"Tell me about your research" Example 2 of 2 - research survey

In the last post, I shared with you the interview exchange between an applicant and the interviewer about her public health research project. In this post, let us look at another applicant [AK] who very enthusiastically shares with me [Dr Ed], in an online practice interview, his research survey that he completed before applying for residency.

Pay careful attention to how he describes the research methods, findings and how he did not settle for just data collection, but moved the project forward to the point of abstract submission in an attempt to present at the largest diabetes conference. Also, have a look at the time-frame when he was able to accomplish all this as it gives you valuable practical information.  Let us start... (Note: Personal information has been withheld to protect the identity of the applicant).

***

Dr. Ed: You indicated in your research experience that you were at __ University doing research in diabetes. Can you describe the research study to me?

AK: Certainly. When I was in (city) staying with my family preparing for Step 2 CS and Step 3, I worked as a research assistant in the Endocrinology division at __ University. The diabetes clinic was situated in downtown __.  I started the research work in May of this year. Dr.__, with whom I worked the most, had created a survey on patient knowledge of diabetes. My role was to survey the patients in the waiting area of the diabetes clinic.

It was a busy place and I was able to survey 106 patients for the study. The questions focused on patient's understanding of what a hemoglobin A1c is, what is the target A1c and what was their recent A1c as far as the patient could tell. After I completed the data collection by the end of August, Dr.__ showed me how to do a basic SPSS analysis. We found that half of the diabetic patients had no clue to what an A1c was, a quarter of the patients heard of the A1c but did not know the target A1c and another quarter knew what an A1c was and their A1c target. We took this one step further, pulled every patient's A1c from the medical records and worked with the biostatistician to look for a relation between knowledge of the target A1c and their actual A1c value. The most interesting finding was a statistically significant trend between a greater knowledge of A1c and a lower patient A1c, that is, a higher patient awareness of the target A1c was associated with better glycemic control in diabetes. I wrote the abstract for this study as the first author and we plan to submit the abstract for oral presentation at the American Diabetes Association conference.[AK then shows me a printout of these findings with a pie chart and bar graph]

Dr. Ed: Very interesting. How do you explain that better awareness of the target A1c led to improved diabetes control?

AK: Our study was not really designed to answer that question and so we could only report the association.

Dr. Ed: Right, right. You used the word 'associated' and not 'caused'.

AK: Yes, we discussed a few possible explanations. Patient knowledge of target A1c, to me, could mean that the person is educated and motivated to take better care of himself or herself and thus may make healthy lifestyle changes such as healthy food choices, close monitoring of the blood sugars, following up with the physicians or working with the diabetes educator.  These are some of the possible reasons for our findings.

Dr. Ed: Right, that's possible. What was the demographics of the patients you surveyed?

AK: The average age was 64 years. Most of the patients were of African - American ethnicity with low socioeconomic status and low educational status.

Dr. Ed: What do you plan to do next with this data?

AK: I wrote the abstract as the first author and I am waiting to hear back from the co-authors. Dr.__ encouraged me to submit it to ADA for oral presentation and I will be very curious to see the response. If it does get accepted at ADA, I will then work on the powerpoint slides or poster. I am interested to learn how to write the manuscript and do realize that its a steep learning curve. With the help and support of the research team, I believe I will be able to complete a first draft by the time I start residency.

Dr. Ed: Did you also look at blood pressure in this study? That is, if knowledge of their blood pressure target led to improved blood pressure control?

AK: In our study, we did not find that knowledge of blood pressure target was associated with better blood pressure control. Dr.__ was very keen on studying this. I saw patients with her in the diabetes clinic as part of my observership and she would ask the patients about their goal blood pressure. It was fascinating to watch some patients who knew their blood pressure target were not happy if their blood pressure was 150/90. She has written about 'physician inertia' and that if patients know enough about their medical condition, they may question the doctor on how they could do better and thus overcome the 'physician inertia'.

Dr. Ed: This certainly sounds like a very talented team of researchers.

AK: Yes, I feel very fortunate to be a research assistant in this endocrinology division. I gained very valuable first hand experience in survey design, conducting the patient interviews, learning analysis on SPSS and presenting the data to the division.

