Obtaining the Residency of Your Choice Residency & Match Must Knows

1. Obtaining the Residency of Your ChoiceResidency & Match Must Knows • FRIEDA • ERAS • Letters of Recommendation • MSPE (Dean’s Letter) • Personal Statements • CV • Interviewing • NRMP • SF Match • Military Match • Supplemental Offer & Acceptance Program (SOAP) • Office of Student & Affairs and Admissions • June 2013

2. Housekeeping announcements • 2- step PPD now required • Recommend you have the 2-step even if your most recent PPD is less than 12 months old. If required by a site and you don’t have it, you will miss clinical time. • Provide documentation to Student Affairs for upload to New Innovations • Absence requests • Same policies as MS-3. These are NOT “personal days” to take • Request 30 days in advance of rotation • Max two (2) excused absences in 4 wks to get credit. • May 19-22, 2014 • Be available! Not vacation time. • Briefings about transition to residency, program-specific and general. Some Student Affairs activities.

3. Year 4 schedule • SIE requirements: • Include grid with work week hours • Note Block # and calendar dates • Faculty aren’t yet thinking Blocks; use dates • Elective totals: • Max 6 two-week electives • Max 4 “away” rotations (XML+SIE) • Max 3 XML /Max 3 SIE • Max 4 in one department • Max 1 longitudinal elective

4. Your Task/Challenge • Research programs through ACGME or FREIDA websites • Complete ERAS • Develop CV and Personal Statement • Request letters of recommendation (LoRs) • Review Medical Student Performance Evaluation (Dean’s letter) • Interview • Register for match(es) • Submit rank list(s) • Avoid SOAP at all costs • Step 2 CK & CS to Pass… • YIKES!!!

5. I NEED HELP!! • It’s normal to feel stressed • Applying to med school you had 135 choices; for residency you have 3,000 plus…that’s how many specialty programs there are • Seem daunting?choices, choices, choices! • You’ve not been there before…it’s OK to be overwhelmed…today you’ll learn what, when, and how to do it

6. Timeline • Jul… start ERAS; start FREIDA, register for SF match, complete CV • meet with advisor (CV, Letters of recommendation (LoR), type of residency, etc), request LoR’s • Aug…finish ERAS; go to website for your MSPE, list activities, review it in Student Affairs; submit military rank list • Sep…certify (send) ERAS application; don’t wait for LoR; begin interviewing • Oct 1st…MSPE is sent • Dec…submit SF & Urology Match rank order lists, Joint Services GME Selection Board (military) releases results • Jan…SF & Urology match results released; submit NRMP rank order list • Mar…SOAP (Supplemental Offer & Acceptance Program) & Match Day Will not be sent unless viewed by you

7. USMLE Step 2 Clinical Knowledge (CK) & Clinical Skills (CS) • Must Pass Step 2 CK & CS to graduate & receive diploma • You may not begin residency without your diploma • CS slots fill quickly & scores take longer than CK scores to be reported; therefore… • register by Mid Sep • prepare for exam. Students have failed; it will be similar to your OSCE • schedule/take it by Dec 31st so your score is available to programs prior to NRMP rank order list mid Feb deadline • No passing score on Step 2 CS? Highly likely that programs will not rank you • SA deadline for 2 CS is end of Jan; for 2 CK – end of Feb.

8. Careers in Medicine • Helpful for students who’ve not picked a specialty • AMCAS ID required to access CIM • To avoid switching residencies after med school… • put time & effort into expLoRing your choice • be thoughtful • understand self…likes, dislikes, preferences • collect info on multiple specialties • talk to others…advisors, faculty, students, family • “try-out” specialties…shadow

