Getting into your Dream Residency

1. Getting into your Dream Residency Billy Terrell MS-4 3/02/09

2. Goals for YOU -- the MS3 • Develop knowledge and skills to be a great Clinician • Perform AWESOME your 3rd year • Get into your dream Residency Program • Go to where you’ll be the happiest, best for your career. • Have average to high average GPA and Step Scores • Have an attractive application • Have letters that are truly personal • Be genuine

3. Start Now • Do NOT procrastinate • Start Career planning NOW, begin work on application in late Spring. • Your Application takes weeks of solid work to assemble • Personal Statement – 2 weeks • Letters of Recommendation - could take a month or more • Compiling Extracurricular activities • Research • Community Service • Medical School Sponsored Activities • Hobbies (be genuine)

4. Choose your specialty • Yes, it is hard! Requires soul searching and realistic appraisal of yourself. • 3rd year rotations • Interested in the common patient complaint? • Does your personality fit? • Patient population • Clinician, Clinician-Surgeon, Academia • Lifestyle • Iserson’s Getting Into a Residency (copies in library) • **NRMP Charting Outcomes in the Match • http://www.nrmp.org/data/chartingoutcomes2007.pdf

5. Away Rotations • Gain exposure to complicated scenarios. • Get to know inner workings of the program. • Allow the faculty to evaluate you. • Get to know the city. • Can really make/break interview experience. • Get Letters of Recommendation from faculty. • Visiting Student Application Service (VSAS) • http://www.aamc.org/programs/vsas/students/start.htm • Other Institutions – Apply through Med school Website

6. Mentor • Guide you to away rotations. • Help guide/review your personal statement. • Write you an awesome letter of recommendation. • Develop contacts for you in the field. • This is VITAL! • Ask MS-4s going into field! Learn from us! • Find out which faculty are connected.

7. Applying • Decide on a general geographic area. • Apply to all schools in that area. • Use ERAS Program List (includes program website links) • https://services.aamc.org/eras/erasstats/par/index.cfm • Schools are viewed on arbitrary Tiers. • Apply based on your qualifications • Ex: Apply to a few top Tier, many middle, and a few low tier. • If needed, apply to institutions in a “backup” field. • Consider especially for high competitive fields. • Use NRMP Charting Outcomes.pdf to know if your field is competitive. • Double the work!

8. What makes a good program • Ask Faculty who went there! • Expect some Bias • See Linda Holmes for list of graduates in a specialty. • Ask MS-4s going into that specialty! • Freida • Specialty Training Statistics • StudentDoctor.net • http://forums.studentdoctor.net/ • US News Best Hospitals • http://health.usnews.com/sections/health/best-hospitals

9. Residency Positions • Categorical: Resident enters a program with the objective to complete the entire program. Length varies with specialty. • Preliminary: Positions for residents who have already been accepted into another specialty, but who are completing pre-requisites for that specialty. • Transitional: 1st year of residency designed to provide a program of multiple clinical disciplines. Typically used to fulfill pre-requisite for a specialty. • Fellow: Post residency sub-specialty training.

10. ERASTransmits Your Application to Residency Programs • 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. • Type ALL sections in Word then copy/paste into form boxes. • 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. • Receiving interview notification via this website Message tab and email. • Fee: 60$ for 10 schools, 8$/school 11-20.

11. ERAS Timeline • July 1st – Application website Opens • September – Applicants may begin applying. • Send Karen Bledsoe a digital photo of yourself. • Acquire transcripts from undergrad / med school. • Interviews – Begin in November, continue through January • November 1st – Dean’s Letters (MSPEs) are released to programs. ERAS automatically distributes this. • 2nd Look opportunity– December, January • NRMP: • January/February – Programs assimilate RANK lists • Mid February – Rank lists due

12. NRMPMatches You to your Dream Residency • Provides a uniform date of appointment to Residency. • Provides uniform rules for appointment. • Historically, recruitment occurred even as a MS-2! • Applicant’s / Program Rank lists compared via computer algorithm . • Applicant Registration Fee: 40$ (2009) • 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!

