The Residency Interview: Making the Most

of It

Phyllis Kopriva, Director, American Medical Association Women and Minority Services

Setting Up Your Interviews Make arrangements for your interviews as early as possible without scheduling them so early as

to look pushy or over-anxious. Certain programs interview by invitation only. In those cases you

must send in your application and hope for the best. If you are extremely interested in a program,

consider doing a visiting elective there before your fourth year.

About the Match Process As a rule of thumb, program directors would like to be finished with their interviews by January

so they can attend to the administrative details in order to meet the National Resident Matching

Program (NRMP) deadlines.

The NRMP is sponsored by five organizations, the American Board of Medical Specialties

(ABMS), the American Medical Association (AMA), the Association of American Medical

Colleges (AAMC), the American Hospital Association (AHA), and the Council of Medical

Specialty Societies (CMSS). Each year, the NRMP conducts a match that is designed to optimize

the rank ordered choices of students and program directors. Registration opens in August with a

final deadline of December 1. From mid January through February, candidates and programs

submit their preference lists. In the third week of March, the results of the Match are announced.

It is a good idea, however, to get a few interviews under your belt before you go to the ones that

you regard as the most important. And it is reasonable to expect that after a dozen interviews you

will be battle-weary. Therefore, scheduling your most prized interviews in the middle might

promote the best results.

Research the Program Research the program as much as possible before you go so that you will be able to target your

questions for that program, rather than doing a generic interview. You might check to see if any

graduates of your medical school are there, and if so, consider getting in touch with them. Do

some research on the latest developments in the specialty that youre interested in, including

what types of people theyre looking for. Different specialty programs may have different

priorities - leadership, community involvement, research, or clinical abilities.

Review your application, personal statement and curriculum vitae and prepare yourself to discuss

anything that youve mentioned on them, including any research that youve done. Prepare a list

of questions that you want to have answered during your stay. And remember, you dont have to

memorize your questions; you can take your notes into the interview.

Plan Your Trip Well Housing. Some students find it helpful to make prior arrangements for housing in residents

quarters. At the same time, check to see if you can schedule an interview on a day when you can

attend morning rounds or a teaching conference. If you have the time, stay an extra day to talk

with residents. Time and again, respondents reported the value of information gained from this

source.

(For help in finding local housing during your interviews, you can also call the American

Medical Association.The AMA Alliance, in partnership with the AMAResident and Fellow and

Medical Student Sections, runs the Community Welcoming Program -- which finds on-site hosts

for fourth-year medical students and their families as they interview for residency. This helps

medical students minimize travel costs while keeping them connected with organized medicine.

More information about the Community Welcoming Program, including how to request housing

and how to become a host, is available on the AMA Alliance website )

What to Pack: A residency interview is a job interview, and the propriety of your dress reflects a

sense of being in touch with the world. Your choice of a residency, and their choice of a

candidate to whom they can entrust patients, is serious business. For men and for women, suits

are serious clothes and are appropriate for interviews. Failure to wear professional-looking

clothes might not cost you a placement, but it can distract the interviewer. Sweaters and slacks

are okay when you're on call in certain programs, but your safest bet when you interview is to

dress for success. Business schools impart lots of information to their graduates about how to

dress for job interviews; medical schools do not. But don't be fooled. Although you may not be

going for job in banking, you are interviewing for a professional position.

In addition to carefully planning what clothes to bring, run through the other possibilities that

may arise while youre away. You may go for a meal with one of the residents. It could rain, so

take an umbrella. It is easy to spill something on a shirt, spot a tie, or rip a seam. Pack

accordingly.

The First Impression Students often go into the interview room very nervous. Most adjust quickly, but wish they could

avoid the early jitters. If this applies to you, and it probably does, follow these helpful hints:

Be on time.

Get the names, including spellings, of the interviewers from the departmental secretary so

that you know who youre seeing.

Look your interviews in the eye, greet them by name and offer your hand for a firm

handshake.

Smile.

Let everyone else sit down first (old fashioned manners).

If youre offered coffee or tea, but youre pretty shaky, refuse it.

Take a deep breath and proceed.

During the Interview Selecting your residency program is a major decision a decision that you will have to make after

very brief contact with people who may be your associates for a long time. Value the

http://www.ama-assn.org/go/alliance

impressions that you make of the program and the people, and keep track of those feelings about

the interview to assess how suitable the fit is between you and the program.

Direct each question to the appropriate interviewer (i.e. program funding to the director and call

schedules to the residents). Consider which questions are appropriate for the interview, and

which are for a less formal setting. For example:

Think about your real priorities and make sure you express them. And, ask your questions at the

appropriate times. The beginning of the interview is not the best moment to ask about salary,

benefits and call schedules. Although they are legitimate questions, bad timing or asking the

wrong people could make your interviewers uncomfortable about your values. In addition,

questions that challenge or confront interviewers can be alienating; nuances such as tone and

word choice are important. What is wrong with your program? is more difficult to answer than

What are some of the challenges that I might face here?

Investigate each year of residency; students often direct their focus only on the first year. And

dont try to buddy up with faculty by telling each of them that you want to go into their specialty

- they might compare notes later.

Beyond the Questions In answering questions about what kind of person you are, why you went to medical school, and

what you want to accomplish, you will want to try and distinguish yourself from the other

interviewees. However, that is often difficult to do. Many have reported that the most common

questions were sometimes the hardest to answer, for example, Why to you want to be a doctor?

Most of us become physicians for the same reasons -- to save lives, improve health care in

America, help people, make a contribution to society, and so forth. That is not to say that

you should not say those things; by all means do so. After all, that probably is what you hope

that you will be contributing.

But in addition to your heartfelt answers to those questions, you can distinguish yourself by

showing that you have spent time in introspection and that you understand how your experiences

have shaped you and influenced your decisions about becoming a physician and choosing your

residency. One experienced interviewer told us, Everyone has a story, but many of the students

we see dont seem as if they know their own particular stories. Many have not really thought

through their lives and what they want. Spend some time with yourself before the interview; ask

yourself these questions:

What are your expectations of what your life will be like after residency? Whats your

visual image of your life as a doctor?

What have you done in your life that shows that you are a hard working and dedicated?

(Remember, it doesnt have to be restricted to medicine.)

What besides medicine do you have in your life that you feel passionate about?

What About Lifestyle The medical profession continues to debate the advantages and disadvantages of the intensity of

the residency demands and schedules. Long resident work hours, sleep deprivation, high stress

levels, relationship interruptions -- these are somewhat par for the course in a typical residency

program, but of legitimate concern nonetheless -- particularly as you may think about your now

or future spouse or children.

Its appropriate to ask about call schedules such as How often will I be taking call or What

are the expectations for a new resident But too many questions about time off will make you

look like youre picking your residency on that basis, which does not speak well to the program.

Its a fine balance.

After the Interview Go back to your housing and immediately write down your impressions of the interview. After a

few interviews, you will tend to start forgetting what happened where. Write a description or

make a list of what you liked and didnt like, and do it right after the interview because you

wont remember later.

Dont rank a program you will feel uncomfortable working for. If youre going to interview at

many programs, its a good idea to prepare a checklist in advance of the factors that are

particularly important to you that you can use for all your interviews. At the end of the process

you can then use a consistent rating system to help sort out your decision.

Follow up your interview with a note of thanks -- but not one that sounds like a form letter. Make

sure that you sound genuinely interested.

Commonly Asked Questions Interviewers routinely ask certain questions of applicants, and for some of them you will have

ready answers. Interviewees report that they found some questions appropriate; others they felt to

be off-limits, though frequently asked. Ranked among the most difficult to answer were vague,

open-ended or very general questions. Interviewees reported anxiety about questions like, Tell

me about yourself, or What do you want to know about the program?, and yet those were the

kinds of questions they repeatedly faced.