9. Medicare Payments for Graduate Medical EducationInitial Residency Period (IRP)What Every Student Needs to Know • The Feds want to pay for you to train in 1 specialty only, therefore, your Initial Residency Period (IRP)…determines how much Medicare reimburses the hospital on your behalf forever… • Example…Let’s say after 1 year in Family Med, you switch to OB…(1yr + 4yrs=5yrs) in the 2nd & 3rd years, the hospital will receive 100% reimbursement, in the 4th & 5th years, only 50%...OUCH☹☹☹☹ • IRP… designed by the Feds to discourage hospitals from training you in >1 specialty

10. ACGME Accredited Programs - searchable website - • Go to: http://www.acgme.org/adspublic/ • Has info on every accredited residency, fellowship program • Similar to FREIDA, can search by specialty & geographic area • An “apples to apples” comparison of program details • Contact info for program director and coordinator • Details about number of positions, how many filled, training sites • Link to program’s own website • double WOW them by knowing what they don’t want you to

11. ACGME website Search results for: “Internal medicine” “Wisconsin” Yielded 5 programs: Shows cities “View details” for each Sponsoring institution If any fellowships there When last accredited Slots per year Sites residents train at

12. FREIDA Fellowship & Residency Electronic Interactive Data Access • Go to: www.ama-assn.org • Has comprehensive info on all 3000 plus training programs • Can search by specialty & geographic area • Has all the info you will need on each program, download it, read it over the night before your interview… • you’ll WOW them by looking informed and prepared

13. ERAS…Electronic Residency Application Service MyERAS…Your App • Go to: www.aamc.org • Web-based, 1 application, user friendly • Your token ID will be sent via email on July 1st • For $92, students can apply to 10 programs under the same speciality. Additional fees for additional programs. USMLE Transcript Fee: $70 assessed once per season. • MyERAS includes… • application • MSPE & letters of rec • BSOM transcript • AAMC ID number…provided by ERAS immediately upon registering token…needed for couples match • color photo…we’ll use your official BSOM photo or you may provide your own (no later than July 31)…call WSU Photography, @ 775-4968, 013 Dunbar library…they’ll charge $20 for 30 minutes…send digital copy to som_eras@wright.edu as email attachment

14. Curriculum Vita & Personal Statement • CV…same as resume • used for requesting letters of recommendation • Personal Statement…important in helping programs to assess your character, convictions, beliefs, compassion, professionalism, if you’ll fit in as team member & what you’ll do after residency • may have up to 5 (for different specialties have different points) • you’ll assign them to programs • avoid saying how much you like the specialty, the reader assumes this. • DON’T just spell check. Read through it yourself and ask others to review for you! see examples at Careers in Medicine

15. Letters of Recommendation • Words to use when asking… “Dr. Smith, Do you feel you know me and my work well enough to write a strong letter of recommendation for me?” • Consider… • one from BSOM chair (expected) & two from preceptors • 3 from preceptors is OK • Some programs will accept or require a 4th • In MyERAS, list author & print out request cover sheet, sign & waive right to see letter, fill-in location to send letter… reccomended

16. Getting LoRs to ERAS • DIRECT UPLOAD!! Authors of LoRs may upload directly to ERAS • Email: som_eras@wright.edu • U.S. Mail: SOM ERAS, Boonshoft SOM, Student Affairs, P.O. Box 1751, Dayton, OH 45401 • Campus mail: ERAS, BSOM Student Affairs, 190 White Hall recommended

17. Medical Student Performance Evaluation (Dean’s Letter) & Transcript • Go to New Innovations/RMS…complete Request for Medical Student Performance Evaluation…although not required by school, virtually all programs require it • Review MSPE for accuracy & approve…you’ll receive email from Ms. Joyce Baver…you may not revise evaluative statements • The MSPE (if approved by you) & transcript will be uploaded to ERAS by School & transmitted on Oct 1st by AAMC rule…requests received on or before Aug 25th will be ready by Oct 1st • For non-ERAS programs, provide Ms. Baver with list of program addresses for sending MSPE & transcript

18. When You Interview, Be Able to Explain Our Transcript Quintiles Transcript Legend For each course/rotation, the class is rank- ordered by final Percent score, if available, and divided into five quintiles. The first quintile is the top one-fifth of students, and the fifth quintile, the bottom one-fifth.

