How Do I Develop a Residency Rank List?

Sheila M. Bigelow, DO

Disclosures

October 27, 2011

Question

I need to apply to residency programs and make my rank list, but I can't decide which programs I like most. What should I do?

Response from Sheila M. Bigelow, DO
Resident Physician, Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio

One of the biggest career decisions you'll make is choosing your residency.

You think about the Match most of your time in medical school. You've heard the success -- and horror -- stories.

The residency process is the same for everyone. Apply, interview, rank, and hopefully match. However, the way you approach the process can make all the difference in how satisfied you are with your outcome on Match Day.

Follow this advice to help refine your residency choices.

Where to Apply

Before you start your ERAS application, sort out your criteria for a residency program. Is location most important? Perhaps the reputation or size of the program matters most to you.

During medical school, you may have the opportunity to rotate at some of the programs in which you're interested. This is a great opportunity to see what your day-to-day life would be like as a resident in that program.

In addition, talk to your peers, mentors, advisors, and upperclassmen about their interactions with various programs. This advice might help you gauge your interest and competitiveness in the programs.

Even after talking to others, do not forget that the decision is yours and yours alone.

After getting an idea of what you're looking for in a residency and which programs meet those criteria, it's time to start applying. The number of programs you apply to can vary a lot depending on how competitive your application is and the specialty to which you're applying.

In my experience, I felt more comfortable applying to many programs and whittling down the number of interviews than applying to too few and not receiving enough invitations.

After applying, sit back, try to relax, and wait for your invitations to interview. Be prompt when scheduling your interviews and polite to all administrators involved in this process.

The Interviews

The interview process can vary based on the specific program as well as the specialty. One thing I noticed was how different residency interviews are from medical school interviews. During medical school interviews, I was trying to sell myself to the school and get an acceptance letter.

In contrast, in residency interviews I felt like I was trying to get the perfect fit for a residency as much as the residency program was trying to find a perfect fit for itself.

Make sure to ask all the questions you can think of in the interview. Take advantage of additional time -- such as lunches and tours -- with residents to ask them about the program. What are their favorite and least favorite aspects of the program? What do they wish they had known when they were applying and interviewing? What would they change about the program or their ranking decisions?

Of course, you should always be polite when asking your questions, because the last thing you want is to come off looking like a difficult person.

No residency is perfect, and it's best to know each program's positives and negatives before you make your rank list. After every interview, go home and write down what you liked and disliked about the programs, and include any distinctive features.

Most programs will welcome second looks if you're strongly interested. These can be extremely beneficial, especially if you have not had the chance to rotate there. You'll get a chance to learn more about the program and show your interest.

During these second looks, you'll start to pick up important tidbits that you missed during your first interview. You'll also start to notice the culture of the program. What are the residents like? What type of physicians does the program develop? Are the residents happy?

Pay attention to your gut. You'll know immediately that there is no way you'd be happy in some programs; others you may leave thinking that you could really see yourself there.

The List

Ranking is an individualized process depending on the number of interviews you attended, how competitive your application is, and your specialty.

As you develop a rank list, continue to think about what you want in a residency and how you want to spend the next 3 or more years. (Throughout the application process and third year, you should be thinking about all of this, so by the time it comes down to ranking you should feel comfortable with what you want.) Discuss your concerns and ideas with your mentors, advisors, friends, and loved ones.

Exercise caution when making changes in your rank list in the few days leading up to the deadline, because those decisions may not be well thought out.

When you hit that final "submit" button, you should feel that no matter which program on your rank list you're matched with, you would be happy being there.

In conclusion, choosing your residency can be scary and intimidating. The most important advice I can give is to do serious thinking about what is important to you, what will make you happy, and what programs will help you fulfill your personal and professional goals.

If you do this, then on Match Day when you open that envelope or email, you will be just fine.

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