Another common question was about personal weaknesses. As one respondent said: You should

pick something that doesnt expose some horrible shortcoming -- something that could actually

be seen as a strength. For example, you may feel that Im a perfectionist, I trust people too

much. Or Im too organized. You certainly cant respond, Im insensitive, cruel and lazy!

If you are prepared to answer the following list, you should be ready for many of the questions

you will face.

Why did you choose this specialty?

Why are you interested in this program?

What are your goals?

Tell me about yourself?

What did you do before medicine? (To an older student)

Why should we pick you?

What are your strengths?

What are your weaknesses?

Where else have you applied?

Are you interested in academic or in clinical medicine?

Do you want to do research?

Where will you rank us?

What was the most interesting case that you have been involved in?

Present a case that you handled during medical school.

Do you plan to do a fellowship?

What could you offer this program?

How do you rank in your class?

Do you see any problems managing a professional and a personal life?

Are you prepared for the rigors of residency?

Where do you see yourself in 5 years?

What questions do you have?

Uncommonly Asked Questions Beyond the routine questions, there are others that are more difficult, unusual, or even strange

inquiries that may not seem to pertain to your future as a doctor. You cannot prepare for all the

questions you hear about through the grapevine. Nor can you prepare for all the remote

possibilities that you conjure up in your head.

Questions that are unexpected often fall under the general category of getting to know you. Its a

good idea to spend some time on personal reflection before you start the interviewing process;

give some thought to who you are in the world both as a doctor and as a person, what you like

and dislike, why youre in medicine and what you want out of your residency.

If you are asked something that seems pretty off-beat, it is probably best to assume that you are

being judged on your grace under pressure as much as on the substance of your answer. Some

program directors think that the way to test your smarts in the face of medical emergency is to

put you into a crisis in your interview.

Remember, not all interviewers are equally skilled. You can correct some of the problems you

encounter by keeping the interview focused. When questions are asked that dont seem germane

to the interview, you may tend to over-answer hoping to hit on something your interviewer

wants. But dont go on and on. If youre asked a question about whether there are any physicians

in your family, you neednt give a monosyllabic yes or no, but dont do your family tree, either.

Rambling in an interview robs you and the interviewer of the opportunity to exchange the

information you both need.

The following is a list of some uncommonly asked questions as reported by students:

Are you religious?

What is the one event you are proudest of in your life?

What do you plan to do after residency?

What are your hobbies?

What do you think about housestaff unionization?

How would you redesign the health care system?

Why did you get (a certain) low grade?

Of course, no one wants to force the issue, if possible. Instead be ready to use such opportunities

to gauge the real environment and philosophy of the institution. For example, you might respond,

Im glad that you asked that question. It gives me an opportunity to ask you the employee mix

and patient demographics hereand your philosophy on teaching cultural competency. Im very

interested in improving the health status of minority populations.

An approach like this can open a dialogue between you and the interviewer. It also gives you an

opportunity to find out how the attitudes of the program reflect (or dont reflect) your own. In a

wider context you question can elicit information about the working conditions of the program,

which affect all residents.

Questions to Ask During Interviews Everyone who interviews for a residency has different priorities and ideas about what they want

in a placement. Therefore, there is no way that someone can send you into your interview with a

list and tell you that if you ask these questions you will cover everything that you need to know.

In addition, different specialties demand that different questions be asked. However, it is very

important for two reasons that you develop a set of questions. First, it is imperative that you

glean the information that you need to assess the program; as one respondent to the questionnaire

said, Youre interviewing them just as much as theyre interviewing you. Second, it is a handy

emergency procedure in the event that you run into an interviewer who wants you to direct the

interview. The following is a list of questions for which you may want answers, broken down

into categories which may also be useful as a guideline for developing your own questions. Be

careful not to ask a question that is already covered in the literature on that program.

Education/Philosophy:

What is the philosophy of the program?

Who are the faculty?

What kind of curriculum is offered?

How many hospitals participate in the program?

Is a thesis or publication required during training?

Is there time and funding for conferences and meetings?

To what extent do residents manage patients?

What is the patient mix and what are the community demographics?

Do residents perform surgery?

Is the program changing, and why?

What do residents here like most and least?

What are the research, clinical, teaching opportunities?

What is the scope of experience I can expect?

What is the program like (in the sub-specialty Im interested in)?

Where are the graduates of the program now?

How much elective time is there and how is it usually used?

Is the Chairperson staying?

What percentage of graduates enter fellowships?

How is the training divided?

What are the weaknesses of the program?

Do residents have time to read?

How available are the attendings (including nights and weekends)?

What were the results of the last accreditation visit?

Are there any joint residency activities?

What is the patient mix? Does it reflect the community demographics?

What kind of community outreach might we be involved in?

Competitiveness of the Program:

What do you look for in a candidate?

How many people do you rank?

How do your residents perform on boards?

What is this program most respected for?

What is the ownership of this institution?

How financially stable is the program?

Quality of Life:

What is the mix of married and unmarried residents?

What is the racial/ethnic/gender breakdown of residents?

Do the residents socialize as a group?

Are their support groups?

Is there an Office of Minority Affairs? What is its role?

How many residents are there?

What is call schedule like?

What happens if someone is sick?

Characterize faculty-resident relationships.

What is the relationship between this program and other specialties?

Have any housestaff left, and why?

What do you expect of your housestaff?

Is there a house staff grievance process?

How are complaints handled?

What is the parental leave policy?

Benefits:

Do you offer health, life, disability insurance?

What is the salary?

What is your meal plan?

What kind of vacation time do you offer?

Do you have sick days?

Do you have maternity/parental leave?

Does the curriculum include training in cultural competence?

Is training offered in medical Spanish or other languages?

Does the program seek and actively recruit minority residents?

How many attendings/faculty are minorities, and are efforts being made to actively

recruit them as well?

Does the medical school have an Office of Minority Affairs?

What is the make-up of the patient population?

Is the program or hospital involved in any projects to help the undeserved?

Other Things You Might Want to Know There are other questions that you wont be asking in the interview but might want to investigate

on your own. For example:

Where is it?

Do you like the city?

Do you like the fact that its rural, or in a suburb?

What is the community seem like?

What is the climate like?

What kind of transportation is available?

What is the access to theater, movies, sporting facilities, the great outdoors?

What are the financial implications of living here?

The Hospital:

How are the individual call rooms?

What are the meals like?

What is the library like?

Can you easily photocopy articles you need?

Where are the lockers?

Do men and women have equal facilities?

Are there fitness facilities?

Not Matched? The Decision to Reapply

Written by Ugo A. Ezenkwele, MD, Resident, Department of Emergency Medicine,

Hospital of the University of Pennsylvania

Its two days before Match Day at exactly 12:00 pm and you receive the dreaded call from your

Dean. You did not match. Uh oh! What do you do now? Should you scramble for a spot in an

unmatched residency program, apply for a one year research grant giving yourself time to

reassess, or throw the towel in entirely and give up the hope of ever becoming a physician?

These are tough decisions to make and you have 48 hours to make them. What do you do?

Fortunately, you are not alone. In 2000, the National Residency Matching Program (NRMP)

offered 20,598 first-year positions among 3679 programs. 25,462 applicants participated and of

these, eighty-nine percent matched. Among those who did not match were graduates of US

accredited medical schools, former graduates of US medical schools, US osteopathic students,

Canadian students and graduates of foreign medical schools. Therefore, throughout the US and

the world, people like you are faced with the decision of what to do.

