The final gauntlet in the medical school experience is selection of a residency. Many students go through this process inadequately prepared due to limited advising or misinformation from both faculty and fellow students. This presentation is designed to provide students with a framework for how to approach the residency selection process and highlights specific resources that can be used in improving the quality of student decision-making.

1. How to Navigate the
Residency Selection
Process
Presented by:
Francis S. Nuthalapaty, MD
Sponsored by the Upstate Chapter of the
Christian Medical and Dental Associations

2. What do you think
would make the
“optimal” residency
training environment?

3. The Optimal GME
Environment
Education Service

4. Defining the Optimal Residency
Author, Year Population Scope N
(Response Rate)
DiTomasso, 1983 PGY-1 FP National 830 (46%)
Weissman, 1984 PGY-1 Psychiatry National 274 (51%)
Sledge, 1987 Graduates entering Psych. National 318 (64%)
Hitchcock, 1989 PGY-1 FP 1 State 115 (91%)
Simmonds, 1990 Graduates 1 Univ. 111 (71%)
DeLisa, 1992 Graduates 1 Univ. 73 (41%)
Flynn, 1993 Graduates 1 Residency 315 (88%)
Lebovits, 1993 Graduates 1 Univ. 197 (87%)
Mayeaux, 1993 PGY-1 FP National 660 (27%)
Diebold, 1995 PGY-1 EM National 463 (68%)

5. The Optimal Residency in the 80’s – 90’s
• Geographic location
• Quality of training experiences /
educational curriculum
• Academic reputation of program
• Perception of house staff
satisfaction

6. The Changing GME Landscape
The GME training environment has changed
dramatically over the past 4 decades
–Resident unionization
–Duty Hour Restrictions (2002)
–Federal definition of resident employment
status (2005)

7. Controllable Lifestyle and Specialty Choice –
The Educator’s Viewpoint
• Coined by Schwartz in 1989
• Broadly defined as control over the number of
hours devoted to professional responsibilities
to enable time for leisure, family, and
avocational pursuits
• Shown to be a significant determinant of
specialty choice

8. The Contemporary GME
Environment
GME
ServiceEducation
Resident Well-being

9. What’s important to
residency applicants in
the new millennium?

11. The Optimal Residency in the new Millennium
Factor No. %
1. Resident satisfaction with program
7,043 98.1
2. Level of concern program has for its
trainees
7,037 98.0
3. Perception of “fit” into residency
6,948 96.7
4. Geographic location
6,836 95.2
5. How well residents work together
6,753 94.0
6. Quality of hospital facility
6,176 86.0

12. The Optimal Residency in the new Millennium
Factor No. %
7. Amount of faculty supervision
5,604 78.0
8. Academic reputation
5,474 76.2
9. Level of resident autonomy
6,836 76.0
10.Amount of faculty teaching
6,753 74.1
11.Amount of conferences
5,294 73.7
12.Size of patient case load
4,230 58.9

13. The Optimal Residency in the new Millennium
Factor No. %
13.On-call frequency 4,018 55.9
14.Cost of living in program area
3,656 50.9
15.Amount of clinical support services
3,608 50.2
16.Emphasis on research
3,067 42.7
17. Emphasis on teaching students
2,632 36.6
18.Employee benefits
2,462 34.3
19.Salary
1,600 22.3
20.Supplemental income opportunities
1,408 19.6

15. Factors in Interview Selection

16. 2013 NRMP Applicant Survey
Important Factors In Interview Selection
Factor 2013 2011 2009 2008
1. Geographic location 95% 95% 95% 72%
2. Academic reputation of the
program
90% 92% 92% 79%
3. Quality of educational curriculum 86% 92% 92% N/A
4. Quality of residents in program 79% 88% 88% N/A
5. Academic Setting 74% 87% 87% 64%
6. Work / Life balance 68% 87% 87% N/A

17. The Learning Culture
Academic rigor vs. Malignancy
Autonomy vs. Supervision
Role models vs. Mentors

18. What’s important to
the Program?

20. Factors in Selecting Applicants

21. 2014 NRMP Program Director Survey
Factors in Selecting Applicants for Interviews
Factor 2014 2012 2010 2008
Step 1 Score 94% 82% 73% 82%
Letters of Recommendation 86% 81% 71% 75%
MSPE (Dean’s Letter) 84% 68% 60% 76%
Step 2 CK Score 80% 70% 61% 70%
Personal Statement 78% 77% 68% 75%
Grades in Clerkships 70% 71% 62% 71%

22. Breakdown of USMLE Step 1

23. USMLE: Making the Cut
The boxes in the boxplots above represent the interquartile range (or IQR, which is the range between the 25th
and 75th percentiles) and the line in the box is the median. The x-shaped symbol in the box is the mean
Obstetrics and Gynecology

24. A Structured Approach to
Residency Application
1. Set a Timeline
2. Gather Data about your Specialty
3. The Letter of Recommendation
4. The Personal Statement
5. Electives – Good or Bad?
6. The Interview
7. The Rank List

25. The Match Timeline
• Late May: ERAS user guide available
• June: MyERAS website open for use
• Sept 15: Programs begin download
• Oct 1: MSPE sent to Programs
• Jan 15: Rank list entry begins
• Feb 24: Students finalize Rank list
• Mar 14: SOAP begins
• Mar 18: Match Day!

