Match 103: Where Do We Go From Here? CHRIS WOLEBEN, MD, FAAP ASSOCIATE DEAN OF STUDENT AFFAIRS VCU SCHOOL OF MEDICINE 2 December 2013

Background Information On The Match Process

Match Overview System by which medical students are paired with residency training programs Administered by National Resident Matching Program (NRMP) Applications to residency programs through AAMC Electronic Residency Application Service (ERAS)

NRMP Algorithm Designed to favor students All applicants are treated equally (U.S. M.D. and D.O. students; physicians; IMGs) Computer matches students in six minutes based on student and residency training program Rank Order Lists (ROLs) The Match is complete when all applicants have either been matched with one of their choices or all the programs listed by the applicants have filled their positions

Participating Specialties Most residency positions are offered through the NRMP using ERAS: Ophthalmology, Urology, programs have separate matching process Neurosurgery first used NRMP in 2009 Child Neurology first used NRMP in 2011 Intern positions (PGY-1) include: Categorical Preliminary Transitional

Categorical Positions Designed for broad specialty training Do not require preliminary training Optimal for those who wish to remain in the same program throughout their residency:  Family Medicine  Internal Medicine  Pediatrics  Emergency Medicine  Obstetrics and Gynecology  General Surgery  Pathology  Other programs

Advanced Programs Programs available to senior medical students above the PGY- 1 level Students must also match into a preliminary year – you must check with each individual program to determine its requirements Examples of programs that may require a preliminary year include: Anesthesiology, Diagnostic Radiology, Neurology Dermatology, Ophthalmology, Radiation Oncology Physical Medicine and Rehabilitation

Preliminary Programs Designed for students needing a year of clinical experience prior to completing another specialty Available in two program types: Internal Medicine General Surgery If you apply to an advanced program, you must also apply separately for a preliminary position

Transitional Positions Generally designed for students who cannot decide upon a medical specialty Year closely resembles the M3 Clerkship requirements May serve as substitute for a preliminary year for some advanced programs

What Should You Be Doing NOW?

Decisions, decisions … 60% of our students decide what specialty they want to pursue during their M3 year 20% decided prior to starting medical school 15% figure it out during M1/M2 years 5% figure it out during the M4 year 60% of our students change their mind about specialties at least twice during their M3 year Ask resident and attending physicians about their career choices Seek out opportunities to explore fields outside the required clerkships

Once you’ve decided … Seek out a mentor in the department you have chosen “Official” advisor assignments will be made in January by the Student Affairs office Use multiple advisors based on who you trust for advice May allow you to gain some research experience, particularly for competitive programs Career specific advice about scheduling your M4 year, planning for away electives

Scheduling M4 Year Overview of M4 Year: There are eight 4-week time periods during the M4 year Time PeriodMonth 1July/August 2August/September 3September/October 4October/November 5 (4 weeks reserved for interviews) November/December/ January 6February 7March 8April

Scheduling M4 Year Requirements: Step 2 CK Study Period / Exam (prior to November 1, 2014) Step 2 CS (prior to November 1, 2014; schedule EARLY!) Two Acting Internships One of these may be at another institution Critical Care Elective At least four months of “clinical” electives Update Course Interview travel Electives: Pick things you think will help prepare you for your intern year

Scheduling M4 Year M4 schedules are determined by a lottery process Lottery requests are due on May 9, 2014 Detailed information about the lottery process will be sent by Nancy Jackson in the Curriculum Office in January The schedule you receive in the lottery process is not set in stone! Changes can be made if you change specialty tracks or change your mind about elective experiences

Scheduling M4 Year Meet with Nancy Jackson in the Electives Office for scheduling tips and advice getting what you want in the lottery Meet with your assigned advisor to help plan your schedule: Please schedule an appointment to meet with your advisor early Do not wait until the last minute You will be given information as to how your advisor would like to be contacted by the Student Affairs office when your advisor assignment is made Their signature is required prior to submitting your lottery requests If you are unable to meet with your advisor, please contact Dr. Woleben to review and sign off on your schedule

Scheduling Step 2 CS and CK Step 2 CS: About a week of study prep ideal, based on how well you perform on OSCE’s during the M3 year Good dates to take it: 2/22/14 – 2/24/14 (Spring Break #1) 4/19/14 – 4/21/14 (Spring Break #2) Sometime during your Step 2 Study block during the M4 year Step 2 CK: About 2 to 3 weeks study time Perhaps more or less time needed for preparation depending on how well you are doing on shelf exams during the M3 year Low step 1 score? Taking it early may help your application

Acting Internship How to Choose an AI: Make a logical choice that will broaden your knowledge of a particular career field Get exposure to areas that may challenge you during residency Opportunity for a strong Letter of Recommendation It is not necessary for it to be in the field you will be entering Listen to the advice provided by your career specific advisor Optimal time to complete your AI is in Time periods 1, 2, or 3 Alternate months reserved for Board preparation, other clinical electives Early AI’s MUST be approved by Dr. Ryan and are usually reserved only for fields you do not get exposure to during the M3 clerkships

Away Electives Excellent opportunity to evaluate a program you are interested in attending in depth  Get to know residents  Get to know hospital, medical record system  Get to know region where you may be living Make an excellent impression on the residency program you are visiting  They will remember you when it comes time to making their ROL if you display a solid work ethic and demonstrate excellent clinical skills – a no-risk applicant who completed a 4-week on-the-job interview! One away elective is sufficient for most specialty fields  Usually time periods 3 and 4 are ideal during the M4 year