Lets look at some options: 1) The Scramble for an Unmatched Spot; 2) A Year Off; and 3) A

Life other than Medicine.

The Scramble for an Unmatched Spot After you have received the call, your Dean will provide you with a list of programs with open

residency positions. Your task will be to call these programs, find the one most favorable and

submit your name. The key is to be prepared. Make sure you own a fax machine or have access

to one. Furthermore, have someone available (either a spouse, friend or colleague) who will help

you with the process of contacting residency programs. As soon as you know the unfilled

positions, download the contact information and start phoning. The key is to start with the

programs you already interviewed, then proceed to other programs in your specialty in a

favorable geographical location. If the program agrees you may use the ERAS application

service. If not, fax or email your applications immediately!

If you are fortunate you may end up in a program in which you interviewed or one within your

specialty. Advantages are you have a job, especially in the field you are interested in and at the

end of it all, you will be a medical doctor. The disadvantages are you may end up in a specialty

that is different from the one you are interested in and/or you may end up without a job. Some

people will opt to undertake a transitional or preliminary position in medicine or surgery for a

year that will allow them to re-enter the match the following year.

The key with the scramble is to be prepared. The possibility of not matching can happen to

anyone and not being prepared can result in others in a similar position making off with choice

residency positions.

A Year Off For some people, a year off is an excellent opportunity. During that period most will spend time

bolstering their resumes either with research projects, volunteer exercises, and/or extra degrees

(e.g., a masters in business, public health, or the sciences). It is imperative that you spend this

time wisely. During the following Match period, most residency directors and/or or program

directors would like to know what you spent the extra time doing.

People do not match for various reasons. Whether you set your sights too high, or you ranked too

few places, or you were "deceived" into believing you had a spot, etc, the reality is a year off is

not the time to travel the world. It is the time to strengthen your application and make sure

history does not repeat itself.

Furthermore, being prepared is also important if you choose this option. Recognize that applying

for research positions or graduate programs require a lengthy application process with letters of

recommendation, personal statements, and/or project proposals. Fortunately, much of this you

have prepared already. However deadlines may have passed. Therefore, being prepared with

appropriate contact information, knowing whom to call for an immediate response and being

able to identify an appropriate research mentor would be helpful toward ensuring a successful

year off.

A Life Other Than Medicine You have come this far and dedicated nearly a decade of your life toward medicine. I would

advise you to persist and continue toward a career path in medicine. Do not let the fact that you

did not match become a deterrent toward that goal. If you scramble and/or take a year off to try

again, chances are you will persevere. However, if you decide to discontinue for any number of

reasons there are multiple other fields related to medicine which look for students who have

graduated from medical school. These include: consulting, health care research firms, investment

banking companies, health maintenance organizations, and non-profit organizations. Your

options are open.

Making the Most of Your Residency

Part 1: Successful Life Balance in Residency Written by Sheila Roundtree, MD, Internal Medicine, Columbia, South Carolina, AMA-MAS

Governing Council Member-at-Large

Physicians in training can extract an invaluable lesson from the wild. The female lion is

responsible for securing prey for her family to consume for sustenance. Typically, the lioness

partakes first, then shares the remainder of the kill with her cubs and mate. You can learn from

this scenario. Make certain that your needs are met and you will be well positioned to provide

the best of care to patients and the most of yourself to your friends and family. Although the

residency years are almost uniformly mentally and physically taxing, one can emerge healthy

and successful.

Network Effectively Interns and residents often relocate to a new city to pursue post-graduate training. Networking

prior to the move may provide a unique opportunity to establish new relationships and gain

insight into the community. For example, I contacted several physicians who worked in the

Southern town where I trained (weeks before I moved). My new acquaintances provided me

invaluable information concerning housing, travel routes and employment possibilities for my

husband. Additionally, I developed a support system with people who enthusiastically invite me

to social functions and are always available to offer professional advice.

Most communities have at least one established minority sponsored organization for health

professionals. Those who join such groups benefit from ample opportunities to make new

friends and, possibly, build a referral base for the future. Entities such as the National Medical

Association, National Hispanic Medical Association, and the Association of American Indian

Physicians offer excellent educational venues and impact the healthcare system via political

vehicles. Also, join the AMA Resident and Fellow Section, and get in touch with your local

county and state medical associations, most of which also support, resident and young physicians

sections. Involvement in professional organizations also often provides a vehicle for your spouse

or significant other to develop new relationships as well. Moreover, consider allying with

members of your Greek letter organization, religious affiliates, and other groups of interest in

your new town.

Maintaining Healthy Relationships in Residency Most people find that the happier their loved ones, the greater their potential for personal

happiness. Be sure to keep the lines of communication open between you and those closest to

you . This is a critical time in which you are launching a career; solidifying your personal

identity and establishing committed relationships. Keep in mind, however, that those who

comprise your support system need you as well. Remain in tune with their goals, struggles, and

triumphs.

Stay connected with life events. Try to tailor your schedule so that you may attend weddings,

baptisms, graduation exercises and the like. Although you may not be able to attend all such

functions, your effort and interest will be appreciated and you will be able to find support when

you need it as well.

Try to have at least one meal a day with your family or significant other when you are not on

call. On call days, perhaps they can join you at the hospital for a brief visit, should your

workload permit. If visits are not feasible, however, communicate via email or phone. Fiercely

protect your leave allotment, and plan time away from work strategically. I find that taking a

vacation in the midst of a demanding stretch of call months is particularly helpful. Seize every

opportunity to rejuvenate your spirit, mind, and body.

Getting the Work Done. Early in your intern year, obtain practical information regarding your

residency program and the functional aspects of your institution from upper level members of the

housestaff. Quickly identify at least one senior resident who is especially knowledgeable and

willing to help a newcomer. Keep a good pocket guide specific to your specialty accessible at all

times.

Work efficiently, and lay out clearly defined goals in your mind and/or on paper. Lurie et al.

discovered that during a typical twenty-four hour call, most housestaff spend a mere eighty-

seven to one hundred and seventy-five minutes on true patient-related activities. Surprisingly,

most of their time was spent starting intravenous lines, drawing blood, transporting patients and

similar activities. Delegate these types of tasks where appropriate. Take advantage of the

specialty expertise available in your place of practice e.g. radiology, pathology, . . . In the long

run, these consultations may save time and facilitate better patient care.

Ascertain that each member of your team, including medical students, has clearly delineated

responsibilities. Foster a sense of team spirit. Remember that cohesive teams are much more

likely to operate efficiently. You may find it worthwhile to convene with your team doing the

course of the call day in order to assess everyone's progress and identify those who need

assistance. Prioritize tasks, realizing that priorities may change pending patients' status.

Healthy Habits for Life Exercise. I strongly recommend engaging in aerobic exercise balanced with low to moderate

level weight training several times per week. Initially, such frequent exercise may seem

unrealistic for the house officer committed to frequent call and long in-house hours. Take

advantage of your days off as well as the days you are able to leave work early. Those who

exercise regularly are less likely to miss time from work due to illness, and physical activity is

one of the best diffusers of stress.

Furthermore, exercise is proven to enhance ones sense of personal well being, facilitate weight

control and decrease the incidence of vascular diseases. (Does this sound familiar?) I often

power walk in the morning when I am due to work later in the day. Interestingly, a post-call

workout may set the backdrop for more restful sleep.

Diet. Unfortunately, many house officers gain a significant amount of weight during residency,

and the number of overweight residents seems to be on the rise. Plan to eat at regular intervals,

and resist the temptation to consume snacks high in fat and concentrated sugar content. Opt,

instead, for fruit and lower calorie snacks. Substitute spring water or flavored water in lieu of

soft drinks. Limit total fat consumption to 35% or less of your total caloric intake. And, when

ordering take-out meals, select a lighter fare entree on (at least) some occasions. We must

display the level of discipline that we expect from our patients.