Dr. Ed: Great! Let's move on and see if you have any questions for me?

***

Again, you will see that the applicant did an excellent job describing his research study concisely, had a deliverable (printout of the important data with pie chart and bar graph), and fielded followup questions thus demonstrating his ability to critically think and know the ins and outs of his project.

Preparing yourself for the interview by a careful reflection of your learning experiences, as in this interview exchange, can certainly improve your performance on the interview day and increase your chances of being ranked high by the residency program.

Check out ed4medus.com and learn how personalized services such as online practice interviews can help you in your goal to a US residency program. 

Before you go: Here's your golden opportunity to have your voice heard! I am working on some of the questions that you asked (including this topic). But I need more questions!

Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this post or message at my Facebook page or email me at varun@ed4medus.com

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Photo credit for images in blog post: https://weillcornell.org/sites/default/files/clinical_service_images/c_endocrinology_and_diabetes.jpg
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https://i.ytimg.com/vi/MWUM7LIXDeA/maxresdefault.jpg
https://images.slideplayer.com/16/5016498/slides/slide_2.jpg

"Tell me about your research" Example 1 of 2 - a public health project

Here are excerpts from an online interview that I recently conducted at Ed4MedUS.com. The applicant is an IMG from India [SS], where she talks about her research project during medical school.  Look carefully at how she describes her study, the choice of words by the applicant and follow-up questions by me [Dr Ed, the interviewer].

To me, this is an exemplary way of presenting your research study, even if you feel that 'your project is not great'. This post is the first in the series of 2 posts. In the 2nd post, I will describe the conversation about another research project that was completed prior to the applicant’s residency application.

Dr. Ed: I see on your application that you have done some research in med school. Can you describe your research experience?

SS: Yes, I would be glad to. In my third year of medical school, I performed a research survey with the guidance of my professor of community medicine. This was a cross-sectional study, where we wanted to explore the knowledge and practices of waste management in a rural area in Kerala, India.  You may have heard of Kerala in India being 'God's own country' but there are many villages in this state. I and four medical students formed a team and we created a survey. We approached 450 households over one and half years where he went to each house in our assigned area of survey and asked the head of the household about demographics, socioeconomic status and education. We then asked a list of questions about waste management that is how were the families handling biodegradable wastes, plastic, electronic and glass materials. We had some very interesting findings and some findings that were concerning.

Dr Ed: Go on. {Following image comes to mind}

SS: Almost all the houses that we surveyed in the village were finished houses and had a toilet. We found that about two-thirds of the households did not practice safe handling of biodegradable wastes and half of the homes did not handle plastic wastes appropriately. Interestingly, three-fourths of the homes handled electronic wastes well by discarding batteries, toys and devices through a collection service.  I worked with my colleagues entering the data into an excel file and then we took the help of our professor in doing an SPSS analysis. What was interesting and concerning at the same time is that the waste management practices did not appear different based on educational or socioeconomic status, that is, it did not matter whether the head of the household was educated up to 10th standard or had higher education and whether they were above or below the poverty line.

This study really made me realize that we need to do a better job educating the public on waste management. Incentives for use of technology such as a bio-gas plant or a compost pit located far from a water source may improve waste management practices and reduce pollution. The study helped me learn the importance of careful data collection, timely recording in an excel, SPSS analysis, presenting the data and writing the report.

Dr Ed: Very nice. Is there any similar data available?

SS: I did a literature search and there is very limited data from India. In fact, one study found even worse, that is 90% of households disposing solid wastes inappropriately.

Dr Ed: What should be done next?

SS: The effect of an intervention on waste management practices, such as improving public awareness, should be studied. For example, there is a public health mission going on in India called 'Swachch Bharat' that aims to increasing people's awareness and motivating them to keep their environment clean.

Dr Ed: If you had to redesign the study and had all the resources in the world to do research, what would you do?

SS: [after thinking briefly] I would test the level of pollution in the air and water and study the effect of an educational intervention and an incentive program where each household is rewarded to turn in all the wastes appropriately. I would study the effect of this intervention by retesting the air and water and show a decreased level of pollution.

