So now you want to be a resident….

1. Presenting….the dirty details of your ERAS application, interviewing, etc, etc, etc… So now you want to be a resident….

2. Getting started…see previous talk • Specialty Choice • Away Rotations • Program websites • VSAS • http://www.aamc.org/programs/vsas/students/start.htm • Sub-Internships • Mentors • Letters of Recommendation Writers • Personal Statement/CV

3. A brief bit of residency lingo • Categorical (or Advanced): Resident enters a program with the objective to complete the entire program. Length varies with specialty. • E.g. General Surgery, Emergency Medicine, OBG • Preliminary: Positions for residents who been accepted into another specialty, but who are completing pre-requisites for that specialty (Advanced positions); or for residents who fail to match into categorical/advanced spots • E.g. Dermatology, anesthesiology do preliminary years. • Transitional: 1st year of residency designed to provide a program of multiple clinical disciplines. Typically used to fulfill pre-requisite for a specialty. Similar to Preliminary, but often tied directly to specific programs. Often considered “cushier” than prelim years • Fellow: Post residency or mid residency sub-specialty training

4. ERAS = Residency AMCAS • Electronic Residency Application Service • http://www.aamc.org/students/eras/start.htm • Karen Bledsoe will give you your login “Token” • Electronic Form that is basically your med school CV (more about this later) • Select Schools to apply to through your personal application page • Uses Application Document Tracking • Tab within your ERAS site that allows you to see which schools have received/viewed/downloaded your application, track your letters of recommendation, personal statements, etc • Receive interview notification via this website and email • SMART phone tangent • (2010) Fees!!! $65 for 1st 10, $8/ea for 11-20, $15/ea for 21-30, $25/ea 31+ all per specialty $ $

5. NRMP • National Resident Matching Program • Provides a uniform date of appointment to Residency • Provides uniform rules for appointment • Historically, recruitment occurred even as a MS-1! Good-ole-boy • BINDING commitment (for 1 year) • Applicant’s / Program Rank lists compared via computer algorithm that favors the student • Applicant Registration Fee: 50$ (2010) • In Summary: ERAS helps you set up interviews with programs, NRMP helps you match with a program via a fair process. • You MUST register for both!

6. ERAS/NRMP Timelines • July 1st – Application website opens so you can start entering data • Send Karen Bledsoe a digital photo of yourself if you don’t like your MS3 photo • Transcripts (not TOO early! Need all rotation grades) • September 1st: APPLICATION CERTIFICATION can begin • Interviews: late October through late January, specialty dependent. • More about this later • November 1st: Dean’s Letters (MSPEs) are released to programs. (ERAS automatically handles) • 2nd Look opportunity (if you want): December, January, early February • NRMP: • January/February – Programs submit their RANK lists • Mid/late February – Your rank list(s) due • Mid March – Match Day

7. A Digression – The SF Match • The “Early Match” http://www.sfmatch.org • 3 Specialties Participate via SF Match • Ophthalmology • Pediatric Neurology • Some categorical Plastics (many are ERAS/NRMP • NOT electronic service • Centralized Application Service (CAS) • Every Document must be in print. (Type app in Word first ) • Letters of Rec. – Sealed Envelopes w/ writer Signature on Seal • Original Transcripts – Notarized, in envelope. • Gather ALL required docs – mail Next Day Air as one package. • 100$ Registration Fee (2009), 60$ first 10, 10$/school 11-20 • Is the combined ERAS/NRMP equivalent for these specialties. • Still must apply for PGY-1 via ERAS/NRMP (prelim or transitional) • See website for EARLY timeline details and additional info

8. Further Digression - Urology • American Urological Association Match • http://www.auanet.org/content/residency/residency-match.cfm • Applicants apply for interviews via ERAS. • Similar to service provided by NRMP. • Some programs require NRMP for PGY-1 Surgery. • Registration Fee: 75$ (2009) • See website for timeline details and information – EARLIER than standard ERAS/NRMP

9. Back to ERAS • Transcripts (medical school) • Board Scores (step 2) • Letters of Recommendation (4 is a good number) • Personal Statement • Your “CV” (extra-curricular, leadership, awards, hobbies, etc. Do NOT leave HOBBIES blank & do not LIE! Interview fodder!!) • MSPE (Dr. Veitia!) • Guess what….all this can take a while!!