Sleep. Obviously, ensuring that one receives adequate rest is of paramount importance for the

house officer. Although most trainees fall asleep readily once relieved from their duties, a

surprising number complain of sleep pattern disturbances. Most authorities recommend going to

bed and awakening approximately the same time daily in order to establish a stable biological

clock.

The average adult requires seven to nine hours of sleep nightly in order to feel well and rested.

Keep in mind, however, that there are physiologically short sleepers who need only three to five

hours of sleep per night. Conversely, the physiologically long sleepers require more.

Remain cognizant and respectful of your personal sleep requirements. Avoid working in the

bedroom; preserve this sanctuary for relaxation and sleep. While some folk sleep well after

exercise, others may notice that they experience difficulty resting after a vigorous workout.

Furthermore, heavy caffeine intake should be avoided in those who are vulnerable. Although a

regular sleep schedule is advisable, by all means, take naps whenever you can when you are on

call!

Go Forth Boldly. You are destined to complete residency successfully. Never doubt yourself or

your abilities. Admittedly, the learning curve is quite steep during these formative years.

Nevertheless, you are well equipped to effectively negotiate any challenges that lay ahead. After

all, you graduated from medical school, remember?

Part 2: Life in Residency and Beyond Written by Erica Phillips, MD, Resident, Department of Medicine, Hospital of the University of

Pennsylvania

The philosophy of most training programs is twofold: 1) to provide a core curriculum designed

to promote the acquisition of basic clinical competencies in a particular field and 2) to tailor the

educational experience to meet the career objectives of its trainees. This latter principle is

challenging given the uncertainty that many trainees have about their career goals. In addition,

during graduate medical education there is the likelihood that a trainee will change their career

goals several times. One of the most difficult tasks during graduate medical education is to look

forward to the future when the present day is wearing you down.

The first year, post-medical school completion, is spent predominantly developing survival

skills. These skills will develop in areas such as time management, and team development. At the

same time there is the adjustment for friends and loved ones to a new environment, and your

busy schedule. The truth is you will often find yourself pondering over the same two questions

When will I sleep and When will I eat. In between these thoughts, it is advisable to try and

think about the following;

Feedback from fellow interns, residents, and faculty is key. If it is not readily offered then

initiate the discussion at least midway during each rotation.

Talk to your program director early on, especially if you are having difficulty

adjustingbecause, whether you realize it or not, they already know. Dont wait to be called into

the office.

Seek out a mentor(s) early in your training.

If you have done research or have a research idea that you would like to develop talk about it,

talk about it, talk about it. someone will be listening and opportunities will open up.

Based on the specialty of the program, after the first graduate medical education year the trainee

will gain a higher level of responsibility in the form of supervising medical students, interns,

coordinating patient care, and performing procedures to touch on a few. The active pursuit of

fellowships, and employment will vary based on the length of each individual training program

but the general principles remain the same.

If your institution is lacking individuals with similar career objectives or mentors who can advise

you on achieving your objectives, contact your local/national medical associations and

neighboring institutions.

Join and attend a national meeting in your specialty. Many programs provide funding for trainees

to attend national meetings. Remember to take your business cards because networking is key.

If you do not have a curriculum vitae, start writing one. Ask your program director to review it

on completion. Update your CV on a continual basis. Document all curricular activities

(conference presentations, submission of an abstract to a journal, an award, etc.) as they occur.

When presenting or teaching, consider having the attendees complete an evaluation. Compiling

this feedback will allow you to carve out a clinical expertise, which is especially important

when pursuing a career in academia.

Choose wisely when requesting recommendations from faculty members. The status of the

faculty member (i.e.; chairman, well known researcher) is less important than how well they

know you as a house officer and person.

If applying for fellowships, speak to as many faculty members in your respective department.

They will be able to offer advice on the reputations of other programs, as well as provide

referrals. Remember the application and interview process for fellowships is far different than

residency. Overall it is a less competitive environment, whereby honesty is your best policy.

Dont tell a program you are truly interested in them and make a verbal commitment if you are

not. The word gets around.

Be prepared to apply broadly for competitive fellowships (i.e. cardiology, thoracic surgery) and

keep your options open when looking for employment in popular cities like New York, or San

Francisco.

When searching for employment, talk with those who have recently completed the process to

gain a sense of the market for your specialty and skills. Throughout training you will be

approached by at least one if not several head hunter groups. Ask around about the individuals

groups before providing personal information. Overall they are a useful source. Faculty

members, program chairs and directors are excellent sources for employment referrals. Be open

with them about asking around on your behalf. Journals are another excellent source for

identifying openings in various market places. However, remember there are hundreds of other

physicians reading the same ad, so do not expect a quick response.

Have a lawyer that specializes in medical contractile agreement review your contract before

signing. Dont hesitate to ask for special amenities like coverage of moving expenses and

licensing fees. The worst that can happen is they say no.

These are just a few key points that may seem obvious, but often take the back seat in the hectic

schedule of a house officer. The most important thing to remember is that its never to late.

Residency Programs: An Inside Look

This online resource guide is a work in process and, as such, our Minority Affairs Section (MAS)

colleagues continue to provide materials and add their particular insight. Following below is a

look inside some the the residency programs that you might be considering. Obviously, this is

not an inclusive list, however, we will continue to add information on other specialties as our

colleagues volunteer it. We welcome your contributions. If you would like to contribute to this

piece, send us an e-mail and we will review your topic for possible inclusion.

Anesthesiology

Written by William A. McDade, MD, PhD, Department of Anethesiology and Critical Care, The

University of Chicago, Associate Dean of Multicultural Affairs, The Pritzker School of Medicine

mailto:mac@ama-assn.org

Qualities of Anesthesiologists

Candidates who tend to do best in anesthesiology are those who have an affinity for more

technical and manually oriented activities. Those who particularly enjoyed anatomy,

pharmacology, physiology, biochemistry, biomedical engineering, biostatistics and basic science

research are going to find anesthesiology particularly fascinating. While there is a great deal of

cognition required of an anesthesiologist, the true passion of the clinician is the ability to perform

special skills to a high level. Anesthesiologists are expert in the management of airway and

circulatory problems in critically ill patients. They are adept in pharmacology, drug delivery

systems, use of blood products, and techniques of regional and central neuraxial blockade.

Because decision-making is of the utmost importance, anesthesiologists must be astute clinicians

and logical scientists. Anesthesiology is a hypothesis driven field where there is a blend of

application of specific knowledge, exercise of clinical judgment and performance of a myriad of

technical skills. Further, because time is frequently of the essence in the operating room setting,

these decisions are often make quickly, wherein each intervention serves as the instrument to test

the next hypothesis.

Frequently, and incorrectly, anesthesiologists are thought of as having only to use

pharmacotherapy to allay a patients anxiety. However, few anesthesiologists rely on drugs to

achieve this end; rather, the competent anesthesiologist is able to use excellent interpersonal

skills to inform the patient and ease anxiety. The anesthesiologist typically does not have patients

who are soley in their care. Rather, anesthesiology is a consultation practice exercised in the

association with a surgeon and/or an internist. Therefore, as a consultant, the anesthesiologist has

to be able to communicate with a variety of colleagues as well. Those who seek variety are

definitely fulfilled with a career in anesthesiology for it is truly at the intersection of all medical

disciplines. Because any patient can have a surgical problem, clinical anesthesiology may

involve neonatology, pediatrics, adult medicine, obstetrics, radiology and, of course, surgery.