Dr Ed: Interesting. How will this research experience help you in the future?

SS: The study makes me more aware of how there could be a problem with management of biomedical wastes. For example, when I was observing in Oregon Health Science University, I was concerned about the medication changes and wondered if a patient had a 90-day supply of a medicine and the doctor then changed the medicine due to intolerance, then how would the patient dispose of those unused tablets. If they cannot return the medicines to the medical store, are they dumping it in the toilet? I was glad to see separate medication bins to dispose unused medicines. Also, I visited the local library when I went to visit my cousin and saw prepaid envelopes to mail unused medicines. I did some more reading and found that these medicines are then burned to reduce pollution and prevent damage to water life.

Dr Ed: Uh-huh...

SS: Also when I was rotating in nephrology in Oregon, the attending I rounded with had concerns about the amount of waste generated in dialysis such as water waste, plastic tubes, dialyzer waste, blood waste. We discussed papers where some nephrologists are trying to make dialysis less harmful to the environment. I feel this would be a great quality improvement project in the future.


Dr Ed: Are you going to do this improvement project in residency?

SS: I am not sure about a nephrology project, but in internal medicine residency, I would like to survey the patients and find out what they are doing with their bottles of medicines after the doctor asks them to stop the medicines.  For example, when I was rounding in nephrology, I saw that dialysis patients need to take a lot of phosphorus binders. If a dialysis patient is prescribed calcium carbonate 1 tablet 3 times a day with meals, then a 90-day supply means 270 tablets. What happens if after 2 weeks of taking the calcium, the patient has an intolerance to the binder? I would really find this topic to be very interesting and a quality improvement project that could be completed.

Dr Ed: What else did you learn from your research project?

SS: This research project taught me a lot about how important it is to carefully plan every step right from the survey questionnaire, the visits, data collection and storage in excel. My skills in working in a team of medical students, working to finish the assigned work and helping each other out allowed us to complete the study. The project also improved my skills of organizing and presenting data in a form that is easy to understand and with the help of tables and bar graphs. I also learned to collaborate with a biostatistician for the analysis and doing a literature search. As this was a teamwork, we all had different pieces of the report to write and thanks to our perseverance, I am glad that the report turned out very well.

Dr Ed: Did you get any award for this study?

SS: No, I did not. And I am fine with that as my goal was not really to compete with other teams, but to learn the research skills and do more research or quality improvement projects in the future.

Dr Ed: OK, let's move on to the clinical side of things.....

___

You will see that the applicant has done a marvelous job of describing her research project very concisely and demonstrated the ability to critically assess how this helped her be a better physician even if her future goals (or research efforts) are very different from her medical school project. She demonstrated presence of mind by very satisfactorily answering the questions that followed the results of her project.

Preparing yourself for the interview by a careful reflection of your experiences, as in this interview exchange, goes a long long way in improving your chances of being ranked high by the residency program.

Before you go: Here's your golden opportunity to have your voice heard! Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this post or message at my Facebook page or email me at varun@ed4medus.com

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Photo credit for image on top of post: https://elearningindustry.com/wp-content/uploads/2015/11/10-online-research-tools-every-online-learner-know.jpg
https://archive.indiaspend.com/wp-content/uploads/village_620.png
https://community.data.gov.in/wp-content/uploads/2018/10/swachh-bharat-infographic_Home-300x185-01.jpg
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'Do you have any questions for me?' Part 1 of 3 - teaching and research questions

So you have made it to the residency interview. Congrats! The interview is going well and you have said everything to the interviewer that you planned you say. As the interview comes to an end, the interviewer then throws "Do you have any questions for me?" at you. How should you tackle this question - should you choose to be modest and not trouble the interviewer or is this another opportunity to shine at the interview? Read on.

On the surface level, 'Do you have any questions for me?' seems a a very benign question. In my opinion, the interviewer is giving you yet another chance for you to show your interest in the program and your critical thinking skills.

Before you go for any residency interview you have a lot of information accessible to you through the programs website, emails sent to you by the program coordinator, YouTube, twitter, PubMed, local information about the town, climate, jobs, schools, safety and so on. So while you don't want your questions to be redundant and boring, asking the right questions can demonstrate your interest in the program and commitment to excel in your career.

