Guide to Residency Application and the Match Dwight Davis, M.D.

Specialty Selection Important decision about career direction Appropriate investment in time to get it right Review: motivation, interests, skills, competitiveness, early career goals, Plan B if need Careers in Medicine Components  I Self assessment  II Career exploration  III Decision-making  IV Residency application

Senior Year Responsibilities Complete graduation requirements  Review and track rotation requirements  MSR submission and approval  Pass USMLE Step 2 (CK and CS) early  Maintain academic and non-academic good standing Do well in your remaining clinical rotations ( and AI’s) Make a planning calendar of important activities and deadlines through Match Day

Specialty and Residency Resources  Careers in Medicine Program and specialty web sites  Student specialty interest groups (faculty advisors)  Library reserve (Iserson’s – Getting into a residency)  NRMP references  Clerkship attendings  Residents  Individual program information (internet)  Graduating seniors from match list  Directors of Medical Student Mentorship

Directors of Medical Student Mentorship Program AnesthesiologyCarolyn Barbieri, MD ; DermatologyBryan Anderson, MD ; Emergency MedicineLawrence Kass, MD ; Family & Community MedicineDennis Gingrich, MD ; Internal MedicineTed Bollard, MD ; Medicine/PediatricsRonald Williams, Ob/GynJohn Repke, MD ; OphthalmologyDavid Quillen, MD ; Orthopaedic SurgeryKevin Black, MD ; NeurologyMiland Kothari, MD x283934; NeurosurgeryRobert Harbaugh, MD ; PathologyDani Zander, MD ; PediatricsLaura Murphy, Physical Medicine & RehabilitationStacy Stark, DO ; PsychiatryErika Saunders, MD ; RadiologyJanet Neutze,MD ; Radiation OncologyHeath Mackley, MD ; SurgeryDavid Han, MD ;

Faculty Mentor Support All students should establish a relationship with a Faculty Mentor to assist with the application process Procedure  Meet early to review specialty decision, your background information, and career goals  Copy of transcript  USMLE results  Curriculum vitae (leadership, awards, unique experiences, research, publications, etc.)  Candid discussion about competitiveness for specialty selected, backup plan if appropriate  Critique of personal statement when prepared  Help with appropriate distribution of residency programs

Applications to Highly Competitive Specialties (1)  Critical review of your background credentials  Review profiles of successful applicants  Charting Outcomes in the Match 2009  Frank discussion with faculty mentor about competitiveness  Work closely with faculty mentor throughout process  Take Step 2 early  Acting Internship rotations if possible  Attention to details  Meet all deadlines

Applications to Highly Competitive Specialties (2)  Early submission of application  Apply to large number of programs (wide geographic distribution)  “Reach” programs on list, but adjust number so it is appropriate  Apply broadly to a good number of preliminary programs  Commit yourself to large number of interviews if offered  If few invitations by mid-October, extend list of applications  Discuss if you should apply to second specialty  Second faculty mentor, second set of letters  Programs - ? commitment to specialty  Prepare two application packets  Meet with faculty mentor late October if no interviews

Residency Program Considerations Program evaluation examples NRMP Applicant Survey  Educational structure / clinical responsibilities  Inpatient, outpatient, procedures, OR time  Patient diversity and disease categories  IT infrastructure / electronic charts  Program size / type (acad, comm, clin setting)  Opportunities for teaching and research  Call schedule, rotations at affiliate hospitals  Reputation of program  Placement of graduates (practice / fellowships)  Breath of subspecialty offerings  Assessment of program quality (faculty mentor)

Curriculum Vitae Succinct and accurate chronicle of past experiences (start w/ important college or work experiences) Typical sections  Personal data  Education  Pertinent organizations (indicate leadership)  Pertinent employment  Significant extracurricular experiences  Honors and awards  Research, publications, and formal presentations See references for examples

Personal Statement  Motivation for specialty  Process of specialty decision  Relevant background experiences  How you fit the specialty (interests, skills, etc.)  Unique qualities or talents (modestly)  Career goals if formulated  Avoid quotes  Good grammar and spelling  Critique by faculty mentor  Avoid commercial writing services

Letters of Recommendation  Usually three letters (four in file if manageable)  Faculty in specialty area, clinical faculty who know you well, strong rotations, Chair’s letter (Medicine)  Ask early if faculty can support your application  Work closely with their administrative assistant  Provide the following: Transcript, USMLE scores Curriculum vitae Personal statement  Waive your right to see letters Programs reassured about candid comments

Medical Student Performance Evaluation MSPE - AAMC Structured evaluation of medical school performance Not a document of recommendation Unique Characteristics  Brief academic background, leadership, service, research, and special honors  Significant challenges or hardships Academic history  Matriculation date, LOA breaks  Repeat or remediated coursework  Adverse institutional action

Medical Student Performance Evaluation Academic Progress and Performance  Transcript and narrative summary of overall performance in basic science curriculum  Grades and verbatim comments from all third year clerkships and electives (transcript AI grades) Summary statement “Summative assessment of comparative performance relative to peers”  Superior 5%  Outstanding 25%  Excellent 50%  Very Good 20%