Knowledge in all these areas, as they relate to anesthesiology, is required by the consultant

anesthesiologist.

For the individual who wants more of the traditional patient-doctor setting, there is the

possibility of a career spawned from anesthesiology in intensive care medicine or pain

management. These certified fellowship programs follow initial training in anesthesiology and

offer the ability to have a career in which patients look to you as their doctor. Still, you are not

the primary care physician for the patient and therefore act in a consultation capacity. However,

you have a longer interaction with a given patient and you form a more lasting bond between the

patient and their familes. In critical care, continuous relationships with patients throughout a

finite critical illness are formed. There are still many procedures to perform and rapid

assessment, diagnosis and therapy implementation are vital. In pain management, there are

likewise many technical procedures to perform, but the assessment can be less acute and the

relationship between the patient and you can be quite long-lasting throughout the duration of a

patients painful condition.

Medical School Exposure to Anesthesiology It is uncommon for medical school students to interact with anesthesiologists during the

preclinical years. If you identify one early in the medical school curriculum it is most likely in

the context of pharmacology, physiology or in research. In addition, many medical schools do

not have a required third year rotation in anesthesiology, so as a student, you may not get the

opportunity to learn about what anesthesiologists do during your third year unless you venture to

the head of the OR table during your surgery rotation and ask questions. Not every medical

school even offers academic electives in anesthesiology in the third or fourth years; whereas, a

select few mandate an anesthesiology rotation as a clinical requirement. This variability exists

because of the way in which anesthesiology has developed as a field.

There was surgery long before there was anesthesiology. When it was invented late in the

nineteenth century, surgery without pain was seen as the single greatest contribution to humanity

of all time. However, because the emphasis was on the drugs used to cause analgesia, amnesia,

autonomic control and surgical immobility and the use of these drugs seemingly could be

provided to patients without a great deal of apparent effort, less skilled individuals were enlisted

to hold the ether mask. It soon became clear that some skill was necessary, but anesthesia could

be delivered by individuals who were less significant in the role of patient care than the

surgeons. This impression, fueled by ignorance of the science underlying anesthesiology, led to

the slow development of the field and its relative subjugation by surgical departments. The path

to forging anesthesiology as a rigorous academic discipline with equality to peer departments

within the hospital and medical school has been hard fought. However, due to the nature of this

less highly regarded position in medical society, anesthesiology became a land of opportunity for

the disenfranchised in medicine.

Surgery is still a mostly white, male dominated field of practice within medicine. The common

perception of a surgeon is a strong, demigod, who works inhuman hours and who stands ready

with intelligence, skill, and scalpel, ready to tackle the next big case. Women were not easily

accepted into their ranks, nor were minorities or the less highly regarded. These individuals

could not be the operating room principal in twentieth century America. However, they could

work for the surgeon, and administer the gases used to cause anesthesia. That was seen as a

minor role, subordinate to the surgery itself, and American society accepted these individuals

into the operating rooms so long as the captain was the white, male surgeon. The legacy of this

discrimination is a persistent relative overpopulation of women and minorities in anesthesiology.

This is a credit to anesthesiology as it is now populated by a great diversity of individuals and it

typically one of the most diverse staffs within most medical schools and hospitals. This may

provide for a more comfortable environment for the minority candidate and represents a

continuing opportunity for fellowship and collegiality.

The Road to Anesthesiology Residency If you are thinking about anesthesiology residency, then it is good to do a rotation in it. Look for

opportunities to take an elective rotation in it during your surgery rotation in third year. You will

appreciate the integration of basic and clinical sciences, the hours spent in patient care, the

excitement of learning invasive techniques, and the sense of problem solving pace and technique.

If you like this, schedule an early fourth year month-long elective in anesthesiology. In the fourth

year, you will have the ability to see the various subspecialty areas within anesthesiology and

you will then develop an idea of the breadth of the field. You will also have the opportunity to

have worked with a number of anesthesiologists as mentors, role models and advisors. Certainly

ask them questions but allow them to get to know you too. Choose one as your principal advisor

and then a few more of whom you will use as additional supporters. Make sure you have worked

with these people and that they know you to be a hard-working, intelligent and motivated

candidate fro residency.

Think about the type of practice in which you would feel most comfortable when you finish

training. Is it academic or private, high volume bread & butter cases or low volume challenging

cases with critically ill patients?This will help you to decide the level of rigor of the department

to which you will want to apply. Some programs are high volume, others are slower. There is

good and bad in each. High volume programs give you great exposure to clinical examples, but

the high volume makes reading harder to squeeze in and the days longer. Low volume is also

good because it allows more time to read and to be taught by the excellent staff in the department

you choose. Some departments place heavy emphasis on didactic opportunities and have

multiple learning conferences during the week. Others have only one conference per week and

an approach to patient care that encourages less supervised and more clinical independence. You

have to determine your learning style and which program will be best suited for you.

Anesthesiology has undergone a large swing in desirability among residency candidates in recent

years. There was a move favoring it in the late 1980s fueled by high income associated with the

reimbursement rates paid to physicians who billed based on the number of procedures they

performed. Anesthesiologists were near the very top of all physician earners at that time. In the

early 1990s there was the institution of the Resource Based Relative Value Scale that was

designed to financially reward cognitive activities of physicians to increase fairness in

compensation and to reduce health costs at the expense of more procedurally oriented physician

reimbursement. Anesthesiologists, being in this latter group saw their real income reduced by

Medicare, Medicaid and insurers by a nearly one third decrement. This caused some dynamic

changes within the residency training community. Because practicing anesthesiologists were not

retiring as rapidly due to the decreased compensation, newly trained anesthesiologists were not

being hired when they completed residency. If they were, the track to partnership within a group

was greatly prolonged and there were reports of extreme predatory practices. Once again, the less

highly regarded and foreign medical school residency applicant looked to anesthesiology for an

opportunity, as other areas of medical study remained closed to them. The number of American

medical school graduates choosing anesthesiology reached it nadir in 1995, but has been steadily

increasing ever since then. In 2002, anesthesiology residency competition is a keen as it has ever

been for American graduates and so new elements in selection are being tested each year.

Only a few years ago, residency selection committees did not consider board scores in

determining whether to interview an anesthesiology American graduate. Now, a board score

above 200 is necessary to be interviewed at select programs. Candidates who have not yet passed

the USMLE Step 1 are not even considered by many programs. A few years ago, residency

programs paid for the travel expenses and hotel accommodation of interviewing candidates who

were American medical school graduates. Today, some programs debate whether to pay for

parking. So, times are changing in anesthesiology selectivity and successful candidates will have

to adjust accordingly.

Once you choose an advisor, then you must determine where you want to train. This may be

based on the institutional/departmental reputation or mission; the population served by the

institution; the opportunity to do challenging cases of a certain type at the institution; the

character of the department chairman; the teaching interest and ability of the faculty; the ability

to place its graduates in excellent fellowship programs; geographical and familial considerations;

the volume and variety of cases; the nature and amount of didactic programming; and,

collegiality among the residents and the espirit de corps.

You should go online to obtain information about any program you are considering and consider

applying widely. Because anesthesiology is a Post Graduate Year-2 specialty field, a separate

internship (Preliminary Year) must be obtained. This can be done in conjunction with the

residency in anesthesiology or apart from it. Typically, an anesthesiology program has a

relationship with the internal medicine department in the hospital that grants them a limited

number of PGY-1 positions for their trainees who need just one year prior to their first year of

anesthesiology (Clinical Anesthesia Year-1, or CA-1). So, a given anesthesiology training

program might have three year and four year positions. The 3-yr positions are for those

candidates who obtain their own internship independently of the anesthesiology program. The 4-

yr (Categorical) positions are for those candidates who allow the anesthesiology program to

schedule them for the internship at the same institution. In general, because it is less of a hassle

to move and to worry about applying to multiple programs in different disciplines and obtaining

letters for each, most people would opt for the categorical 4-yr program. Therefore they are more

competitive, and are often offered to lure the top candidates to a particular institution.

