School of Medicine

Residency Review Seminar Online

Prepared by the Office of Student Affairs and Fourth Year Medical Students

The National Resident Matching Program

The National Resident Matching Program (NRMP) is a private, not-for-profit corporation established in 1952 to provide a uniform date of appointment to positions in graduate medical education. Each year the NRMP conducts a match that is designed to optimize the rank ordered choices of students and program directors. In the third week of March, the results of the Match are announced.

How the NRMP Process Works

Because it provides a uniform date for decisions about residency selection for both applicants and programs, the Match eliminates the pressure that might otherwise fall upon applicants and programs to make decisions before all of their options are known.

Since January 1998, a new applicant proposing algorithm has been used in all NRMP matches. This algorithm assumes that the offers made to applicants for training at the various programs are determined by the applicants’ preferred order lists. Applicants match into the program listed highest on their list that had also ranked the applicant, and that had not filled all of its available positions with applicants the program preferred as determined by the program’s Rank Order List.

There is one cardinal rule for both programs and applicants: neither program nor applicant must ask the other prior to the match top make a commitment as to how each will be ranked. It is okay (and even desirable) for each party to express a high level of interest in the other. However, references to how each party will rank the other should be avoided and should definitely not be solicited. Neither programs nor applicants should consider these comments about interest as commitments. Candor and honesty are important for both programs and applicants.

How the Matching Algorithm Works

The NRMP matching algorithm uses the preferences expressed in the Rank Order Lists submitted by applicants and programs to place individuals into positions. The process starts off with an attempt to place an applicant into the program indicated as most preferred on that applicant’s list. If the applicant cannot be matched to this first choice program, an attempt is then made to place the applicant into the second choice program, and so on, until the applicant obtains a tentative match, or all the applicant’s choices have been exhausted.

An applicant can be tentatively matched to a program in this process if the program also ranks the applicant on its Rank Order List, and either:

the program has an unfilled position. In this case, there is room in the program to make a tentative match between the applicant and program.
the program does not have an unfilled position, but the applicant is more attractive to the program than another applicant who is already tentatively matched to the program. In this case, the applicant who is the least preferred current match in the program is removed from the program, to make room for a tentative match with the more preferred applicant.

Matches are "tentative" because an applicant who is matched to a program at one point in the matching process may be removed from the program at some later point, to make room for an applicant more preferred by the program, as described in the second case above. When an applicant is removed from a previously made tentative match, an attempt is made to re-match this applicant, starting from the top of his/her list. This process is carried out for all applicants, until each applicant has either been tentatively matched to the most preferred choice possible, or all choices submitted by the applicant have been exhausted. When all applicants have been considered, the match is complete and all tentative matches become final

Applicants’ Rank Order Lists

Eight applicants are applying to four programs. After considering the relative desirability of each program, the applicants submit the following rank order lists to NRMP.

Anderson	Brown	Chen	Davis	Eastman	Ford	Garcia	Hassan
City	City	City	Mercy	City	City	City	State
	Mercy	Mercy	City	Mercy	General	Mercy	City
			General	State	Mercy	State	Mercy
			State	General	State	General

Applicant Anderson makes only a single choice, City, because he believes, based on remarks he heard from the program director that he would be ranked very highly at City, and he in turn assured the director that he would rank City number one. It is okay for programs to express a high level of interest in applicants to recruit them into their programs, and for applicants to say that they prefer one program over others. Such expressions, however, should not be considered as commitments.

Applicant Brown ranks only the two programs that were on every applicant’s list—Mercy and City. A member of AOA chosen his junior year, he believes that he is a most particularly desirable applicant. However, he has not been assured of a match with either of these programs. Applicants should consider ranking all programs that they are willing to attend, to reduce the likelihood of not matching at all.

Applicant Ford would be very pleased to end up at State, where she had a very good clerkship, and feels that they will rank her high on their list. Although she does not think that she has much of a chance, she would prefer to go to City, General, or Mercy so she ranks them higher and she ranks State fourth. This applicant is using NRMP to maximum advantage.

Applicant Hassan is equally sure he will be able to obtain a position at State, but he too would prefer the other programs. He ranks State first because he is afraid that State might fill its positions with others if he doesn’t place it first on his list. This applicant does not understand the Match. Applicants should rank programs in actual order of preference. Their choices should not be influenced by speculations about whether a program will rank them high, low, or not at all. The position of a program on an applicant’s rank order list will not affect that applicant’s position on the program’s rank order list, and therefore, will not affect the program’s preference for matching with that applicant as compared with any applicants to the program. During the matching process, an applicant is placed in the most preferred program that ranks the applicant and does not fill all its positions with more preferred applicants. Therefore, rank number one should be the applicant’s most preferred choice.

Applicants Davis, Eastman, and Garcia have interviewed at the same programs. Like the other applicants, they desire a position at City or Mercy and rank these programs either first or second, depending on preference. However, since they are not assured of a match to either of these desirable programs, these applicants also list State and General lower on their Rank Order Lists. They are using NRMP well.

Programs’ Rank Order Lists

Two positions are available at each program. The four programs, having determined their preferences for the eight applicants, also submit rank order lists to the NRMP.

Mercy City General State

Chen Garcia Brown Brown

Garcia Hassan Eastman Eastman

Eastman Hassan Anderson

Anderson Anderson Chen

Brown Chen Hassan

Chen Davis Ford

Davis Garcia Davis

Ford Garcia

The program director at Mercy ranks only two applicants, Chen and Garcia for his two position although several more are acceptable. He has insisted that all applicants tell him exactly how they will rank his program and both of these applicants have assured him that they will rank his program very highly. He delights in telling his peers at national meetings that he never has to go far down his Rank Order List to fill his positions. The advantage of a matching program is that decisions about preferences can be made in private and without pressure. Both applicants and programs may try to influence decisions in their favor, but neither can force the other to make a binding commitment before the Match. The final preferences of program directors and applicants as reflected on the submitted Rank Order Lists will determine the placement of applicants.

The program director at State feels that his program is not the most desirable to most of the applicants, but that he has a good chance of matching Ford and Hassan. Instead of ranking these two applicants at the top of his list, however, he ranks more desired applicants higher. He also ranks all of the acceptable applicants to his program. He is using the NRMP well.

The program directors at City and General have participated in the matching process before. They include all acceptable applicants on the Rank Order Lists with the most preferred ranked high. These program directors are not concerned about filling their available positions within the first two ranks. They prefer to try to match with the strongest, most desirable candidates. They are using the NRMP to maximum advantage.

Summary of Guidelines for the Preparation of Applicant Rank Order Lists

Applicants are advised to include on their Rank Order Lists only those programs that represent their true preferences.

Programs should be ranked in sequence, according to the applicant’s true preferences.

Factors to consider in determining the number of programs to rank include the competitiveness of the specialty, the competition for the specific programs being ranked, and the applicant’s qualifications. In most instances, the issue is not the actual number of programs on the Rank Order List, but the dilemma of whether to add one or more additional programs to the list in order to reduce the likelihood of being unmatched.

Applicants are advised to rank all of the programs deemed acceptable to the applicant, i.e. a program where they would be happy to undertake residency training. Conversely, if an applicant finds certain programs unacceptable and is not interested in accepting offers from these programs, said program(s) should not be included on the applicant’s Rank Order List.

It is highly unlikely that either applicants or programs will be able to influence the outcome of the match in their favor by submitting a list that differs from their true preferences.

Don’t overestimate yourself. Regardless of how sure you are that you will match at your top choice, you cannot be penalized for listing additional programs.

Don’t underestimate yourself. Again, you are not penalized for listing programs that you consider to be a long shot for you. Even if you don’t think that you have much of a chance, if you really want to go somewhere, go ahead and rank it first.

What if you don’t match? Unmatched applicants are notified a few days before Match Day so that they will have the opportunity to contact hospitals that did not fill and hopefully secure a satisfactory position. It is not true that only "bad" programs don’t fill. It is possible for any program not to fill if its rank list is at odds with the applicants who ranked it. There are likely to be several programs with unfilled positions after the Match that you would find desirable.

The above information and additional information on the Match can be found at: www.eraspo5.aamc.org/nrmp/abounrmp/index.htm

INDIVIDUAL SPECIALTIES - STUDENT PERSPECTIVES

ANESTHESIOLOGY
by Brian Hopkins

A lot of people have asked me, "What is it about anesthesiology that interests you? Don't you find it boring and mundane?" To some, it may be boring and mundane, but to me, it's just the opposite. It's a field where you have to think on your feet, be aware of what's going on around you, and possess the skill and technique to help correct what may potentially go wrong. It's a field where you not only get to think, you get to do.

As an anesthesiologist, you spend a lot of time in the O.R. running all kinds of surgical cases, whether it's a tonsillectomy on a six year old, a simple appendectomy on a healthy twenty-four year old, or a quadruple bypass on a sixty-seven year old ... with COPD and diabetes. A lot of time is spent outside of the O.R. as well. Time is spent in the pre-operative clinic examining patients before their "big day," in the pain management clinic helping relieve chronic pain in a number of unique ways, or even in the SICU. Many surgical intensive care units are run by anesthesiologists because of their intensive training with ventilator management and sedation. The anesthesiologist is the one primarily responsible for the patient throughout the pre-, intra-, and immediate post-operative period. He/She is essentially the patient's "guide" throughout the surgical process.

There are many subspecialties within the field of anesthesiology including: pain management, neuroanesthesia, obstetrical anesthesia, cardiac anesthesia, pediatric anesthesia, and critical care medicine. Fellowships are available in every subspecialty and typically last one to two years after residency.

