—coauthor Dan
MAKING CONTACTS AND COLLECTING INFORMATION
Once you identify your specialty, you need to go into a rapid, aggressive, information-gathering mode. Scour the Internet first. Use FREIDA to find out more about the specialty in general and how it compares to other disciplines. Follow links to national organizations and societies governing that field, and read about what’s current in the field on their Web sites. Finally, use the FREIDA links to go direct to residencies in that speciality. Start to narrow down a list of possible programs based on your interests, their locations, and the features they tout as their strengths.
We’ve mentioned at several points along the way the importance of mentorship. A good mentor can be an invaluable source of wisdom and inspiration, and a grounding influence in otherwise turbulent and confusing times. If you haven’t found a mentor up to this point, do so now without fail. A mentor will be a critical element of your application process. He or she will provide critical insight on your fitness as a candidate in your specialty, advice on how to craft your application, and hopefully a strong and insightful letter of recommendation. If you already have a trusted mentor, you might consider broadening your scope within your school to include another opinion (but don’t estrange your primary mentor in doing this). If you do an away rotation, you may be assigned a mentor at the outside institution who can provide this refreshingly new expert opinion. When you talk to your mentors, be sure you run your list of possible programs by them. Ask for their opinions of each program. Ask for additional programs you might not have thought about. Ask if they know anyone inside these various programs and whether they might be willing to make a call on your behalf. Try to get a sense of how competitive your preferred programs are.
Your overall list should remain quite broad at this point, but if you’ve started to home in on five or ten programs, start a file folder for each one and begin cataloguing your information.
PAVING THE WAY TO A SUCCESSFUL MATCH
The general schedule for your transition to fourth year should look something like this:
THIRD YEAR
March—Information Gathering
Make your short list of possible specialties.
Spend time talking with mentors, residents, and attendings.
Work through your pro-and-con list.
Do online research on residencies and the specialties.
April—Starting Out
Arrange away rotations if desired.
Make a contact in the department you want to specialize in and arrange a meeting. Make it clear you want to match in their specialty and are looking for mentorship and advice.
Start asking people what kinds of activities/extra work might make your application shine in your chosen specialty—e.g., research, extra rotations, and so on.
Sequence your schedule so that you will do your sub-I in your chosen specialty so that your remaining clerkships show strong grades.
May—Full Steam Ahead
Try to arrange a phone call or meeting with the program director of any residencies you’ll be directly targeting. Express your interest clearly but politely.
Attempt to identify inroads to any programs you’re interested in. Talk to your mentor about people he or she knows in the field who might be able to put in a good word when the time comes.
Time to start thinking about your application. Read ahead!
You now have the pieces and parts you need to initiate a successful match at your ideal program. You’ve started early, weighed your options, and defined why you want to join a particular field. You’ve met with local faculty to gain more experience and perspective and used them to establish far-reaching contacts at other institutions. You’ve reached out to programs you’re interested in via those contacts and politely declared your interest. You’ve set up an away rotation at your top-pick program.
You’re ready to go.
CHAPTER 22
Applying All Over Again
Success is the progressive realization of a worthy goal or ideal.
—EARL NIGHTINGALE
THE ACTUAL APPLICATION process for residency will closely mirror your med-school application experience. By now you should be an old pro at this, so many of the tips in these chapters will be familiar.
THE SYSTEM
Applications to most allopathic residencies are standardized via the Electronic Residency Application Service (ERAS) (www.aamc.org/students/eras/start.htm), a division of the National Resident Matching Program (NRMP). More than 95 percent of residency programs use this single uniform application. The list of programs that do not use ERAS are listed on the ERAS Web site.
Osteopathic medical students will use a parallel match system run by the American Osteopathic Association (http://opportunities.aoa.net.org). The AOA has its own applications but runs the match through the same computer system that the NRMP uses. Osteopaths match in January, allopaths in March. Thus, it is possible for osteopathic students to participate in both matches. This discussion will focus on the allopathic match, but the osteopathic process and application is very similar.
The universal application requires you to provide a substantial amount of information, so once again it’s time to start collecting your files and organizing yourself. Unlike your medical-school applications, the ERAS application will be the only application you fill out. There are no secondary applications in the residency process. You will work hand in hand with your medical school to register for and complete your application.