When you have gone to the online listing of programs and seen the selections of departments and

availability of 3- and 4-yr programs, meet with your advisors to discuss your choices. Include in

your selection of programs only those that you would really want to attend if matched there.

Because of the way the match works, you may not get your first choice and you are still

obligated to go to where ever you match; so, do not rank a program unless you really want to go

there. Put an assortment of programs in you mix including the very best, a few strong programs

and then a couple of safety schools. Safety schools are programs in your home state, or of lesser

reputation that will ensure that you will have a job on match day. Ask your advisors whether they

are able to write strongly supportive letters of recommendations for you. If they hesitate, do not

consider them further for a letter and withdraw your offer. You want anesthesiologists who are

well-known in the field to recommend you. However, if you do not have that option, then select

individuals who know you well and think highly of you. By having an academic anesthesiologist

as your advisor, they are typically linked into the community of university anesthesiologists or

the national societies of anesthesiology and are known to the community of scholars in the field.

This carries weight in program selection committees. However, surgeons and internists who

know you well and are supportive to you are also potential letter-writers.

Once your list of advisor-endorsed programs is complete, get your application completed. ERAS

has made the application process much easier. Some residency programs may also have an

additional supplemental application. You should check with each program administrator to

determine this. You should have your personal statement complete by the end of August. It

should be read by at least one of your advisors and discussed with you prior to your sending it

out. Your ERAS application should contain all of your community service work and the fact that

you are a member of the Student National Medical Association or other ethnic medical

association. On ERAS, there is no field to indicate your race and so some programs use the

excuse that the data are colorblind to limit the offers of interviews to non-minority students.

Your indication of participation in well-established minority organizations clarifies this for many

program directors and allows them to identify a candidate who could potentially improve their

diversity. There should be no attempt to mask your race or ethnicity because it is rarely used

against you in selection. Your letter writers should be confirmed by September. It may be

necessary to check with busy faculty to ensure they have completed your letters. Minority faculty

are especially busy and generally younger with multiple responsibilities, so be kind yet persistent

in your reminders to complete your letters in a timely fashion. From October through December

national meetings of the major medical organizations are held and faculty use these opportunities

to visit with old colleagues and talk about their residency programs. This is how your advisors

often learn about what is going on in programs around the country. You are often mentioned in

these conversations, one program director to another, or an advisor to residency review

committee member, or faculty to faculty in conversation. Information is shared and impressions

are shorn up following your visit. Therefore, try to arrange an early interview so that you can be

meaningfully discussed. The same conversations by telephone take place among program

directors, but the face to face chat is really powerful in helping you make it to the best programs.

If you have done research in medical school, you might also seek to participate in one of these

national meetings and then you personally get the opportunity to meet the individuals with whom

you will soon be interviewing. It makes an enormous difference in your favor if the first time you

meet someone from the program you desire to attend, it is at a national meeting and you are

presenting your data. When you appear for the interview, it will be as if you are speaking to a

friend.

Most anesthesiology residencies will invite you to interview on a certain day of the week. If you

plan to interview at multiple anesthesiology residencies in the same city or on the same coast,

they have often cooperated to hold interviews on days convenient to the candidate to allow one

pass per city. For instance, one may interview only on Mondays, another only on Tuesdays and

another only on Wednesdays to allow the candidate to fly there just once and cover all the

programs on one trip to reduce travel expenses. Take advantage of this and hold off scheduling

an interview with one program until you hear from other programs in the same region. While on

the interview trail, ask as many questions as you may have and always have a few prepared

questions based on your online investigations and conversations with your advisors. Keep a

record of the information you obtain at your visit so that you can refer to it later when match lists

are being prepared. Most interviews in anesthesiology are low-pressure affairs. Make sure that

you get e-mail addresses for key people you meet during the interview day. You may have

further questions later or you may want something clarified once you leave. Getting someones

number from the program also suggests that you are interested in that program, and the

programs belief that you are interested in them helps you tremendously. If you have the chance

to speak candidly to residents only, ask them the questions that you really want to know. How is

the learning environment?Do you see enough cases of this or that?How do the residents do on

the In-Service (Pre-board) Examination and the American Board of Anesthesiologists

Certification Exam?Do you feel the chairman really cares about you as the resident?Is there

mentorship and support for your ideas?Could I stay on there as faculty?Do the residents really

get along this well all the time?The questions about call schedule, vacation time, financial

compensation and fairness can be asked, but try not to get caught up in these details. Frankly,

one does not choose a program based on any of these factors that are all about the same from

program to program anyway. By dwelling on these items in particular, it suggests that you may

be far more interested in the lifestyle of the field than in learning as much as you can and being

member of the departmental team. This is an immediate turn off for most programs.

On the day of your interview, be there on time, no excuses. Your attire for your interview should

be business professional. You are applying for a job in which you are a consultant

anesthesiologist. Therefore, you must look the part. Even if you chose anesthesiology because

its the only job you can go to every day as a professional and never have to own a tie, borrow

one for your interview day. Be cordial to everyone, including secretaries and janitorial staff.

Everyone has input. Make friends among your colleagues there are the interview. You may want

to keep in contact with some of them as well. As a minority candidate, you may not see many

other minorities in a given program; and so, by teaming up with another minority student who is

interviewing in places similar to you, and therefore has as good a chance of matching there as

you do, you increase your chances of not being the only minority resident in your class. If you

have the opportunity to meet with minority residents already in the program on your interview

day, ask them some of the more difficult questions about race or ethnicity and the community,

patient population and program. Do minority residents graduate at the same rate of other

residents?What is the demographics of the patient population with respect to minority patients?Is

the community in which I plan to live hostile to minority individuals?How many minority faculty

and residents are represented in the program?You still need to use caution in being real with

minority residents and faculty. They typically still give a report on your interaction with them

and you want to be perceived and being excellent, so use discretion; but get your questions

answered.

Faculty, chairmen or program directors may say many things to you during the interview

process. Remember the goals of the program:They want a full residency class to come to work

July 1st; they want candidates who help them fulfill their service requirements, academic mission

and legacy; they want to be seen as being desirable and selective; they want to be viewed as

being honest and inviting; and, they want their residents to graduate without incident. In your

interview, do not give the selection committee cause to believe that any of these goals will not be

met after having interviewed you. The program, in turn, will sometimes suggest to you that you

are a highly desirable candidate in hopes of getting you to commit to them. Because the basis of

the National Residency Matching Programs software strategy is such that everyone gets their

highest, first available choice, a lot of baiting between candidates and programs is really

unnecessary; yet it persists. Simply put, do not believe it when a person at an institution tells you

that you are at the very top of the programs list, even if you are a superior student. It is illegal,

by NRMP rules, for them to tell you or to make an offer, and they are doing it in the hopes that

you will rank them more highly because of their expressed interest in you. In turn, another ploy

is for them to call you subsequent to your visit and to ask you where you ranked them. Your

response should always be cordial and above reproach and should be that you respectfully

decline to give exact details because it against the NRMP guidelines, however, you really

enjoyed the program and would find it hard to believe that anyone could not see how wonderful

it was.

