how to navigate the residency selection process

How to Navigate the Residency Selection

Process

Francis S. Nuthalapaty, MD Upstate Chapter

Christian Medical and Dental Association

What do you think would make the

“optimal” residency training environment?

The Optimal GME Environment

Education Service

Defining the Optimal ResidencyAuthor, Year Population Scope N

(Response Rate)

DiTomasso, 1983 PGY-1 FP National 830 (46%)

Weissman, 1984 PGY-1 Psychiatry National 274 (51%)

Sledge, 1987 Graduates entering Psych. National 318 (64%)

Hitchcock, 1989 PGY-1 FP 1 State 115 (91%)

Simmonds, 1990 Graduates 1 Univ. 111 (71%)

DeLisa, 1992 Graduates 1 Univ. 73 (41%)

Flynn, 1993 Graduates 1 Residency 315 (88%)

Lebovits, 1993 Graduates 1 Univ. 197 (87%)

Mayeaux, 1993 PGY-1 FP National 660 (27%)

Diebold, 1995 PGY-1 EM National 463 (68%)

The Optimal Residency in the 80’s – 90’s

1.Geographic location

2.Quality of training experiences /

educational curriculum

3.Academic reputation of program

4.Perception of house staff

satisfaction

The Changing GME Landscape

The GME training environment has changed dramatically over the past 4 decades

–Resident unionization

–Duty Hour Restrictions (2002)

–Federal definition of resident employment status (2005)

Controllable Lifestyle and Specialty Choice – The Educator’s Viewpoint

• Coined by Schwartz in 1989

• Broadly defined as control over the number of

hours devoted to professional responsibilities

to enable time for leisure, family, and

avocational pursuits

• Shown to be a significant determinant of

specialty choice

The Contemporary GME Environment

GME

ServiceEducation

Resident Well-being

What’s important to residency applicants in the new millennium?

The Optimal Residency in the new Millennium

Factor No. %

1. Resident satisfaction with program7,043 98.1

2. Level of concern program has for its trainees

7,037 98.0

3. Perception of “fit” into residency6,948 96.7

4. Geographic location6,836 95.2

5. How well residents work together6,753 94.0

6. Quality of hospital facility6,176 86.0

The Optimal Residency in the new Millennium

Factor No. %

7. Amount of faculty supervision5,604 78.0

8. Academic reputation5,474 76.2

9. Level of resident autonomy6,836 76.0

10.Amount of faculty teaching6,753 74.1

11.Amount of conferences 5,294 73.7

12.Size of patient case load4,230 58.9

The Optimal Residency in the new MillenniumFactor No. %

13.On-call frequency 4,018 55.9

14.Cost of living in program area 3,656 50.9

15.Amount of clinical support services 3,608 50.2

16.Emphasis on research 3,067 42.7

17. Emphasis on teaching students 2,632 36.6

18.Employee benefits 2,462 34.3

19.Salary 1,600 22.3

20.Supplemental income opportunities 1,408 19.6

Factors in Interview Selection

2013 NRMP Applicant Survey Important Factors In Interview Selection

Factor 2015 2013 2011 2009

1. Geographic location 87% 95% 95% 95%

2. Academic reputation of the program 83% 90% 92% 92%

3. Perceived goodness of fit 80% N/A N/A N/A

4. Quality of residents in program 70% 79% 88% 88%

5. Quality of educational curriculum 68% 86% 92% 92%

6. Academic Setting 68% 74% 87% 87%

7. Work / Life balance 64% 68% 87% 87%

The Learning Culture

Academic rigor vs. Malignancy

Autonomy vs. Supervision

Role models vs. Mentors

What’s important to the Program?

Factors in Selecting Applicants

2014 NRMP Program Director Survey Factors in Selecting Applicants for InterviewsFactor 2014 2012 2010 2008

Step 1 Score 94% 82% 73% 82%

Letters of Recommendation 86% 81% 71% 75%

MSPE (Dean’s Letter) 84% 68% 60% 76%

Step 2 CK Score 80% 70% 61% 70%

Personal Statement 78% 77% 68% 75%

Grades in Clerkships 70% 71% 62% 71%

Breakdown of USMLE Step 1

USMLE: Making the Cut

The boxes in the boxplots above represent the interquartile range (or IQR, which is the range between the 25th and 75th percentiles) and the line in the box is the median. The x-shaped symbol in the box is the mean

Obstetrics and Gynecology

A Structured Approach to Residency Application

1. Set a Timeline

2. Gather Data about your Specialty

3. The Letter of Recommendation

4. The Personal Statement

5. Electives – Good or Bad?

6. The Interview

7. The Rank List

The Match Timeline

1. Late May: ERAS user guide available 2. June: MyERAS website open for use 3. Sept 15: Programs begin download 4. Oct 1: MSPE sent to Programs 5. Jan 14: Rank list entry begins 6. Feb 23: Students finalize Rank list 7. Mar 13: SOAP begins 8. Mar 17: Match Day!

Setting a Timeline

1. Review the Match Timeline

2. Review steps in Application Process

3. Set deadlines for each step

Gathering Data1. NRMP Reports

–Match Outcomes

–Program Director Survey

–Applicant Survey

Comparing the Specialties

Step 1 and OBGYN Match

Comparing the Specialties

Step 2 and OBGYN Match

The Application Process

1. Extramural Electives

2. ERAS Application

3. Personal Statement

4. Letters of Recommendation

5. Interviews

6. Rank Order List

7. Program Follow-up


Should you

do an Extramural Elective?