TASKS AND TIMELINES
As we noted earlier, the timeline for your residency applications should start in the spring of your third year. You should start exploring the ERAS Web site and familiarizing yourself with its tools and resources. Understand the structure of the application and its required content. Start collecting and organizing the required supporting information. By June you should begin crafting your essay and have a list of potential recommendation writers in mind.
On July 15 you will be able to use the unique log-in token supplied by your medical-school dean’s office to register on the ERAS Web site and initiate your application. By early August you should have entered your personal information and your scholastic achievements and awards into ERAS. Your letter writers should be busy crafting your recommendations. Your essay should be in finalized form by mid-August, and the application should be available online by the end of August. On September 1 the residency programs you’ve selected will start to receive initial draft versions of your application. By November your medical school’s dean’s letter (explained below) will be submitted and the finalized application will be sent out to residencies. You will submit your match list in January, interview throughout the winter, and get your match results in March.
Let’s break the process down into its component parts.
Crafting your application and essay
You should aim to devote the same level of painstaking attention to detail to your residency application that you did to your medicalschool application. The good news is that this application is simpler, and overall the process is much more approachable. You’re also wiser and more savvy about the subject matter. You’ve studied the spectrum of medical knowledge, you’ve experienced firsthand the many facets of the profession, and you’ve selected a particular specialty as your chosen vocation. As before, you should not only detail your academic qualifications but also strive to illustrate the path you’ve taken to choose your field.
There is no one ideal application. Your goal will be to demonstrate overall proficiency and to specifically highlight your unique qualities and experiences.
Once again, your personal statement will be a centerpiece of your application. Unlike your medical-school essay, your residency essay will be a focused statement of your rationale for selecting your specialty and your aspirations therein. It should demonstrate the evolution of your perspective and insight during medical school and perhaps tie in some key formative experiences. Just as with your medica
l-school admissions essay, the prose here must be perfect. Proof thoroughly and have several other people read your statement for content and quality.
“Remember that your personal statement is a way the reader can get to know you as a person without having met you,” Deb suggests.
The dean’s letter
The medical-school dean’s letter is the ERAS version of your premed committee letter. The dean’s letter will provide programs with a summary of your academic record and provide categorical assessment of your performance relative to your peers. This used to be a fairly subjective process, but in recent years ERAS and the various residency programs have formalized this letter to provide a uniform format and set of assessment tools.
In general, your academic record will be reviewed and your performance compared to your peers using percentages. The letter will use key phrases that correlate to certain percentages. Thus, “Curly’s performance in his first two years was above average” may effectively say to programs, “Curly is in the top third of his class.” Your dean’s letter will also summarize your extracurricular experience and research experience. Programs will put significant weight on the dean’s overall assessment of your fitness to be a future house officer (i.e., resident). Despite the efforts to standardize this letter, programs across the country will know the propensities of individual deans and will weigh their evaluations accordingly.
There’s not a lot you can do to optimize your dean’s letter—your record is what it is. However, you will probably have a meeting arranged with your dean sometime in the summer of your fourth year to discuss your record and the letter. Deans hold these meetings in an effort to add some personal elements to their letters and verify the accuracy of their information. As such, your dean’s meeting is an opportunity for you to emphasize the elements of your application that you wish to highlight and your thoughtful and insightful reasons for pursuing your chosen field. As long as your requests are reasonable and accurately reflect your record, they will likely find their way into your letter.
Letters of recommendation
The system for letters of recommendation is slightly different in ERAS than it was for your medical-school application. If you are applying to several different types of residencies (i.e., residencies in different specialties), you will need different letters of recommendation for each specialty. Therefore, ERAS allows you to designate an unlimited number of letter writers and also allows you to select up to four letters for each program you apply to.
All letters of recommendation will be sent directly to your dean’s office, which will send them to ERAS along with the dean’s letter. ERAS will then send the dean’s letter along with the specific letters you designate to each program. As always, plan ahead, request your letters early, and meet with each of your recommenders to help personalize your recommendation letters.
CHAPTER 23
Selecting Your Programs
The world is always willing to receive talent with open arms.
—OLIVER WENDELL HOLMES
YOU’LL PROBABLY FIND that the trepidation you felt about selecting medical schools will be replaced with excitement when it is time to select your residency. It’s a very different feeling to be on the inside looking at the next step, as opposed to being on the outside praying you’ll be let in. Of course, it’s still a very important choice, and one that deserves your careful consideration.