After your interview, always send a thank you note by either snail mail or e-mail to thank your

interviewers, program director and chairman. If the chief resident or other residents were

especially helpful to you, thank them too. Do not be obsequious, but if you enjoyed yourself and

see a place for your career development there, let them know it and why you would be a good fit

for them. On ranklist submission meeting day, all your comments have been kept and are

brought out for discussion for final rankings in that department. Having shown continued interest

is as good as great USMLE scores.

Match Day and Beyond Interviewing for residency often is useful when you apply for fellowships later, because people

know you and they remember. So, if you can afford it, go on all your interviews and meet the

program directors. If you had to decline an interview, do so graciously and cordially. Well, thats

it. On Match Day, enjoy yourself because you are about to embark on a wonderful adventure in

residency: The last step in a long journey.

The Dermatology Residency

Written by David Nieves, MD, Resident, Department of Dermatology, University of Rochester

School of Medicine and Dentistry

Dermatology is among the most difficult specialties in which to match. Dermatologists practice

medicine and surgery on patients of all ages. In many cases, dermatologists need only to look at

a lesion to arrive at a diagnosis. Dermatologists can immediately assess a skin lesions response

to therapy and modify a treatment regimen accordingly. Primarily an outpatient specialty,

dermatology enables its practitioners to enjoy a less demanding workload than physicians in

many other fields.

Academics Interest in a career in dermatology is strong, yet the number of training positions is limited to

approximately 270 positions nationwide. Although it is difficult to know precisely how many

applicants fail to match in dermatology, it is estimated that as many as 33% or more may be

unsuccessful. Because competition is keen, successful applicants must prepare for their desired

career well in advance.

When considering a career in dermatology, applicants must realistically assess whether their

academic credentials to date would place them at a disadvantage. At many programs, the

majority of persons selected to be interviewed are AOA and have USMLE Step I scores of 230

or higher. While there are no absolute cutoffs and there will always be special cases, applicants

who are not in the top half of their class or who have USMLE Step I scores that are below the

national average are at very high risk of not matching.

The Dermatology clerkship Although the third year is generally reserved for core clerkships, it is highly recommended that

potential applicants confirm their interest in the field early by doing the dermatology elective

during the third year. This can often be done by scheduling a clerkship such as psychiatry for the

fourth year. Try to do the dermatology rotation in the late winter or spring -- if it is done too

early, lack of clinical experience may cause a negative impression to be made on residents and

faculty (remember that most students take dermatology as a fourth-year elective).

At the end of the rotation, approach a faculty member with whom you had the best rapport and

ask to meet to discuss your interest in dermatology as a career. You should be prepared to

explain the reason for your interest in the field just as when applying to medical school you had

to explain your interest in a career as a physician. In the meeting, ask the faculty member for

his/her advice on the application process.

Research

During your meeting with your faculty advisor, ask about research opportunities in the

department not just laboratory research but also clinical projects as well. Doing research

enables you to demonstrate the ability to contribute to the advancement of the field. It also

enables you to build a close relationship with a faculty member who will then likely go to bat for

you with a strong letter of recommendation. When selecting a research project, factors to

consider include:

Do you have time to do a reasonable job on the project?

If its a lab project, do you have sufficient background in laboratory techniques to be efficient? If

not, are there technicians or grad students in the lab who can help you along?

Does the project make a meaningful contribution to the understanding and treatment of skin

disease?

Will you enjoy what youre working on?

Will you enjoy working with the person directing your work?

Is the faculty member directing your work well respected in the field, so that a letter from this

person catches the attention of an application review committee?

If the project is based in a laboratory, plan to set aside the summer months between third and

fourth year to work on the project full-time. If its a clinical one such as writing a case report or

review article it may be possible to work on it during other clerkships. Regardless of what you

do, it is recommended that you have some result in place by the time you send out your

application.

Recommendations

Aside from academic excellence, strong letters of recommendation are essential. Academic

dermatology is a very small field, and an applicant who is recommended by a senior faculty

member who is well-liked by members of an application committee will stand out of the crowd

more so than one who is recommended by an unknown junior faculty member. Of course, a letter

from a junior faculty member who likes you and knows you well is much more desirable than

one from a giant in the field who writes a few terse sentences that just rehashes your CV.

It would also be a good idea to do a sub-internship in medicine before applying, and to include a

strong letter of recommendation from the attending you worked with. In many cases, a sub-

internship is the only rotation in which the student is an essential part of a team with real

responsibility. A letter stating that your were prepared, responsible, and dependable when it

really counted says a lot about your potential to be a good resident.

Grand Rounds Start going to Grand Rounds whenever possible. This demonstrates your solid commitment to

the field to the faculty in your schools own department.

Internship In the past, dermatology was a late match in which the application season took place during the

summer/fall of internship. Dermatology program directors judged applicants not only on the

caliber of their performance in medical school, but also on the prestige of the internship that they

secured.

Today, dermatology is part of the standard match, and so no one knows where you will wind up

for internship. Nevertheless, program directors will often ask you where you have been

interviewed, and will be favorably impressed to hear that well-regarded academic programs are

considering you, generally in internal medicine. Most program directors encourage the internship

to be in internal medicine, though in the end if you match into a transitional program there is

little they can do to prevent it.

Incidentally, applicants interested in a career in pediatric dermatology should consider doing an

internship in pediatrics. While there are few if any one-year-only positions offered in pediatrics,

this can often be possible by special arrangements, such as working out an arrangement at your

medical school or by applying to pediatric categorical programs but explicitly stating in the

personal statement that you only want a one-year position. In the very near future, a special track

5-year will be available leading to board certification in pediatric dermatology (JAMA, April 25,

2001, p. 2065).

Applications There are roughly 100 residency programs in the United States, most of which receive over 250

applications for only 1-3 spots. As a general rule of thumb, the total number of interviews

granted by a program tends to be 15 per opening (i.e., a program with 2 spots might interview 30

people). You should apply to a large number of programs, and set a goal of securing 10

interviews.

Interviewing Dermatology operates on a slightly later schedule than other fields, and invitations to be

interviewed are not sent until mid-December. Before interviewing at a program, make sure to

thoroughly read the application brochure and check to see if a web site exists. Dress

conservatively. Also, if you have any personal cosmetic problems acne, significant unwanted

facial hair, etc consider getting this corrected well in advance of interviewing season.

Dermatology is a field that is focused on appearance, and it is important to look good for

interviews.

The questions asked most commonly are:

Why do you want to be a dermatologist?

What makes you interested in this program specifically?

Tell me about your research?

Do you have any questions about our program?

How do you like working with so-and-so (a well-known professor at your school)

In addition, many programs sponsor informal activities with residents to provide an inside

guide into what its really like to be at a program. Its a good idea to attend these events to learn

the things that the faculty wont tell you things that may ultimately influence your rank list.

Also, after the interview date, sometimes faculty may informally ask residents about their

impressions of the applicants.

The rank list Follow your heart!

Have a backup plan in case you dont match in dermatology. If you interviewed for high-quality

preliminary programs in medicine, you can rank them at the end of your primary list after derm

programs. Medicine programs are flexible enough that at many places, someone can match as a

prelim and be allowed to stay on as a categorical resident (assuming, of course, that they perform

well during internship). However, the downside to this is that if you in fact match into a prelim

program, then this is still considered a match and you will NOT be eligible to participate in the

Scramble (or even know of your eligibility for it). Of course, there rarely are Scramble positions

available in dermatology anyway, so youre probably not missing out on much.

