Deceber 22, 2021, 10:00 a.m. David Mitchell — Residency interview season will soon be winding down, and most medical students likely are feeling uncertain. How do you reflect on your residency research and interviews and create your Match rank order list?
Applicants face a Jan. 31 deadline to register for the National Resident Matching Program. Program ranking opens the next day and runs through March 2. With so much for medical students to think about, AAFP News gathered a faculty member, a fourth-year student and two family medicine interns who participated in last year’s virtual Match to offer their insights on the process.
Cleveland Piggott, M.D., M.P.H., Vice Chair for Diversity, Equity, Inclusion and assistant professor in the University of Colorado Department of Family Medicine, and faculty at the University of Colorado Family Medicine Residency: What I encourage students to really do is take the time to know yourself, what your values are, who is important to help you make these decisions, and what are your must-haves. You will get great training at pretty much any family medicine residency program, but you probably can trailblaze in one thing. So, is the program strong in the things you need it to be strong in? Is it an area where you will feel supported while doing your clinical rotations? Will you also be able to have fun and enjoy your three or four years at that program? Those are some things I encourage students to do, and it usually takes them until halfway through the interview season to really start asking the right questions to find the best program for them.
Juan Oves, fourth-year student at Florida International University’s Herbert Wertheim College of Medicine: I think the most helpful thing, especially over virtual, has been the socials. Some of them are very helpful because you get the vibe of the team. A lot of times in the socials, the residents are open to giving you information regarding the program, like things that they would like to change. Or if there have been changes, how did the administration approach it and respond to those changes? I’ve also been looking to see if there are alumni from my medical school at the residency programs where I’m interviewing. They’re amazing contacts, and they will text you and talk to you, so make sure you reach out to your alumni department at your medical school to see what alumni are able to open up about a program in a more personal way.
Hannah Smith, M.D., first-year resident at the University of North Carolina: I definitely encourage virtual second looks because the socials, as good as they are, you’re only getting the residents who had that specific time free. So, you might not get to meet the people who have the same jam on their toast as you do. If you go to one of those meetings, more students might be there, but there also might be more residents. You not only get to see who else interviewed at that program and what the program is looking for in students, you also get to see more residents because on those second looks, they’re going to pull residents and make sure that they can have a good showing.
Piggott: Residents will tell you the truth about the culture. And the culture will be set by the program director. Of course, there are other people contributing to the culture, but those interactions you can have with the PD will tell you a lot about the residency. Also, I can’t stress enough how a good question can give you great insight into a program’s values and if this could be a place where you’ll thrive.
Smith: When students are asking questions, they should think about how they want to answer that same question next year. I remember taking in so much information as an applicant, but I rarely would stop and think, “How do I want to answer this next year?” I’m in it now as an intern, and I’m getting these questions and when I’m answering, I’m like, “Oh, I would have loved to have heard what I just said last year.”
Piggott: This relates to what I said in my opening: Is a program strong in what you need it to be strong in? It’s helpful to really know yourself, your values and whose opinion matters to you. Is that your partner? Is that your family? Who needs to make this decision with you? How do other aspects of the program make a difference? Sometimes it’s the weather in the area or how far it is from your family members. All those things really matter. I found I would have been really happy at the top seven programs on my list. It ended up being tiny things that made the difference in my decision.
Oves: One of the things that I’ve been doing is setting up the values I feel are important for me to be happy in those three years and trying to find those same values in the programs that I’m interviewing with. It’s important to kind of get the feel of it and take into consideration all the other factors that can help you make the decision. I’m couples matching, so we’ve been trying to look at the potential cities that we could live in. But he also knows I’m very interested in public health, so we’re trying to balance that out. All those factors play a role.
Oves: It’s kind of been evolving. I’m still interviewing. I try to see if it feels welcoming and inclusive. Diversity is very important to me. I take a look at the program, the residents and just how I feel in general. I wear a rainbow inclusive pin. It’s like part of my personal statement. How the interviewers react is very important to me because I want to be in a program where they’re very inclusive and important issues, like social justice, are part of what of what they do. A lot of programs have been talking about social justice but don’t do enough. So that’s one of the things that I’ve been looking at specifically.
Smith: Using social media was beyond helpful, not just for what the programs are posting, but also as a way to have less-formal interactions with residents. On social media you can have a more casual conversation and just ask questions.
Piggott: I think it depends on the person. You have the people who have their multi-tab, pivot table Excel spreadsheets. And then you have those who are working 100% on gut. Regardless, I think they both end up a little bit on that gut feeling, but there’s a lot of things that go into that gut feeling.
Oftentimes you’re not the only person in your school going into family medicine, so talk to people about what their experience was. You take it with a grain of salt because they might have different values than you, but just talking about what you’re thinking out loud with someone going through the same process as you can be invaluable.
Your advisors generally just want you to be successful, and they have alumni networks all over the place. Also, good advisors are great at helping students see what’s really important to them and guiding them in the right direction.
The last piece of advice is don’t hesitate to reach back out to people you met on your interview day. As a student, many of my questions didn’t come until like two months later when I figured out what I really wanted. Then I could ask those deeper questions. Those questions about the call schedule? That’s not a helpful question. No one picked a residency program because of their call schedule. They picked it because of the OB program or the residents seemed happy. Oftentimes people aren’t ready to ask those more nuanced questions until a little bit later. Just because your interview has gone by doesn’t mean you can’t contact that program again and get clarity on some of your questions.