The factors influencing your choice of residency will be every bit as varied as those governing your choice of medical school. The same differentiators—location, reputation, and curriculum—will remain key factors. You will also want to consider the caliber of the faculty you’ll be working with, the availability of subspecialty fellowships (if you are contemplating a subspecialty), the size of the program, the overall satisfaction of the residents in the program (termed, quaintly, “resident wellness”), the variety of the patient population, and the quality of the facilities.
Your resources for researching programs will be part digital and part personal. There is a wealth of information on the Web about every residency program in the country. Any specialty Web site will have links to the participating residencies in this field, and every residency will have its own Web page detailing its program and offering its highlights. This research makes for great late-night surfing when you’re on call and waiting for lab results or waiting for a patient to arrive. In the beginning, you should just click away, exploring broadly and getting a feeling for what programs are available and what some of their basic similarities and differences are.
After a period of seemingly aimless wandering, you’ll find yourself drawn back to certain Web sites again and again, holding these programs in your mind as the standard by which to judge others. These programs will merit further research for you. Start researching these more intensively and take notes on the relative strengths and weaknesses of each.
As for the personal resources, you should talk to your mentor about your program selection. Anyone who has been in the field for a period of time will have informed opinions about the various programs. As with all personal opinions, be vigilant for bias. Those who have been in academics the longest will have the broadest perspective on the field, but their opinions about specific programs may be based on facts that are no longer current. Conversely, those fresh from their training will have the most current view of the residency field and will have very up-to-date information on specific programs. Yet these same folks may hold strong opinions based on their personal experience in the program they just graduated from instead of a knowledge of the field as a whole.
APPLYING AS A COUPLE
It’s not uncommon for romance to blossom in the trenches of medical school. Let’s face it, you’ve been through an extensive vetting process just to get into school. For the last several years, you’ve been surrounded by several hundred fellow Type A personalities who are smart, driven, and equally passionate about health care. You’ve enjoyed the camaraderie that comes from surviving the trials and tribulations of med school that are simply inexplicable to the uninitiated. But with the end of school looming nearer and nearer, choices have to be made.
If you have a paramour in your med-school class, your first decision is whether to lay out your future as a couple. If you’re married, this is obviously a nonissue—but if you’re just seriously dating, this is going to put you to a choice. Residency is a stressful time, and not being in the same location will make maintaining a relationship virtually impossible. On the other hand, committing to move to the same place for your training is making a statement about the direction of your relationship. If the relationship later doesn’t work out, you may be left in very close working proximity with each other.
Needless to say, this choice requires careful thought and open, honest discussion.
The NRMP does provide a vehicle for couples trying to match together. As you apply to programs, you can select to apply as a couple, either in the same specialty or in different specialties at the same institution. This means when you rank a program on your list, it will be coordinated with your partner’s match list, and the NRMP computers will attempt to match you to these coordinated programs. This definitely adds an additional layer of complexity to an already intricate process, but many people do it successfully each year. The challenge tends to be finding programs that both people are interested in, can get interviews at, and can rank equally.
If you’re applying to a program as a couple’s match, be sure to alert the program to this. Within the institution, the program you apply to will coordinate their interview dates with your partner’s program and will also discuss their relative rankings of your respective candidacies when it comes time to complete their list. Thus, if one of you is held in particularly high esteem by a program, the residency director may pull strings to help ensure that your partner gets ranked favorably in the other program as well.
MAKING YOUR FINAL LIST
The final list of programs to which you apply will be shaped by m
any of the aforementioned factors and probably by several others that you uncover along the way. The list of residency programs you apply to will obviously be broader than the list of programs you rank when it comes time to register for the match. That said, you should resist the urge to apply to every single program in your specialty in the country.
The shotgun approach is tempting, especially if you’re filled with that all-too-familiar paranoia that you might not get in anywhere. In the end, though, the shotgun approach is a self-defeating strategy. First, it’s a disservice to yourself. You’ve worked hard to get where you are, and you should have some faith in your strength as a candidate. Target programs that are realistic for you, but recognize that those programs are seeking to recruit you as well. The days of hoping for an admission should be left behind. Your goal should be finding the best possible match between your strengths and goals as a candidate and the programs you’re looking at.
Second, applying to every single program in the country is a disservice to your fellow applicants and to the system as a whole. It suggests you haven’t given due consideration to the field and narrowed your choices, and by applying everywhere you may be limiting someone else’s chances at getting an interview at a program they love but one you may not even be interested in.
Med School Confidential Page 25