10. Ideal Candidate (according to RDs) • No one is perfect, so be yourself. • RDs go through hundreds of apps – insincerity can be spotted a mile away! • NRMP Program Director Survey • http://www.nrmp.org/data/programresultsbyspecialty.pdf • Step Scores: Predict performance on Specialty Board Exam, are used as screening tool for more competitive specialties • Characteristics of Good Candidates • Knowledge • Teamwork • Strong Motivation • Working at intern level • Genuine Interest • Patient advocacy • Great communication skills • Owning Problems • Integrity • Honesty • No Personality Issues (recall that psych rotation…)

11. Letters of Recommendation • IDEAL: Personal letters that exude what RDs want to see! • Plan and do a rotation with someone. Ask them EARLY in rotation. • Start asking EARLY! (AKA now if you’ve spent a lot of time with someone) • Pick people with contacts in your field or at your program of choice • ASK them if they can write you a great letter (“time to write a letter”) • Ask their office staff/MS-4s if they are quick on getting letters out. (this can be important). • One is from a Dept. Chair of the field of interest (or pretty close) • One letter from same or closely related field • One is from a physician in your field who knows you well • One other…although generally NOT the time for personal letters from pastors, coaches, etc)

12. Personal Statement • “You spend the most time and we spend the least.” ~ direct from the mouth of a RD • Programs may spend from 10 minutes to 1 hour on your ENTIRE application deciding on interview offers • Have faculty member who reads personal statements as part of a residency committee read your final draft • Don’t rely on your PS to be “winning” part of your application. NOT like college/med school apps, but also don’t blow it off

13. PS: Some Dos & Don’ts • Do’s • Be honest & genuine • Present yourself as a mature professional • Make it easy to read (excellent flow, flawless grammar & punctuation) • Convey: • What makes you unique (makes you stand out) • What makes you a good fit for the specialty • Both what motivates you, and your future goals • If necessary, discuss negatives that can be positively explained • Don’ts • Don’t rehash your curriculum vita • Don’t use quotes (cheesy!) • Don’t waste space (i.e. Why I wanted to become a Dr, I want to help people, blah, blah) • Don’t use clichés • Don’t get “too” creative (all caps, eecumings style, etc0

14. CV in ERAS land • Exhaustive description of everything you’ve been a part of: • Work (paid) • Volunteer/Community service • Research • Publications/Presentations • Honors & Hobbies • Etc • Unfortunately you can not copy/paste document you may already have…you have to add it part by part • CHECK YOUR SPELLING • Two versions – ERAS and 1 pager

15. MSPE – Dr. Veitia’s baby • Medical Student Performance Evaluation: • Assessment of a student’s performance relative to his or her peers throughout the first three years of medical school • academic performance AND professional attributes • From questionnaire for Dr. Veitia & clerkship evals • It is NOT a letter of recommendation, standardized format since 2002 • Meet with Dr. V in July, August, Sept • Can revise for factual errors, but can’t change evaluative statements • Release date of November 1 via ERAS (but many programs do NOT wait for this to start offering)

16. MSPE: Six Sections • Identifying Information (demographics) • Unique Characteristics (aka old lady ) • Academic History (matriculation dates, explanation of gaps in educational program, information about repeats or remediation, information about adverse actions) • Academic Progress • Pre-clinical/ basic science course work • Performance in clinical clerkships (grades, narratives) • Summary • Summative assessment of the student as compared to his or her peers • School-specific categories to differentiate students • Professionalism • Appendices

