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How to Navigate the Residency Selection Process

The document outlines the residency selection process, emphasizing the evolution of factors important to residency applicants over the decades, such as program satisfaction and geographic location. It provides detailed statistics on preferences for residency programs and insights into effective application strategies, including timelines, personal statements, and letters of recommendation. The contemporary landscape of graduate medical education (GME) is addressed, highlighting the significance of resident well-being and the changing dynamics within residency training environments.

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How to Navigate the Residency Selection Process Presented by: Francis S. Nuthalapaty, MD Sponsored by the Upstate Chapter of the Christian Medical and Dental Associations
What do you think would make the “optimal” residency training environment?
The Optimal GME Environment Education Service
Defining the Optimal Residency Author, Year Population Scope N (Response Rate) DiTomasso, 1983 PGY-1 FP National 830 (46%) Weissman, 1984 PGY-1 Psychiatry National 274 (51%) Sledge, 1987 Graduates entering Psych. National 318 (64%) Hitchcock, 1989 PGY-1 FP 1 State 115 (91%) Simmonds, 1990 Graduates 1 Univ. 111 (71%) DeLisa, 1992 Graduates 1 Univ. 73 (41%) Flynn, 1993 Graduates 1 Residency 315 (88%) Lebovits, 1993 Graduates 1 Univ. 197 (87%) Mayeaux, 1993 PGY-1 FP National 660 (27%) Diebold, 1995 PGY-1 EM National 463 (68%)
The Optimal Residency in the 80’s – 90’s • Geographic location • Quality of training experiences / educational curriculum • Academic reputation of program • Perception of house staff satisfaction
The Changing GME Landscape The GME training environment has changed dramatically over the past 4 decades –Resident unionization –Duty Hour Restrictions (2002) –Federal definition of resident employment status (2005)
Controllable Lifestyle and Specialty Choice – The Educator’s Viewpoint • Coined by Schwartz in 1989 • Broadly defined as control over the number of hours devoted to professional responsibilities to enable time for leisure, family, and avocational pursuits • Shown to be a significant determinant of specialty choice
The Contemporary GME Environment GME ServiceEducation Resident Well-being
What’s important to residency applicants in the new millennium?
The Optimal Residency in the new Millennium Factor No. % 1. Resident satisfaction with program 7,043 98.1 2. Level of concern program has for its trainees 7,037 98.0 3. Perception of “fit” into residency 6,948 96.7 4. Geographic location 6,836 95.2 5. How well residents work together 6,753 94.0 6. Quality of hospital facility 6,176 86.0
The Optimal Residency in the new Millennium Factor No. % 7. Amount of faculty supervision 5,604 78.0 8. Academic reputation 5,474 76.2 9. Level of resident autonomy 6,836 76.0 10.Amount of faculty teaching 6,753 74.1 11.Amount of conferences 5,294 73.7 12.Size of patient case load 4,230 58.9
The Optimal Residency in the new Millennium Factor No. % 13.On-call frequency 4,018 55.9 14.Cost of living in program area 3,656 50.9 15.Amount of clinical support services 3,608 50.2 16.Emphasis on research 3,067 42.7 17. Emphasis on teaching students 2,632 36.6 18.Employee benefits 2,462 34.3 19.Salary 1,600 22.3 20.Supplemental income opportunities 1,408 19.6
Factors in Interview Selection
2013 NRMP Applicant Survey
 Important Factors In Interview Selection Factor 2013 2011 2009 2008 1. Geographic location 95% 95% 95% 72% 2. Academic reputation of the program 90% 92% 92% 79% 3. Quality of educational curriculum 86% 92% 92% N/A 4. Quality of residents in program 79% 88% 88% N/A 5. Academic Setting 74% 87% 87% 64% 6. Work / Life balance 68% 87% 87% N/A
The Learning Culture Academic rigor vs. Malignancy Autonomy vs. Supervision Role models vs. Mentors
What’s important to the Program?
Factors in Selecting Applicants
2014 NRMP Program Director Survey Factors in Selecting Applicants for Interviews Factor 2014 2012 2010 2008 Step 1 Score 94% 82% 73% 82% Letters of Recommendation 86% 81% 71% 75% MSPE (Dean’s Letter) 84% 68% 60% 76% Step 2 CK Score 80% 70% 61% 70% Personal Statement 78% 77% 68% 75% Grades in Clerkships 70% 71% 62% 71%
Breakdown of USMLE Step 1
USMLE: Making the Cut The boxes in the boxplots above represent the interquartile range (or IQR, which is the range between the 25th and 75th percentiles) and the line in the box is the median. The x-shaped symbol in the box is the mean Obstetrics and Gynecology
A Structured Approach to Residency Application 1. Set a Timeline 2. Gather Data about your Specialty 3. The Letter of Recommendation 4. The Personal Statement 5. Electives – Good or Bad? 6. The Interview 7. The Rank List
The Match Timeline • Late May: ERAS user guide available • June: MyERAS website open for use • Sept 15: Programs begin download • Oct 1: MSPE sent to Programs • Jan 15: Rank list entry begins • Feb 24: Students finalize Rank list • Mar 14: SOAP begins • Mar 18: Match Day!
