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Featured topic and speakers
Where medical students do their residency is one of the biggest decisions they will make. Knowing what program is right for them can be a challenge. Hilary Fairbrother, MD, MPH, vice chair of education at UTHealth Houston, McGovern Medical School, joins to share best practices how to search for residency programs and find the best fit. AMA Chief Experience Officer Todd Unger hosts.
- Learn more about FREIDA™, the AMA’s Residency & Fellowship Database, our “Road to Residency” video series and other helpful content.
- Wondering when residency applications are due, or when Match Day is? Here is a general timeline of the residency application process:
- June-July: Register for ERAS (Electronic Residency Application Service).
- Sept: Submit residency applications.
- Oct-Feb: Receive interview invitations and complete interviews
- Feb: Rank your residency programs in order of preference.
- March: Match Day is March 15, 2024.
- The AMA is your powerful ally in patient care. Join now.
Speaker
- Hilary Fairbrother, MD, MPH, vice chair of education, UTHealth Houston, McGovern Medical School
Transcript
Unger Hello and welcome to the AMA Update video and podcast. It's residency application season. And today, we're talking about five ways to find the right residency program for you. With me today is Dr. Hilary Fairbrother, vice chair of education at UTHealth Houston McGovern Medical School. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Fairbrother, we're glad to have you back.
Dr. Fairbrother: Thanks for having me back. It's good to see you.
Unger Well, determining where you want to do your residency is, of course, one of the biggest decisions that a student has to make. And we also know that according to a new AMA well-being report, more than two out of five residents are burnt out. And your specialty, emergency medicine, is one where residents are especially prone to this. So knowing all of this, from your perspective as a program leader, why is it so important to prioritize this idea of fit over a, quote, "name brand program" and other factors when making a decision this big?
Dr. Fairbrother: Well, I think as you're looking at life as a resident, as you're considering very important topics such as burnout, it is really important to think about what is going to make you happy when you are doing such important activity as being a resident physician and a physician in training. And while the name brand program may have an effect for sure on your future, your ability to get the next fellowship, et cetera, it may not be the only thing that really predicts your happiness.
And there are just many different things that go into picking what really is going to be your job for the next three to seven years. And it's important to make a really sound, well-researched decision as you do such. And the name of the program is only one of the factors in a multifactorial decision.
Unger Navigating the residency search process and finding the right program, of course, it's not an easy task. What do you think some of the key criteria that students should be considering as they begin their search?
Dr. Fairbrother: Well, certainly, every time we look at really what determines where does a student pick a residency, really the number one factor is geography. Where do you want to live? And that may be a region of the U.S. That may be a big city versus a smaller town. There are many things that factor into that equation.
Being close to family, being in a part of the country that has a lot of the activities that you really love to do, all of those things are important. But geography is critical. It's one of the reasons that we're seeing the advent of these geographic signals. So students can really give the idea to the programs that they are in a geographical area that they are very interested in.
And then after that, I think it's really important to look at certain factors behind the program. And that largely has to do with, what is the style of the program? How big is the program? How many co-residents will you have? Is the program at a large university? Is it at more of a community-based hospital? There are pluses and minuses to all of these factors. And really, it takes some knowledge of yourself and what makes you happy and what you are good at and what you might struggle with to really make the best decision about what is going to be the strongest fit for you.
I can tell you, in my experience, I knew I was good at learning and reading. And I really wanted to be in a place that had a really high volume and high acuity for my emergency medicine training. And I actually picked a program that was much more community-oriented because I wanted to be the master of procedures and patients.
And I figured that some of the academics I could do, some of the didactics I could do on my own, that I really was picking my program based on the community that I was serving. And that suited me. And I think everybody needs to know a little bit about themselves. What are they good at? What do they need help with classically? And that can really help guide your decision.
Unger So those are just really great examples of the kind of fit that you're talking about. You talked about the type of operation that you're going to be spending the next few years in. For you, that community part was so important, and of course, that high volume, high acuity environment that is, of course, so essential for someone in emergency medicine.
On top of that, I think what you're also saying is you need to make some basic decisions about where do you want to live. What part, what region? Are you in the city? Are you not in the city? So those are really important parts of this kind of fit. Do you have any advice for students who are thinking through options but are still unsure which programs would be the best fit for them?
Dr. Fairbrother: Sure. I always think that one of the best ways to learn about programs, especially in today's largely virtual interview cycle, is to go on the website for each of your programs and really see what are they passionate about. And it is not the same thing as being there, but you can quickly see what a program is highlighting, what a program is putting forward first, what's on their main web page.