In my online practice interviews at Ed4MedUs.com (schedule your practice interview here), these are some questions that applicants have practiced asking me (and I would like to be asked) as an interviewer.

General questions:
The best questions in my opinion are in the form of “I read on your program's website that your program does such-and-such – could you tell me more about that?” Again, this shows that you're interested in the program and have taken the pain and effort to review the program website or materials.

It is nice to ask the program director as to "what major (or significant) change are you anticipating in the next few years?". Here you could also ask about any changes in the teaching methods or research opportunities that may become available in the near future. But do remember that some of these changes may not happen during your time in residency, so take this with a grain of salt.

Teaching:

"What are the teaching conferences that I will be attending (or participating) in?". This question may be partly answered during the morning introduction to the program by the chief resident (or the program director). "How frequent are the morning report and noon conferences?" - these are the traditional bread-and-butter teaching styles in any residency. However, lately there has been a lot of debate on the educational value of these conferences as residents usually get paged by the nurses and honestly because of our rapidly declining attention span. Some programs have chosen to have academic half days where the residents have protected learning time and are not to be disturbed during these conferences. If the program that you're interviewing at does not have academic half days, ask the program director if they are considering this in the future. Or if they do have academic half days that they started very recently, asking them a question such as "I noticed that the academic half days were just started last year. How is that working out for the residents and are you planning to continue it or make any enhancements?"

Other teaching activities include sub-specialty rounds, grand rounds and M&M (mortality and morbidity) rounds. See if the program is engaged in any of these teaching activities. A schedule of teaching conferences is usually handed out to every applicant and does not need to be asked to every interviewer, especially a sub-specialist consultant. Make sure you are fully aware of all the learning opportunities as well as your teaching responsibilities as you certainly will be asked to present cases at morning report or a paper at journal club.

If not answered already, ask the interviewer "I have an interest in teaching medical students. Would I have opportunities to do so?" This can be a very enriching experience and is great for your resume if you're considering an academic career. Some residents volunteer in an adjoining medical school to facilitate small group sessions. If you have a flair for teaching, go ahead and make sure your interviewer knows about it.

Research opportunities

"What research projects have residents completed?". 
"What research opportunities are available?". 
"Is there a research rotation or protected time for research?" "If so, how many weeks is that?"
"Are there specific faculty members to guide research planning and work during residency?" Every residency program needs to have every graduating resident complete a 'scholarly activity'. This can range from a poster presentation all the way up to a manuscript publication. A resident may choose between an actual research study or a quality improvement project. But to do any of these research activities require a huge investment of time and effort by the resident and commitment by the teaching faculty.

"What are the resources for research or scholarly activity available in the institution?" Some University programs have a Teaching Academy that serves as a formal resource where you can become a protege under a research mentor who guides you through various stages of research such as coming up with a research question, applying to IRB, data collection and analysis, completing the study and presenting the data. You need to realize that you have limited time in residency so please only choose projects that are feasible. PubMed is an excellent resource for all research publications that came out from the institution where you are interviewing. If  you are considering an academic or a research career after residency, make sure that the program where you are interviewing can make you a great doctor and also an excellent researcher. Make sure you are aware of this before the end of the interview day.

Before you go: Here's your golden opportunity to have your voice heard! Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page.

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Photo credit for image on top of blog post: https://maria.gorlatova.com/2015/02/pm-job-candidates-please-ask-questions-in-your-job-interviews/

'Tell me about yourself' - the classic icebreaker question in any interview

'Tell me about yourself'. Often called an 'icebreaker' or 'elevator pitch', this is an open-ended question you are almost guaranteed to be asked. Lets face it, a residency program director has a lot of applicants to interview (on average, a residency program with 7 spots interviews 95 applicants - click to see my previous blog post). There is no way he or she can remember each and every application. This is of even greater concern for 'guest' faculty attendings who serve to interview intermittently throughout the interview season.

'Tell me about yourself' is an opportunity for you as the applicant to put your best foot forward i.e. say everything you had prepared to say and that you wanted to make sure the interviewer has heard. Did you have an exciting research project or a case report that you are working on? Did you have a very moving experience like working in a disaster area or how you discovered your passion for teaching? Here's your chance to shine.