Setting a Timeline • Review the Match Timeline • Review steps in Application Process • Set deadlines for each step
Gathering Data • NRMP Reports • Match Outcomes • Program Director Survey • Applicant Survey
Comparing the Specialties
Comparing the Specialties
Step 1 and OBGYN Match
Comparing the Specialties
Step 2 and OBGYN Match
The Application Process 1. Extramural Electives 2. ERAS Application 3. Personal Statement 4. Letters of Recommendation 5. Interviews 6. Rank Order List
The Application Process Should you do an Extramural Elective?
1. Electives – Good or Bad? • Electives are extended interviews • Most beneficial for very strong candidates and weak/marginal candidates • Could help or potentially hurt intermediate candidates • Expensive! The Application Process
The Application Process 2. ERAS Application – 4 main components • Identifiers • Education • Current / Prior Training • Experiences
The Application Process What makes a good Personal Statement?
The Application Process 3. Personal Statement – Before you start • Check with program for any special content requirements • Line up at least 3 reviewers: • Medical perspective • Lay perspective • Editorial perspective • Be prepared to write MANY drafts
The Application Process 3. Personal Statement – What to include • Your motivations for a career in medicine • How you chose the specialty and why you are a good “fit” • Distinguishing features of your personal / professional background • Your unique qualities /talents / passions relevant to the specialty • What you see yourself doing after training – your future scope of practice
The Application Process 3. Personal Statement – What to avoid • Autobiography • Why you like the specific program • Poor composition • Grammar • Spelling • Literary style
The Application Process What’s the best strategy for Letters of Recommendation?
4. Letters of Recommendation (Advice for Students) • Check individual program requirements • Ask early / ask often • Always ask the faculty person what the strength of his/her recommendation will be! The Application Process
4. Letters of Recommendation (Advice for Faculty) • Ask the student to give you as much data as possible • Transcript, USMLE Scores • Personal Statement • CV • Meet with the student / ask questions • Always discuss the strength of your recommendation • Proof read to ensure student’s name is correct throughout The Application Process
The Application Process What should be your approach to scheduling interviews?
The Interview Roulette - 2008
The Interview Roulette - 2012
5. Interviews • Schedule them early • Many programs complete all interviews by the end of December • “Be nice” to all contacts • Be prepared for behavioral interviews The Application Process
The Rise of Behavioral Interviewing
How should you determine your rank list order? The Application Process
The Application Process 6. Rank Order List • Rank based on where you want to be – not where you think you were liked • More programs = greater match success • Many programs will try to pin you down – don’t be afraid to tell programs you liked them – but don’t divulge your ranking.
Applicant Rank List
 Single Most Important Factor Factor % Potential “fit” into residency program 34.6 Geographic location 30.3
2013 NRMP Applicant Survey
 Important Factors In Ranking Factor % 1. Geographic location 86 3. Academic reputation of program 84 4. Quality of residents in program 80 5. Quality of faculty 76 2. Quality of educational curriculum & training 67 6. Work / Life balance 67
2013 NRMP Applicant Survey
 Ranking Strategies Factor 2013 2011 1. I ranked in the order of my preferences 98% 99% 2. I ranked all programs I was willing to attend 71% 95% 3. I ranked all programs at which I interviewed 60% 63% 4. I ranked a mix of competitive and less competitive programs 53% 88% 5. I ranked 1 or more less competitive programs as a safety net 34% NA
How do Programs determine their rank list order? The Application Process
Program Rank Factors
Program Rank Factors • The “Big 3”: • Residency Interview - Interactions with faculty - Interactions with residents • Interpersonal Skills • Academic performance
How many programs should you rank? The Application Process
Rank List Length
Rank List Length
The Application Process 6. Rank Order List • Rank based on where you want to be – not where you think you were liked • More programs = greater match success • Many programs will try to pin you down – don’t be afraid to tell programs you liked them – but don’t divulge your ranking.
Useful Resources • AAMC Resources: • ERAS Information Website • Roadmap to Residency Document • Careers in Medicine Website • NRMP Resources: • Charting Outcomes in the Match • 2012 Program Director’s Survey • 2011 Applicant Survey
Useful Resources • Program Information: • FREIDA • ACGME • Other Resources • Career and Professional Development Website • UK Career and Professional Development Website
Useful Resources