American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

How do I select the best residency program for my specialty?

By now, you may have become familiar with the Directory of Graduate Medical Education, which is published by the American Medical Association (AMA). Commonly known as "the green book," this nationally recognized source contains detailed information to assist medical students in evaluating specific medical residency programs. In addition to geographically listing the accredited residency programs in all medical specialties, the Directory also lists the requirements for accreditation for each program, and provides statistical data on graduate medical education in the US. The Directory of Graduate Medical Education can be found in most medical school libraries, or it can be obtained from the AMA's Book and Pamphlet Fulfillment section.

Another resource to use in researching a potential residency position is the AMA/FREIDA, the AMA's Fellowship and Residency Electronic Interactive Database system. FREIDA is a computerized version of the Directory of Graduate Medical Education, and it gives the medical student instant access to information about graduate training programs in approximately 76 specialties and subspecialties. FREIDA is available in a select number of medical libraries, medical schools, medical teaching institutions, and graduate medical education programs that have purchased the CD-ROM. You can also access FRIEDA by logging onto the website of the American Medical Association.

In addition, The Accreditation Council for Graduate Medical Education (ACGME) publishes the Directory of Accredited Programs annually. The Directory provides a list of accredited programs organized by specialty and state, and it can be found on the ACGME's website.

In the last two decades, the number of medical student graduates has grown, resulting in a more competitive residency selection process. Therefore, being selected into the residency program of your choice is a challenging goal, because there are a limited number of positions available each year in each residency program. To facilitate the selection process, a computerized matching system called the National Resident Match Program (NRMP) was developed to match applicants with a compatible postgraduate training setting. Graduate medical education programs generally select their first-year residents through the NRMP.

Every October, the NRMP publishes a directory that lists all of the hospitals that have signed an agreement to participate in the match for the coming year. Medical school students apply to the match during their fourth year of medical school and are apprised of their selection to a residency program in the spring of that year. The number of residency positions that are available in the medical specialties varies each year.

Typically, residency positions are available in university, university-affiliated, or freestanding residency programs; the university programs are the largest, and therefore, accept more residents into their PGY-1 programs. The residency selection process commonly requires the applicant to submit a personal statement of inquiry along with his or her application for a residency position. When applying to residency programs, it is imperative that you carefully review the employment policies and eligibility requirements, and that you are mindful of application deadlines. Many programs will not accept documents that arrive after the deadline. The applications for residency programs must either be requested from the programs, completed via the Electronic Residency Application Service (ERAS), or applicants can use the Universal Application for Residency, which, along with ERAS, was designed by the Association of American Medical Colleges.

Although there are programs that offer residency positions to "independent applicants," you should also check with the programs to determine whether or not they participate in the National Resident Match Program (NRMP) and whether or not applicants to those programs are required to enroll in the NRMP. The NRMP publishes the National Resident Match Program Directory of Hospitals and Programs Participating in the Matching Program, which can be found on the NRMP website. The program is only available to registered match participants and lists the residency programs and the number of positions that each program is attempting to fill. According to the NRMP website, the 1999 Main Match placed 20,170 applicants for postgraduate medical training positions into 3,775 residency programs at 701 teaching hospitals throughout the United States, and 94 percent of U.S. medical school seniors who participated in the 1999 match received a PGY-1 position. For more information about the National Resident Match Program, contact the program at 2501 M St. NW, Suite 1, Washington, DC 20037-1307, or through their website.

Another residency option is appointment to United States Uniformed Services graduate medical education programs. The Army, Navy, Air Force, and the Public Health Service (PHS) all have PGY-1 positions that are filled by graduates of accredited U.S. medical schools. Most of these PGY-1 residencies are given to people who have already committed to active service and usually, the PGY-2 positions and beyond are given to people who are on active duty. Any medical school graduate who plans to pursue a residency position in the Uniformed Services must fit the requirements for active duty and be willing to participate in active duty. If you are interested in applying for residency positions with any of the Uniformed Services, contact the local recruiting office of the branch that you are interested in.