They might say that community service is really important for them. But at the same time, if they don't really have much community service opportunities on their web page, it might not be something that is systematized throughout the entire residency or highlighted as a high level priority.
I also think it gives you a chance to look at the different faculty and residents who are at a program, see is this the group that you see yourself being a part of, see what they're interested in, see what people are doing researching in. How are they practicing? What's the mission statement of the program that you are looking at? This is part of your due diligence behind doing research behind a program. And I think there's a lot of information to be gleaned off the website.
Then, the next step would be to find someone that is training or that has trained at that shop. And your own medical school is a great resource for this, because odds are, there's been somebody that has gone to this program in this specialty sometime before. And it might not be someone that you know personally, but your school, your dean's office, is often a good resource to find someone that has been to that program before.
Or you can go on the website, and almost every program will give you the email of their chief residents or maybe even all of their residents. And it can be intimidating, but reaching out to some of those people and getting an idea of what their residency experience is all about really might help you figure out whether you fit at that program in so many different ways.
Unger Well, that's a good segue into my next question because we've been talking a lot about fit from the medical student's perspective when they're evaluating. But of course, this is a two-way street, and program directors also have to believe that the student is a good fit for their program. What are some things that program directors look for when they're assessing fit on their end? And how do you suggest that students best highlight those things in their applications?
Dr. Fairbrother: Program directors are really looking for successful people. And medical students are really successful people. I think they know their program. They know their own personal strengths and weaknesses.
Again, there are some programs that have some of the best didactics I've ever imagined in my whole life, and they know that they can really teach anyone anything there is about emergency medicine and verify that they will pass their boards and have all of the knowledge necessary, versus someone that knows that they have a really busy and high acuity environment, and maybe they are looking for residents and students who are grittier, who are really looking to work really hard. They may not have as many research opportunities. They may have tons of research opportunities.
And each program director knows their strengths and weaknesses of their program. And they're going to be looking for candidates that they feel will be really successful there. And I think that it's really important when you're interviewing to be also listening to the kinds of questions that they are asking you. That can often give you some insight, again, into what they prioritize and what's really important to them from a program leadership standpoint.
Unger Now, Dr. Fairbrother, this idea or concept of preference signaling is relatively new to GME. And your specialty, emergency medicine, is one that allows it. How should students be using preference signaling in their applications? And how do you view it on your end?
Dr. Fairbrother: Well, so preference signaling, I think, is pretty great. It allows students to let a program know that they have a lot of interest in them. And there's a lot of different aspects of preference signaling depending on specialty. There are different types of tokens. There are different gold and silver and different levels of tokens. Different specialties give different numbers of tokens. So this is definitely specialty-specific at this point in time.
But in general, I think it allows students to really tell a program, hey, you're one of my favorites. I am really interested in you. And you might be applying to 50 different programs. But as a student, you have your top 10 favorites. And it really does allow you to transmit that in a transparent way to the programs. I can tell you, in emergency medicine, a lot of times what it will do is potentially give you an easier chance at getting an interview.
So if you and another candidate look the same on paper, and then a program director or program leadership sees that one student has given a preference signal, a token, and one student has it, I think it's wise for them to understand that potentially the student that gave the token is potentially a little bit more interested in that program. And so I think we've seen that it can change students' ability or statistics behind getting an interview at those specific programs.
As for what it does for someone's spot on a rank list, again, I can only say at my program and in my experience, I haven't seen preference signaling move people around on the rank order list from programs. But I do think, again, it can get you in the door, and it can really allow for a student to tell a program that they are one of their top programs, that they are very interested in this program.
Unger That's really good advice. And let's, of course, start with that first step, which you said preference signaling can have an impact, and that's getting the interview in the first place. We know some programs have returned to in-person interviews, but others have stayed virtual. An in-person visits seems like a much easier way to evaluate fit. But how can students also get a sense of fit virtually?
Dr. Fairbrother: So virtually is always a little bit more challenging, though there are some definite benefits of having virtual interviews. And I can't deny that the decrease in financial expenditures from students is very hard to deny. In an age when medical education is just so expensive, really cutting costs in this way is something that has a huge benefit to many students across our country.
That being said, if you're going on a virtual interview, I think it can feel really challenging to get that feel of fit. And I would encourage you to do your due diligence, to do some research before you have your virtual interview. If you are able to, you can even look up the people who are interviewing you. If not, just in general, take a look, again, at the website for the program.
