The Road to Residency: Osmosis Video

Rebekah Apple, MA, DHSc


March 09, 2018

Editor's Note: Osmosis is a web and mobile-learning platform used by more than 500,000 people and more than 40 institutions and organizational partners. The Osmosis mission is to make learning medicine as efficient and enjoyable as possible. They accomplish this by uniquely integrating proven cognitive science techniques with cutting-edge technology and seamless user experiences. For USMLE study questions and more videos, see our collaboration page here.

For every medical or osteopathic student aspiring to be a clinician, a key stop along the way is residency. In total, there are 23 major types of residency programs, and to ultimately find one that is a good fit, you need to figure out what sort of training you're looking for, complete the application process, and participate in the match. We'll go over the specifics of applying to a US residency program, but some aspects of the process are universal.

One way to think about any career is to think about the intersection of four goals: What can you be paid for? What does the world need? What do you love? And what are you good at? Most would agree that becoming a physician offers a reasonable salary, but some professions pay much more than others especially when it's broken down by an hourly rate. The pay rate, as well as the number of hours and type of hours, meaning night shifts versus day shifts and taking call, are all important factors to consider. The world also needs physicians, but some types of physicians are more important to certain communities. For example, really great primary care physicians are in high demand especially in lower income communities. That leaves what you love and what you're good at. Figuring that out is often the biggest challenge for medical students, but hopefully you've had a variety of clinical experiences to help you figure out whether you like to work with adults or children, in an operating room or in a clinic, in front of a microscope or a light box.

We can also flip this around and ask "What do residency program directors think is important in selecting an applicant?" Well the National Resident Matching Program conducts surveys where they ask that exact question, and out of 33 items, the top five across all specialties were 1.) USMLE Step 1/ COMLEX 1 score, 2.) letters of recommendation in the specialty, 3.) the Dean's letter, 4.) USMLE Step 2 (CK) score, and 5.) grades in clerkships. At the very bottom of the list is the USMLE Step 3/COMLEX level 3 score.

So knowing what you want and what residency program directors want is a good first step, but then comes the process of actually applying to a specific specialty within a hospital system, some of which even have subtracks within a program. It's important to get to know each program you're interested in, because just like applicants, each one is different. Start by reaching out and getting to know current residents and faculty, maybe even paying a visit or scheduling a rotation if you are able to fit it into your schedule. This all takes time, but is worth the effort. The key here is to start early, and to get to know the various programs as well as the communities that house them.

After you've decided on a list of residencies that you want to apply to, it's time to put together your application. First off, there's your personal statement which is where you can tell your story and why you're applying. Remember that people relate to one another through stories, so this is your chance to tell an authentic story that allows the residency program admissions committee to get to know you. Also, don't forget to get feedback from trusted friends and family—it will definitely help. Another step is preparing your letters of recommendation, including your dean's letter and those from professionals in the specialty. Give your mentors plenty of time and offer to meet up with them to explain to them in your own words why you'd like to apply to a specific residency program, this is a great opportunity to strengthen those relationships. Then there's the messy business of doing well on the various USMLE and COMLEX step exams, which can cause incredible stress for applicants. Pretty much everyone agrees that these are not perfect measures of success and often have little or nothing to do with how you'll perform as a physician, but in the absence of other benchmarks, these exams continue to dominate admissions conversations.

Finally, if you're invited to interview at a program, it's well worth doing mock interviews and reaching out to any connections you may have at that program ahead of time to learn the specifics of the program, so that you can be well-prepared for your conversations.

After all of those steps are done, comes the match. Every year, the AOA Intern/Resident Registration Program, which is for DO students, as well as the National Residency Match Program or NRMP, which is for DO and MD students, use a proprietary algorithm to place individuals into their preferred residency programs. The first step of the match is completely based on applicant preference, and once there are too many applicants for a given program, the program's preference gets taken into account, and then they match. Now, there's also the couples match which is a feature that allows two applicants who are in a relationship to match at a single program. Given that system, it makes the most sense to simply rank programs based on order of preference, and for residency programs to do the same.

Key factors for students include things like how the program ranks nationally, where the program is located, the length of training, how well the program pays relative to the cost of living, the community and patient population, the availability of mentorship in specific fields, and for international medical graduates there may be additional concerns regarding visa status. There are a number of personal factors and relationships to consider as well, so the process of finalizing a match list can take quite a bit of time.

After applicant and program match lists are submitted, the AOA match results are released on a specific day in early February and the National Residency Match Program results are released on the third Friday of March. Match day is when everyone, both applicants and programs, find out results of the match, and at this point both sides are contractually obligated to accepting the results.

Unfortunately though, every year some applicants don't get matched to any of the programs that they selected. For those applicants, there's a process called the Supplemental Offer and Acceptance Program, or SOAP, which replaced the older "scramble" system. This system gives applicants access to the list of residency programs with vacancies in the days leading up to the NRMP Match day, so that they can reach out directly to fill a spot. Once the match process is over, applicants work closely with residency programs to prepare for the road ahead.

Alright, as a quick recap, applying to residency is a long process, so be sure to take your time and find a program that fits you well. Take care in putting together your application, which includes your personal statement, letters of recommendation, and your board exams, because it will all pay off when you match your dream program.


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