My prior posts gave an introduction to the Match, how to approach interviews, and how to travel for interviews.
Stock Photo from: Pixabay
So where are we in the match?
It’s now mid-November, which I consider to be the mid-point for the Match process. So let’s do a quick evaluation of where you are.
You should have a few interviews under your belt by now and should have a few more between now and mid January-ish. So, now a few questions for you:
Have you been to an interview that “feels right?”
If so, you need to make note of it. This feeling may get lost in the days before rank lists are due and you may inadvertently decide to drop this program down in ranks because it may not have the “paper” stats that the other interviews have.
Try your best to articulate why this particular program “feels right” compared to the others. If another program comes along that “feels right-er” then try to articulate that as well. Leave these post-it notes as “extras” when you start making your rank list.
Have you been on an interview that “feels wrong?”
For the same reasons above, you need to make note of it. While it may have better stats or whatever, if it “feels wrong” to you, you need to remind yourself of this fact.
You also need to decide whether you even want to rank this program. But remember what I said, “would you rather go unmatched than rank this program?” If so, then don’t rank it. Otherwise, you need to rank any and all opportunities that are available to you, especially if your specialty is very competitive or you stats aren’t that competitive.
What about a program is most important to you?
This is heavily dependent on you and your choice of specialty. For example, if you are going into surgery, the number and type of cases you get to see will likely be very important. Additionally, knowing whether you will get any real OR time as an intern is probably also important to you. For others, getting into your choice of fellowship may be important. If you want to do Gastroenterology or Cardiology, which are subspecialties of Internal Medicine, then going to a program with those fellowships will likely be important. Knowledge of how many people per Internal Medicine class get into their subspecialty of choice is likely an important statistic as well.
Whatever is important to you, try to sit down and write a list of these things, in order of importance, and then start giving them a 1-10 rating. This rating may change as you interview at more programs. For example, that 2nd interview you thought was great and you would rank at as 10 in terms of OR time, number and type of cases. However, then you went on interview #6 and that one now has better overall numbers, so you need to make that 10, and 2nd interview drops to a 9 on the 10 point scale.
Have you though about how to rank programs yet?
This will be very person and specialty dependent. However, I think these criteria should probably be on everyone’s rank order list.
This may be important for some, wanting to be near a family or loved one, or in a specific city. However, this may less important or even unimportant for someone who has no particular ties to anywhere and simply wants to get the best experience/education. You may need to subdivide this into “Cost of Living” and “Weather”, etc. depending on you.
Not all programs are made equal. Some programs stack the early years with call and it trails off during the later years (front-loaded program). Others may divide call relatively equally throughout the years. What do you prefer?
As you probably suspected, this section will likely be subdivided into call. How exactly is call? q4 call at two different programs may not be the same at all. For example, if you are q4 overnight at Program 1, but also cross-covering 2 other floors at the same time. That is not the same thing as q4 overnight only covering your floor at Program 2.
Also, how much is the residency salary? Is that good for the area (based on cost of living)? Are there opportunities to moonlight?
How often do you get didactics? Is it a “didactic day” or is it “noon conference” everyday? Which fits you better? Are the conferences primarily resident-run, fellow-run, or is an attending always giving conference? How often is Grand Rounds? Is the opportunity for first author research available? Has any resident ever received a grant before? What fellowships are available?
You can subdivide this into “Didactics”, “OR Time”, “Research”, Preparedness for Real World”, and “Fellowship Opportunities”, etc.
Like it or not, training at a big-name program program may open some doors in the future. For some specialties, this is also pretty important. Any specialty that can open its own practice and requires out-of-pocket pay will have patients who want to “get their money’s worth”.
For example, dermatology and plastic surgery may need to market themselves to get clients. Having a big name institution behind you gives you some degree of prestige starting out. When you apply for your first job, having a big name on your institution could potentially push your application into “interview” pile in a competitive job market, or competitive location.
For some, this may be very important. For others, this may be completely unimportant.
Make no mistake, residency is tough. How do the residents look? Do they seem genuinely happy? At the interviews, try to talk to as many residents as possible. There is usually one or two people who can’t hide their disdain for the program, no matter how hard they try. Those are the people you want to talk to.
Anything else I should do?
Also, if any resident (other than the chief resident(s), who will always offer) offers up their email address to answer any follow-up questions, utilize that opportunity. Send them an email with a few questions you may, but also make sure to include these (or some variation):
“Do you think the residents are happy at your program, and Why?”
“What is the major weakness of the program?”
“What changes would you make to your program?”
How you ask is important here:
I am not asking about this particular resident’s happiness, but that happiness of the residency program as a whole. It then goes on to ask “Why” to allow this person to go into a few details about what they think about the program contributes to resident happiness.
Don’t ask “Does your program have weaknesses?” — that’s an opportunity to say no there aren’t any. I have worded the question such that it implies the program HAS a weakness, and am asking about its MAJOR WEAKNESS. Every program has weaknesses.
I also didn’t ask “Would you make any changes to your program?” — that’s also an opportunity to say “no”. Like above, I have worded the question such that it implies that the resident would change something about their program, and you want to know what that is. Every resident should want to change something about their program. It could be as small as “I wish we more chances to moonlight.” or “I wish we got more OR time as interns.”. No program is perfect. I have also used the plural “changes”, to imply that there is more than one change this resident would make. Hopefully, this pushes them to give a few different changes they would make.
If you want to, you could send the same questions to the chief resident(s) and this resident and then compare their answers. You may learn something you didn’t know about the program.
Anecdotally, I think resident happiness is likely undervalued when people are making their rank lists. This is probably because it is difficult to quantify, especially based on the limited time you will have spent with the residents. However, I think it is probably one of the most important criteria.
Remember those “feels right” and “feels wrong” post-it notes I mentioned above? Those should be posted in this area.
Also, just for fun:
— Senior Resident, MD (@ResidentSensei) November 21, 2016
Time to start thinking about your rank order list.
Don’t forget about what “feels right” or “feels wrong”.
Think about what is important to you, and start developing/refining your own rank list criteria.
Don’t let Evil Kermit win.
Agree? Disagree? Questions, Comments and Suggestions are welcome.
You don’t need to fill out your email address, just write your name or nickname.