Anesthesia residency lasts for a total of four years. The first post-graduate year (PGYI) is spent as an intern (yes, an intern) doing a full year in just about anything except psychiatry. Most people usually spend their intern year doing a full year in medicine, surgery, or family practice. Transitional years, where you do a few months of everything (surgery, medicine, peds, radiology) are quite popular and are allowed as well. You have the option of spending your PGY 1 year at an institution different from the one where you'll be doing your anesthesia residency. Obviously, there are pros and cons for doing this. Your anesthesia residency rounds out your four years (PGY2-PGY4).

Because most anesthesia residency programs are three year specialty programs (PGY2-PGY4), you have to apply for a separate PGY1 position. This requires twice as many applications etc. Yes, it's a pain especially when PGYI positions are on ERAS (Electronic Residency Application System), and anesthesia positions are still on paper. Hopefully, anesthesia positions will be a part of ERAS soon and everything will be much easier. It is of note that there are some anesthesia programs that offer the full four-year residency with the PGY1 year included. These programs are few and far between, however.

The interview process isn't all that bad. You've probably heard that programs are paying for your airline tickets, hotels, and food. For the most part, this is true. Every program I visited fed me (at least one meal), and offered to put me up in a hotel. However, there weren't many programs that paid for airfare. All in all, interviewing was a fun time. The numbers of anesthesia applicants dropped precipitously in the early to mid-nineties. Now, the numbers are beginning to rebound. They aren't stellar yet, but they're on their way. With the drop in applicant numbers, there are a lot of great programs actively searching for people like you to fill them.

Things to ask and look for while interviewing:

Are the residents happy? If not, why? Every fteakin' anesthesia resident I ran into was happy, so this question becomes "moot" after some time. It's still an important question. A resident can say anything. Look 'em over - are there bags under their eyes? Did they have time to shower this morning? You catch my drift.

Is the department "stable"? Who cares, right? Wrong! There's been a lot of flux in anesthesia departments lately. If a department ends up hiring a residency director who doesn't give aflip about the residents, then kiss your happiness goodbye. (This seldom, if ever, happens) Same goes with hiring new dept. chairpersons. Ask if the current chairperson or residency director is planning on staying or leaving...

What's the staff to resident ratio? This brings up several points. Is one staff person covering six rooms? If so, your one-on-one educational opportunity just went down the drain. Are there enough people to cover the "boring" cases as well as the "cream-of-the-crop" cases? There's only so many appendectomies one resident can take.

What kind of cases are done at that institution? Is the place where you're going the "inguinal hernia capital of the world? " Or is it the place where they're doing heartl1ung transplants and cutting edge medicine? Where would you want to go? This brings up another point. To be a certijied anesthesia residency, the residents have to do a certain number of heart cases, peds cases, neuro cases etc…. Obviously, every place you apply will be "certified " So, be sure to ask just who is doing those cases. Is it you, the PGY2 resident, or are you watching the cardiac anesthesia fellow do all the work. Sometimes, case load numbers can be padded.

Are residents excused when they're post-call? Most programs give their anesthesia residents their post-call day off Some programs say the residents have no "clinical" or "O.R.. "duties. Think about it, there's a difference. You don't want to have to be in the hospital after staying up all night doing a liver transplant. Know what I'm saying?

Are any of the faculty members oral board examiners? Does the program provide mock oral boards? And you thought boards went away after Step 3? Pretty sickening, I know, but they're baaaack. Might as well try and get an idea of what oral boards are like as soon as you get the chance.

Who assigns resident's cases? Is it the residency director (watch out for #2) or is it the O.R. director (who could care less about what the residents want anyway). Keep in mind, too, that most residency directors DO in fact keep the residents' interests in mind.

How has the program changed - especially in light of what happened with decreased applicant numbers? This can tell you a lot about what people do when things get tight. Did the residents end up having to take more call? Were nurse anesthetists hired? Did caseload numbers decline?

Finally, how do residents typically score on boards after completing residency? Refer to #6 Does the program have a good didactic session? Is the one-on-one education a true education, or just a malignant pimp session?

Obviously, some of these questions are better for the residents themselves vs. the staff that oversees the program. I believe that good programs consist of residents who work hard and play hard. Camaraderie between the residents and the staff is something to look for as well.

Finally, if you think you know where you want to go, try and do anexternship month there before you decide to interview there. The time to start externship applications is now! Call the program and ask to see if they offer externships. Any academic hospital should. Then, you can really see the good, the bad and the ugly of a program and decide if it's the right one for you.

Best of luck, and HAVE FUN!

DERMATOLOGY
by Walter Williams

Although dermatology is limited primarily to the treatment of skin disorders and diseases, it is very diverse in that medicine, surgery and pathology are all integral parts of the specialty. The use of keen observational skills to "solve the puzzle" and the fast paced, problem focused approach to medicine are some of the features I have found unique to dermatology. The amount of surgery and pathology involved in an individual's practice is quite variable and can be tailored to one's own interest. Dermatopathology and surgical fellowships are available to those who desire more specialized training.

Unlike many specialties which are characterized by certain personality types, most of the individuals I have met in Dermatology are extremely diverse in their interests and personality. Interestingly, I did notice as I interviewed that there seemed to be twice as many female applicants as male applicants. Dermatologists spend most of their eight-hour day in the office. They are occasionally called to the hospital for consultation, but rarely have their own hospitalized patients. The opportunity to work with all age groups is an additional bonus in dermatology.

Many students asked me if I mostly saw acne during my rotations. Although acne, psoriasis, and eczematous dermatitis are among the more common entities treated in dermatology, there are a great deal of exotic diseases a dermatologist sees as they receive many referrals from primary care physicians. Diagnosis and removal of the skin cancers seems to be more prevalent these days as the population ages and the younger generations continue to be "sun worshipers".

Dermatology is a three year residency program at most institutions. Additionally, one year of postgraduate training in a transitional program, or a preliminary year in internal medicine, general surgery, family practice, Ob-Gyn, pediatrics or emergency medicine is required. Most applicants do a preliminary year in medicine, while some choose to do a transitional year. Starting next year, dermatology will no longer have its own specialty match and will match at the regular time in March.

Traditionally, dermatology has been considered very competitive. Membership in AOA, class rank, board scores and research experience are often cited as the top criteria for applicant selection. However, don’t panic of become discouraged if you don’t have high marks in all of the above. In recent years, the percentage of applicants successfully matching has gone up, weaknesses in one area cam be bolstered by strengthening other parts of your application.

Doing research or completing a residency in internal medicine are common approaches used to improve qualifications. Almost everyone I have met during my interviews has done some research, If you are unable to find research opportunities at KU, inquire about research opportunities at another university. This will not only help you get valuable research experience, by will also help you get your "foot in the door" at another program, besides your home school.

In addition to research, one to two months of clinical elective in dermatology is generally required, It is important to do at least one of the clinical rotations with the KU Dermatology Department as their letters of recommendation will be most valuable to you when you are applying for residency, The clinical elective in dermatology at KU has gotten a reputation in recent years as being an elective in which it is very difficult to get a good grade. If you work hard and let them know your are sincerely interested in dermatology, they will be very fair and helpful.

As with most specialties, the role of the dermatologist in this era of managed health care is being redefined and is not entirely certain. Unlike other specialties, dermatology has one advantage in that the supply and projected needs for the future are currently close to being balance. In conclusion, dermatology is an exciting and interesting field that will always be needed.

DIAGNOSTIC RADIOLOGY
by Matt Harmon

A career in radiology offers the prospective resident an opportunity to participate in the diagnosis and treatment of a broad range of disease states while still maintaining a healthy lifestyle separate from the profession. As a technologically oriented specialty, radiology has been quick to implement the many advances in technique and equipment that enable the radiologist to practice with an increasing degree of accuracy and efficiency. Similarly, the refinement of various interventional techniques has extended the reach of the radiologist, and allowed for more frequent "hands-on" participation in the care of the patient.

Residency programs currently require a total of five years of training. The first post-graduate year is spent in the completion of an internship or transitional year (both of which involve a separate application/interview process). The latter option has become quite popular for a number of reasons. Transitional programs tend to be significantly more flexible with regard to which services through which you are required to rotate, as compared to a traditional internship. The second through fourth years are then spent studying the various aspects of diagnostic imaging (chest, ortho, peds, CT, MRI, US, etc.)

As far as practice setting is concerned, the vast majority of residency programs are university-based. The important distinction lies in the degree to which different programs emphasize research participation. If you plan to pursue a career in academic radiology, look for a program that requires its residents to complete research projects. Such programs will generally be better positioned to provide the expertise and resources necessary to complete such a project.

The didactic structure offered to residents differs quite a bit from program to program. The volume and quality of academic resources is also somewhat variable. Look for programs with a scheduled lecture series that current residents find to be adequate. A well-stocked library (especially one with an up to date American College of Radiology (ACR) teaching file) and plentiful computer access are important clues about the value that programs place on resident education. One component of the radiology board examination focuses on radiation physics and biology. Ideally, programs should have a physics instructor on staff. Most programs allow time for their residents to attend a one month course at the Armed Forces Institute of Pathology (some programs will also finance your attendance). Perhaps most importantly, try to get a feel for what the residents see as being their primary role in the department. Unfortunately, the occasional program will view its residents as a cheap source of labor, and treat them as such.

During the interview season, residents encountered during the process are, not surprisingly, a great source of information. Important topics to explore include; the call schedule and the availability of back-up, the volume of procedures performed by residents (especially important in those programs which also offer fellowship positions), the efficiency of the film library (a potential source of big headaches), and the flavor of the didactic sessions (benign v. malignant).

The interview process is fairly standardized among different programs. Fortunately, programs tend to reserve their interview dates for candidates they are seriously interested in recruiting. In most cases, you will meet with a variable number of faculty members, on an individual basis, prior to touring the hospital with some of the residents (a great opportunity to assess the facilities and equipment available in the department). The interviews, themselves, tend to be quite informal in nature. Many interviewers focus on answering any questions you might have about their program. Be prepared to discuss any research projects that you included in your application materials. Otherwise, don’t expect many questions involving topics directly related to the specialty (other than the ever popular, "why did you choose radiology?").

