Danielle Gottlieb, MS, MD

Disclosures

December 15, 2006

Question

Now that I've decided what specialty I want to pursue, how can I figure out which particular residency program will be best for me?

Response From the Expert

 

Response from  Danielle Gottlieb, MS, MD 
Resident, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Research Fellow, Children's Hospital Boston and Massachusetts General Hospital, Boston, Massachusetts

Residency is a time to gather a collection of experiences that will help you develop sound clinical judgment. The best training programs are broad and offer high patient complexity. As you search for the right program for you, keep the big picture in mind: This decision will influence many subsequent career decisions, in both tangible and intangible ways. So it's important to find a good fit. Here are some tips:

1. Clearly define your own goals. Make a list of your most valued features in a program. These are some examples of features and ways to measure them:

  • Geographic location of the hospital. Hospitals will tell you about their catchment area, which refers to the population they serve (local area or distant, international referral base). A wider area is generally better, as it will expose you a variety of patients and pathology.

  • Prestige of the program. US News and World Report's annual ranking offers a good indication. This is only one source, but one to which people frequently refer. The annual report can be found at http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm. Prestigious programs are correlated with the advantages of large academic centers: well-trained, research-oriented faculty, diverse patient populations, and a broad, strong education.

  • Residency graduates. Find out the percentage who went on to fellowships or faculty positions; many programs provide this information on their Web sites. Understanding the trajectory of past residents will help you understand whether your career plans fit with those of the graduates who usually complete a particular program. Also, determine the percentage of residents at a given program who passed the boards on their first attempt. This information is found on residency Web sites and can be obtained during the interview process.

  • Depth and breadth of hospital system. Check a program's Web site to determine the number of residents in the program, the number of procedures performed per resident, and the complexity of procedures. Also look for the number of subspecialty residencies or services (such as pediatric burns, orthopaedic oncology, level of accreditation for trauma, etc.) This information is a good topic for questions during informal meetings with residents during the interview tour. The tour is a great time to ask residents about their life in the program and what they see and do.

2. Study the available residency programs. Collect some initial data about those features that matter most to you. Start a spreadsheet, making a row for each program and a column for each feature; put the features in order of importance.

3. Consider your lifestyle preferences. Usually, urban areas have higher patient complexity. However, this advantage may be offset by the cost of living in a city, especially if you have a large amount of debt.

4. Interview at programs that interest you. The interpersonal nature of the interview visit yields particularly good information about the organization's culture. Look at:

  • The top of the hierarchy, particularly the clinical and research interests of the department chair and faculty, as well as where they trained. If you have research interests, aligning yourself in a department with research expertise is valuable. The ongoing academic activities of the faculty will give you a sense of the opportunities you may encounter. Also, look at the age distribution of the faculty to see whether there is a good representation of new techniques and management styles, as well as multiple perspectives. Training programs have philosophies; try to find a program with a philosophy of training and an approach to new techniques that suits your style.

  • The residents. A common but relatively unproductive question that many applicants ask the residents is whether they are "happy." Instead, ask about more objective measures that you can rank on your scale, like how much time residents spend outside the hospital, or how the workload is offset by the educational aspects of the program. Determine whether the residents chose this program for reasons similar to yours. Notice the level of formality between residents and faculty; do residents feel that the faculty invest in their futures? Get a feeling about who the residents and faculty are, and whether you would enjoy the culture and environment. Once you get there, residency will be more like a marathon than a sprint, so you should make sure that you will enjoy the company.

  • The hospital system. Determine the number and type of hospitals where residents spend rotations; exposure to varying levels of patient acuity and complexity is important.

5. Score the programs that you are considering. Rank each one for each factor on your spreadsheet. Try to record scores soon after you visit the programs, when the information is fresh.

6. When your spreadsheet is complete, see how you feel about it. Many important decisions cannot be made purely mathematically. Allow your "gut feeling" to interpret the scores and direct your choice.

7. Use additional strategies, such as doing an "away" rotation and making "second-look" visits, to solidify a choice or to choose between close competitors. Both strategies demonstrate your interest in the program.

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