades wanted to go into ENT, Ortho, Neurosurgery, or Urology, then they would apply directly to residencies in those fields. There are also some plastic surgery residencies that start from the intern year.</p>

<p>However, if Shades decided that Pediatric surgery, Trauma, Vascular, Colorectal or minimally invasive surgery was the end all be all of careers, then completing a general surgery residency prior to starting a fellowship is necessary.</p>

<p>3) Fellowship is the process by which further specialization is accomplished. There are medical fellowships like critical care, cardiology, endocrinology and nephrology. As mentioned above there are some general surgical fellowships. ENT has fellowships like Pediatric ENT and Neurootology, Ortho has fellowships in pediatrics, foot and ankle, hand surgery, or spinal. </p>

<p>Going into fellowship is major undertaking - it requires going through another match process. I’m going to be applying for a Pediatric Critical Care Medicine fellowship next summer. I’m lucky because for the last 4-5 years there have been more available spots than applicants, but that’s definitely not the case for many other fellowships. Fellowships out of medicine like GI and Cardiology are very competitive. Even though Peds CCM is not to that level, I’m still working on multiple projects - one a research/Quality Improvement project with my hospital’s helicopter transport team as well a couple other things…because I want to make sure I can go where I want. Additionally I have to garner more Letters of Rec (luckily I have amazing Critical Care faculty I’m working with) and write another personal statement. There will be more interviews, and another rank list.</p>

<p>Most fellowships in all fields except pediatrics are 2 years in length. Pediatric fellowships are 3 years. In addition to spending the clinical time dedicated to the particular field, there are also “scholarly projects” that must be completed. The peds fellowships are typically almost 50% research time. Not being a Medicine or surgical resident I don’t know what the research requirements are for their fellowships.</p>

32

<p>Welup, I’ve had my last interview, sent out my last thank you notes, and am now starting a new rotation. At this point in the year, there are essentially two things left for me to do:</p>

<p>1) match into a categorical general surgery program, and
2) finish my graduation requirements.</p>

<p>With regards to finishing the first task, I’ve started actively thinking about my rank order list - this is the list that I submit to the NRMP by February 23 that lists all the programs I’m interested in my order of preference. There are a lot of things that are important when considering how to order your list, and I’ve been soliciting opinions on I should be considering from the residents and attendings who I consider my mentors. Right now, the things that I’m juggling are my gut feeling about the place, the program’s academic reputation, the living expenses associated with being a resident at the program, and the program’s location.</p>

<p>As for being able to graduate come May, I’m ticking off the two last required rotations and the elective credits I need to earn. To that end, I started my emergency medicine rotation. I’m dreading it because to me, the ER is a loud, disorganized place where nothing happens as it should, but I’ve realized that in a way, I’m relieved to be back to work in a clinical hospital setting. Two months off for nothing but interviews was getting stressful in its own way.</p>

33

<p>It’s a big week coming up. Next Monday is what I think of as “Match or No Match” day. We’ll all receive an email from the NRMP at noon stating whether or not we matched. If I matched, great! If I didn’t, then I need to get in contact with my med school’s administration ASAP in order to begin the process of scrambling.</p>

<p>Come Thursday at noon, our school will pass out the envelopes that’ll tell us where we all matched. We’ll also get an email at 1pm with the same information, in the event that we can’t handle going o the school to get that envelope in person. Luckily, our school doesn’t have a formal ceremony, so you don’t have to worry so much about your emotional reaction to good or bad news.</p>

34

<p>Jeebus. :eek: I advise you to start drinking now. JK. Well, sort of. Kidding…but not really. Yeah, yeah. I guess I’m kidding. (I look forward to your letters. ;))</p>

35

<p>when you scramble are you trying to get into any residency specialty, not just the one you applied to?</p>

36

<p>Wow! Please sticky this thread. This information is incredibly helpful. Thanks so much for sharing your experience and lessons here, Shades and BRM.</p>

37

<p>My school did have a formal match day ceremony…I think for most of my classmates (and definitely for me) it was more exciting than actual graduation/hooding ceremonies. Some people skipped and probably a few wish they would have skipped it, but the majority of my class was ecstatic with their results. </p>

<p>Of course, on the resident side of things, it’s also a pretty exciting day. We have our own match day ceremony unveiling the new interns at noon on Thursday. My guess is that this isn’t that common…but we’re pediatricians, we chose our jobs so we could play at work, and certainly the investment the program makes during interview season is different than in the specialties that are only trying to fill 5 spots (not the mid 20’s like we are).</p>

<p>Shades…once you’ve gotten that email on Monday, just spend the rest of your week rehearsing what your response will be to whatever shows up on Thursday.</p>

38

<p>Somewhere, some program wants to train me to be a surgeon. I am both incredulous and humbled. Can’t wait to see what news Thursday brings.</p>

39

<p>So you know what but you don’t know where yet? Still…big congrats. I think my kid is looking that way, too.</p>

40

<p>Welcome to the world of the gainfully employed! Not only do they want to train you, they’re going to pay you too!</p>

<p>In less stellar news…one story of an unmatched (now scrambling) 4th year I know is a cautionary tale.

  1. Don’t make the residents at your home program angry - from the time you start your 3rd year clerkship, through your sub-internship as a 4th year and into any 4th year electives you may end up doing</p>

<p>2) #1 is all the more true when your home program is very popular with students from your school and it’s incredibly obvious that the program places a premium on diversity (thus making the competition for spots at your home program even more cutthroat, even in a field that’s considered much less competitive - like peds)</p>

<p>3) Don’t “suicide” rank. In other words, no matter how much you want to stay in the area, it’s better to match at your 4th or 5th (or higher) choice than to scramble. Only ranking one or two programs is never the right strategy.</p>