On the whole, the diagnostic radiology residency application and interview process is relatively painless.

EMERGENCY MEDICINE
by Kevin Pogreba

Since the advent of it's first residency program in 1970, Emergency Medicine has been billed as the fastest growing medical specialty over the past two decades. Currently, there are over 90 residency programs with new programs being formed all the time. The intense demand for these new programs stems in part from the ABEM's move to allow board certification only to those physicians residengy trained in the specialty. In the past, physicians trained in any specialty were allowed to become board certified with, at minimum, 36 months ER work experience. As a result, there is now a high shortage of residency trained/board certified EM physicians. The field is wide open and should continue to be for the next 10 years.

Because there are so few programs right now, attaining a resident position has become a much more competitive process. Be sure to look at a number of programs so you can increase your chances of securing a match. Basically, there are 3 types of programs:

PG- 1,2,3: Three year curriculum designed by the EM program;
PG- 1,2,3,4: Four year curriculum designed by the EM program; and,
PG-2,3,4: Three year EM curriculum requiring prior completion of an intern year.

The difference in the programs has some historical basis, but I don't know exactly what the reasoning is behind the whole issue. Take a close look at the curricula each place has to offer and decide what would be best for you. I'll include a couple of editorial comments on this topic from some of the big guns of EM.

The field itself is diverse and requires clinical competence in every discipline of medicine and surgery on an acute level. If you find you like just about every clinical rotation but can't put your finger on any one, EM might be for you. All residency programs have core curricula based on: EM, adult and peds intensive care, general internal medicine, general and trauma surgery, general peds, OB-GYN, EMS, neurosurgery, and usually ortho, plastics, toxicology, ENT, optho, and various other electives.

Here are some suggestions that might be helpful during the application/interview process:

Electives: Try to gain some elective time early to help you decide if this is right for you. Most programs require a letter from the director of EM at an applicants school. Dr. Allin and his crew were more than happy to provide letters for all of us applying this year. He is also a good resource when you are weighing the pros and cons of various programs. If you find you don't have time to do an elective at KU and at another program you might be interested in, I suggest doing the away elective and having that director write a letter for you. hi any case, try to have program directors at any elective you take write a letter. Selection committees are very interested 'in how their peers rate your performance.

Letters: Aside from what was mentioned above, you do not have to have all your letters from boarded EM docs. Most places require 3-4 letters, me being from the Dean and one from an EM program director. Get your other letters from people who know you on an academic as well as a personal level ... these tend to be the best.

Memberships: It's probably a good idea to join ACEP (American College of Emergency Physicians) and EMIZA (Emergency Medicine Resident's Association) if you decide on EM. Membership fees are discounted for students and you will get Annals Emerggincy Medicine plus newsletters and some other interesting stuff. It also looks good on your CV.

Interviews: The best way to approach interviews is to know yourself solid. Know why you're interested in whatever specialty you choose, review your CV and personal statement before each interview, and most of all be honest...selection committees are pretty good at sorting through bull --- t. All of the interviews I went to were very laid back and I was never pimped or questioned about any part of my application file.

Be confident but not cocky. You’ve already proven you can handle med school, so they should be recruiting you as much as your are trying to sell yourself to them.

Ask questions about their specific program:

-Call schedules on non-ER rotations
-How are EM residents treated on these rotations by staff
-How well is the department respected by the med-center community
-Quality of didactics, board preparation, etc.
-Research and other departmental requirements
-Affiliations with other hospitals
-Salary and benefits
-Moonlighting opportunities

Most places will give an overview of their program during your interview, but always have some questions socked away…it shows you are interested in important issues. Generally, the residents are an excellent source of info…after all, they are the ones in training and they are the ones you’ll have to work with.

Although a little outdated, the following references are a good source of information about interviewing and the specialty in general:

-Koscove, EM: An Applicant’t Evaluation of an Emergency Medicine Internship and Residency Annals of Emergency Medicne 1990, 19 774-780

-Delbridge, TR: Emergency Medicine in Focus: a handbook for medical students and prospective residents. I think Laura has a copy in her office.

Lastly, the intangibles are extremely important when looking for the right residency. Call it gestalt or gut feeling…either way, rank places that seem fun and have people you like. EM tends to attract laid back personalities with many interests outside of medicine.

The lifestyle allows for this.

FAMILY PRACTICE
by Kerry Glynn

Family practice continues to grow rapidly due to the current emphasis on primary care and the flexibility that the specialty offers. There are ample opportunities for family practitioners nationwide. The number of residency programs is greater than 400, and though competition for residency positions is on the rise, the interview process is mostly very pleasant. Programs that look good to you, however, probably look good to other applicants, so assertively pursuing programs that you are interested in is recommended.

The basic curriculum of a family practice residency varies little due to the requirements that programs must meet in order to fulfill accreditation. Most programs offer a well-rounded education. There is great diversity, though, in the educational style and working atmosphere from one residency to the next. It is important to find a program that is well suited to your educational needs and provides an atmosphere conducive to your personality and life style.

Answering basic questions may help you begin selecting a program:
In which parts of the country am I interested in living?
What size of city do I prefer?
What size of program do I prefer?
Would I work best in a university setting or a private setting?
Am I interested in practicing obstetrics as a family practitioner?
Do I plan ultimately on practicing in an urban or rural area?
Any special interests, such as sports medicine, international medicine, etc?
Do I work best with close supervision, or do I prefer quite a bit of independence?
Do I learn best in high-volume atmospheres or in one that is more relaxed?

These questions are often easily answered by the applicant, and help one narrow down lists of programs to consider. Recent graduates are also good resources, and have valuable information about programs.

Interview at variety of programs that satisfy your needs and interests, so that you may make accurate and educated comparisons. During the interview, inquire directly about strengths and weaknesses of the program; most interviewers will give open and honest answers. Talk to the residents about their daily routine, call schedule, and overall lifestyle. If you have special interests in areas such as research, women’s health, community service, or others, ask the program director and residents about these individually. Your overall feeling about a program is probably a good indicator of whether you could potentially work and be happy in that setting. Some students prefer to closely examine a program of interest by spending a month of elective time at the program. Also, some students find "second look" visits valuable, where they spend a day in clinic in order to meet more residents and faculty members. There is a wide variety of family practice training programs available. Knowing what you are looking for in a program is extremely valuable and helps to formulate the rank order list that is best for you.

Questions I was asked most during interviews:
Why have you chosen family practice as a specialty?
Why have you chosen to interview at this program?
Why have you chosen to interview in this part of the country?
Tell me about a patient that you learned from, and how this experience will be valuable to you as a family practitioner?
In which part of the country do you plan on practicing?
How do you best deal with conflict?
What qualities as an individual will you bring to a family practice residency program?

Finally, the American Academy of Family Physicians (AAFP), whose national office is in Kansas City, is a useful resource. There are two publications that offer insight into the match process. The "Directory of Family Practice Residency Programs" provides a comprehensive, detailed list of all accredited programs in the country. "Strolling Through the Match" is also a helpful tool to use during the months prior to interviews.

Good luck!

INTERNAL MEDICINE
by Daniel C. Buckles

Internal Medicine has traditionally been the largest area of postgraduate medical training. This is because it serves to train practitioners of general Internal Medicine, but it also serves as the starting point for careers in the medical subspecialties, such as Cardiology, Gastroenterology, Pulmonology, among others.

Many institutions are currently offering Internal Medicine training programs in both Traditional and Primary Care tracks. While both of these programs are three years in length, they emphasize different aspects of medicine. The Traditional tracks are geared more towards future subspecialty or academic training, and the Primary Care tracks are designed to better prepare one for practicing as a generalist physician. The major difference is that Primary Care tracks tend to contain more outpatient exposure, and this comes at the expense of inpatient and ICU training. Most program directors will admit, however, that there is a great deal of overlap. Many graduates of Primary Care tracks pursue fellowships, and many Traditional track graduates practice primary care. But if you know your ultimate goals before entering residency training, these different types of programs allow you the opportunity to individualize your training to a certain degree.

The process of applying for positions in Internal Medicine programs has been greatly simplified by the recent switch to the Electronic Residency Application System (ERAS). The amount of paperwork needed to complete the process has definitely been reduced. However, you are still well served by being organized and paying attention to the numerous deadlines.

Most applicants begin the process by requesting information from programs. This is usually done in the early summer, that is June or July. This can be accomplished by either writing to residency programs using addresses available in the Student Affairs Office or found on the FRIEDA system. Also, requests for information can be sent via the internet, as most programs will have websites on-line. Making things even more convenient is that print information, such as brochures and pamphlets are often replicated electronically on these websites. This can be a valuable way of quickly finding information about the many programs available.

Letters of recommendation should be obtained from professors by the end of September. Most programs will require at least two in addition to a letter from the Chairman of the Department of Medicine. It is usually a good idea to get these letters from individuals within the Department of Medicine. It is often helpful to schedule a medicine elective for early in the fourth year so that one has additional faculty to choose from for letters of recommendation. The ERAS system has made getting letters relatively a breeze. Whereas previous year’s applicants had to provide faculty with program addresses and many faculty would limit the number of letters they would write, current applicants need only provide the professor with some information. This usually consists of a cover sheet printed off of the ERAS system, a copy of the applicant’s CV, and possibly the applicant’s personal statement, depending on the professor. One copy of the letter is sent to the office of Student Affairs and the letter is included, electronically, in the application.

For the most part, the entire ERAS application needs to be completed by November 1, when the Dean’s letters are sent out. Programs vary with regards to whether they will extend offers to interview before they receive the Dean’s letter. Some will make offers if they have completed applications before that, some will not. Interviews take place from late October to the end of January. Scheduling interviews can get tricky, but it certainly helps if you have scheduled a month off. This large block of time, usually taken in December or January, can afford you the flexibility to schedule interviews conveniently. It is conventional wisdom that one should interview later rather than earlier. That means that December and January are the most popular months to interview, so it is helpful to schedule these dates far in advance so the slots do not fill up.

