Professional Development Series: Part 3

1. Professional Development Series: Part 3 How to Choose and Apply for a Residency Program Chariny Herring, DO February 21, 2011

2. When to make the big decision……

3. Unraveling the Mysteries of the Residency Application Process

4. Allopathic vs. Osteopathic • Allopathic spots are more plentiful, but can be more competitive. Check the % of osteopaths at allopathic residency programs • States with both DO/MD schools have more “mixed” residencies • If going allopathic, check for osteopathic compatibility • What are the internship requirements to meet AOA guidelines? • Not meeting AOA requirements means you won’t be able to sit for osteopathic specialty boards and you will get no CME credit for taking allopathic boards • http://www.aacom.org/InfoFor/students/careeradvice/Pages/default.aspx

6. ACGME vs OGME Boards:Step 1, 2, 3 • 1) Both? • 2) OGME usually sufficient unless applying for a highly competitive allopathic residency

7. Narrowing the List of Options Don’t waste time or money!!! Self check for competitiveness

8. Selection Criteria for Residency: Results of a National Program Director’s Survey(1207 Program directors from 20 specialties responded) 1. Grades in required clerkships 2. Step 1 board scores 3. Grades in senior electives in specialty 4. Number of honors in clerkships 5. Step 2 board score 6. Step 2 CS pass • Class rank

9. Selection Criteria for Residency: continued 8. Membership in Alpha Omega Alpha 9. Medical school reputation 10. Medical school academic awards 11. Grades in other senior electives 12. Grades in pre-clinical courses 13. Published medical school research 14. Research experience while in medical school Green, Thomas and Jones AAMC 2008 http://www.aamc.org/members/gsa/sessionnine621jones.pdf

10. Pre-Interview • Find a program where you can learn “happily” • You are interviewing the residency program (not the other way around at this point) 3) Talk to residents directly ( and not just the “pre-selected” residents) 4) Check off list/take inventory of how each program measures up to YOUR criteria before you even consider applying

11. Pre-Interview List • 1. Accreditation data/ranking • Probation? ACGME for MD or OGME for DO • 2. # of Residents in the program/unfilled slots/drop out rate • 3. Compliance with “TOAD” regulations • 4. # of affiliated hospitals • 5. Sites for rotating internship • 6. Hospital/Clinic financial information/ budget cuts or closings • 7. Elective time/flexibility

12. Pre-Interview • 8. SUPERVISION!!!! • 9. Forecast of upcoming changes • 10. Available associated fellowships/ % of residents going into fellowships • 11. Specialty Board Support and Prep and Pass Rates • 12. Resident support/”well being” resources • 13. Resident Satisfaction • 14. %FMG

13. Pre-Interview • 15. Resident representation at the faculty level/Elected “chief” • 16. Teaching commitment/availability of the faculty/Quality of conferences • 17. Availability of the Program Director • 18. Pt load per resident • 19. Call frequency • 20. Support staff and facilities (including UTD technological abilities)

14. Pre-Interview • 21. Salary • 22. Moonlighting Opportunities • 23. Benefits: Insurance (health & malpractice), pager, food, vacation, educational leave • 24. What is the official process for filing a complaint or affecting change? • 25. Program strengths and weaknesses

15. Introduction to Residency Application Process

16. Application • Standard Application vs. Specific Application: Standard APP is via ERAS for both MD and DO Specific will be generated by the individual residency program • Typos/grammar • Professional picture: Can use the one from school or email one to Angela Bacon Has to be in an electronic format

17. Photographs Do I need a new photograph?

18. Photographs First Year

19. Photographs Before After

20. Application • Letters of Reference: • 1 from department chair • 3 from chosen specialty docs • Do not send letters from academic professors, friends, relatives, or ministers • Can waive or retain rights to see letters/all letters reviewed and screened and uploaded by A. Bacon. • MSPE/Medical School Performance Eval: (formerly know as the Dean’s Letter) • Eval of yrs 1,2,3 • Quotes from site evaluations • Class Rank • In April, you will get and email with instructions on what you need to do/Can meet with Dr. Stewart if special circumstances • June is the deadline • Will be given the chance to review it • Uploaded to ERAS in October

