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

Specialty Decision Final consideration of specialty choice Review: motivation, interests, skills, competitiveness, early career goals, Plan B Careers in Medicine Components  I Self assessment  II Career exploration  III Decision-making  IV Residency application guide

Senior Year Responsibilities Complete graduation requirements  Review and track rotation requirements  MSR submission and approval  Pass USMLE Step 2 early  Maintain good standing Do well in your remaining clinical rotations (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 references (Iserson’s guide)  NRMP references  Clerkship attendings  Residents  Individual program information (internet)  Graduating seniors from match list  Directors of Medical Student Mentorship

Directors of Medical Student Mentorship AnesthesiologyLen Pott ; DermatologyBryan Anderson, MD ; Emergency MedicineLawrence Kass, MD ; Family & Community MedicineDennis Gingrich, MD ; Internal MedicinePhilip Masters, MD ; Ob/GynJohn Repke, MD ; OphthalmologyDavid Quillen, MD ; Orthopaedic SurgeryKevin Black, MD ; NeurologyMiland Kothari, MD ; NeurosurgeryRobert Harbaugh, MD ; PathologyDani Zander, MD ; Pediatrics Laura Murphy, MD Maryellen Gusic, MD RadiologyChristine 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 program selection

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 (specialty specific)  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 early November if no interviews  If few interviews by mid-November, meet with MSPE Dean

Residency Program Considerations Program evaluation examples NRMP Applicant Survey – 2009  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  Obviously avoid 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  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 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 score and repeat if necessary  COM must indicate if graduation in jepordy  Complete your MSR by early fall  Decide on away specialty/hospital rotations now for July, August, or ? September  Review vacation time  Anticipate most travel mid Nov. to late Jan.  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 – 2009  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  Leave impression 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 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

Issues for Unmatched Students You don’t want to participate in the scramble  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

Scramble Issues  1,140 First year position offered in the scramble  7,739 Total unmatched applicants  1,078 Unmatched U.S. seniors  Positions in highly competitive specialties gone  Restricted specialties remain  Applicants have little information about remaining programs  Inefficient scramble system (phone, fax, )  Two day timeframe

2010 Match Results Participant Categories Total participants30,543 Positions offered22,809 U.S. Seniors16,070 Previous U.S. graduates 1,356 Osteopathic participants 2,045 International participants10,941 % Positions filled during “initial” Match 95% % U.S. seniors matched 93.3% % IMGs (U.S. citizens) 47% % IMGs (non-U.S. citizens) 40%

Selected Main Residency Match Specialties PGY-1 PositionsTotal Positions Offered Unfilled at Start of Scramble Anesthesiology Dermatology 312 Emergency Medicine1,55616 Family Medicine2, Internal Medicine (Categorical)4,99952 Neurosurgery 1913 Obstetrics & Gynecology1,1875 Orthopaedic Surgery 6563 Otolaryngology2801 Pediatrics2,42845 Plastic Surgery690 Surgery (Categorical)1,0772

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 (at least read 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 three years (SA site) 7. MSPE 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 PediatricsUniversity of Wisconsin Hospital and Clinics PediatricsUPMC Medical Education Program 2008PediatricsVanderbilt University Med 2007 PediatricsWalter Reed Army Medical Center 2008PediatricsYale-New Haven Hospital 2007 Peds/Psych/Child PsychBrown University/Rhode Island Hospital 2006 Physical Medicine/RehabNYP Hosp-Columbia Presbyterian 2007 Physical Medicine/RehabLSU SOM - New Orleans 2006 Physical Medicine/RehabNorthwestern McGaw/RIC 2007 Physical Medicine/RehabUPMC Medical Education Program 2006 Physical Medicine/RehabVirginia Commonwealth University Hlth Sys Plastic SurgeryHershey Med. Ctr./Penn State 2007 Plastic SurgeryMt. Sinai Hospital 2007 Plastic SurgeryOhio State University Med Ctr 2008PsychiatryAlbert Einstein Medical Center 2006 PsychiatryBrown University Psych Res 2008PsychiatryHarvard Longwood Psych

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