Comparing Apples to Apples: Selecting a Residency Program That is Right for You

Thomas Masters

Disclosures

May 30, 2008

As all fourth year medical students, program directors and residents are undoubtedly aware, by the time you read this the residency interview season will be over. For most medical students, this has been a time of miles traveled, credit cards maxed and a certain bit of understandable anxiety as we tried to make it to all of our interviews and put our best foot forward. However, as we contemplate putting our well-worn interview outfits back on mothballs, medical students faced a new (and arguably greater) challenge—selecting a program that is right for each of us.

Hopefully, for most fourth year students at this stage, getting information about each of the programs is no longer a problem. Many students will have completed away-electives at specific programs, which offer an "up close look" at a place, but with around 140 programs nationwide, it is obviously impossible to do this everywhere. The American Medical Association offers FREIDA (http://www.amaassn.org/ama/pub/category/2997.html), which provides the numbers on each program's duration, residents, benefits and other factual information.

Also online, most programs have very well maintained websites that offer a bounty of information offering specifics about who they are—often including detailed curriculum and rotation schedules, ultrasound, EMS, trauma and toxicology training, sites utilized, faculty interests and information on current residents. This last resource can offer a convenient way to get in touch with residents for follow-up information and allow them to answer any questions about their residency.

Of course, the standard venue that an applicant gains information is during the program's interview day. Every interview presents an opportunity to learn something about the specific residency program that goes beyond what one can find on the internet. It gives a chance to meet the faculty and residents, ask questions and to get to know what makes this program different from any of the others at which one has interviewed. Beyond that, visiting a program can allow a person to get a "gestalt" feel for what goes into that residency.

So now that interviews are done and our rank order list is submitted to the NRMP (February 27th was the due date this year), the problem usually is not "where can I find out more about the programs," but "how can I sort through everything that I have learned."

For those participating in this process in the future, there are abundant resources available at most university bookstores that can be very helpful with thinking about various important criteria that go into selecting a residency. Written for applicants to every specialty, these books sometimes risk being too general, but are usually very helpful and offer topics on optimizing the rank-order lists and deciding when or when not to rank programs. At the very least, these books are worth checking out of the library.

Another invaluable resource in emergency medicine residency selection continues to be AAEM's Rules of the Road for Medical Students. Written specifically for candidates interested in emergency medicine, Rules of the Road offers advice on many topics including choosing between three and four years of training, university versus public versus community hospitals and sorting through other characteristics of programs. This book also offers discussions on numerous topics in emergency medicine that will continue to be relevant during residency training and beyond and is a valuable benefit of being a paid member of AAEM/RSA.

With all of these resources available, if one is still feeling "information overload" the AAEM/RSA's EM Select (http://emselect.org) provides a great way to organize everything. In addition to providing program statistics and allowing AAEM members to organize their scheduled interviews and keep track of thank you notes sent and programs applied to, this website offers the option of recording the pros and cons of each of the programs. EM Select provides a way to organize both the valuable statistical and practical information about the program, as well as confidentially record impressions about the people and personalities of the residencies. As the deadline for the rank-order list approaches, EM Select is a convenient way to recall things that may have been forgotten from an interview months earlier.

Finally, if one has narrowed down his or her choices to a few programs and wants to get a closer look, most residencies offer "second look" opportunities. These low pressure shifts in the program's emergency department provide a chance to see how residents and attendings interact, the type of patients seen and give a "snapshot" of life in that ED.

Fortunately, the national Residency Review Committee works hard to assure that residencies all meet certain criteria that will allow their graduates to function as successful attending physicians. This means that graduates of any accredited program will be well prepared. In some ways, an applicant really cannot go wrong when selecting a program and will leave his or her residency well trained. The issue is then sorting through all of the intangibles that make up the program and the applicant to arrive at the best fit.

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