What is their mission statement? How interested are you in the things that they seem to prioritize on their website? And how much of a match in your personal interests and personally what makes you tick as a human and as a future physician, how does that line up with what they are presenting? And looking at the faculty, what areas are the faculty in? Are they big policy and advocacy people? Are they big research people? Are they really strong and very passionate about their clinical education?
What are the hospitals like? The hospital where you are going to work is really where most residents—most residents spend the majority of their time in an inpatient setting. And the hospital where you are going to be working, what does it look like? What's the volume? What's the patient mix? Who is going to that hospital? And does that jive with what you want as a future physician? And all of these things are really important, and they can feel very abstract.
But know yourself. Do you really like the urban areas and the faster pace and the higher volume of trauma? Are you more comfortable being in a community setting, where you might have less people to consult, but you are going to be inspired to be much more independent and really have to do things much more for yourself than if you have a whole tertiary care center behind you? And there again, there are pluses and minuses to both. There's no right answer. There's only know yourself and know what the right answer is for you.
Unger Good. One more piece of advice, the last or the fifth way that students can increase their chances of landing at a program that's a good fit for them, and that's to take into account this idea of rank order lists. You mentioned that before. At this point in the process, students should have a lot more information. They should have been able to assess that fit. How should they be thinking about fit as they order their lists?
Dr. Fairbrother: Well, so at the top of your list, I really think you should be putting your most favorite program. Even if it feels like a reach, I think it's a really good idea to aim for the stars and go for your number one program. Now, your rank order list is only filled with programs that you have interviewed at.
And I do want to tell you, if you are interviewing at a program, that means you have all of the necessary components of your application to match at that program. You should go into your interview really believing in that because they wouldn't be interviewing you if you didn't have what it took to match at that program. But then I do encourage students to really dig deep, question where do you want to live. What kind of place do you want to train? Try to get away from maybe other people's expectations for you and really dig deep into what you think is going to make you happy and how do you want to train.
All of these residencies are accredited. They all have to pass and maintain levels of excellence that mean that they are going to be able to train you to be competent and board-certified physicians by the time that you are done or board eligible physicians by the time that you are done. So now you have to do the hard work of figuring out what really is your top choice. And it might not be the top choice of your mentor or your advisor. And that can be really challenging.
So I encourage you to really do some deep digging and think about what makes you happy, what makes you whole. If you can't live without mountain biking, try not to match in a place where you can't go mountain biking, right? Even if it is the best program in every other way, if that is truly your happy, you might really need to make some hard decisions about what it is that keeps you whole and that makes you OK as a person.
I know a lot of people are also worried about splitting up families and relationships at this time. And that can be very, very emotionally taxing and challenging as well. And I wish you luck. There is no good or right answer. And these are really tough decisions to make. But again, dig deep. Know yourself. Know your relationships. Figure out what works for you. And good luck.
Try to make sure you have a mix of top-tier, middle-tier, more safety programs. You don't want to only be ranking and interviewing at the top-level programs. That does put you at risk potentially for not matching, especially if you're looking at a highly competitive field. You want to have a mix of spots. You want to put them in order of your true preference. And you want to take into account all of the different factors in making this really challenging decision.
Unger There's a lot to consider. And Dr. Fairbrother, your advice is incredible. Thanks so much for your perspective and being with us here today. We know it's going to help students search with confidence and find the right program for them. Dr. Fairbrother, any final piece of advice during this stressful time for students?
Dr. Fairbrother: Just good luck. This is a really stressful time. And I just want everyone to know that the vast, vast, vast majority of students match. And even if they don't match, we have a really robust SOAP process to really help put students into positions that are really good, even if the worst-case scenario their match is unsuccessful. Know that this process has really worked for the vast majority of students for many, many years. And it's going to work for you too. It just takes a lot of time and energy. And I know it's stressful. But I also know that you can do it.
Unger Thanks, Dr. Fairbrother. The AMA also has a number of resources to help students with Match, including FREIDA™, our residency and fellowship database. It's the largest database out there, with more than 13,000 programs. And students can customize their searches by the criteria that we've talked about today, around that fit.
And AMA members have access to advanced features like member-only dashboards, where they can save, compare and rank programs. You can learn more by visiting freida.ama-assn.org to find out more. Thanks so much for joining us today. We'll be back soon with another AMA Update. In the meantime, you can find all our podcasts and videos at ama-assn.org/podcasts. Thanks for joining us. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