The actual interviews in Internal Medicine are almost universally non-confrontational. Most programs will have you interview with one or two faculty in addition to the program director. For the most part, they are interested in getting to know you, answering your questions about the program, and selling the program to you. Be prepared to discuss your career plans and your interests. Also, have in mind some specific questions to ask, as every interviewer will end the interview with "What questions do you have about our program?" It will go a long way toward making yourself look interested and informed if you have something to inquire about. The interview day usually also consists of a tour, having you sit in on Morning Report, and possibly visiting Floor Rounds. Some programs will provide room and board, others will not. Many people recommend that you write thank you letters to faculty members that have interviewed you. Whether or not this is expected, it certainly will not hurt.

The final portion of the application process involves submitting your rank order list by mid-February. There is no set number of programs that you should rank, however, most applicants apply to about ten programs and interview at six to eight. Your own qualifications as an applicant will determine whether you need to apply to more or can apply to less. Internal Medicine positions are numerous, therefore most people do not have difficulty matching somewhere, but it can require more effort to ensure matching at a particular program or matching at a program with a top national reputation.

Good Luck.

INTERNAL MEDICINE/PEDIATRICS
by Dave Basel and Jennifer Firestone

Programs which combine internal medicine and pediatrics, better known as Med/Peds, train their residents to become specialists in both Internal Medicine and Pediatrics. A physician so trained is board certified to take care of the full age range of patients. This specialty allows its members the ability to practice general primary care upon completion of the residency or to proceed to any fellowship program in either Internal Medicine or Pediatrics. As this specialty has developed in the past 20 years, there are even opportunities to do fellowship training which coordinate both the adult and child aspects of that particular sub-specialty. Med/Peds graduates have the unique advantage of being qualified to take care of any age patient as well as having the option of sub-specializing. In contrast to Family Medicine, which also prides itself in being able to take care of the full age range of patients, Med/Peds physicians are not trained in OB/Gyn, Surgery, or Psychiatry. Thus, the time that is spent in Family Medicine to train in those disciplines is spent in more intensive care and subspecialty areas of Internal Medicine and Pediatrics. This is one reason why some Med/Peds graduates go into practice with Family Practitioners to handle their more complicated/hospitalized patients.

The scope of practice in Med/Peds is wide, but allows enough depth of training to allow one to act as a consultant to other physicians in general practice as well as the opportunity to extend training in a more specific area of interest. Thus, the Med/Peds physician is wonderfully positioned in the world of primary care with easy access to the world of specialist medicine.

The following are some resources that might be of interest to those considering Med/Peds:

1. American College of Physicians. The role of the future of general internal medicine defined. Ann Intern Med. 1994;121(8):616-622.

2. Ciccarelli M. The Clinical Philosophy of Medicine-Pediatrics. Am J Med. 1998; 104:330-1.

3. Lannon CM, Oliver TK, Guerin RO, et al. Internal medicine pediatrics combined residency graduates: What are they doing now? Submitted.

4. Onady GM. A community collaborative practice experience between med/peds and family practice. Am J Med. 1997; 102(5):441-448.

Interview Questions Specific to Med/Peds

Board passage rate in each specialty and among med/peds graduates?
What type of careers graduates have chosen?
Does curriculum adhere to "Guidelines for Combined Medicine/Pediatrics Residency Training Programs"?
Flexibility of electives, any combined electives?
ICU and inpatient floor time compared to ambulatory and elective time?
Does peds schedule allow residents to see all infectious seasons?
How long are residents considered interns on a service?
Is there a combined Med/Peds coordinator or chair?
How many Med/Peds trained faculty in their program?
Is there a separate Med/Peds chief resident?
How do combined and categorical residents get along?
Is there a combined Med/Peds clinic?
Any Med/Peds practices nearby to observe/train in?

MILITARY MATCH
by Eric Halsey

One question looms as military scholarship students finish their third year. Should I go

military or civilian? Before you fret excessively, consider this: you may not have a choice. If your branch has six residency slots in the field you are considering, and there are six students applying, chances are you will be wearing a uniform for the next few years. As an example, take this year's Air Force match. If you wanted to pursue internal medicine, the Air Force residency program took nearly all the 48 students selecting medicine. If ENT was your thing, the Air Force had no residency slots this year, guaranteeing a civilian residency for the applicant (provided one could match in it)

As for general surgery, half the applicants went military and half did not (this was the case for many other fields)

One thing is for certain: next year will be different from this year. It always comes down to a few factors:

How many residency slots are available in the military
How many non-military residency slots the government will allow to be filled (civilian deferments)
How many students are applying in your field

The first two factors are re-evaluated periodically by the government based on perceived need. The last factor is determined by number of applications. All three factors are impossible to predict. Still, there is a chance you will be forced to chose between military and civilian when the time comes. Both options have advantages and disadvantages.

Military residencies are offered in such coveted locations as Hawaii, San Francisco, Washington D.C, coastal Florida, San Diego, and San Antonio. As a rule, residents complain less about abuse (hours, ego, etc) than their peers in the civilian world and they score extremely well on boards. Furthermore, the pay is substantially more than civilian programs, and a portion of the yearly wad is tax-free. Military match day occurs in mid-December, providing the luxury of knowing where you will be next year while your peers sweat it out in March. Some fields that are extremely competitive in the civilian world, may be more attainable in the military. The converse may be true for other fields. Civilian match, on the other hand, provides more diversity for locations and programs. Plus, it delays the everyday military reality of uniforms, saluting, and funny hats. There are always a group of students gung-ho about matching military and an even greater number scrambling to avoid a military residency. Remember that if the military has three residency slots in radiology and is allowing three to match civilian, it will take the three most attractive candidates. This is often an unpleasant realization for the 4.0 student with their sights set on Mass General. Only compelling excuses will ensure a civilian deferment (spouse being unable to move, etc). Every year, a few students devise elaborate plans to subvert a military match and every year those students are still matched in the military so be aware.

As you plan your fourth year, schedule at least one externship at the location you would like to match in the field you are pursuing. This means making sure you have a free month for an externship in July, August, September, or October because match lists are due by October (although changes can be made for a few more weeks). This allows a month-long preview of the program you plan to select. It also provides a month for the attendings and program director to know you and all of your wonderful qualities. You will also have the opportunity to interview while you are at the site, saving the cost of a visit. I performed clerkships in the months of July, August, and October, and by the end I knew exactly where I wanted to be.

Most of the application process is easier or comparable to the civilian match. The military asks for a personal statement, letters of recommendation, grades, test scores, honors, and a CV. On-site interviews are not always required, but some programs will arrange for a low-key phone interview. Avoiding interviewing, whether it is in person or over the phone, is a risky endeavor. The military may still select you, they will just send you to an undesirable location because nobody knows who you are but there are still slots to fill.

Matching military appears daunting, mostly because so few of your Jayhawk peers are doing it. Ignorance is your worst foe. Start early, talk with others familiar with the process, and approach it with an open mind. After the smoke clears and the committee makes its selections, most students end up where they desire.

NEUROLOGY
by Matthew Flaherty

The traditional foci of neurology has been diagnosis and prognosis, with therapeutics assuming a less prominent role. While this balance is changing in favor of treatment, neurology’s reputation for therapeutic nihilism probably accounts for its status as an "undersubscribed" specialty.

Though "undersubscription" is detrimental to neurology in general, it does provide an advantage for students with an inherent interest in the central nervous system: graduate from an American medical school without committing a felony, and you will almost surely match in neurology (obtaining the position of your choice is another issue). In 1999, only 7 of 232 U.S. seniors failed to match. The vast majority of unmatched candidates were FMG’s.

A neurology residency starts after a preliminary year of medicine. For this reason you must register for both the neurology (NEMP) match and the standard (NRMP) match. Because neurology is an early match, you will know your eventual destination when ranking your medicine choices. Most individuals complete their medicine year at their home institution or the site of their neurology training.

The following is a general time-table for the application process:

May-July
Begin considering different neurology programs. Discuss possibilities with colleagues, residents, and staff neurologists. Write or call programs for printed information. Cast your nets widely at this time, as you can always narrow them later. Take a month of neurology at KU early in your fourth year and get to know the faculty, including (if possible) the chairman. An outside rotation in neurology may be of benefit, but is certainly not necessary. Register for both the neurology and regular matches and complete the other tasks set forth by Laura Zeiger. They may seems comlex at first but are actually quite easily satisfied.

August-October
Complete applications to your schools of choice. For most candidates, five to twelve should be sufficient. Unfortunately, each program has its won application form. Be sure to note the relationship between neurology and medicine at each institution. Some require separate applications and interviews, others do not. Schools with separate may require the use of ERAS.

Make an appointment with faculty and discuss letters of recommendation approximately one month before you wish them sent. Generally, programs require three such letter (two from neurologists, including one from the chairman).

October-January
Schedule and complete interviews. These are typically low key and focus upon your questions about the program (so have good ones ready!). Students are sometimes asked to present an interesting neurological case they have seen.

Most candidates interview in late November, December, and early January. It helps to take December off from clinical duties as the majority of interviews occur at this time. You will cut travel costs substantially by making arrangements 3-4 weeks in advance. Write thank you notes to program directors following your interviews.

January-March
Match lists in neurology as due in late January, with results available in early February. NRMP match lists should then be completed (by the mid-late February deadline), with results available on "Match Day" in March.

For more information, try the early match website at www.sfmatch.org or contact Laura Zeiger. Good luck in the match process and your career in neurology.