22. MSPE Excerpt: Histories and physicals are considered average. Fund of knowledge is considered below average. Clinical judgment is considered average. Case presentations are considered below average. Personal interactions and communication skills are considered below average. Professional attitudes and behavior are considered average. Overall he is an average to slightly below average student. Faculty comments include: “Adequate performance. He was reliable and typically competent. Hard to assess knowledge as his responses seem below the 3rd year. He appears to be okay regarding clinical judgment. His case presentations were a little too concise. His histories and physicals are typically complete and accurate. He needs improvement in knowledge, presentation, communication skills. Good attitude and tried hard but has many deficiencies. Would be better If he shows more initiative and interest in learning about surgical patient. He was punctual. Apathetic; did not show interest. His history taking was too succinct, not well-organized.” Bad Letter

23. Personal Reference Letter Dear Program Director: It is my pleasure to provide this letter of recommendation for Applicant A. She is currently a senior medical student at the University of ____________ and is expected to receive her DO degree in June 2005. I worked with Applicant A while she was serving as an acting intern in my surgical service. Applicant A entered medical school with a background in research and the pharmaceutical industry. Her added maturity has served her well in developing the skills necessary to become a physician. As such her academic performance is not reflective of her clinical abilities. Her attention to detail and concern for her patients’ well being is notable. She is a true team player who is well liked by peers, faculty, and patients. As a senior, she successfully completed the departmental honors program in surgery. This program is an intensive eight week experience in the fundamentals of surgical science designed specifically for students who will be competing for surgical residencies. She functioned as an acting intern in the surgical ICU and consistently provided compassionate and thorough patient care. Her patient presentations were well-organized and concise. She was a model of professionalism. I believe that Applicant A is dedicated to a career in surgery, and will work diligently toward this goal. I sincerely recommend her to you for consideration. Please feel free to contact me should you need further information. Associate Professor of Surgery Good Letter Chief, General Surgery Associate Program Director

24. Personal Reference Letter Dear Program Director: I have known Applicant C since his fourth year rotation on my General Surgery Service. During his rotation I found him to be an outstanding student. He was always well read regarding the patients who were under his care. He treated all individuals, both hospital personnel and patients with the utmost respect. His work was always top notch because of his rapport with the patients and his meticulous and thorough examinations and notes. Applicant C’s previous experience in the _________ University Student Senate has prepared him with maturity and a solid foundation of teamwork. It is without hesitation that I highly recommend Applicant C for a position in your residence program. He is a solid candidate in all frontiers. He is personable, intelligent, hardworking, conscience and dependable. Associate Professor of Surgery Director, General Surgery Residency Good Letter

25. Personal Reference Letter Dear Program Director: I have been asked to write a letter in support for Applicant B. I met Applicant B this year when he rotated on our family practice service as a subintern. Applicant B is a kind and caring student. While on the service he followed several patients and participated adequately. I would categorize him as a good student and given the right environment he will really shine. As you can see from his personal statement, he is passionate about medicine. He has had some unique experiences and his family is proud of his accomplishments. I have had time to discuss his plans and he is committed to a career in family practice. In summary, I recommend Applicant B for your training program. Associate Professor of Family Practice Average Letter

26. Application • Curriculum Vitae /CV • Name • Contact Info • Education: Medical, Graduate, College, High School (school name, yr of grad, GPA and rank) • Honors/Awards

27. Application • CV: • Publications/research • Employment/Military • Organizations/Clubs • Hobbies/Interests/Languages • Personal data (marital status, children) • References • CV workshop given in May by A. Bacon

28. Personal Statement • 1 page or less • Provides a window into your personality • Can also be used to rule out people who are not well spoken or have no tact • Balance between bragging and humility • Talk about accomplishments and abilities • Reference inspiration by a mentor • Personal story that led you to a career in medicine • Discuss future plans (keep in mind program type to which you are applying)

29. How to for the Red Flags in Resident Applications

30. RED FLAGSReference Letters • No letter from the Chairman or PD. • Letters from physicians in other specialties. • Less than three letters of reference. • Very short reference letter – no real content, especially from the chairman. • Chairman’s letter states you should call for additional information. • Concerning comments: “Given the right environment, this student will do well” “I have been asked to write this letter of reference” vs. “I am delighted to provide a reference”

31. RED FLAGSDean’s Letter • No explanation of gaps in medical school. • Failed clerkship’s or lots of B’s and C’s. • Failed Board Exams • Last paragraph for final Dean’s recommendation is vague or weak or doesn’t match other recommendations/comments.

32. RED FLAGSCV • Large list of volunteer activities, of which all or most are self serving. • Multiple research projects and no publications. • Disconnect between board scores and clerkship grades. • Consistent spelling errors in the application. • A parent calls regarding their child’s application.