19. Letters of Rec ERAS Cover Sheet Listing Authors • On the MyERAS letter of rec cover sheet… • The author appears as listed by you • You’ll print-out cover sheet, sign to waive right to see letter & fill in mailing address from earlier slide • Give cover sheet to the author, she/he needs it to send with letter • Two proper ways to list authors… • John Donnelly, MD or • Dr. John Donnelly • do not say Dr. John Donnelly, MD (redundant)

20. Letters of Recommendation Process • Schedule appointment to make request early, give packet to author, it serves as a reminder of what she/he will do… • ERAS cover sheet • CV • Personal Statement • List of programs you’ll apply to • Generic letters work best if applying to multiple specialties (they do not specify a specialty), otherwise request specialty-specific letters • For SF & Urology Matches, send directly to them • A thoughtful touch for voluntary faculty…provide preaddressed & stamped envelopes to make it easier for those without campus mail • 3-4 weeks after request, send thank you note to author, it will serve as gentle reminder…guilt is a powerful motivator Packet

21. When it’s all said and done…don’t find yourself saying…Woulda, Coulda, Shoulda • Apply to enough programs, 10-30 • Know the qualifications of matched & unmatched applicants • …Which are you more like? • Know if you’re at-risk of not matching • NEED TO TALK with your faculty advisor / mentor if a potential • Have safety (back-up) specialty if at-risk • Certify (send) MyERAS early…Aug 1st • If you don’t match at first, SOAP is your next option.

22. Applying Strategy • Be Aware….. • many specialties have more applicants than positions… • plastic surg 1.9 • derm 1.7 • surg, neurosurg, psych & IM 1.5 • ortho, oto, path, & rad 1.4 • PM&R, OB-GYN, anesth 1.3 • consider…class rank, AOA, GPA (yours is %), USMLE scores, research, publications, volunteer & work experiences • check…Charting Outcomes in the Match…view at www.nrmp.org

23. Interviewing • Interviews are by invitation… • the season begins September & ends January • you’re expected to use RIB time • time off should be requested well in advance… • You are not entitled to miss time from a rotation • You must be granted permission by elective/course director & preceptor • Limited to 2 days/4-week block…donot exceed (may lose credit ☹) • might receive email or phone invite • may or may not be given choice of day • It may be easier to be off in the last half of month after you’ve shown preceptors how hard you work • Schedule interviews for your 1st choice program(s) in middle of the interview season… that’s when you’ll make the best impression

24. Interviewing • Best advice…be yourself • Practice… • Research their program and have 4-5 questions ready • Be prepared to discuss… • your favorite book/movie from last year • your heroes & mentors • an interesting patient • your willingness to work & fit in • what you believe in…your values, beliefs, convictions & passions • what you’ll do after residency • Keep post interview notes & construct your rank list as you go • Ignore promises to rank you high… • put zero trust in what they promise you • 2nd visit might be possibility. Recently many have cut back, might be good strategy if you have early interview & want to be remembered. Will be at own expense.

25. Stay in a Host Home @ No Cost☺ • Apply on line & get more info… • 1. the AMA Physician In-training Host program • http://www.amaalliance.org/site/epage/41976_625.htm • 2. the BSOM Bed & Breakfast Program • http://www.med.wright.edu/alumni/bedboard.html

26. National Residency Matching Program • Go to: www.aamc.org • Enrollment is web-based. Registration begins Sept 15th • You’ll submit rank list & get result via the web • Most students will enroll… the NRMP is a back-up for • SF PGY-2 Match students • Urology Match students • Military Match students…IF released for civilian residency • Enroll only if available to begin residency on July 1st… • by Match rule…off-cycle students may not go through Match☹ • rather you’ll learn about mid-year vacancies thru FindAResident… • https://www.aamc.org/students/residents/findaresident