What exactly should you say? Here is a framework:

(Source: https://www.amazinggoodwill.com/hs-fs/hubfs/Marques%20Clark/Elevator-speech-02.jpg?width=564&name=Elevator-speech-02.jpg)

Here is an example from a practice interview that I conducted online at ed4medus.com (schedule your practice interview here)

"I am an international medical graduate from India. After I graduated from med school in 2018, I looked closely at my future career options. Fortunately, my brother who lives in California encouraged me to explore medical residency in US. I talked with graduates from my medical school who are in US and I then decided that the high quality of training, education and research opportunities in US residency would be best for my career.  I took Step 1 and Step 2CK and then landed in Atlanta for US clinical experience. I am currently a research assistant at Emory University in the Endocrinology division. My role is to survey patients with diabetes on their knowledge of hemoglobin A1c. I ask patients if they know what their A1c is and what should be the target A1c. We hope to correlate this data with their actual A1c. I also observe the attendings in their diabetes clinic. Now the reason why I got very interested in internal medicine is that I love pathophysiology. I find it very interesting that I can apply my knowledge of pathophysiology to understand a patient's problem and come up with a treatment plan. I particularly enjoy talking to patients and explaining complex diagnoses in simple terms while being honest and reassuring to them. I am very interested in training in a community hospital program that is just not too big or small and where I can have opportunities for research and fellowship. In fact, I was recommended to apply here by J_ J___ who graduated from this program 4 years ago and spoke very highly about the training he received. I haven't decided which fellowship yet but I find myself drawn to nephrology. I believe that my passion to work hard and train hard in a warm and supportive program will greatly help me grow as a physician." - A.K.

Red flags: Don't make it sound like you gave the exact same speech at another program. You need to personalize your 'elevator speech' to every program. Maybe you have a friend where the program is located. Maybe you know a former grad in that program. Maybe you are interested in the location for your spouse. Maybe you are interested because of school system for your children. Try to give the interviewer as many reasons as possible as to why you would be the perfect fit for their residency program. 

So that's it - what is your favorite response to 'tell me about yourself'. Share your wisdom in the comment box below and I will offer my feedback to your response.

Before you go: Here's your golden opportunity to have your voice heard! Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page.

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Photo credit for images in this blog post: https://www.successco.com/images/2008/06/25/meeting_success.jpg; https://www.sacmeetings.org/files/images/students/elevator-pitch.jpg

How do Program Directors decide which applicant to interview and rank? Here are the data from a national survey

Have you ever wondered what is a residency program director (PD) really looking for in a residency applicant?  Are they looking for stellar USMLE scores? What about research experience? How important is US clinical experience? Let's look at the available data to answer these questions.

NRMP surveyed PDs in 2018 and scored a variety of factors that a PD looks at when he or she receives a residency application.

Disclaimer: The survey had a response rate of about 30%.  This means that more than two thirds of the program directors did not respond to the survey and there is no way of knowing if those non-responders would act differently from the data summarized below. Also there are subtle differences in how each specialty values these factors in selecting applicants for interview.  You can look up the details pertaining to your specialty of interest in this link.  The following summary takes into account all specialties and is a valuable starting point.

1.  USMLE scores.  94% of residency program directors cite USMLE Step 1 score as an important factor in selecting an applicant to interview with an average rating of importance of 4.1. To me, this was interesting. I wondered if performance in a standardized exam in the 2nd year of US medical school that tests knowledge and application of basic sciences and pathophysiology could reliably predict how good a resident you are likely to be. It's possible that in residency training, having a good foundation of knowledge can help residents build their diagnostic and management skills quickly.

Also 30% of these responding program directors indicated that they would not consider an applicant who failed step 1 on the first attempt.

These data indicate that USMLE Step1 score is very important in enhancing your chances of getting an interview offer.  So what score should you be targeting? The responding PDs in 2018 indicated that Step 1 score of about 235 and above almost always qualifies for an interview, while a score less than 218 generally disqualifies that applicant for an interview.