33. RED FLAGSPersonal Statement • “Strange” personal statement. • The word “I” is used on almost every line. • If the applicant had a leave of absence from medical school and does not address it in any way. • Typos

34. Preparing for the Interviews • Create a folder for each program for which you have applied • Photocopy EVERYTHING you send out! • Send each program a self addressed, stamped postcard which they can return upon receipt of your materials • Create a master list with deadlines, interview date, etc • Collect data on the program and place it in the folder • Review the folder prior to each interview

35. Use the Application Data tracking Service (ADTS) within the ERAS program to confirm which programs have received your documents

36. Preparing for the Interviews • Set up a mock interview • Prepare to answer the following questions: 1. What will you do if you do not match at our facility? Don’t want to give up easily, but be prepared with a back up plan 2. Where do you see yourself in 5-10 yrs? Rural vs urban, large vs small, research, teaching, private practice, interest in subspecialization, avoid rigidity!

37. Preparing for the Interviews 3. Why did you apply to our program? Show that you have done your research: give examples of what has impressed you about the program such as program reputation, resident satisfaction, faculty members, research projects you have heard about, board pass rates, etc.

38. Preparing for the Interviews 4. What are your strengths and weaknesses? Interviewer is looking for tact, confidence, humility, optimism, or pessimism. Avoid extremes, try to keep it positive, do not brag, give specific examples of strengths. Important strengths are: empathy, devotion, consistency, being a team player Pick an “acceptable” flaw: “I am intense at times or I tend to strive for perfection”

39. Preparing for the Interviews 5. Why did you choose this specialty? A rotation experience, a mentor, a special skill, be enthusiastic! 6. What is the most interesting/outstanding/significant thing you have done? • What do you do with your free time?

40. Preparing for the Interviews 8. Discuss a memorable patient. 9. Did you have any problems in one or more areas? Discuss short comings honestly. If extenuating circumstances exist, state them concisely and then move on without belaboring the point. End on an “up” note. May try to offset academic problem with better performance in other areas such as patient care.

41. Preparing for the Interviews • Describe an instance in which you had to work with someone who was considered difficult. 11. What do you think about the future of medicine? • Good time to discuss altruistic motives • Journal citations 12. How do you perform under pressure? • Give a specific example

42. Preparing for the Interviews 13. Discuss your research. 14. Have you ever been terminated from a position? • They are looking for the why and how you reacted. 15. Where else are you applying? • Ok to list places and mention their strengths briefly.

43. Preparing for the Interviews Inappropriate Questions: • What is your sexual orientation? • Are you going to select this program if we rank you high? • Are you physically healthy? • Do you have any psychiatric problems? • Any plans for marriage/pregnancy? Best answer: “ May I know why you ask that?”

44. Preparing for the Interviews • Read a current book (can be thin, but meaningful) ie: “Who Moved my Cheese?” Spencer Johnson • Go to the medical library and scan the last few mos of articles from the specialty journal or email the professional organization and ask for the top 5 areas of attn/interest in that subject in the last 6 mos • Don’t forget to be courteous to support staff • Beta Blockers • Prep 2 -3 questions for the interviewer: • What are the strengths and weaknesses of your program • Are you aware of any upcoming major changes to the program?

45. Preparing for the Interviews • Buy one nice, comfortable yet formal outfit. Newer shoes (not blister new!), polish shoes, use conservative accessories and make-up, clean nails, trimmed facial hair • Choose a brief case or executive bag • Survivor Kit: program folder, list of questions, extra copies of resume and app materials, Kleenex, deodorant, disposable dental care, small mirror, snack, small water bottle, breath mints, pens, notepad, cash/change, ID, phone (set to silent), any necessary personal items (female items or rx meds), prn meds such as Tylenol, Tums, band aids

46. Interview Follow-Ups • Send a thank you note • Try to include something personal or memorable about the interview, visit, tour • Can include a picture as a reminder

47. Career Advisor • Angela Bacon, MS angela.bacon@okstate.edu • Provide CA with CV, personal statement, transcript • Review your permanent record • Stay in touch with CA to discuss: • choices of programs • info on previous student’s experiences • activities/suggestions to strengthen application • number of applications/interviews • interview etiquette • ranking strategies

48. Credits: Staying Human During Residency, 4th Ed • Allan D. Peterkin, MD The Residency Handbook • Lyle D. Victor, MD