2003 Neurology Match results

NEUROSURGERY
by Chad Morgan

General
There are several key concepts to the field of neurosurgery. First, one should appreciate the uniqueness of the specialty. No other field allows physicians to care for the patient in such a critical manner. Neurosurgeons must balance a confident knowledge with a stern sense of humility. We study what we can not possibly understand, and we intervene for the preservation of fundamental human existence.

Secondly, applicants should realize the surgical sub-specialties are an extremely small group of physicians. With this in mind, everyone you encounter must be treated with the respect you all hopefully display by second nature. As the saying goes, "Everyone knows everyone", and in the application stage it is vital to be well known and well liked. This should never be problem. Be polite. Learn the names of the chairpersons; they will be featured in your readings and shape your practices.

Finally, please realize that neurosurgery is wed to research. Harvey Cushing and those who followed were as much basic scientists as clinicians. The tradition continues.

Competition
Don’t be fooled. Although the competition is steep, the goal is achievable. In 1999, the percentage of U.S. Seniors matching was 85%. Programs and the application are quite explicit in their criteria. At the top of the Central Application Service document you will enter: class rank, GPA, and AOA membership status including junior or senior AOA admittance. These credentials, along with board scores, are the fundamental points for consideration. To give general guidelines, in my opinion, board scores should exceed 220, class rank should be within the top 20%, and AOA is moderately important depending on the program.

www.sfmatch.org

Familiarize yourself with this site immediately. It is the single best source of information on nearly all match programs. It contains vital statistics, useful links, and the means to register with the Society of Neurological Surgeons via the Central Application Service (CAS). Once registered ($35), sfmatch will provide you a registration number, the standardized application, labels, distribution service, rank lists forms, etc. The sf.match organization will also provide you with a pocket-sized book that lists every program including their phone number, address, contact person, and chairperson. Also included on the sf.match site is a link to the match report comparative statistics table. This details the number of positions available for the last nine years and the percentage of U.S. Seniors matching each year. The table has been included within this book for reference.

The easiest portion of matching in neurosurgery is filling out and submitting the application. Every program in the U.S. (except two) subscribes to the CAS. Applicants need only fill-out the forms and check your desired programs. The sf.match organization will distribute the completed packet which will include: the application, your personal statement, letters of recommendation (x3), KUMC transcript, undergraduate transcript(s), and a list of programs for application submission. The Dean’s letter will follow submission of the packet (see timetable), but sf.match will provide the applicant with an envelope and label to be given to the Dean’s office.

Choosing a Program
As unfortunate as it may be, your long-term career goals should be partially realized prior to application. Some programs are designed to create future chairpersons. Others teach only the basic neurosurgery skills. The remaining programs reside somewhere in between. Depending on an area of interest or your long-term goals, you should choose wisely. Every program does something well. Talk to residents and faculty and find programs tailored to your needs.

Beyond the reputation of a residency, several other factors are unique to the field of neurosurgery. 1) You must enjoy spending time with the other residents. This is best determined by spending an away month at an enticing program. 2) Call schedule and trauma demand must be considered. Please realize, the most demanding cases are the elective procedures, and as important as head trauma and spinal cord injury are to training, they do not need to dominate one’s life. 3) Several programs have integrated neurology, neuropathology, and neuroradiology into the PGY-1 year. 4) A new trend at some residency programs is the integration of a fellowship into the existing years of training. The fellowship integration trend stems largely from the need to obtain Spine Fellowship Certification for competition with some fellowship-trained Orthopedic Surgeons. Generally, however, fellowships are sought for the purposes of special interest or the desire to obtain an academic appointment.

Interviews
Make this an enjoyable experience. You will never again have the opportunity to visit with so many leaders of the field. The other interviewees are future colleagues; use the opportunity to get to know them.

Expect the standard questions: why are you interested in our program, where do you see yourself in 10 years, what are your research interests, and how did you become interested in neurosurgery?

Expect to apply to 16 to 24 programs, and plan on completing approximately 10 interviews. Have fun, be courteous, and promptly send thank you notes to chairpersons, residency coordinators, secretaries, and faculty you enjoyed talking with. The bulk of interviews will occur in the month of December, although the two weeks in November are when the interviews begin.

PGY-1 Year
Check with the programs you are interested in regarding the need for NRMP application and matching. Most residency programs do not require separate application and matching to their respective General Surgery programs, however, you may still call and double-check.

Program Stratification
Programs are often viewed by their the type of Neurosurgeon they usually produce. Below is a subjective list of the top tier programs in no particular order:

Chairperson/Academic Positions:
Johns Hopkins
Barrow Neurological Institute
U. of Seattle
U. of Virginia
Columbia University
U. of Florida
U. of Michigan
U. of Cincinnati
UCSF
Washington University

Academic/Strong Private Practice Positions:
U. of Utah
Emory University
Pittsburgh University
Cleveland Clinic
Mayo Clinic
Northwestern University
Brigham and Women’s
Duke
U. of Wisconsin
UCLA
Baylor
Vanderbilt

2003 Neurosurgery Match results

OBSTETRICS AND GYNECOLOGY
by Samantha Neighbor

Obstetrics and Gynecology is a very popular choice for those individuals who enjoy both practicing general medicine and performing very specialized surgical procedures. Managing labor and delivery and surgical complications is always very exciting. Furthermore, with advances in genetics and sonography, there is also the opportunity to make prenatal diagnoses at a time when in utero surgical intervention may be possible. Another appealing aspect of OB/GYN is that working with women of all ages provides a spectrum of young, relatively healthy women, to more complicated medical and surgical problems such as high risk pregnancy, endocrinology/infertility, urogynecology, and oncology. On the other hand, one of the negative aspects of OB/GYN is that it is becoming increasingly competitive. In addition, the 4- year residency is relatively time-intensive. In the past, the average call schedule was every 3rd-4th night. While some programs continue with such a schedule, other programs offer the night float system which minimizes the amount of call. Some programs also have two weekends designated off a month for the residents. The medicolegal issues and high malpractice insurance are also concerns for those who choose this field.

For those who decide that OB/GYN is for you, here are some helpful hints. First of all, you should know that residency programs vary from strictly university based to strictly community based or a combination of the two. With the current changes in insurance reimbursement, it seemed that several of the university programs incorporated community rotations in order to increase numbers of deliveries and procedures. There are excellent programs in all three areas, however, there are advantages and disadvantages to each. In addition to emphasizing clinical skills, university programs are more geared toward research and academics. They usually have "well known" faculty and a reputation for placing their residents in competitive fellowship positions. Community programs usually have more "perks" such as a higher salary, 100% insurance coverage at no cost, book and conference allowances, and newer facilities. They usually emphasize clinical skills with high volumes of various surgical cases. In general, most community programs are successful in placing their residents in Maternal-Fetal Medicine and Endocrine/Infertility fellowships. Gynecology Oncology is still very difficult to get into from wither setting. If you are interested in fellowship, be sure to ask about placement rates. I was told while I interviewed that a few years back the fellowships in OB/GYN were changed to three years instead of two. Since these changes, Gynecology Oncology has stayed competitive, spaces in Maternal Fetal Medicine have opened up, and the amount of endocrinology fellowships has reduced. Also, I found that most of the catholic hospitals do not allow tubal ligations and the assisted reproductive techniques are limited. You may want to investigate the various policies in the programs that you are interested in. The combination programs are usually organized so that the university hospital provides a more structured setting with lower numbers, but more complicated and interesting patients. The community programs provide more autonomy and increased numbers of both normal deliveries and surgical cases. Beware of the programs that require their residents to travel long distances to community hospitals, or who require residents to rotate through 3 or 4 setting. This tends to spread the residents thin and increase call to every 2nd or 3rd night.

The majority of programs participate in the NRMP with applications accepted only by ERAS. ERAS packets are available in the Dean’s office in the early fall. Deadlines for completed applications are usually in November, however, can be as early as October and as late as January. The Dean’s office likes to have the applications my the end of September to be sure that everything is together. Requests for general information and applications should be mailed by August. Letters of Recommendation should be requested by September keeping in mind that it often takes up to 3 weeks for letters to be completed and mailed. Be sure to read the application material carefully. Some programs will often request letters from specific people and specific departments. If you have a particular interest in a program, some advocate doing an externship at that program so that the staff and Housestaff know you better. A good time to do this is in October or November after your applications have been mailed. I would recommend setting up these externships early in the third year and keeping in touch with the program of interest. These spots for externships can fill up quickly. Most interviews take place in December and January, so I would advise taking off one of these months. Many programs do not interview over the Christmas holidays. Interview dates in November and December fill up, so January might be the best choice. I was told to apply to over 24 positions, and ended up interviewing at 12.

When evaluating each program, make sure that each subspecialty (MFM, Reproductive Endocrinology, Gynecology Oncology) is represented in the curriculum and that the full-time faculty members are stable. Changes in the chairman position are concerning- make special efforts to learn about his/her plans for the program. Other discerning features include patient population, number of residents, call schedule, night float system, continuity clinics, abortion clinics, lectures and conferences, benefits/salary, and presence/role of fellows. It is also very important to assess the relationship between the faculty and residents, as well as your future relationships with the current resident during your interview.

In general, the program curriculum were quite similar with most of the differences noted in the 1st and 4th years. The interns year now consists of more primary care to confirm the new Residency Review Committee (RRC) Requirements. Programs are now required to include 6 months of primary care. Typical primary care rotations include Family Practice, Internal Medicine both outpatient and inpatient, ER, SICU, Geriatrics, MICU, and SICU. Most places that I interviewed at do not offer Anesthesiology or NICU rotations due to the increased primary care requirements. Another distinguishing factor between programs is the amount and type of responsibilities given to the intern. Some programs expect the intern to run labor and delivery and perform c-sections while others allow the interns to take part of deliveries only if they are on call and the surgical experience is reserved for upper level residents. As for the chief year- the 4th year is generally responsible for supervising the various teams. They also spend time in the specialty clinics (breast, urogyn, adolescent OB/GYN, colposcopy, etc.) and as the administrative chief resident. Most programs require or encourage a research project. Some programs offer elective time, some do not.