Away Electives Decide on a program and research their website for application details Visiting Student Application Service (VSAS) Central application service Usually start applying to programs in late March or early April (after Match Day) Follow instructions on AAMC website Non-VSAS application process varies per program Some competitive programs start offering applications as early as January Nancy Jackson in the Student Affairs Office will help you with both application processes

Scheduling M4 Year Time PeriodMonthActivity 1July - AugAI / Elective / Step 2 Study 2Aug - SeptAI / Elective / Step 2 Study 3Sept - OctAI / Away Rotation / Elective 4Oct - NovAway Rotation / Elective 5Nov – Dec - JanTravel for Interviews / On-line Elective / Reading Month 6FebruaryElective 7MarchElective 8AprilElective 9April - MayUpdate Course

ERAS Application Having a complete and updated CV will greatly assist you in completing the ERAS application  Demographic, educational history  Pertinent activities from medical school, especially those with leadership positions  Complete list of publications, research efforts  Pertinent past work and clinical experiences  Personal statement Indicate programs where you would like application sent  May transmit letters of reference, updated grades and board scores at later date  Can Submit ERAS application on September 15, 2014

Personal Statement Start thinking about writing this once you decide what field you are entering  Think about what you want to tell residency program directors  Start with a story about yourself or a patient that will be memorable and catch the reader’s attention  Keep a log of memorable patient encounters – detailed descriptions of past patient encounters can help programs tell what type of physician you may become  Understand your personal career goals  What will you get out of the residency training?  What will you contribute to the residency program?  Use excellent writing style  Have multiple people read your personal statement, some for content, some for grammar/spelling

Letters of Recommendation Ask those who you feel know you well if they can write you a strong letter of reference:  Longer inpatient or outpatient rotations  Those who have written good comments about you on evaluations  Acting Internships and away electives early in M4 year You need at least two letters from those in the field in which you wish to match  Each program may have different requirements  Some require department chair, clerkship director letters … make appointments early with these individuals  Better to have too many letters on file – Janet can help you pick and choose which letters to submit

Letters of Recommendation Send ERAS cover letter indicating waiver of right to see the contents of the letter to the letter writer:  See attachment  Also available in the Student Affairs office (MMEC 4 th floor) Follow-Up Reminders sometimes help procrastinators  Ask early to avoid any potential delay If you are applying to more than one residency field, it is appropriate to ask certain letter writers to write more than one letter on your behalf Send a thank-you note to letter writer once letter is submitted Letters are only kept on file for current application cycle

MSPE (Dean’s Letter) Standardized letter written by Dr. Wood for each student – released October 1, 2014 to programs Not actually a letter of recommendation Indicates your academic performance across each year with comparison to class means Provides narrative descriptions of your performance in each clerkship Describes any irregularities in your academic history Section written by you includes list of important activities and accomplishments you wish to have included in the letter Summary statement written by Dr. Wood You should review this letter for content error

Residency Interviewing Some programs fill up all interview spots well before MSPE is sent to programs  Early application increases chance of securing interviews Try to cluster interviews together in geographic regions to minimize travel costs  Utilize alumni network to find FREE housing Timing of interviews is controversial  Selection process is unique to each program Interview Format quite different than medical school interviews  Utilize mock interviews!

InterviewStream

Rank Order Lists Four Key Elements: List your first-choice programs first. Consider how many programs you should list. DO NOT rank a program where you would not want to be trained. DO NOT believe a single word that residency programs tell you about your position on their ROL You have no idea what they are telling every other applicant Take their information with a grain of salt!!!

Rank Order Lists Applicants consistently do better if they list their top choices first  Then rank programs in the order of desirability to you … not in the order in which you think you are acceptable to the programs For highly competitive programs, a long ROL increases the odds a student will match  Especially true for California programs  The most common reason that applicants do not match is that they do not list enough programs on their ROL Determine if you would rather take your chances in the Supplemental Offer and Acceptance Program

Important Dates Through the End of the M3 Year: Specialty Decisions! Contact Dr. Woleben if you are stuck for a career counseling session Update your CV Plan your M4 schedule Meet with your advisor and Nancy Jackson Apply for away electives Some competitive programs may start taking applications as early as January; most start taking applications after Match Day in March/April Start thinking about writing your personal statement

Important Dates May – July 2014: ERAS user guide and tokens will be distributed by Janet Mundie MyERAS website will open for students to start completing residency application M4 Orientation (July , 2014): Dr. Woleben will conduct ERAS / NRMP workshops in CIRC Page by page look at ERAS application Tips for writing personal statement Review of timeline for application process More thorough description of interview process, scheduling considerations

Important Dates September 15, 2014: You can start to submit applications to individual residency programs via ERAS October 1, 2014 MSPE goes out September – November, 2014: Dr. Woleben will offer individual mock interviews – contact Janet Mundie to schedule October 2014 – January 2015 Interviews are conducted

Important Dates Mid-January 2015 Rank Lists can be entered – deadline for submission of Rank List is usually the last week of February Match Week – March 2015 Monday 3/16/15 at noon: Unmatched students and Unfilled programs notified Monday – Tuesday: Unmatched students can apply to unfilled programs by ERAS only; Programs can contact student by phone for interview Wednesday – Friday: Eight rounds of offers for unmatched students through the Supplemental Offer and Acceptance Program (SOAP) Friday 3/20/15 at noon: Match Day Ceremony

Confused? Stressed?

Resources nrmp.org Good source for data and statistics Charting outcomes in the Match Yearly Match statistics ERAS application Visiting student application service

Confused? Stressed? Please schedule an individual advising session with Dr. Woleben! Not mandatory but HIGHLY recommended!! Contact Janet Mundie to set up a time for us to meet: Special Groups that MUST schedule advising sessions sometime during the Spring Semester: Couples Match Early Match