13. San Francisco MatchThe “Early” Match • http://www.sfmatch.org • 3 Specialties Participate via SF Match • Ophthalmology • Plastic Surgery (However most participate in ERAS instead) • Child Neurology • 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

14. SF Timeline • June 1st – Application Process open • August 1st – Few school deadlines (Mayo, Bascom Palmer) • September 1st – Application Deadline • Interview Offers start – End of September, all by mid October. • Rank List Due – early January • Match – mid January

15. The Urology Match • Hosted by the American Urological Association • 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) • Timeline: • Rank list submission: Beginning of January • Match: End of January

16. Medical Student Performance Evaluation • An assessment of a student’s performance relative to his or her peers throughout the first three years of medical school. • An assessment of the student’s academic performance AND professional attributes. • It is NOT a letter of recommendation. • Standardized format since ~ 2002. • Release date of November 1.

17. How is the MSPE Prepared? • Each student completes a Dean’s Letter Questionnaire to be available on the Student Affairs webpage. • Each student has a meeting with Dr. Veitia in July or August. • Students review their MSPE to correct factual information. • Students cannot revise evaluative statements.

18. The Six Sections of the MSPE • Identifying Information • Unique Characteristics • Academic History (matriculation dates, explanation of gaps in educational program, information about repeats or remediations, information about adverse actions) • Academic Progress • Pre-clinical/ basic science course work • Performance in clinical clerkships (grade, narrative) • Summary • Summative assessment of the student as compared to his or her peers • School-specific categories to differentiate students • Professionalism • Appendices

19. What Residency Directors Want • Be yourself! Impossible to be the perfect applicant. • NRMP Program Director Survey • http://www.nrmp.org/data/programresultsbyspecialty.pdf • Step Scores – Predict performance on Specialty Board Exam. • Characteristics of Ideal Candidates (from MSPE Comments) • Knowledge • Teamwork • Strong Motivation • Working at intern level • Genuine Interest • Patient advocacy • Great communication skills • Owning Problems • Integrity • Honesty • No Personality Issues

20. Letters of Recommendation • Goal: Attain PERSONAL letters that exude what RDs want to see! • Plan and do a rotation with someone. Ask them EARLY in rotation. • Start asking EARLY! • Pick people with contacts. • ASK them if they can write you a great letter. • Do not submit one that you think is lukewarm. • Ask their office staff/MS-4s if they are quick on getting letters out. (this can be important). • Typically one is from the dept. Chair of the field of interest. • One letter is from a separate but related field. • One is from a physician in your field who knows you well.

21. Personal Statement • Have a faculty member who reads personal statements as part of the residency committee read your final draft. • Depending on specialty – some programs spend 12 minutes per ENTIRE application, 1° care may spend an hour per application. • Take Home Point: You must craft your application to describe your strong points across various sections of the application.

22. Personal Statement Do’s/Don’ts • Do’s • Be honest and Genuine! • Present yourself as a mature professional. • Make it easy to read (excellent flow, flawless grammar). • 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, only negatives that can be positively explained. • Don’ts • Don’t rehash your curriculum vita. • Don’t use quotes. • Don’t waste space (i.e. Why I wanted to become a Dr…).

23. Advice • Be aware of BAD advice! • Talk with program directors here. • They read 100’s of applications every season. • Use people who went to the school of your interest! • Talk with FACULTY in your field of interest • Talk with MS-4s going into that field! • Rule of Thumb: You do not want your personal statement or interview attire to “stand out.” • You want the total package to “stand out.”

24. Something to Remember… • Program Directors or Residents of programs to which you are applying may “Google” you or look you up on Facebook or MySpace. • Clean it up, or keep your profile Private! • Google will find you Blog! • In Summary: Give them nothing other than you application / interview to judge you by.

25. Scheduling Interviews • Significantly better Interviewee with experience • Schedule your dream schools after a “trial run” • Available interview dates • Depend on when you receive interview offer • Depend on competitiveness of program • Respond to interview offers IMMEDIATELY. (24hrs) • Competitive fields are first come first serve for spots. • Re-schedule/ Cancel • Goal: Notify at least 1 wk prior.

26. What to Wear • 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 • Blouse – nothing flashy. • No flashy jewelry – use your judgment on nose piercing. • Natural hair colors only. • Carry black leather folder w/ case presentation, 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 (d’oh). • Photo: Wear your interview attire for photo, mid-chest up. (passport size)

27. Questions to ExpectPart 1 • Research Programs before Interview! • Use Program Website – Read Everything • 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. • Be prepared to discuss current events! • Read Wall Street Journal 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?

