Medical

Lessons Learned on the Residency Admissions Trail

This time last year, I embarked on my own medical residency admissions journey. I realized that the decision-making process involved in the ERAS and residency application cycle can be dauntingly ambiguous to many applicants, including myself. Gone are the lists of medical schools or colleges ordered by objective measurements such as research dollars, student-faculty ratios, and admission statistics of entering classes. While there is significant debate on which criteria should be included in ranking schools, the availability of that data at least allowed for individual interpretation based on personal beliefs.

Data on individual residency programs is much less consistently available and is difficult to use in comparing programs. This often leaves us dependent on the insights of graduating students, residents, and faculty members. I learned that, while these advisors are genuinely attempting to help students, their advice and insights are often outdated or incomplete. Here is what I know now that I wish I knew then.

When Choosing a Residency Program to Apply to:

1) Avoid the allure of ‘celebrity’ physicians. There are many individuals in each field that are seen as leaders or legends, but beware placing too much emphasis on a single individual. The truth about exceptional physicians is that they are just as desired by other programs as by us (the mentees). This means that such individuals are often prone to move into more senior positions at other programs where vacancies are available.
A good thought experiment when considering a program is to consider it without a given individual. Would the loss of that person significantly alter your impression of the program? If so, you may want to rank this program lower or leave it out altogether.
1.5) Pay close attention to the current composition of the program. It is best not only to seek out programs that have strengths that interest you, but to also be sure that those strengths are spread out among multiple physicians or faculty members. Instead of individuals, look for programs that appear to generate top-notch doctors, or programs which have a culture that has been permanently marked by the beliefs and traditions of great leaders. Another good quality to look for is the diversity of training present in the physician staff. Multiple points of view and techniques often exist in a given specialty. It is in your best interest to be exposed to as many as possible and choose which you most agree with upon graduating.
2) Remember, residency is the job you need to get the job you want. Thus, the professional prospects of current and past residents of a program are essential data. The most fundamental piece of the Match process is finding a job. A program with significant attrition in the recent residency staff should be viewed with concern. What if the same were to happen to you? Losing a residency position is financially and personally devastating.
Secondly, look at where past graduates end up in terms of both type of practice and even location to an extent (i.e. if all graduates stay in the area of their program versus end up in many different locations). Does this fit with your own career goals? Things like prestige matter little if you won’t be able to use your residency training to fulfill what you find most important in your career.

When Visiting a Program:

Whether you are performing a sub-internship, attending an interview or just visiting a particular faculty member to cultivate a relationship, make sure to consider the following when you are up close with any residency program.
1) Opinions about residency programs may be based in fact, but those facts are almost always changing. Even the opinions of a program from residents that you know can be several years out of date. Residency programs are constantly in a state of flux. Even a few years’ time can radically change the culture of the program. Because of this, take the advice you receive from senior individuals as things to confirm or disprove for yourself. If there are rumors of malignancy, see if the individuals precipitating such a culture have left or changed. Has the format of the residency training changed? Similarly, if there is emphasis on excellent teaching, training, or research, make sure to confirm that that is a tradition of excellence that has continued and does not show signs of flagging.
2) Think of where a program is going as well as where it is. Another helpful thought experiment is to consider where a program is currently based on general opinion. Does the program appear to be stable, increasing in quality, or decreasing in the next five years? What about the next twenty? Are a number of senior attendings near the end of their careers? Is the hospital system keeping up with national trends in terms of facilities and equipment? (A hospital system with no current or recent construction/renovation going on is often a bad sign.) Are there a number of junior faculty that seem to be advancing in their careers and, therefore, will be poised mentor and vouch for your capabilities when you are looking for employment? Has there been any recent instability such as rapid loss of physicians or residents? Alternatively, has the department been expanding the number of attending physician or residency spots? These are good signs.
Most importantly, trust your instincts and consider the gut feeling you get when interacting with residents and faculty. These are the people that you will work with and for during the coming years. Personal fit and happiness with your colleagues is crucial to a productive medical residency. It is not uncommon for the preconceived match list of applicants to drastically change post-interview. This isn’t necessarily because programs were bad, but because they were perhaps not as good a fit as once thought. It is called the Match for a reason.

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Michael McDowell, MD is a Senior USMLE Tutor and Admissions Adviser for Med School Tutors. He is a graduate of Columbia University College of Physicians and Surgeons and is beginning his residency in neurosurgery at the University of Pittsburgh. Michael McDowell, MD is a Senior USMLE Tutor and Admissions Adviser for Med School Tutors. He is a graduate of Columbia University College of Physicia...