The interviews were for the most part cordial and informal. However, there are those that will turn into case presentations and teaching rounds. Some programs offer an informal gathering the nigh before the interview. I thought that this was a great time to meet the residents and to ask questions in an informal setting. The most frequently asked questions included the following:

1. Why OB/GYN?
2. What are you looking for in a program? What are you avoiding?
3. What are your strengths and weaknesses?
4. Where do you see yourself in ten years?
5. What are your plans after residency?
6. What made you decide to apply to this program? to this part of the country?
7. Why should we consider you for a residency position?
8. Where else have you applied?
9. What do you do with your free time?
10. Do you have any questions?
11. What does your husband/wife do? Is he/she mobile?

While you do not want to sound rehearsed, your interviews will be less stressful if you think about these questions in advance. For those high intensity interviews, you might want to prepare one case presentation that interested you the most or from which you learned the most. Also identify specific things that are important to you and ask about them. By far, #10 above was the most frequently asked question. I found the following useful:

1. What are the strengths and weaknesses of the program?
2. Do you foresee any changes in the near future?
3. How much contact do you have with the residents?
4. Do you feel that the residents are well trained?
5. How do you feel that the residents perform on Boards?
6. How do you evaluate residents? How often?
7. What percentage of graduates are successfully placed in fellowships? Where?
8. What percentage pursue private practice? Where?
9. If you could change one thing about your program, what would it be and why?

I asked the residents the following questions:

1. Do you feel well trained?
2. What would you change about the program if given the opportunity?
3. How often are you able to attend lectured and conferences? or Are you too busy?
4. How are the clinics organized? Are attendings present?
5. How does call coverage work?
6. Does the call schedule change around the holidays so that residents can have time off?
7. What is there to do outside the hospital?
8. Where do most of the residents live? Cost of housing?
9. Are you happy?

The application interview process is tedious and time consuming. Take notes so that when it is all over you can look back and review. Remember to write thank you notes soon after each interview. It is also a good idea to write follow-up letters to your top 2-3 choices just prior to entering in your rank list in

February. I called up a couple of my favorite programs and indirectly inferred about how they felt about me and my interview so that I could construct my ranking list most effectively. Remember, OB/GYN is competitive, but the majority of programs would rather have a good student who is interested than an excellent student who is not. Good Luck!!

OPHTHALMOLOGY
by Erin-Tov Gilliland

Ophthalmology is an exciting and unique specialty which involves both medical and surgical treatment of ocular diseases. It is a highly specialized field that continues to make significant technological advances at a rapid pace. Ophthalmology relishes a broad scope of practice which includes both medicine and surgery, and the treatment of pediatric and adult patients. Due to the nature, prevalence and wide variety of ocular disorders, a patient’s relationship with an ophthalmologist often continues over may years. Because of this ophthalmology offers a unique and rewarding blend of primary care and highly specialized treatment.

The typical ophthalmology residency consists of a general internship year (internal medicine, surgery, or transitional) followed by three years of training in ophthalmology. The average size of an ophthalmology program is three residency positions offered per year. The competitiveness of ophthalmology residency positions had decreased in the mid nineties such that in the 1997 match 94% of U.S. seniors matched. However, in the past two years the competitiveness has increased with 83% of U.S. seniors matching in 1999. Whether or not this latest trend continues will be of interest to anyone considering ophthalmology.

Ophthalmology is an early match so it is important to take a rotation in ophthalmology by the end of the third year or early in the fourth year if you are interested in this specialty. The ophthalmology match occurs in late January and is done through a Central Application Service (CAS). The applicant only has to fill out one application which is then distributed by the CAS to all of your chosen programs. If you decide that you are going to pursue a career in ophthalmology, it would be a good idea to talk with Dr. Hunkeler (Chairman) or Dr. Warren (Residency Director) about your interests. They can help you assess your competitiveness and give useful information regarding programs throughout the country. The current KU ophthalmology residents and fourth year students who have just gone through the match are also helpful resources.

A reasonable time table for the ophthalmology application process would be as follows. In the spring/summer of the third year put together a list of 20-30 programs that you would like to write to for information, and send out letters/postcards to request information from them. Most programs will not send new information until July 1. Also during this time you should register with the CAS for the Ophthalmology Match Program (OMP). For 1999 the OMP has set a target date for getting your complete application in to them on August 16^th. This is not a deadline but is simply their recommendation. In the past, the OMP had an deadline of October 15 for receiving applications. The OMP changed the timetable this year from a deadline (Oct. 15) to a considerably earlier target date (Aug. 16) because too many applicants were waiting until the last moment to have their application sent in. Each ophthalmology residency program sets their own deadline after which they will no longer accept any more applications. A small number of them have deadlines as early as late September/early October so you should know the deadlines of the programs you are interested in. This information is usually contained in the mailings that the programs send to the applicants. In general it takes the CAS about two weeks to distribute your application to the individual programs from the day that they receive it, although they warn that it may take longer a peak times. Therefore, it is a good idea to begin gathering application materials (copies of board scores, college and medical transcripts) and request letters of recommendation in early August or at the very latest by early September. The CAS require 3 letters of recommendation (they will not accept four). It is a good idea for two of these to be from ophthalmologists, with one being from the chairman of the department at KU. The third can be from other clinical faculty that you feel would write you an excellent letter or with whom you may have done research. Most programs send out invitations for interviews between the end of October and the beginning of December. The match then occurs in late January.

The match for the first year is completely separate from the match for ophthalmology and is done through ERAS. The results for the first year are given on the regular national match date in March. Some people try to coordinate their interviews for their preliminary year with the ophthalmology interviews, but many times this is not possible.

The average candidate applied to 31 programs and went to eight interviews in the ’99 match.

The bulk of ophthalmology interviews will occur in December with some in November and very few in early January so it is a good idea to take December off.

Questions to be prepared to answer include:
How did you become interested in ophthalmology?
Where do you see yourself in five years? (fellowship, private practice or academics)
Why did you apply to this program?
Why should we choose you over all of the other highly qualified applicants?
Where else did you apply and where else are you interviewing?
Be prepared to discuss any research that you may have done.

Questions to ask while on your interview:
Do you expect any changes in your program in the next five years?
What do you feel are the strengths and weaknesses of this program?
What are the surgical numbers that the residents get?
Where do your residents go after completing your program? (private practice, fellowships)

You may want to do an externship in ophthalmology to gain more exposure to a certain program. You should try to plan this early in the fourth year in case you want to get a recommendation from some of the faculty. Most programs don’t recommend more than one or two rotations in ophthalmology. If there is a particular program that you know that you are interested in and want to get to know the staff and residents better, it would be a good idea to do an externship. Otherwise, it will be of little benefit unless you work with someone who is known throughout ophthalmology and will give you a letter of recommendation.

A great source of information is the CAS website: http://www.SFMATCH.org/

Best of Luck!

2003 Ophthalmology Match results

ORTHOPEDIC SURGERY
by Brett Miller

Orthopedic surgery continues to be one of the most competitive residency positions to obtain. It is a seller’s market with you being the buyer. Only three positions went unfilled in the 1999 Match. Approximately 15% of U.S. Seniors who only ranked orthopedic programs went unmatched (this number has been fairly consistent over the past five years).

Programs tend to look at board scores, class rank, and research experience when deciding who to interview. AOA election is said to carry a lot of weight. While it is rumored that one must be in the top 1% of their class with board scores in the 99^th percentile before even considering applying for an orthopedic residency, this is simply not the case. If you are in the top 25-30% of your class with board scores of at least 200, there is a good chance of obtaining plenty of quality interviews. With lower numbers, interviews will not come easy, but if this is your dream go for it.

How do I choose which programs to apply to? Start with the FREIDA web site. It has some very basic information such as program size, program director, contacts, etc. It should have all the addresses you need to request information. There are several ways to narrow your choices. First, eliminate programs in areas that you will absolutely not live for the next five years. Then you have to decide which programs to request information from. This number should be much larger than the actual number you plan to apply to. You can start writing for information anytime but April or May is the earliest most programs like to start sending packets. This information is helpful in deciding on which programs to apply to, but the most useful resource is the orthopedic residents at KU. Other sources are the orthopedic staff members as well as KU alumni at other programs. Most are very willing to talk about their program. Former grads doing orthopedic residencies are listed in the back of this book.

How many programs should I apply to? In 1999 six students applied for orthopedics and the number of programs applied to was between 30 and 40. Ten interviews is said to be the magic number to assure a good chance of matching. In 1999 the number ranged from 8-13 interviews per applicant. The number of interviews you do depends on how confident you are in yourself and how many trips you can afford.

Ways to improve your chances of matching in the program of your choice.