28. Questions to ExpectPart 2 • What do you do in your spare time? • Why should I choose you over the other applicants here today? • 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 Field - Do NOT get flustered by Dexterity tests.

29. Questions to ASK Faculty • ALWAYS ask Questions- This conveys your interest in the program • 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? • Local VA Hospital? Location of all clinic sites? • 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 (for p/interview)

30. Questions to ASK Residents • Residents: • 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?

31. Illegal Questions • Any questions concerning childbearing! • What are your family plans? – “Answer that you plan to have children at the end of your residency. My training comes first.” • 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!

32. Post Interview • Write down info about each program immediately! • Try to Rank programs as you go. • Send Thank You Note/Email within a few days. • Thank ALL faculty with ONE letter to Program Director • 2nd look Interview – scheduled 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 Residents p/ interview with new questions/criteria as you mature along the trail.

33. Writing the Thank-you Note • Thank the PD (obviously) for the opportunity • Be Flattering • Ask the PD to thank the other faculty for you • Convey your interest in the program • List specific factors (their strong points) • State your specific reasons for wanting to be at that program • Re-iterate your strong points • Why you are a better choice over other applicants! • Be concise!

34. 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?

35. Making your Rank List • National Resident Match Program (NRMP) • http://www.nrmp.org/ • Both Residency and Fellowship Match • Register on-site before December (discount price) • Certify Your List (Green) –Confirmation Email • SF Match – PDF form fill in, submit electronically • Confirmation Email • In general, Rank at least 6 schools • Use whatever criteria you feel is important • Always trust your gut feeling! • Do NOT Rank a program because they told you they would rank you High!

36. How the Rank Works • NRMP: http://www.nrmp.org/res_match/about_res/algorithms.html • It is not that complicated. Just Rank IN ORDER OF YOUR PREFERENCE! • Basically, the system is in your favor if you rank a program 1! • A program’s Rank list is used as a tie breaker between 2 students that 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!

37. Common Errors Made • Not giving enough thought to your Rank List • Creating too Short a Rank list • Ranking a program you have serious doubts about • You are committing yourself if you rank them! • Ranking programs based on where you will get accepted. • You will only match to the program you want if you put it at the top of your list!!!! • Do NOT reciprocate because a program told you they would Rank you High.

38. Criteria I used to Vet ProgramsI Literally had all categories on a spreadsheet • Gut Feeling • Interview • Geographic Location • Faculty Size • Specialty Exposure • Fellows • Resident Clinic • Clinic Locations (1 site) • Local Housing • Facilities (New) • Happy Residents • Call • Didactics • Family factors • Equipment provided

39. Match! • NRMP: Occurs in middle of March • NRMP: Outcome announced via email / Web on Monday • Informed of un-match status same day. • List of un-filled programs posted Tuesday at Noon. • NRMP Results: Disclosed at Match Day, posted NRMP website at 1pm ET. • SF Match: Occurs in middle of January • SF Match: Disclosed on Match date to you and residency program.

40. Avoid the Scramble! • The “scramble” for unfilled positions occurs p/ Match. • Scramble version of ERAS available on Tuesday of Match Week. • This is not your opportunity to get into a competitive specialty. • 2,000 US Graduates PLUS 7,000 FMGs use the scramble • **Factors that often lead to Scramble: • Poor candidate interviews • Did not Rank enough Institutions • Revise your application • Alter Personal Statement if needed, Update CV to present. • Application Document Tracking – same as traditional ERAS.

41. But if you Scramble… • http://www.aamc.org/students/eras/info_scramble/start.htm • Process lasts 2 Days • Tuesday Noon- NRMP Dynamic List available • Use program ID code to search for program on ERAS. • During Scramble, you can apply to a maximum of 30 new programs and 15 programs to which you’ve already applied free of charge via ERAS Scramble edition. • Have all App Documents Ready to Fax to non-ERAS programs. • http://www.efax.com • Contact Program Directors DIRECTLY! There will be a phone Interview. • Some programs will accept you on phone, others wait. • Find A Resident Service (Post-Match AAMC Service) • http://www.aamc.org/students/findaresident/ • For unsuccessful Match via NRMP and Scramble

42. Good Luck! • Know this! Programs are as terrified as you are! They want you to like them! • You determine your success in the Match. • Take Initiative, this is your future career! • Medical School was just a stepping stone. • The Odds are in your favor! • Around 95% Match in their preferred specialty! • PLEASE fill out the Survey!