17. General Application ADVICE • Be aware of BAD advice! Everyone different! • Talk with program directors here…they read 100’s of applications every season • Use people who went to the school/programs of your interest! • Talk with FACULTY • Talk with MS-4s • Rule of Thumb: You do not want your personal statement or interview attire to “stand out” too much…. • You want the total package to “stand out.” • You WILL be searched by google, MySpace, facebook, blogspot, etc. Clean it & make it private • Don’t give anyone anything other than your app & interview to judge you

18. Where/How Many to Apply??? • There are no “US News” reports of top residency programs • Programs are viewed on relatively arbitrary tiers depending on faculty, reputation, age of program, etc. • “Top” programs in your field may not be where you expect • Talk to your mentors (including 4th years!), FREIDA, faculty • Apply based on your qualification (see NRMP report again!) • Apply to a few top, many middle, a few low • Scramble often from delusions or not enough programs • Consider applying to a “backup” field • Especially for highly competitive fields • Can be double the work (two statements, many letters, etc) • Geography is generally people’s #1 consideration • Use ERAS Program List (includes program website links) • https://services.aamc.org/eras/erasstats/par/index.cfm

19. Your Friend the NRMP report

20. Interviews!! • Significantly better Interviewee with experience • Schedule your dream schools after a “trial run” but not totally at the end (FATIGUE!) if possible • Available interview dates • Depend on when you receive interview offer • Depend on competitiveness of programs (don’t freak out!) • Try to allow at least one day off in-between…most interviews have social night before/after – VERY IMPORTANT!! • Respond to interview offers IMMEDIATELY • Competitive fields are first come first serve for spots • Can always cancel • Re-schedule/ Cancel • Goal: Notify at least 1 wk prior

21. Interview Attire • GENERAL RULE: CONSERVATIVE • Men • Black or Grey Suit – this is not the time to be cheap! • White Shirt • Windsor Tie – Yellow, Red, Blue – Power colors • Black dress shoes – CLEAN, NO SCUFFS! (cited by RDs) • Buy Chap stick (also cited by RDs—interview season is winter time!). • Women • More variable – Black or Grey skirted suit still most common, pants OK • Blouse – nothing flashy (watch the cleavage!) • No flashy jewelry – use your judgment on nose piercing • Natural hair colors only • Carry CV, spare photos, and your list of questions to ask! (You’ll be nervous and forget them!) • Carry a nice pen, do NOT use a drug pen or another institution's pen unless it is MUSOM • Try to look like your photo on your application!

22. Interview ?s to Expect – the faves • Research Programs before Interview! (program website) • YOU MUST SELL YOURSELF! • Be prepared for 3-on-1 & Panel (8+) interviews (Relax) • Tip: Scan room periodically while speaking to engage all interviewers. • Be prepared to explain ANY areas of your record • Some suggest pre-emptive discussion of weaknesses, do not avoid • Be prepared to discuss current events! • Read newspaper in airport/plane. • Tell me about yourself? (Difficult ice breaker) • Variant Question: What are your strengths/weaknesses? • Answer: Explain what motivates you and include strengths • What accomplishment are you most proud? • What is the most difficult thing you have done? • Not mentioning family, who are your heroes? • What do you do in your spare time? • Why should I choose you over the other applicants here today?

23. More Common ?s • Where do you see yourself in 10 years? • Describe something unethical that has happened in your career. • Which patients do you find difficult to deal with? • Why do you want to go into this specialty? • Why did you apply to this program? • Tell us about a patient you learned to most from? (BE prepared for a case presentation!) (Competitive- absolutely necessary) • Where else have you interviewed? • Can you think of anything else you would like to add? • Be prepared to discuss common patient complaints/diseases! • Competitive Surg Fields - Do NOT get flustered by Dexterity tests.