27. NRMP • Fee is $60 (Sept 15-Nov 30), pay by credit card or check. Late fee of $50 added after Nov 30. • individuals may rank 20 programs ($30/program for each program over 20) • couples may rank 30 programs (additional couples’ fee) • Use your AAMC ID and password for • Couples (married/unmarried) may go through as a pair… • for students who need to match in same location • You’ll provide your partner’s AAMC ID number when registering & submitting your couples rank list

28. NRMP Couples Rank Order List • A rank is a pair of choices… • Student AStudent B 1.FP WSU Dayton Ortho WSU Dayton 2. EM Mt. Carmel, Columbus Ortho OSU, Columbus 3. FP U. of MI, Ann Arbor Ortho, U. of MI, Ann Arbor 4. FP WSU Dayton Ortho, U. of Cincinnati 5. No selection (unmatched) Ortho U. of Chicago • 6. FP U of N Carolina Gen Surg, U of N Carolina Note Safety Specialty

29. NRMP Timeline • Sept 15…registration opens • Nov 30…registration deadline, avoid $50 late fee☹ • Jan 15…rank order list entry begins • Feb 26…rank order list entry deadline • Mar 17-21…Match Week Schedule • Monday…you’ll log in to the NRMP site at noon, it will say… “you’re matched☺” or “you’re unmatched☹” • 12:00 PM…Unfilled positions on Web…ERAS begins sending apps • Tuesday…Programs may begin entering their SOAP preference lists • Wednesday…11:55 AM Programs finalize first round SOAP preference lists. SOAP offers begin at 12 PM • Thursday…SOAP offers conclude at 5 PM • Friday at noon…Match Day Ceremony…families welcome…your location & program are announced. SOAP Supplemental Offer & Acceptance Program New for 2012

30. NRMP Strategy • 3 Types of Positions Offered… • Categorical(C) most students want this, a multiyear position, train straight through and qualify for board certification • Advanced (S) a Post Graduate Year-2 (PGY) position for entry in 2015, when entering NRMP rank list, the computer prompts you to pair this up with a preceding PGY-1 2014 position • Preliminary (P) 1-year positions…usually in medicine & surgery, provide prerequisite training for Advanced (S) programs • To use NRMP to your advantage…rank programs in descending order according preference & desirability • Only rank programs where you interviewed & are willing to go… • Once matched, you are contractually/legally obligated to go to that program

31. NRMP Strategy…the New Reality • Reality in Match 2012 and years prior: On average, 3-6 students fail to match to a PGY-1 or PGY-2 position or both, rarely do they not get a position in the SOAP (Supplemental Offer & Acceptance Program). • Reality in Match 2013: 1097 seniors of U.S. Allopathic Medical Schools st did not match (6.2% of active applicants). 93.7% of U.S. allopathic seniors were matched to PGY-1 positions in Match 2013, within the historical 92-95% matched rate. • Note where students have matched in past…programs like to keep the BSOM pipeline flowing…for match results of last 5 years see • http://www.med.wright.edu/admiss/match/index.html

32. Match Fill Rates • Specialties with at least 10 positions in Match 2013 and 100% fill rate: • Medicine-Emergency Medicine • Pediatrics-Primary • Ped/Psych/Child Psych • Physical Medicine & Rehabilitation (PGY-1) • Plastic Surgery (PGY-2) • Psychiatry-Family Medicine • Radiation Oncology (PGY-1) • Thoracic Surgery • Specialties with at least 10 positions in Match 2013 and filled more than 90% by U.S. Seniors: • Psychiatry-Family Medicine: 100% • Plastic Surgery (Integrated) (PGY-1): 95.7% • Otolaryngology: 93.1% • Neurological Surgery: 91.8% • Orthopaedic Surgery: 91.8% • Plastic Surgery (PGY-2): 90.9%

33. What does this mean??? • Plan, don’t panic. • Talk to people who know how it works. • My Dad’s advice: Dream Big. My Mom’s advice: Someone has to pay the bills. My advice: Dream Big and Be Smart. • Have a back up plan if you are interested in a competitive specialty/competitive program. • Take CK and CS early. • Register as soon as you can. Don’t delay on any deadlines. You don’t want to play catch up.