Have great grades, great board scores, do research, and be elected to AOA. If you interview well it’s practically a done deal.
Get good letters of recommendation from the chairman of the department as well as from the most prominent nationally known orthopedic surgeon at KU. This requires that you get to know these people before August of your fourth year so you will be able to get a letter from that person before application deadlines (the deadlines range between September 20^th and November 15^th with the majority due on November 1^st. It is the experience of myself and others that it takes 2-3 weeks for these letters to be completed after they are requested so ask for them sooner rather than later. Try to spend some extra time with these individuals during your breaks or try to work with them during a clinical rotation. Another option is to take time to do a research project with one of these individuals (more about this later). The orthopedic department has an excellent summer project prior to the fourth year in which one student is chosen to do anatomy dissections for three months as part of the resident’s anatomy review. This is not only an awesome educational experience but also an opportunity for each member of the staff to "see you in action."
Research. For some students, this word makes their skin crawl. I was one of those students until I started a research project in the second semester of my third year. It turned out to be one of the best experiences in medical school. I discovered that research can actually be enjoyable if it’s in a field you’re truly interested in. The time commitment is minimal and the pay-off is enormous. You must remember that orthopedics is becoming more and more academic. Questions regarding my research were asked at every place I interviewed. Don’t forget, there is a very large section on the ERAS application for research projects and publications. Even stellar applicants can look mediocre if there are holes in their application.
Do a rotation at another school. First this will give you a chance to see another program which will help you compare different programs as you try to narrow your list. A few programs will only seriously consider those applicants who have done a month at their institution. Choose a place you really would like live and do your residency. To decide which programs to do rotations, talk to the orthopedic residents at KU. Plan to work the hardest you ever have for a month or don’t do it.
Get to know the staff as well as possible during your third and fourth years. Most of them trained at other institutions and have connections at a number of different programs. This can be an invaluable asset as programs are deciding on their rank lists. A well-timed phone call can help solidify program’s opinions of you.

Most orthopedic residencies are five years total. Only a few remain six years in length. The number of residents per program ranges between 2 and 12 per year. There is talk of implementing a standardized orthopedic internship as deemed by the residency review committee. You can choose between strictly university programs, community programs or combined programs. There are excellent programs in each category. Most programs participate in ERAS and are a part of the NRMP. This is not an early match as of 1996. Interviews occur between late November through January. January is probably the best month to take off to allow for interviewing. December would be another option. Whichever month you are doing a rotation make sure they will allow you time to go to interviews.

The ideal program. Most people look for a program with all of the subspecialties covered (hand, sports, reconstructive, foot & ankle, pediatrics, spine, trauma, oncology) by fellowship trained staff. There are many differences in programs with regards to clinic versus operative time, amount of trauma, call schedule, attitude of staff towards residents, etc. Finally, location is important. Remember, you are going to have to live there for the next five years.

Questions you will be asked.

Tell me about yourself.
Why do you want to go into this specialty?
What made you apply to our program?
What is the ideal program? / What are you looking for in a program?
What are your strengths/weaknesses?
Tell me about your research.
What sets you apart from the other applicants?
Where do you see yourself in 10 years?
What do you do in your spare time? / What are your hobbies?
What was the last book you read?
Describe a particularly satisfying/meaningful/difficult experience in your life/medical training.
Of which accomplishments are you most proud of?
What questions do you have for me? / What do you want to know about this program? (probably the most commonly asked question)
A few current events and heath care delivery questions. (relatively rare)

Questions to ask the residents.

What do you think of the chairman?
What is the call schedule like? / How much sleep do you get on call?
Saturday conferences?
Number of cases / volume of trauma.
How much time in clinic / OR?
How much time do you have to read?
Is there enough / too much supervision?
How many conferences? / Taught by residents or staff?
How well do you do on the OITE?
What is an average day like? / Do you have time for lunch?
How many people get the fellowships they want?
When do you begin to operate?
How much money do you get for books/ loops/ conferences?
Are staff members approachable?
What is this city like to live in? / housing costs?

OTOLARYNGOLOGY - HEAD AND NECK SURGERY
by C.W. David Chang

The field of otolaryngology, commonly known to the lay public as ear, nose, and throat (ENT), is an attractive specialty that all interested in surgery should consider. Although otolaryngologists are most widely known for procedures such as tonsillectomies and placement of PE tubes, the specialty encompasses an even broader spectrum of disorders and treatment modalities. Subspecialties within otolaryngology include otology, laryngology, head and neck oncology, facial plastics and reconstruction, and pediatrics. With such a diverse scope, otolaryngologists perform a wide variety of surgical procedures from the delicate ossicular chain reconstruction in the middle ear to the removal of large head and neck tumors.

Completion of a residency in otolaryngology takes five or six post-graduate years. The first year (and second year in a small subset of programs) is spent doing a general surgery internship. The remainder of the years are spent exclusively with the otolaryngology department. While five-year training is standard, some programs are six years in length, adding an additional year of general surgery training and/or a full year of research.

The matching process for otolaryngology requires registration in both the National Resident Matching Program (NRMP) and the Otolaryngology Matching Program. The otolaryngology match is an early matching process and takes place in mid January (as opposed to the NRMP match which occurs in March). The match is coordinated by an organization called the Central Application Service (CAS), which also coordinates the matching process for a few other early-match residency programs such as neurosurgery, ophthalmology, and neurology. The beauty of CAS is that only one application needs to be submitted by the applicant regardless of the number of programs to which s/he is applying. CAS copies and distributes the application to all the programs in which the applicant is interested. The fastest and easiest way to register for the Otolaryngology Matching Program is to visit the CAS website at www.SFMATCH.org. Do this as early as possible, preferably by summer following your junior year. In order to match to a surgical internship, registration with NRMP is required. Most programs require the internship year be performed at the same institution as one’s otolaryngology residency. In this case, general surgery positions are automatically reserved for incoming residents. The NRMP match is a mere formality: simply rank the institution you were accepted for an otolaryngology residency as your number one preliminary-year choice.

Because otolaryngology is an early match specialty, you will of course need to spend a rotation with otolaryngology department before submitting your application, which should be sent by September. A rotation is most advisable during second semester of the third year or, at latest, June or July of that summer. However, the current design of the clinical clerkship curriculum does not allow for adequate exposure to otolaryngology during the third year. Normally, there are no slots available for electives in the third year. You can do two things to get around this: 1) petition to bump one of your required rotations to the fourth year so an elective can be taken; or 2) petition the surgery department to allow you to work with the otolaryngology department for one half of your general surgery rotation. If you decide to bump a rotation, remember that electives are usually 4 weeks in length while your third-year rotations are either 6- or 8-weeks long. Because otolaryngology and surgery are separate departments at KUMC, the surgery department may not be accommodating in your request to modify your surgery rotation. It may be helpful to have the backing of an otolaryngology attending. In addition, there is an otolaryngology elective available that will fulfill your fourth-year requirement for a subinternship.

Research experience, especially one in otolaryngology where significant publishable results were realized, is strongly recommended. All otolaryngology programs encourage their residents to pursue research and will smile upon applicants with this background already.

The "world" of academic otolaryngology is a small one. Virtually all otolaryngology residency programs are at academic institutions and all the department chairmen as well as staff know one another. Repeatedly during my residency interviews I encountered staff members of other institutions that either trained with or were well acquainted with staff members at KU. During interview season, attendings from other institutions will phone those they know at KU and ask about your character and credentials. Cultivate relationships within the department early. The staff attendings can recommend programs that match your interest, while the new otolaryngology residents can give you the gestalt of certain programs having recently finished the interview process themselves.

There are differing views on how beneficial an elective at another program is. If you have a specific program you are dying to join, an externship may be a good idea, since it would give you an opportunity to learn about the program and make yourself known to the staff. There are very few programs that will only seriously consider those who have done an externship with them, and that will be explicitly stated in their literature.

Upon receipt of your $35 registration fee, CAS will assign you an official match number and send an application packet. Addresses of all the otolaryngology programs are included in the packet. Your first goal is to request information from the various programs of your interest. Some will send extensive literature, some will refer you to their website, and others send hardly anything at all. Be sure to request your letters of recommendation early. The application requests three letters, one of which has to be from a "core" rotation. I received all three of my letters from attendings all within the otolaryngology department. Be sure to spend some time with the department chairman, Dr. Hoover, during your rotations; it is important to get one of your letters from him. In addition, Drs. Tsue and Girod are well connected if you are looking to leave Kansas for your training. As Dr. Hoover is extremely busy, it is imperative that you request your letter from him as early as possible. Set a deadline for return and continually remind his secretary (not him) until it is completed. You cannot submit your application until all letters of reference have been collected.

It is difficult to say what qualities programs look for when deciding whom to interview. Generally applicants are placed through a "weeding algorithm," which factors USMLE part I scores and GPA. It is impossible to state a general cutoff. However, otolaryngology is a fairly competitive residency and applicant scores are high. Other factors include letters of reference, research experience, and anything that makes you stand out from the crowd (musical talent, athletic interests, foreign medical experience, etc.). Interviews start in late October and run through mid December. Most programs have 2 or 3 positions per year and typically interview between 10-15 applicants per position. Each program establishes its own interview dates, which are generally are few and inflexible. Inevitably tough choices will have to be made between programs with conflicting interview dates. During the months of November and December, try not to schedule a rotation and/or schedule an easy/accommodating rotation. Know your CV well and be prepared to expound on specific points during the interview. Above all, have fun, meet new people interested in your field, and hit the town at night. I recommend renting a car whenever possible so you can spend time getting to know the city.

The otolaryngology department at KUMC is excellent. All subspecialty fields are represented in the department. A large number of surgical oncology cases with microvascular free-flap reconstruction are performed at KU. Two operating rooms are dedicated to head and neck surgery only, with state-of-the-art equipment including a real-time three-dimensional CT localization system. The staff and residents are extremely congenial and demonstrate great comradery.

Below are current attendings and their areas of interest:

Dr. Larry Hoover, Professor and Chairman - sinus surgery, oncology
Dr. Daniel Bruegger, Medical Student Coordinator - pediatrics
Dr. Daniel Kirse - pediatrics
Dr. Doug Girod - oncology, reconstruction
Dr. Terance Tsue, Residency Program Director - oncology, reconstruction
Dr. Pam Nicklaus - pediatrics, general
Dr. Al Merati - otolaryngology
Dr. J. David Kriet - facial plastics and reconstruction
Dr. Gregory Ator - otology
Dr. Dianne Durham - cochlear research
Dr. Thomas Sanford - allergy, general

2003 Otorlaryngology Match Results

PATHOLOGY
by Robert Lorsbach

Pathology offers a diverse array of career opportunities, One may choose to practice in either an academic or a private, community-based environment. In either setting, one may focus on surgical pathology, laboratory administration, or a number of sub-specialties including forensics, neuropathology, hematopathology, or blood banking. Excellent opportunities in both private practice and academic pathology exist, and most projections indicate a shortage of pathologists in the future.