While the majority of students who participate in the NRMP find residency positions, there is still an option for those who do not. Usually, once the match process has been completed, there are residency programs that have unfilled positions. To help prospective residents find these positions, the NRMP Program Results and Listing of Filled and Unfilled Programs, which is on the NRMP website and is available only to registered match participants, gives details about the number of positions each participating program had open and the number of positions that were filled. Once you find out which programs have unfilled positions, contact the programs to find out the availability and requirements for those positions. If you are looking for a residency position in a certain specialty, you can also contact the appropriate specialty societies; many of the organizations compile information about residency positions.

For students who are interested in residency programs in Canada, which are not accredited by the Accreditation Council for Graduate Medical Education (ACGME), contact the Royal College of Physicians and Surgeons of Canada at 774 promenade Echo Dr, Ottawa, ON KIS 5N8, Canada, or through their website.

In addition to filling out applications, there is also the need for investigation about the programs that you are considering, as well as finding out what is required of you as an applicant. Tom Gadacz, MD, FACS, presented a talk that shed light on How to Select a Residency Program.

Program Chair and Faculty?

  • Training
  • Professional Interests
  • Clinical Skills
  • Teaching Interests
  • Research Commitment
  • Balance of Interest and Age
  • Staff Turnover Rate

Where Do Rotations Take Place?

  • Hospital (university, city/county, private, VA)

Caseload

  • Getting Credit for Cases/Variety (types) of Cases
  • Cutting Edge Cases–availability of

Current Residents–Talk to residents, ask if you can, to find out:

  • Their attitudes towards each other, faculty, the training they are receiving
  • Perception of faculty interest–faculty members availability
  • Post residency plans, based on their experiences during residency

Examinations

  • Residents performance on in-service exams over the last five years
  • Residents performance on certifying and qualifying exams over the last five years

Fellowships

  • What types residents from the program have chosen (in what specialties)
  • Where are they doing the fellowships
  • Why those fellowships

Balance of the Program

  • Is there a good variety of cases
  • What is the composition of the faculty (age, experience, training)
  • Opportunities
  • Fellowships
  • Compatible culture (is the culture within the program compatible with you)
  • Will you be able to have fun

Prestige and Tradition

  • This is important, but there are a lot of good programs that are not at the Johns Hopkins and Harvards.

Good vs. Bad

  • Remember: There are no good or bad programs, only programs that are potentially good for you and programs that are potentially bad for you.

What Do Program Directors Look For

  • Academic Performance
  • Letters of Recommendation
  • Personal Statement
  • Qualities that may not be apparent on paper

Electronic Residency Application Service (ERAS)

  • Cannot accommodate all of the important information about you
  • Fulfill the requirements needed for completing ERAS, then send additional items that you feel are important

Academic Performance

  • 3.5 GPA or better
  • Successful completion of USMLE
  • AOA
  • Research that you have done

Personal Qualities

  • Team player
  • Dedication
  • Communication skills
  • Leadership qualities
  • Compassion
  • Attitude/Affect
  • Achievement
  • Competitiveness

Letters of Recommendation

  • From the chair, if you have had more than casual contact with him or her
  • From Faculty members that have personal experience with you (have rotated with you or are familiar with you and your work from other interactions)

Personal Statements

  • Why did you choose surgery
  • What type of surgical career are you interested in pursuing–academic/private sector
  • Interesting experiences–not necessarily related to medicine
  • Thoughts about where you are headed in the future
  • Be sure that your statement is truly about you, and be sure to read it before the interview: you may be asked about it

Compatibility/Matching

  • Personality and culture of the program
  • Your personal philosophy, habits, aspirations, and attitude in comparison with the program

Advice for the interview

  • Be honest
  • Be yourself
  • Be prepared
  • Be well dressed
  • Be on time

Making the Final Decision

  • Make notes on the program as soon as possible after the interview
  • Compare your notes with your goals
  • National Resident Matching Program (NRMP)–your match list should be competitive, but realistic
  • Ask yourself, based on what you have seen and heard during the interview, "Will I fit in?"