There are 4,815 total residents training in nearly 250 ACGME-accredited obstetrics and gynecology training programs.1 Of these, 71.8% are graduates of U.S. allopathic medical schools, 19.9% are international medical graduates, and 8.1% are osteopathic graduates. In recent years, over 1,100 categorical positions have been available in the Match.
We recently discussed the obstetrics and gynecology residency selection process with Dr. Eugene Toy, the Vice Chair of Academic Affairs and residency program director in the Department of Obstetrics and Gynecology at The Methodist Hospital in Houston, TX. Dr. Toy is widely known as the creator, series editor, and primary author of McGraw-Hill’s popular Case Files Series.
After completing his undergraduate education at Stanford University, Dr. Toy earned his medical degree at the Baylor College of Medicine, graduating with high honors and induction into the Alpha Omega Alpha Honor Society. Following residency training in family medicine and obstetrics and gynecology, he joined the faculty at the University of Texas Medical School at Houston where he has been deeply involved in medical student education through his role as clerkship director of the obstetrics and gynecology clerkship. For his dedication to teaching, he has been the recipient of numerous awards, including the Herbert L and Margaret W Dupont Master Clinical Teaching Award and the McGovern Award for Best Clinical Teaching.
In one survey, students at 15 U.S. medical schools were asked about their specialty interest at the time of freshman orientation. Four percent indicated that obstetrics and gynecology was the specialty they were most interested in pursuing.2 How can students interested in the specialty explore their interest further during the preclinical years?
It is interesting how many times students will be neutral or even leaning away from obstetrics and gynecology, and then during the rotation, they will be surprised by how much they love ob/gyn. My recommendation for any preclinical student is to keep one’s mind open, talk with different physicians in different specialties, and be willing to explore the different subspecialties. Shadowing a physician in private practice, doing some research for a summer, and talking to a student-friendly faculty member in giving advice are good ways to gain such exposure.
Obstetrics and gynecology is considered a core clerkship, and most U.S. students take the rotation during their third year of medical school. A new academic year is set to begin, and, for some third year medical students, obstetrics and gynecology will be their first clerkship. What can students do to make the most of their clerkship, and have a successful experience?
No matter where ob/gyn falls within the third year, a student can show the basic characteristics of enthusiasm, interest, active learning, effort, and attitude. Because ob/gyn tends to attract physicians who are ready to act quickly and intervene surgically, students should also prepare to be assertive learners balanced by knowing one’s place in the hierarchy.
How should students – who decide to pursue obstetrics and gynecology as a career – plan their fourth year schedule?
My recommendation is to do between 2-3 ob/gyn electives early in the fourth year. This allows the student to truly be certain that this is the correct career choice, and also will enable the student to get valuable letters of recommendation. The main time for interviews for ob/gyn is Nov, Dec, and Jan. Thus, scheduling easier rotations or a month of vacation during this time is advisable. Thereafter, required or educational rotations can be taken to round out the year.
Dr. Carol Major, director of the obstetrics and gynecology residency program at the University of California-Irvine School of Medicine, feels that audition or away electives can be beneficial to all students, regardless of their class rank.3 Of course, to gain maximum benefit, she states that students must do well. What is your opinion on the importance of audition electives?
The audition elective can be both an excellent way for the student to learn about the program, and also for the faculty and residents of a program to learn about the student. This can be a double-edged sword. For instance, a student who goes into a new hospital system has to learn an entire medical record system, the hospital logistics, and the medical school specifics; this puts a visiting student at a disadvantage as compared to local students. Nevertheless, with sufficient preparation and dedication, a student can overcome these obstacles. I always advise a student doing an audition elective to be prepared to work harder than any other student in the history of the hospital, to put off any leisure during that month until after the rotation is over, and to do more research, read more, arrive earlier, and stay later than any other student.
In a recent survey of 64 obstetrics and gynecology residency program directors, participants were asked to rank the importance of 16 applicant selection criteria.4 Ranked lowest in importance was “published research.” Students find this surprising since they are often told that research experience, particularly if it leads to publication, can strengthen the residency application. In your opinion, how do obstetrics and gynecology residency programs view research experience when reviewing residency applications?
I would agree that published research does not rank as high as many other criteria. For instance, clinical performance on medical school rotations, commitment to the specialty, attitude and ability to work with people, performance on the standardized tests, and work ethic are more important. Nevertheless, if two students are equally qualified in these areas, and one has research, then that student would be ranked higher. To that end, if a student has to decide what to do with their several months of the fourth year prior to interviews, I advise that student to work on addressing their weakest area based on what matters most to residency programs. For example, if the student’s USMLE step 1 score was average or slightly below average, then spending time studying for the USMLE step 2 examination would be more important than research.
Students understand the importance of having mentors or advisors in their specialty of interest, but sometimes have difficulty identifying the “right” individual. Obstetrics and gynecology departments generally have a number of faculty members who are available to advise students in the residency application process. What factors should students consider in their efforts to select an advisor?