What about Step 2CK scores? Fewer PDs [80%] considered Step2 CK score important while 94% of the PDs gave more weightage to Step1 score. However, it is difficult to know if this is truly the case (see the above disclaimer about non-responder bias). Similar to Step 1 data, 35% of the PDs would not consider an applicant for interview if he or she failed Step2 CK on the first attempt. Again, a median score of 235 and higher resulted in an interview offer.

My interpretation of this data is that a score of 240 or higher (greater than 75th percentile in this report) should remove any doubts in your mind about your USMLE scores impacting your chance to get an interview. Again remember this is just one of the many other factors in your application that is considered by the PD. 

2.  Letters of recommendation. Letter of recommendation were second most popular among PDs in deciding whether to interview an applicant. PDs certainly want to get a feel for the applicant's professionalism, commitment and their actual performance in clinical rotations.

Think for a moment from the shoes of a PD.  On average, for 7 residency positions in the match, the program receives 904 applications of which 121 qualify for an interview. That is, for every 10 applicants, only about 1 gets an interview letter. Besides using the USMLE scores as discussed above, the PDs also review the letters of recommendation in making this decision.

I would consider it very essential to obtain letters of recommendation from a US physician.  If you are an IMG, these letters are highly regarded and carry much more weight than that from a physician from your home country. While letters from a community physician are helpful, I would recommend working with and obtaining a letter from a teaching faculty member at an academic medical center through an observership, clinical rotation or research opportunity. This also increases your chance of interviewing in that academic medical center and other teaching hospitals especially if the faculty member is well known.  Four letters of recommendation are golden.

The Dean's letter (or MSPE) is also very important as it summarizes the course of an applicant's entire four years in medical school including the basic and clinical sciences.  Here are some examples (example 1, example 2).  The dean's letter also states class rankings as every medical school has its own way of grading the performance of its medical graduate. The Dean's letter typically includes snippets of written evaluations by teaching faculty members and grades to offer a 360 degree evaluation. If you are an IMG, chances are that your dean's letter is going to be very different. See if your medical school is willing to draft a dean's letter as in the specifications and examples above.

3. Commitment to specialty and evidence of professionalism and ethics: This should be evident from your ERAS application, work, research or volunteer experiences and personal statement. Remember that the personal statement should not repeat what you stated in ERAS - it should describe what skills you gained from an experience or how you became a better physician (and person). For example, as an IMG, you should offer details on your observership in your ERAS application. And also, you should describe how the observership prepared you for residency by giving you a glimpse of the interactions between residents and attendings, patient communication, EMR and team management.

4. Grades and class ranking. Are you someone who is just good at taking exams and scoring well? Or have you done well the entire time in medical school? This will be evident by your scores and MSPE/Dean's letter.

5. Research experience: Interestingly, only about 40% of PDs chose to consider research experience in their decision making. That seems quite low. It may be because PDs know that not much meaningful research can be completed during medical school, let alone that it be presented in a conference or published. It is very difficult to complete any solid research in 1-3 months. The most you can do is a survey or retrospective chart review. Quality improvement is another feasible option.

Some other notable findings:

1. Program directors were very clear that if the candidate was 'flagged by NRMP' for irregular behavior or match violation, they would not interview or rank that applicant. Don't get yourself into any trouble.

2. Visa status for IMGs: This was important for some PDs (about 40%). Now this does not mean that PDs are not worried about visa status for IMGs and will call an IMG for interview without looking at their visa needs! You wish. It means that the PDs who didn't need to bother about visa status either (a) are not planning to invite IMGs or (b) are not planning to sponsor a visa anyway or (c) will sponsor only J1 visa that requires little work and expenses from the program standpoint.

3. Personal prior knowledge of applicant: More than 2/3rd of the responding PDs strongly considered this factor in their decision to interview an applicant! This just goes to show that NETWORKING is key! Use all your resources - friends, family, medical school alumni, just anyone really. I remember a shopkeeper once approached me as his nephew was looking for an observership!

That’s all for now. Hope you like this blog. I would love to hear your thoughts and comments. Join the mailing list for the blog or my facebook groups and check out Ed4medus.com to learn more about personalized services to help you get into a US medical residency program.