If you dont match

There are essentially three options at this point:

1. Do an internship. Re-apply either during internship or while doing research the following year.

2. Do a year of research and reapply during that year.

3. Give up on dermatology and select a different career.

Choosing between 1 and 2 is tricky. On the one hand, doing a year of research gives you

additional opportunities to enhance your CV, whereas reapplying during internship doesnt give

you much of a chance to improve your application. On the other hand, occasionally derm spots

open up with short notice, and can only be filled by someone who has already done an

internship. Getting that out of the way puts you in the running for these positions, because you

would be able to start working at a moments notice. Of course, finding out about these openings

can often be tricky they may be publicized by word of mouth, a mass mailing to department

chairmen, or an announcement at a national meeting. Its important to have a strong advocate in

dermatology circles who will keep an eye out for these for you.

Universities that offer formal research fellowships in dermatology include UCSF, Harvard, UT

Galveston, and Mount Sinai School of Medicine.

Emergency Medicine

Written by Jocelyn Freeman Garrick, MD, Assistant Professor, Department of Emergency

Medicine Kings County Medical Center

Emergency Medicine is a relatively new field. The American Board of Emergency Medicine was

first recognized as a specialty board just 22 years ago. Despite its novelty, Emergency Medicine

(EM) has become popular as a specialty and thus competitive. Emergency Medicine allows one

to be a jack of all trades while giving the freedom of a flexible schedule and healthy lifestyle.

As with most specialties, being prepared and having a mentor in your field is key to a successful

match.

A few items should be highlighted prior to creating a timetable for successful matching:

Three (3) year versus Four (4) year residencies. As you begin to make your list of residencies in

which you may be interested, you will notice that some are three-year programs and some are

four-year. Are there advantages and/or disadvantages to each? Most people who want a career in

academic EM will choose to do a four-year program. This does not mean that you will be

isolated from a career in academics if you attend a three-year program. The elective time in four-

year programs tend to be more spread out and gives one more opportunity to work on interests

and research. Three-year programs are packed with a lot of ER time and less electives. However,

residency is completed sooner. Approximately 2/3 of the nations EM residencies are three-year

and the remaining 1/3 are four-year.

Academic versus Community Emergency Medicine. Prior to applying to an EM program, one

should have an idea of what type of setting in which to practice. Academics requires one to work

in the Emergency Department, perform research and administrative duties, lecture and

supervising residents and medical students. Most academic positions are at large teaching

hospitals with EM residencies. Community positions offer clinical responsibility and a more

flexible schedule. Administrative tasks are usually present. Community EM also offers

opportunities to travel via locum tenens. Teaching opportunities may still be present.

Choosing a Residency Program. There are over one hundred emergency medicine programs

recognized nationally by the Residency Review Committee. If you plan well and are realistic in

your goals, you should be happy with your program selection. Selecting a program should not be

limited to the reputation of the program and quality of training. The dynamics of the city where

the hospital is located, cost of living, patient population, and quality of life outside the hospital

should be considered.

Research. Many students ask whether they should do research and if it is required to match in a

competitive program. It is not required but it can only help. Most EM departments have ongoing

research projects and love to have eager medical students help with data collection, chart review

and study design. While conducting research with an emergency physician, you will have the

opportunity to work with an attending one-on-one and form a relationship. In a few months you

may be able to ask that attending for a letter of recommendation.

Memberships. Join the Medical Student section of the Emergency Medicine Residents

Association. This should be done early in the third year. Besides getting a handbook, which is

useful for the application process, the monthly literature you receive will keep you abreast of

issues in the specialty. There is also a national conference where most residency programs will

be recruiting.

Timetable

1st and 2

nd year.

Study hard! Make good grades and pass the boards. Participate in research and extra-curricular

activities.

May-July of Third/Fourth Year.

Obtain an advisor in the Emergency Department (ED). If your medical school does not have an

Emergency Medicine Department or Residency then seek one at a neighboring school or

hospital. This is not the time to be shy. Go to a neighboring hospital and find out where their ER

physicians trained. Ask one of them if they would be willing to mentor you during this process or

if they can recommend someone. If you have a neighboring medical school with an ED, arrange

to visit for a day. Speak to the Chairman of the department, the Director and the Residency

Director. Explain that your school doesnt have a department and you need an advisor. ER

physicians tend to be team oriented and willing to lend an extra hand.

Create your list of residencies for which to apply. The list should be based on the type of

environment in which you want to be (urban, community or rural), the career you have set forth

(academic or community), your personality, and your family structure. What if you like a

program but its location will limit opportunities for your spouse or significant other? In addition,

you should consider the diversity of the program, patient population and city. For example, if

youre considering a program thats in New York City but you hate the snow, the program

shouldnt be on your list.

When your list is complete, contact the programs to obtain an application (most now are

electronic) and program material. Narrow your list and work on the materials needed for your

application- the Curriculum Vitae, personal statement, transcripts, Deans Letter, letters of

recommendation and photos. The personal statement and CV should be reviewed by at least four

(4) people including your advisor.

Consider Doing an Outside Elective You may be at a medical school that requires ER as an

elective or at a school with a strong EM residency and choose to do an elective at your teaching

institution. However, some students may not have this opportunity and/or may want to

experience how another institution operates. Doing an outside elective may be beneficial. It

allows you to meet and work with ER-trained physicians, to meet other students going through

the process and hopefully you can form good relationships with the attendings during your

elective and obtain letters of recommendation. Before the elective, become familiar with the

administrative heads (Chair, Director, Residency Director). Network during the elective and

arrange your schedule so you may work with key individuals within the Department. Come

early, stay late, be a willing worker, participate in and attend lectures. This is your time to shine

and make an outstanding impression.

August-September of Fourth Year

Final revisions of your CV and personal statement should be completed and your letters of

recommendation should be obtained. At least two letters should be from well known or highly

regarded Emergency physicians.

Apply early -- I cannot stress this statement enough or in any other way. Apply early!

Early applications get first choice for interview dates. Some competitive programs fill all their

interview dates and applications received later in the process may not receive interviews (even if

the application is strong).

October- December of Fourth Year

Arrange Interviews. Most programs begin interviewing in late October and proceed through

early February. Some people have a strategy to interviewing and believe you shouldnt interview

very early or very late. I will suggest that you NOT interview on the last interview day. The

Directors are burned out and tired and may not even recognize your star quality. November

through January are safe months. Try to arrange electives during this time. For interview day, I

have two points to make, which may seem obvious to most but are missed by many:

1) Remain warm and friendly during the day. Act interested and ask questions. Interview days

can be long and exhausting especially if you traveled a distance the night before. Plan ahead, get

adequate rest so you can arrive early and be prepared. I cant say that enough.

2) Stay the entire day. If the program offers you a tour and you dont want to go, you dont want

to go to the program. Participate willingly in all activities.

Take notes. Youre not only being interviewed, you should be interviewing the program as well.

(It is important to take notes because after six or seven interviews, you can mix up the

programs). If youre not comfortable writing things down during the day, sit down as soon as

you leave the program and write everything you remember. Ask questions. Create a list of

standard questions to ask the residents and a separate list of questions for the attendings. Create a

rank list with pertinent questions for each program. (See Exhibit III. )

Spending Time in the ER Consider spending a few hours after your interview in the evening or

the night before in the ER. It gives you the opportunity to interact with the staff, to see how

responsibilities are divided and get to know some potential interviewers. Most tours are held at

10 or 11 AM when the ER is clean and relatively under control. It can be the complete opposite a

few hours later. Always send thank you letters and get the correct spelling of your interviewers

name. Remember, express real interest in the program of your choice with frequent notes,

telephone calls, visits and e-mail.

February of Fourth Year Youve successfully matched in Emergency Medicine. Congratulations!

Obstetrics and Gynecology

Written by Joanne Quinones, MD, Resident, Department of Obstetrics and Gynecology, Hosptial

of the University of Pennsylvania

Why Obstetrics & Gynecology? If you are interested in an exciting, fast-pac