How Should I Rank Residency Choices for the Match?

[IMG SURVIVOR]

THIS IS NOT IMG SURVIVOR

Associate Attending Physician, Department of Emergency Medicine New York, NY

The other day I was interviewing an applicant for a position in our residency program. She told me, "I think that I know who I want to rank at the top of my list." (This program, of course!). "It's the middle of my list that I'm having trouble with. Do you have any suggestions?"


It's that time of year. All of you fourth-year medical students are wrapping up or have completed your interview journey. You may have traveled all over the country. You certainly spent a small fortune for airfare and hotels. Hopefully you accumulated some frequent-flier miles in the process. You also likely have sat through 10-15 sessions describing programs, listened to residency directors try to convince you that their program is the best, and had one too many "night before" social events with the residents in each program.


So how do you make your list? Is it clear to you which program should be first? Is it less clear to you, like my medical student, what to do with the middle of your list?
The most important thing for you to take home from this process is that your rank list should be truly that. You should rank programs in the order in which you would like to match. Many people believe that there is a way to outsmart the algorithm. Or maybe one program has given you feedback that makes you think they really want you. At the end of the day, you are dealing with perhaps the most formidable time in your development as a physician, and you should go where you want to be. So the list should be your own. It should not be the order that your dean or faculty advisor says it should be (they have their own interests in mind as well) but the rank order that would make you most happy.


There are a number of factors to consider as you think about each program. The first and foremost is something that cannot be determined by a formula or list of pros and cons. The question is, Can you see yourself as a resident in that program? As you have gone through the process, you likely spent a day somewhere where you thought there was no way you would fit in. Additionally, there were likely others that left you almost giddy with the feeling that it would be a perfect fit. I still recall the chairman of the program where I trained meeting with us on the interview day. He casually spoke about a gut feeling of whether or not the glove fits. There is something important about your gut. Frankly, it is something that will get you through many difficult decisions in medicine, and choosing a residency is certainly one of those.


Certain criteria should always be considered when evaluating a residency program: patient population, tertiary care exposure, clinic experience for the specialties with outpatient components, resident independence in regard to decision-making, electives, and where graduates go for fellowships or jobs.


Other criteria that should play a role in your decision-making include:

Location. This is not insignificant. There are many glamorous cities in the country, but not every city is made for every person. Do you know anyone in the city that you are considering? Will you have any kind of support system outside of the hospital? You will immediately establish lifelong friendships during residency, and there is something exciting about starting over in a new place. But everyone has a different personality, and some people find it easier if a network already exists during a very challenging time.


Housing and salary. Is housing provided? If not, will the program's salary allow you to rent an apartment and still have money left over for your usual expenses? (See our previous columns on the accrual of credit card debt and how this should be avoided at all costs!)


Are the residents happy? You will hear rumors along the interview trail. Pay attention. Obviously, rumors are rumors, but hearing that residents in a particular program are very happy is an important piece of information.


Do you know any graduates from your medical school who are there? We all have a loyalty to our school. We want the best for students from our school. Often, these residents will be fantastic resources as you try to get real, honest information.



What is the academic vigor of the program? If you have a long-term goal related to academics, you want a program that will help foster that. If faculty members are not doing research and publishing, it may be more difficult for you to find a mentor. What are the daily or weekly conferences like? What are the academic requirements of the residents?


Teaching environment. With shorter work hours and increased patient volumes affecting all programs, many residents feel that the clinical teaching suffers. Ask about bedside teaching. The accrediting agency mandates a core content of lectures and conferences, but it is really the day-to-day operations that help you develop your clinical skills. You may best experience this with a second look. Show up on a noninterview day. See how the residents interact with each other and their attending staff.
Finally, I'll share some advice that I got from my med school dean. He told us to put Post-It notes around our apartments with each program listed in order. Put them somewhere that you will see every day, preferably multiple times. Believe it or not, that gut will start talking again. Imagine yourself opening the envelope with each program named inside, and likely you will have a different response to each one. Looking at this list and thinking about that feeling may help you tweak the order. It certainly helped me solidify my final list, as I grew more excited about the prospect of my first choice. And remember, the formula should work in favor of you, the student. Don't try to play a game. Do not shorten your list because you think you are guaranteed a spot based on program feedback. Take a phone call or email from a program with a grain of salt. Do what YOU want to do with your list!

[drnane]

Thaks for ur tips.
What if u get only one interview?

[MightyMice]

Thaks for ur tips.
What if u get only one interview?

Well then you only have one place to rank! So now you will have to decide whether you want to come to America and be in that program or stay in your country

[drnane]

Thats the sad part of the process.
Can u tell me whether we can participate in scramble even if u have not applied to the program through eras.

[MightyMice]

Thats the sad part of the process.
Can u tell me whether we can participate in scramble even if u have not applied to the program through eras.

Well if your dream is to practice neurology in America, then you've at least been given one opportunity by the program that decided to interview you, many would kill to be in your position with your board scores, even with your one interview. It might not be in the most desirable place but that's what most of us IMGs/FMGs are going to have to accept.

I believe you can scramble into any program that has not filled all of its spots through the match although I hear the process is a fire-storm at best...if you have to scramble for a prelim make sure it is NOT a surgery prelim as it won't count towards your neurology requirements and in essence you will have wasted a year, good luck

[drnane]

Thanks mightymice for ur words.
i'll be lookin forward to attend the interview.

[soniaa]

Neurology in Korea is english and good i dont know about china

[JbizzleMD]

Hey everyone I had a question I just found out from some internet news source that one of the residency programs that I interviewed at (University of Nevada -Las Vegas, Family Medicine program) might be closing down in the next 3 years due to debt issues with the hospital, the hospital might be closing down. How does this effect me should I take this in consideration...should I still rank the program??? any help would be great

[socialboom1]

There could not be a better reason to help realization of the dream of passionate and resilient young men and women into medical schools/Residency other than to salvage the lives of people. As regards the September 11 2001 attacks on the US when as related by the Times Magazine, Doctors and other health professionals had to work with the crudest instruments to save lives that were fast spilling away.

It's Japan again! Ravaged by Tsunami. Surely Medics in that country must be having some of the most challenging times. In fact emergency cases must be overtaking the number of doctors. Therefore it is a worthwhile vision to make sure that the dreams of many across the globe who have impassioned hearts coupled with talented hands are not aborted when there is utter need all around the globe for personnel who are competent in ophthalmology, ENT, Emergency medicine, Internal medicine, paediatrics, obstetrics and gynecology among fields of medicine are fast increasing all around the globe.

[soniaa]

Hey everyone I had a question I just found out from some internet news source that one of the residency programs that I interviewed at (University of Nevada -Las Vegas, Family Medicine program) might be closing down in the next 3 years due to debt issues with the hospital, the hospital might be closing down. How does this effect me should I take this in consideration...should I still rank the program??? any help would be great

They are opening 4 new FM program in NV