Before you go: Here's your golden opportunity to have your voice heard. Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page.

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Photo credit for image on top of post: http://digitaluniversity.elis.org/wp-content/uploads/2018/04/smart_recruiting.jpg

How to decide where to apply? Things that applicants look for in their desirable US residency program.

Selecting which residency program to apply to is an arduous task.  How does one decide which ones among the thousands of residency programs in US should he or she apply to?  You cannot possibly apply to ALL the programs. While limiting the number of programs to apply to, also consider the fact that the costs go up considerably beyond 30 programs.

For example, if a medical graduate applied to 80 residency programs (this being the median number of applications submitted by an independent applicant in 2019), the cost of submission would be about $1800 (use the official residency fee calculator here). Also, it would be very difficult to interview beyond 12-15 programs because of travel costs, interview scheduling and your personal stamina.

It is very difficult to know how many programs to apply to without risking the chance of losing a potential interview by applying to fewer residency programs.  This becomes even more challenging for an IMG.

As discussed in my previous blog, independent applicants [that is US citizen IMG, non-US citizen IMG, or former US medical graduates] applied to a median of 78 residency programs as compared to 39 programs by US seniors. This is to say that, independent applicants had DOUBLE the number of residency applications as that of a US senior.

The NRMP data table provide information on how medical graduates decide to apply to a residency program and rank a program for matching. Here is a summary of the top 5 factors from the NRMP survey (ranked in order of importance):

1.  Desired location.  Location, location, location! This is the most important factor for applicants to decide which program to apply to. This comes as no major surprise as you will be spending three or more years of your professional life, living, breathing and working in a hospital. What is it about the location that is so important? Everything! Consider the safety of the neighborhood where you would be living and where the hospital is located, having family and friends in the area, cost of living, rents, climate, time spent on traffic, ease of getting to and from your workplace, activities for yourself and family such as restaurants or jobs for spouse, schools for children are some of the essential factors in deciding a location.

For example, a friend of mine chose not to apply to New York City even though he knew of the many IMG friendly programs in that city as he was turned off by the high cost of living, questionable safety and traffic difficulties. This is a very personal decision, but an excellent starting point as your start to narrow down the list of programs were you intend to apply.

2.  Perceived goodness of fit.  There is a lot of subjectivity in deciding whether a program is a good fit for you are not.  Some applicants prefer a small program that allows closer and more personal interactions with the teaching attendings as opposed to a much larger program in major teaching hospital where you maybe just a "person in a white coat". The goodness of fit is best assessed at the time of the actual interview day. A residency program with two or more IMGs is looked upon favorably by IMGs. So ask yourself if you will be happier in a program with 8, 20 or 50 residents.

3.  Reputation of program and academic medical center program.  Residency training at a reputable program is likely to increase your chances of landing a satisfying position after graduation, and more importantly helps you get into fellowship programs or academic careers. This is because of greater research opportunities in academic medical centers as compared to community hospitals.

Now this may be less of a concern if you choose to be in private clinical practice after residency graduation or are unable to get interviews because of your residency application (such as low USMLE scores, second or more attempts or long time since graduation). As alluded to in my earlier post on five reasons to pursue US residency training, training in an ACGME accredited program and obtaining board certification are adequate for one to have a thriving clinical practice. So, take it easy.

4.  Collegiality among residents and teaching faculty and quality of educational curriculum. This may be difficult to judge just by browsing through a website. Some helpful information to learn about a program include fellowship match rates or boards passing statistics. 

On the actual interview day, one should get a feel for the collegiality among residents. What is the morale of the residents? Do they look troubled at work? Are they willing to help each other out? Are many attendings approachable and easy going or are they malignant or aggressive? Do you think the program director would be a good friend for the next three years of residency (or even many years later)? 

Look for any teaching initiatives or changes in educational curriculum (such as academic half days or point-of-care ultrasound) that the program is proud of. Are the chief residents and faculty responsive to feedback from the residents?

You surely have heard of the highly prevalent burnout and emotional distress among US resident physicians. Choose to train in a learning environment where your colleagues can look out for each other and the faculty is approachable and helpful to you as a person and a physician. This is very important. You want to be training at a place that is comfortable to you but at the same time that does not leave you stressed and emotionally drained. Try to find out how the program is invested in your well-being.