34. San Francisco Advanced PGY-2 Specialty Match • For second year positions beginning in July, 2015 • Go to: www.sfmatch.org • For positions in • Neurotology • Ophthalmology • Plastic Surgery • For Plastic Surg, there are PGY-1 and/or 2 spots offered through the regular NRMP match as well…it’s confusing.

35. San Francisco PGY-2 Match…the Low Tech Match • Submit… • application • undergrad college transcripts • medical school transcript & MSPE • USMLE scores (request/purchase from NBME) • 3-4 letters of rec • your list of programs • SF Match mails your application to programs • Costs about from $50-$160 for up to 10 programs, addt’l programs are extra

36. San Francisco PGY-2 Match • Application deadlines based on the programs. • Check their website for specifics. • Jan… results released prior to regular NRMP rank order list deadline in event you don’t get a spot • If successful… • you’ll apply for a 2014 PGY-1 position through the regular NRMP • this will precede your PGY-2 spot for 2015 • If unsuccessful… you’ll go through the regular NRMP • Please feel free to see me, your Advisor, or Drs. LeRoy & Watt to discuss strategy…It can be a little complicated, they’ve been there, done that

37. Urology Match • The only specialty with their own match • Most Urology programs use ERAS • An early match like the SF PGY-2 match • Go to www.urologymatch.com for info & to register on-line • Aug…register • Jan…get results • If unsuccessful, you’ll go through NRMP, provided you registered • If successful, you may… • go through the NRMP as a formality for a PGY-1 Surgery-P spot at same institution, or • go through the NRMP for a PGY-1 Surgery-P spot elsewhere

38. Military Scholarship Students • Military branches have a selection/match process • see http://www.militarygme.org • handled by Joint Service Graduate Medical Education Selection Board • Army & Navy programs use ERAS, Air Force has own system • MUST also apply through ERAS for possible deferment to NRMP • You’ll apply early (Summer) & find out in mid-December • Your MSPE will be sent on October 1st according to AAMC rule, sorry no exceptions • If given a deferment to do a civilian residency, you'll continue in NRMP for the March match. Remember Nov 30thdeadline • Dr Tous says HPSP students should talk with him to review process • Commissioning ceremony is the morning of graduation, 23 May 14!

39. Supplemental Offer & Acceptance Program (SOAP) • Monday, March 17, at noon • Something you can avoid with planning & smart work, it’s… • highpressure/stress…something you prefer to avoid • Typically, the profile of an unmatched student… • there is a mismatch between program/specialty & the student’s credentials/qualifications --or-- • the student applied to only unrealistic dream programs/specialties --or— • the student limited the geographic area. • If applying to dream/competitive specialty and at-risk… • You must have a safety (back-up) specialty…be discreet. • programs do not get this from NRMP • Don’t apply to different specialties/programs at same hospital… program directors may find out via grapevine…to programs this looks like specialty indecision…programs are looking for reasons to rank you low

40. Supplemental Offer & Acceptance Program (SOAP)…the New Reality • You can SOAP from Student Affairs or from your home • Everything is computerized. • The source of stress… • The typical unmatched student will changes specialties between • 12:00 Noon & 2:00 PM on Monday & typically, get a 1-year spot… -- categorical spots in one’s preferred specialty will be more difficult to get • Match Day, Friday, March 21 at noon • All students (including successful SOAPers) get an envelope. • SOAPers are treated the same as matched students. • No one knows you participated in SOAP unless you tell them.