26. Setting a Timeline
• Review the Match Timeline
• Review steps in Application Process
• Set deadlines for each step

27. Gathering Data
• NRMP Reports
• Match Outcomes
• Program Director Survey
• Applicant Survey

29. Comparing the Specialties

30. Comparing the Specialties

31. Step 1 and OBGYN Match

32. Comparing the Specialties

33. Step 2 and OBGYN Match

34. The Application Process
1. Extramural Electives
2. ERAS Application
3. Personal Statement
4. Letters of Recommendation
5. Interviews
6. Rank Order List

35. The Application Process
Should you
do an Extramural
Elective?

36. 1. Electives – Good or Bad?
• Electives are extended interviews
• Most beneficial for very strong
candidates and weak/marginal
candidates
• Could help or potentially hurt
intermediate candidates
• Expensive!
The Application Process

38. The Application Process
2. ERAS Application – 4 main
components
• Identifiers
• Education
• Current / Prior Training
• Experiences

39. The Application Process
What makes a good
Personal Statement?

40. The Application Process
3. Personal Statement – Before you
start
• Check with program for any special
content requirements
• Line up at least 3 reviewers:
• Medical perspective
• Lay perspective
• Editorial perspective
• Be prepared to write MANY drafts

41. The Application Process
3. Personal Statement – What to include
• Your motivations for a career in medicine
• How you chose the specialty and why you
are a good “fit”
• Distinguishing features of your personal /
professional background
• Your unique qualities /talents / passions
relevant to the specialty
• What you see yourself doing after
training – your future scope of practice

42. The Application Process
3. Personal Statement – What to avoid
• Autobiography
• Why you like the specific program
• Poor composition
• Grammar
• Spelling
• Literary style

43. The Application Process
What’s the best
strategy for Letters
of Recommendation?

44. 4. Letters of Recommendation (Advice
for Students)
• Check individual program
requirements
• Ask early / ask often
• Always ask the faculty person what
the strength of his/her
recommendation will be!
The Application Process

45. 4. Letters of Recommendation (Advice for Faculty)
• Ask the student to give you as much data as
possible
• Transcript, USMLE Scores
• Personal Statement
• CV
• Meet with the student / ask questions
• Always discuss the strength of your
recommendation
• Proof read to ensure student’s name is correct
throughout
The Application Process

46. The Application Process
What should be your
approach to
scheduling
interviews?

47. The Interview Roulette - 2008

48. The Interview Roulette - 2012

49. 5. Interviews
• Schedule them early
• Many programs complete all
interviews by the end of December
• “Be nice” to all contacts
• Be prepared for behavioral interviews
The Application Process

50. The Rise of Behavioral Interviewing

51. How should you
determine your rank
list order?
The Application Process

52. The Application Process
6. Rank Order List
• Rank based on where you want to be –
not where you think you were liked
• More programs = greater match
success
• Many programs will try to pin you
down – don’t be afraid to tell
programs you liked them – but don’t
divulge your ranking.

53. Applicant Rank List
Single Most Important Factor
Factor %
Potential “fit” into residency program 34.6
Geographic location 30.3

54. 2013 NRMP Applicant Survey
Important Factors In Ranking
Factor %
1. Geographic location 86
3. Academic reputation of program 84
4. Quality of residents in program 80
5. Quality of faculty 76
2. Quality of educational curriculum & training 67
6. Work / Life balance 67

55. 2013 NRMP Applicant Survey
Ranking Strategies
Factor 2013 2011
1. I ranked in the order of my preferences 98% 99%
2. I ranked all programs I was willing to attend 71% 95%
3. I ranked all programs at which I interviewed 60% 63%
4. I ranked a mix of competitive and less competitive
programs
53% 88%
5. I ranked 1 or more less competitive programs as a safety
net
34% NA

56. How do Programs
determine their rank
list order?
The Application Process

57. Program Rank Factors

58. Program Rank Factors
• The “Big 3”:
• Residency Interview
- Interactions with faculty
- Interactions with residents
• Interpersonal Skills
• Academic performance

59. How many programs
should you rank?
The Application Process

60. Rank List Length

61. Rank List Length

62. The Application Process
6. Rank Order List
• Rank based on where you want to be –
not where you think you were liked
• More programs = greater match
success
• Many programs will try to pin you
down – don’t be afraid to tell
programs you liked them – but don’t
divulge your ranking.

63. Useful Resources
• AAMC Resources:
• ERAS Information Website
• Roadmap to Residency Document
• Careers in Medicine Website
• NRMP Resources:
• Charting Outcomes in the Match
• 2012 Program Director’s Survey
• 2011 Applicant Survey

64. Useful Resources
• Program Information:
• FREIDA
• ACGME
• Other Resources
• Career and Professional
Development Website
• UK Career and Professional
Development Website

65. Useful Resources