5.  Work-life balance (or work-life integration).  Again this is specialty specific. Find out if the program encourages or even actively participates in out-of-the-hospital social gatherings and activities such as the events found in my hospital. Look on Twitter or Youtube. Get a feel for the kind of documentation responsibilities while you take care of the patients. Also, look at the number of electronic medical record systems (for example, a VA hospital has a separate EMR system if you also round in the VA hospital or clinic). While this should not be a deal breaker, it is best to be fully aware of the extra effort you may need to put in.

TWO additional points to be noted:

1. Salary and benefits are very similar in all residency programs. This should not really be a consideration when choosing between ACGME accredited programs.

2.  For IMGs and those requiring visas, visa sponsorship is of the highest priority (if you need a visa and the program will not offer you one, there is no way for you to work in that hospital). Visa sponsorship would be an important starting point for IMGs as they narrow down their list.

That’s all for now. Hope you like this blog. I would love to hear your thoughts and comments. Join the mailing list for the blog or my facebook groups and check out Ed4medus.com to learn more about personalized services to help you get into a US medical residency program.

Before you go: Here's your golden opportunity to have your voice heard. Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page.


The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

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The ONLY reason why you should FOREGO your dream of US residency training

In a previous blog, I discussed five reasons why aninternational medical graduate (IMG) should seriously consider pursuingpostgraduate medical education in US. But what might be absolute contraindication(s) i.e. are there some reasons one should totally give up the thoughts of US residency training?

After a lot of thought and search, I could find just one potential problem: Having a cause for the state medical board to not authorize you to practice medicine would be this sole reason.

So having a criminal history, being involved in litigation or a medical malpractice case, irregular behavior on the exams, history of drug or alcohol use jeopardizing your ability to practice, being dismissed or withdraw(n) from medical school, medical school not being in the world directory of medical schools, multiple attempts at USMLE (maximum 3 attempts for my state of VT https://www.fsmb.org/step-3/state-licensure/) are serious red flags.

Here is another blog post with more details. 

Any information pertinent to the above needs to be revealed to residency programs (in ERAS) when you apply and to the state medical licensing bodies. If you have any of these red flags, you really need to weigh whether it is worth applying to a US residency training. 

Psychiatric or physical disability is something that you cannot be discriminated against and need to provide the information to residency programs and the medical boards. 

Other factors below are not insurmountable: 

1.  1. Specialty choice: maybe you were an orthopedic surgeon, ophthalmologist or neurosurgeon in your home country and looking to be one in the US. If you choose to pursue a competitive specialty (as in my previous blog post), you would just need to be prepared to go through a long steep road with many bumps and have the resilience and patience to ‘stay the course’. You would really need to strengthen your portfolio through research, publications, networking. I personally know two general surgeon IMGs who after trying for a few years to get into general surgery, then chose to pursue internal medicine residency and move on with their lives. This might work for some and not for some - you need to decide.

2.   2. Need for visas: yes this does make it onerous to get interviews and match, but again you need to buff up your portfolio as best as you can through research, clinical observerships etc. Some get lucky to marry and have a spouse with US citizenship that opens a lot of doors for their careers.

3.      

4.   3. Low score on USMLE or a second attempt: What are your chances of getting into a US residency? Again, this is not an absolute contraindication. Some just are not good exam takers and still do very well. 

So that’s it – I would love to hear your thoughts and comments. Join the mailing list and check out www.ed4medus.com to learn more about personalized services to help you get into a US medical residency program.

Before you go: Here's your golden opportunity to have your voice heard. Write down your ONE question regarding your US residency program application, personal statement, interviews or anything that has been bothering you and keeping you up at night. You can reply at the end of this blog or post a message at my Facebook page.

The top 10 popular questions will be featured on my next blog posts at https://ed4medllc.blogspot.com/ and the winners will receive a coupon each for a FREE practice interview at Ed4medus.com ! Put those thinking caps on and hurry up!

Opinions in this blog are solely of the author and Ed4Med LLC and not the employers or affiliations of the author. 

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