Planning the Senior Year  USMLE Step 2 CK and CS designed to be taken early in the 4 th year (plan dates soon b/o space)  Many programs want the results in making rank order  Helpful for programs if low or modest Step 1 score  Must complete CK and CS exams by Jan. 1 st  Time for repeat if necessary  COM must indicate if graduation in jeopardy  Complete your MSR by early fall  Decide on away specialty/hospital rotations now for July, August, or September  Review vacation time  Anticipate most travel November to late January  Avoid high intensity rotations during travel months

Program Directors Academic Ranking Green et.al., Acad. Med. 84:3, 2009

Average Number of Programs to Consider Based on competitiveness of specialty NRMP Applicant Survey  Review information on 30 programs after you have a priority list  Based on review, consider 25 programs  Formal application to 20 – 25 programs  Interview at programs  Rank most acceptable programs  BUT, rank only programs that are true preferences (no surprises on Match Day)

The Interview  PREPARE  Arrive early  Business attire  Professional  Dress comfortably, including shoes  Know all aspects of your background  Know the program well  Mission, unique features  Have appropriate answer for why you selected the program for interview  Interviewer evaluations  Level of maturity  Thoughtfulness of answers  Interpersonal skills  Commitment to specialty  Enthusiasm

The Interview  Understand the specialty and training process  Think about your future plans  Know your research (short abstract and detailed discussion if asked)  Always have thoughtful questions about program  Understand the rules about offers  Make the point that your decision about specialty was based on a thoughtful process  Be accountable for blemishes in your record  Be Honest

Interview and Follow-up  Obtain a professional appearing photograph  Positive attitude and professional demeanor with all contacts before and during visits  If plans change or travel delayed, contact program immediately  Brief follow-up thank you note  Complete your program assessment and rank after each visit  Match results are binding  Remember, you are a representative of the College of Medicine

Common Reasons for Failure to Match You do not want to participate in the Supplemental Offer and Acceptance process “SOAP”  Unrealistic assessment of competitiveness for specialty  Limited geography for competitive specialties  Professionalism issues  “Odd” personal statement  Rank small number of programs (3 – 4)  Troubling personal qualities conveyed at interview  Little rationale for specialty at interview  Mediocre academic profile and no Step 2 result  Program concern about not being able to graduate

Residency Applicant Pool and U.S. Seniors NRMP 2010 Results and Data

Selected Residency Positions in the 2012 Scramble PGY-1 PositionsUnfilled at Start of Scramble Anesthesiology22 Dermatology0 Emergency Medicine0 Family Medicine149 Internal Medicine (Categorical)51 Neurosurgery2 Obstetrics & Gynecology17 Orthopaedic Surgery0 Otolaryngology2 Pediatrics32 Plastic Surgery4 Surgery (Categorical)3

Useful References 1. Roadmap to Residency (30 pages, a must read first, Student Affairs web site) 2. Charting Outcomes of the Match (SA site) 3. Iserson’s Getting Into A Residency, 7 th edition (review the table of contents, library reserve) 4. NRMP Results and Data Book (Google) 5. Fellowship & Residency Electronic Interactive Database (Freida online) 6. Penn State specialty match list for last six years (SA site) 7. Medical Student Performance Evaluation Guide (SA site)

Charting Outcomes of the Match Read carefully and note limitations  Match success rate by specialty  Range of USMLE Step 1 scores by specialty  Programs ranked by matched and unmatched students  Percent AOA students ranking specialty  Percent participating in research  Percent with one publication ranking specialty  Graphs of individual specialties  Missing data: grades, Letters of support, personal statement, experiences, interview, etc.

Student Affairs Residency Match Chart 2010 AnesthesiologyNYU School of Medicine 2009 AnesthesiologyNY Presbyterian Hosp-Weill Cornell Med Ctr 2011AnesthesiologyNYP Hosp-Columbia University Med Ctr AnesthesiologyOregon Health and Science Univ AnesthesiologySAUSHEC - Lackland AFB 2011AnesthesiologySt. Luke's-Roosevelt-NY 2011DermatologyUniversity of Florida CoM-Shands Hosp 2010 DermatologyUniversity of Michigan Hospitals 2011DermatologyUniversity of Tennessee CoM-Memphis 2007 DermatologyUVM/Fletcher Allen 2011Emergency MedicineCase Western/Metro Health Med Ctr Emergency MedicineChristiana Care 2010 Emergency MedicineDrexel Univ CoM/Hahnemann Univ Hosp 2010 Family MedicineUniversity of MO-KC Programs 2007 Family MedicineUniversity of PA Hospital Family MedicineUPMC St. Margaret 2011Family MedicineUniversity of Toronto 2011Radiation OncologyUC Davis Medical Center 2010 Radiation OncologyUniversity of Michigan Hospitals 2011Radiology-DiagnosticAllegheny General Hospital 2010 Radiology-DiagnosticBI Deaconess Medical Center

Rotations During the Senior Year  Plan to use vacation for most of your travel  Limit time away from rotations  Discuss and request travel time well in advance (attending and senior residents)  Offer extra time or patient evaluations to round- out experience  Work hard to master medical knowledge and improve clinical skills  Choose senior rotations wisely to prepare for residency