24. Illegal ?s….but… • Any questions concerning childbearing! • What are your family plans? • What is your corrected vision? • What medications do you use? • How much EtOH do you drink/wk? • How many days were you sick last year? • Any specific rank order questions! • You may get in a round-about way at social

25. Sample ?sU should ask Faculty • ALWAYS ask Questions- This conveys your interest in the program • DON’T ask obvious questions answered on program website • Faculty: • Strengths/Weaknesses of Program? • Changes do you anticipate in next few years? • What do most of your graduates pursue p/ graduation? • How are the residents evaluated? • How do your graduates perform on the board exam? • Opportunity for research? • Is attendance to national conferences encouraged? • What is the Lecture schedule? • How long have most of the faculty been here? • Is there a Resident run Clinic? If so, is there an attending on staff? • What aspect of the program do residents find most difficult? • Finally, ask for contact information

26. Sample ?s for RESIDENTS • “Social” event greatest source of information • Strengths/Weaknesses of the Program • Call Schedule, who is my backup? Is there initial buddy Call? • What is the patient load? • What attracted you to the program? • Would you come here again? • Do the residents get together outside of work? How often? • How are the lecture series? • Do you feel the program prepares you for the boards? • Any initial lecture series/ training? • Fellows helpful? Do they teach? Do they share cases? • Local Housing? • Specialty Exposure? • Equipment provided (Books, surgical tools i.e. Loupes) • How much time off do you have? • What is the relationship between faculty and residents?

27. Post Interview • Take brief notes about each program immediately! • Try to Rank programs as you go – go with GUT • Send Thank You Note/Email within a few days. • Thank ALL faculty with ONE letter to Program Director • 2nd look Interview – you schedule with program personally • Allows you to further narrow down your top 3. • Common among certain specialties • Do not expect to be with program director (i.e. no re-interview) • Email follow-up questions

28. Questions you need to ANSWER • Will this Residency Program provide me with strong training? • Does this program offer an environment that will allow me to reach my full potential? • How did I FEEL when I visited the program? • Will I feel comfortable at this program? • Will I enjoy working with the faculty/staff there? • Could I live and work in this city for the next several years? • Can I see myself walking in the front door everyday? • The ONE SENTENCE summation for “your person” of each program

29. The Rank List • National Resident Match Program (NRMP) • Register on-site before December (discount price) • Certify Your List (Green) – Confirmation Email • Can “Re-certify” list over & over until deadline. • SF Match – PDF form fill in, submit electronically • Confirmation Email • In general, try to rank at least the “magic number” for your speciality, but definitely anywhere you’d be willing to go and NOT anywhere you wouldn’t be willing to go • Do NOT Rank a program highly because they told you they would rank you High! (This WILL happen. Emotional Manipulation!) • It is to the PROGRAM’s advantage to get you to move them up your list but not yours!

30. How the Match Works • Just rank IN ORDER OF YOUR PREFERENCE! (Gut + envelope test) • System starts with YOUR number #1 program – as long as the program ranked you, you go there… • The program’s list is used as a tie breaker between 2 students that both have Program X ranked #1. • The un-matched student goes to 2nd choice, process repeats as if that school is their #1 • Summary: There is NO reason to not Rank a competitive program as #1, if you do not match there it is as if that program was never on your list • DO NOT ALLOW programs to take the advantage you have by succumbing to their blackmail! • NRMP: http://www.nrmp.org/res_match/about_res/algorithms.html

31. Errors • Creating too Short a Rank list including the dreaded “suicide match” • Ranking a program you have serious doubts about • You are committing yourself if you rank them! • Ranking programs based on where you think you will be ranked • You will only match to the program you want if you put it at the top of your list!!!! • “Believing your own press” from programs • Interviewing/Ranking only top programs • Listening too much to everyone else – use YOUR criteria

32. Match! • NRMP: middle of March • “IF” Match announced via email / Web on Monday of match week • Do find out prelim/transitional/categorical status • List of un-filled programs posted Tuesday at Noon….scramble…details on ERAS site • “Where” announced at noon at Match Day ceremony, posted/emailed at 1pm ET. • SF/AUA Match: Occurs in middle of January • Disclosed to you & program on same date

33. Off you go… ?s and Small Groups! GOOD LUCK!!