1. Electives – Good or Bad? – Electives are extended interviews – Most beneficial for very strong

candidates and weak/marginal candidates

– Could help or potentially hurt intermediate candidates

– Expensive!



2. ERAS Application – 4 main components

– Identifiers

– Education

– Current / Prior Training

– Experiences


What makes a good Personal Statement?


3. Personal Statement – Before you start

– Check with program for any special content requirements

– Line up at least 3 reviewers: • Medical perspective • Lay perspective • Editorial perspective

– Be prepared to write MANY drafts


3. Personal Statement – What to include – Your motivations for a career in medicine – How you chose the specialty and why you

are a good “fit” – Distinguishing features of your personal /

professional background – Your unique qualities /talents / passions

relevant to the specialty – What you see yourself doing after

training – your future scope of practice


3. Personal Statement – What to avoid – Autobiography – Why you like the specific program – Poor composition

• Grammar • Spelling • Literary style


What’s the best strategy for Letters

of Recommendation?

4. Letters of Recommendation (Advice for Students)

– Check individual program requirements

– Ask early / ask often – Always ask the faculty person what

the strength of his/her recommendation will be!


4. Letters of Recommendation (Advice for Faculty) – Ask the student to give you as much data as

possible • Transcript, USMLE Scores • Personal Statement • CV

– Meet with the student / ask questions – Always discuss the strength of your

recommendation – Proof read to ensure student’s name is correct

throughout



What should be your approach to scheduling interviews?

The Interview Roulette - 2008

The Interview Roulette - 2012

5. Interviews – Schedule them early

– Many programs complete all

interviews by the end of December

– “Be nice” to all contacts

– Be prepared for behavioral interviews


The Rise of Behavioral Interviewing

How should you determine your rank

list order?



6. Rank Order List – Rank based on where you want to be –

not where you think you were liked – More programs = greater match

success – Many programs will try to pin you

down – don’t be afraid to tell programs you liked them – but don’t divulge your ranking.

Applicant Rank ListSingle Most Important Factor

Factor %

Potential “fit” into residency program 34.6

Geographic location 30.3

2015 NRMP Applicant SurveyImportant Factors In Ranking

Factor %

1. Overall goodness of fit 87

2. Interview day experience 81

3. Geographic location 80

4. Quality of residents in program 74

5. Reputation of program 71

6. Quality of faculty 66

7. Housestaff morale 63

2015 NRMP Applicant Survey Ranking Strategies

Factor 2015 2013 2011

1. I ranked in the order of my preferences 92% 98% 99%

2. I ranked all programs I was willing to attend 76% 71% 95%

3. I ranked all programs at which I interviewed 69% 60% 63%

4. I ranked a mix of competitive and less competitive programs 64% 53% 88%

5. I ranked 1 or more less competitive programs as a safety net 57% 34% NA

How do Programs determine their rank

list order?


Program Rank Factors

Program Rank Factors

1. The “Big 3”:

–Residency Interview

- Interactions with faculty

- Interactions with residents

–Interpersonal Skills

–Academic performance

How many programs should you rank?


Rank List Length


6. Rank Order List – Rank based on where you want to be –

not where you think you were liked – More programs = greater match

success


7. Program Follow-up – Recognize that each program has

differing expectations – The program’s view of applicant

follow-up is based on many factors • PD experience • Program competitiveness

Quotes from PDs“If they email you and tell you that they loved the program and it is their first choice it has no significance. After doing this for the last 13 years, I don't believe any of the emails or even the recommendations from medical school. They played no part in the decision making process since I don't think they have any value in predicting who will fit in your program.”

“In my time as a Program Director, we ranked students that expressed great desire in our program near the top. But ONLY if we felt that he or she has the necessary criteria that we set. These criteria included grades, references, research interest and how they performed in the interviews.”

Quotes from PDs“I encourage applicants to email me rather than send letters, although they all took me up on my offer this year, and responding is a lot of effort. It helps me a lot to know that an applicant is genuinely interested in our program, so I do think they should reach out to those programs at the top of their list.

Telling me I'm "in the top" is somewhat helpful, but may not mean much. Telling me I'm "#1" on the list tells me more, but isn't necessary, and they may change their mind.

It's hard to keep someone high on the list if none of us have heard a word out of them since they interviewed. We assume, sometimes incorrectly, that they're not interested in us.”

Useful Resources

1. AAMC Resources: –ERAS Information Website –Roadmap to Residency Document –Careers in Medicine Website

2. NRMP Resources: –Charting Outcomes in the Match –2012 Program Director’s Survey –2011 Applicant Survey

http://www.aamc.org/students/eras/

https://services.aamc.org/Publications/showfile.cfm?file=version78.pdf&prd_id=183&prv_id=222&pdf_id=78

https://services.aamc.org/careersinmedicine/

Useful Resources

1. Program Information: –FREIDA –ACGME

2. Other Resources –Career and Professional Development

Website –UK Career and Professional

Development Website

http://www.ama-assn.org/ama/pub/category/2997.html

http://www.acgme.org/

http://www.kumc.edu/som/medsos/cpd.html



Useful Resources