The two most important factors are availability/interest of the faculty member, and experience/expertise of the faculty member to give good advice. Sometimes a faculty member will be well qualified but have little time for students due to their busy schedule. In these circumstances, a student should not feel badly about gaining advice from another faculty. Other factors include honesty and integrity, confidentiality, and the mentor’s placing the students’ interest as higher than one’s own or the institution’s.
When assessing the quality of residency programs, applicants have traditionally focused on resident satisfaction, surgical volume, and faculty supervision, among other factors. However, in a recent article published in JAMA, researchers introduced another factor – comparing residency programs based on patient outcomes.5 Specifically assessed was whether programs can be “evaluated by the quality of care their alumni deliver.” In their conclusion, the authors wrote that “programs can be ranked by the maternal complication rates of their graduates’ patients.” What are your thoughts on this recent research?
I am a strong proponent of outcome-based research including medical education. In fact, residents should be taught not only the safest ways and best ways to approach clinical problems, but also the best methods to communicate to patients to minimize legal complications. Students should look for programs that not only provide the number of cases in the different areas, but also the instruction, teaching, challenging, and sharpening of one’s skills.
Residency programs often request that one letter of recommendation should come from either the chairman, program director, or clerkship director of the obstetrics and gynecology department. However, many students do not have opportunities to work closely with these faculty members. What advice can you offer to these students?
As much as possible, a student should try to get a letter of recommendation from one of these individuals, since these faculty members have great insight into what type of student is appropriate for the field of ob/gyn. Even if the student doesn’t have a chance to work clinically with these people, a student can set up one or two meetings. For instance I have written plenty of letters of recommendation on the basis of meeting with students, learning about their interests and passions, and reading their evaluations.
In 2008, the NRMP released the results of its comprehensive program director survey.6 Surveys were sent to 246 obstetrics and gynecology program directors, and 146 responses were received. Seventy-two percent cited the personal statement as a factor in selecting applicants for interview. For many students, the statement is the most dreaded part of the residency application. What can students do to write a statement that sets them apart from others?
More than anything else, I look at the personal statement to answer the questions: “Why is this student interested in ob/gyn, and does this interest seem to ring true?” Certainly if the personal statement tastefully and artfully presents some unique aspects of the student without being awkward or bizarre, then all the better. As a program director, I am looking for a solid responsible resident who will be committed in a demanding specialty to the end. I am not looking for a literary or creative genius. Grammar, spelling, and diction, however, are important. Sometimes spell check can create strange words, so a careful read is mandatory.
In 2005, the Association of Professors of Gynecology and Obstetrics (APGO) and Council on Resident Education in Obstetrics and Gynecology (CREOG) convened a joint committee on career counseling.7 The work of the committee led to the development of the document “Comprehensive Women’s Health Care: A Career in Obstetrics and Gynecology,” which provides useful information for students contemplating a career in the field. The document reminds applicants to “not underestimate the impact of the interview. It can open or close the door for you.” What do you recommend students do to ensure a successful interview?
Other than the grades and USMLE scores, the interview is the single most important factor in the ranking of a candidate. The student should do adequate homework ahead of time to learn about the program and the hospital, being prompt to the interview, going to the social event, and making the most of the entire interview day. The student should treat every interview as his/her only interview, and remember that from the correspondences, telephone calls, and the entire interview day, everything counts. Students sometimes forget that in a field such as ob/gyn, it is a small world, and one act of poor judgment in one program can be broadcast to many different programs. In other words, there is not the same anonymity as there was as an undergraduate student. Much of the student’s behavior is governed by common sense, such as being respectful to everyone, asking and answering questions even after a long day, and smiling despite being tired.
1Brotherton S, Etzel S. Graduate medical education, 2008-2009. JAMA 2009; 302(12): 1357-72.
2Compton, M, Frank E, Elon L, Carrera J. Changes in U.S. medical students’ specialty interests over the course of medical school. J Gen Intern Med 2008; 23(7): 1095-100.
3Major C. UC Irvine Career Guidance Handbook: Obstetrics and Gynecology. Available at http://www.meded.uci.edu/education/residencyselection/obgyn.html. Accessed March 24, 2010.
4Green M, Jones P, Thomas J. Selection criteria for residency: results of a national program directors survey. Acad Med 2009; 84(3): 362-367.
5Asch D, Nicholson S, Srinivas S, Herrin J, Epstein A. Evaluating obstetrical residency programs using patient outcomes. JAMA 2009; 302(12): 1277-83.
6Charting Outcomes in the Match, 2009. Available at www.nrmp.org. Accessed March 24, 2010.
7The Association of Professors of Obstetrics and Gynecology. Comprehensive Women’s Health Care: A Career in Obstetrics and Gynecology. Available at http://www.apgo.org/binary/Comprehensive%20Doc%202004.pdf. Accessed March 24, 2010.