Pathology training has historically been categorized into anatomic (AP) and clinical (CP) pathology. Residency training in the former consists of rotations in surgical pathology, cytopathology, autopsy, as well as several other subspecialty services. CP training typically consists primarily of rotations in microbiology, clinical chemistry, toxicology, coagulation/hematology, and immunology. Very few pathology departments have trairiing programs that are equally strong in both AP and CP. Therefore, if you intend to enter a combined AP/CP residency but wish to focus primarily on either AP or CP during your residency and in your career, it is important to select programs that are relatively stronger in your area of interest.

There are three residency formats in pathology: a combined, five year program in AP and CP (generally selected by those interested in private practice) or a four year residency in either AP or CP (useful for individuals intending to practice in large private hospitals or academic centers). Regardless of which type of residency is selected, one year must be devoted to either an internship or "clinically related research". The latter is liberally interpreted by most programs and may be spent doing or used essentially as a fellowship to acquire further training in an area of interest, e.g., surgical pathology, cytopathology, hematopathology.

The most important factor in selecting a residency program is your personal career goals. Some programs put more emphasis on training for careers in private practice pathology, whereas others stress training to prepare residents for academic careers. However, there is not a rigid division of programs into either academic or private practice type residencies. Given the relative shortage of applicants to pathology residencies, most programs are flexible and willing to tailor their program to meet the needs of residents provided service and board-eligibility requirements are satisfied. Electives in surgical or clinical pathology are useful for clarifying your interests in pathology. Important resources for information about residency programs and career choices in pathology include the handbook Residency Training Programs in Pathology, which is updated annually. Faculty members at KU, particularly Drs. Anderson, Bahtia, and Tawfik, are knowledgeable of other programs and willing to answer any questions that you might have. Lastly, recent KU graduates are training at several excellent residency programs around the country, and all would be happy to discuss pathology training in general as well as their own program, providing you with a valuable "insider's" perspective of pathology residencies.

Most programs use their own application form and not the "Universal" type. Typically three letters of recommendation are needed. At least one of these should be written by a pathologist. Interviews are usually scheduled from November to mid January. Interviews are typically individualized and usually consist of 4-10 one-on-one meetings with faculty members, a department/hospital tour, lunch, and an opportunity to meet residents. Interviews are extremely low-pressure and devoid of pimping. Be prepared to articulate your career goals, why you chose pathology as a specialty, why you chose to interview at a particular residency program, etc... More importantly, be prepared to spend the bulk of your interview time asking questions.

Some important issues to address:

how do residents rotate on the surgical pathology service; how quickly do cases have to be signed out and is there the opportunity for you to review slides prior to signing out with the staff
what is the breadth of the case material; is there a good representation of soft tissue tumor, GYN, transplant, and forensic cases
in which specialties are fellowships offered (many programs preferentially offer fellowships to graduates of their own residency programs).
are there any anticipated changes in the program or personnel
if interested in research, how much time is available for research; when doing research, will you be compensated at the appropriate resident's salary and not that of a post-doc
if pursuing exclusively AP training, does the opportunity exist to take relevant electives in CP, e.g., hematopathology

PEDIATRICS
by Heather Johnson

Pediatrics is a challenging and rewarding field that tends to attract dedicated, patient, and compassionate individuals with a common love of children. As a pediatrician, you can establish the foundation for children’s lifelong health and well-being by serving as a caregiver, role model, and advocate. After completing a three year pediatric residency, you may decide to practice general pediatrics or choose to specialize by completing a 2-3 year fellowship.

APPLYING

When deciding where to apply, there are several approaches depending upon your goals. General program characteristics to consider include: 1) program size, 2) is it university affiliated? 3) is there a children’s hospital? 4) are there research and advocacy opportunities? 5) degree of competitiveness, and 6) city or location.

You may want to start by limiting your geographic location. But if you are open to move anywhere in the country, start by outlining the type of program for which you are looking. Are you looking for a small, medium, or large-sized program? There are residency programs with anywhere from 6 to 30 residents per year. If you learn by experience and seeing lots of patients, then a large program with high volume may suit you. If you learn by clinical experience, didactic, and one-on-one teaching, then you might fit into a smaller program better. In a program with few residents, you may be limited as far as time off, maternity-paternity leave, time spent abroad etc. On the other hand, a large program could afford you that flexibility. Popular cities, especially on the coasts, tend to be more competitive with a high number of applicants for a limited number of positions.

If you are planning on going into general pediatrics, you may want to look for programs that have a lot of "bread and butter" pediatrics as well as the unique diseases that specialty hospitals draw. Find a program that emphasizes both general outpatient care and inpatient management.

If you know you want to specialize, there are several things to consider. First, training in a university setting and an academic environment where research opportunities are abundant may be important to you. Second, if the program offers fellowships, you need to consider if the hospital is more fellow or resident-run and if you will be gaining the necessary experience. However, if you are aggressive enough as a resident, you will always gain the clinical experience and skills that you need regardless of the presence of fellows.

Once you have decided on the kind of program you are looking for, start gathering information and GET ORGANIZED. Talk to residents, mentors, and other physicians to hear their pros and cons of different programs. Use the FREIDA system and visit the websites of programs.

Send your applications off early. Once you have been invited to interview, try to schedule the interviews as soon as possible and during a month in which you will have plenty of spare time to travel (Nov - Jan).

EXTERNSHIPS

Spending a month away from KUMC in another hospital and another city can be a great way to find out what you are looking for in a program and whether or not you see yourself fitting into that program and living in that city. Further, the program can get to know you and you can try to prove yourself. I advise you to pick a rotation where you will be working hard, like a subinternship or PICU/NICU rotation. This way you can really prove yourself and get to know as many people there as possible.

RECOMMENDATION LETTERS

Programs usually require 3-5 letters of recommendation, including one from the chair of the peds department. The others should include someone who has seen you in action with patients, particularly children. However, all of your recommendations do not need to be from pediatricians. Choose those that know you well and will write a solid letter of support.

THE INTERVIEW

Most pediatric interviews are very laid back and you run the show. They usually involve meeting the program director and department chair, an overview of their program, a tour of the hospital and other sites, lunch, and 2-3 interviews. Try to meet with as many residents as possible to get a better feel of the program, their level of happiness, and their feelings on the training that they are receiving. Be sure to take notes.

Be prepared with a long set of questions including:

Questions for interviewer/program director
1. Pros and cons of program
2. Any curriculum changes
3. Research opportunities
4. Child advocacy program
5. Patient population/ cultural diversity
6. Resident teaching workshops
7. Time spent in continuity clinics/ subspecialty rotations/ PICU-NICU
8. Where do residents end up (general practice, academic medicine, subspecialty)

Questions for residents
1. Describe a typical day.
2. Call schedule
3. Work load
4. Interaction with faculty
5. Overall happiness
6. Cost of living/ city life
7. Check in/out rounds

Also be prepared with answers to the obvious questions like "why pediatrics? why this institution?" etc. Be able to give a more original answer than "Because I love children."

Because all accredited pediatric residency programs are required to have a set curriculum, look for residency programs that have unique features. For example, some programs have rural outreach opportunities, some offer primary care or subspecialty tracks, others have several different participating hospitals allowing you to see a wide range of patient populations. Find out what is unique about the residency program, because that is what will set it apart from the others.

GOOD LUCK!

PHYSICAL MEDICINE AND REHABILITATION

Linda Ladesich, Class of 2002

This specialty is sometimes referred to as "the best kept secret in medicine." However, interest in this field has increased rapidly in the past few years with last year being the highest match rate in many years. Physical Medicine and Rehabilitation physicians are often called physiatrists but this specialty is also referred to as "Rehab. Medicine" or PM&R. Physiatrists are specialists in the diagnosis and treatment of patients of all ages in three major areas of medical care:

Diagnosis and treatment of musculoskeletal injuries and pain syndromes

Electrodiagnostic medicine (i.e. electromyography [EMG], and Nerve Conduction Studies used in the diagnosis of various neurological disorders)

Rehabilitation of patients with severe impairments: The physiatrist directs a comprehensive rehabilitation team of professionals often including Physical, Occupational, Recreational, and Speech Therapists, rehabilitation nurses, psychologists, social workers, speech-language pathologists and others. Physiatrists treat neurological rehabilitation conditions including stroke, brain injury, and spinal cord injury. Many other disabling conditions such as amputations, multiple trauma, burns and sports injuries are treated as well.

One of the advantages of this field is that there are a wide variety of practice opportunities once you finish residency. Choices include outpatient clinics, inpatient rehabilitation centers, and hospital based inpatient rehabilitation. There are also opportunities to serve more of an administrative role such as being a Director of a rehabilitation facility.

Some of "traits" of this specialty includes the development of in-depth and long-lasting relationships with patients. In-patient care requires a well-rounded base of knowledge in internal medicine for day-to-day care. You work as part of a team of professionals with your primary goal being to direct the overall care of the patient to optimize their potential for independence. There are few "rehabilitation emergencies" which translates into a consistent working schedule with time to pursue outside interests. Although there are a few programs that require you to be in-house for call, most programs are set up for home call and the average workweek is 50 hours (ref: FRIEDA). It is very conducive to having time for your family. Because a patient's rehab gains are often made in small increments, having a positive outlook and patience is an important attribute of a physia

Mercy	City	General	State
Chen	Garcia	Brown	Brown
Garcia	Hassan	Eastman	Eastman
	Eastman	Hassan	Anderson
	Anderson	Anderson	Chen
	Brown	Chen	Hassan
	Chen	Davis	Ford
	Davis	Garcia	Davis
	Ford		Garcia