Smith: When a resident gives you their email or their phone number, or they say, “Follow me on social media,” we mean it. Reach out to us. I don’t care what kind of question it is or what time of day it is. If you are sitting in bed at 3 a.m. and can’t think of this thing that’s really important to you and you just have to ask, send it to us. We know exactly what shoes you’re in right now, and we want to help you make the best decision. I was hesitant to reach out to residents last year. But if you connect with residents, even if you don’t end up with their program, sometimes they’re going to be some of your favorite and most influential people.
Oves: When it comes to virtual, I think I can go by gut feeling, but I have to have multiple interactions.
Piggott: I think gut feeling still works. I think you just trust it a little bit less. As opposed to getting those multiple contacts on one day in person, you might need to take advantage of other opportunities to get more interaction.
Smith: I was a strong advocate for pro-con lists, but not by yourself. Do them out loud with someone else. That way when you add on a really silly con or really silly pro, they can be, like, “Does that carry that much weight?”
Oves: I’m the Excel spreadsheet type of person, so I created a spreadsheet and I share it with my partner. There is a tab for gut feeling, and we just write what we felt right after the interview.
And I usually go by that, and then I’ll just rank them based on my feeling, but also what cities are we willing to live in and certain factors that are important to us, like diversity and culture.
Smith: I used the AAFP app. As I went to different conferences, you can keep notes in the app about programs. I didn’t use it during the interview, but I came back to it after the interview to see what second-year Hannah, third-year Hannah or pre-interview Hannah had thought when I listened to a session or read an article by someone from a program. Using the app would be a similar system to a spreadsheet.
Piggott: After you have that interview, write down all the feelings — all of them, plusses, minuses and everything in between. Ultimately you don’t rule out as many programs as you thought you were going to from the spreadsheet. It helps a little bit, but then you usually end up with a list that’s a little bit longer. And I think that’s OK. It’s also OK to realize that you have so many wonderful choices in family medicine, and that you would probably be happy at many of your top choices. I think that’s something special about our field.
One other trick we do sometimes for our students is we ask them for their top programs, and then we write one of the program names down and put it in an envelope. Then we hand it to the student and have them open it. Their first reaction to seeing the program name often helps clarify their rank list a bit. It’s a nice way to trick the brain to tell you what you truly want.
Piggott: Right before rank order lists are due if people are struggling. Maybe they don’t know where to put three of their top programs and they need help. For some people it’s really clear, but for the ones who are not quite sure that’s a good trick.
Carmen Simmons, M.D., first-year resident at the Morehouse School of Medicine Family Medicine Residency: I think my biggest thing was that I was looking at hardcore, very specific things about the programs. How many electives did they have? How many babies do they deliver? How big were they in whatever things I was interested in? Those things are important, but honestly, I’ll bring my interests to any program I go to. As long as you have supportive faculty, you can carve out your own interests. Just because a program doesn’t have a fellowship attached to it doesn’t mean you can’t do OB, sports medicine or whatever it is that you’re interested in.
Smith: I think I put a lot of weight in all of the boxes, and I would do less of that now because it’s a big-picture game. If you’re like, “I really don’t want to do an open ICU,” but you love the program, I would put less emphasis on that because it really doesn’t matter. If a program overall is the right fit for you and there’s just one thing that’s missing or one negative that’s there, remember that you can do anything for a month, and you’re going to be at this program for three years.
Simmons: Oh, my gosh. I think that the process, or the final result, worked way better in my favor then I could have ever imagined. To be completely honest, I did not think that this virtual season, ERAS and the Match algorithm in general would work because it just seems super sketch. Even in a regular year, it seems super sketchy that we just put our faith in a computer system. But it really did match me perfectly. And I’m really blessed and excited. It surpassed my expectations.
Smith: I’m in the middle of nowhere on a road home from my rural clinic, heading to a big city, so I think the Match process worked pretty perfectly because I wanted a marrying of rural underserved as well as an academic, full-access setting, and I got that. Intern year is hard because there are going to be months that are a going to be a different jam and you’re going to be like, “This isn’t the jam that I saw when I interviewed,” or, “This isn’t the jam that I felt last month.” But it’s going to still sustain life, and it’s still going to bring you joy at the end of the year. You want to find the people that are going to allow you to have fun and be a really great doctor. I have that here at UNC, so I think it worked really well. I would be lying if I said I didn’t question my gut feeling a time or two. So if you have a gut feeling and you question it, that’s normal, too.
Smith: I told a friend recently that it’s hard because when you interview, you’re the person you are today. You have to remember that the program you go to is accepting and nourishing who you are today, but it’s also creating the physician you’re going to be in three years. Really think about where you’re going to be, who you want to be or what you want to be doing in three years. Sometimes we get so caught up in what we’re doing today, but when I started my journey to become a doctor, I never would have imagined COVID would be a thing. And I would have never thought vaccines and public health would be such a big part of who I want to be in three years. But things change, and residency is going to help you become the doctor you want to be.
Piggott: I think that’s beautiful advice. I would add that a lot of applicants don’t quite know what their vision is of the future. They also don’t know if they want to do fellowship or not, and that’s OK. But is this a place where you feel like you could have mentors and be supported in your growth? If the answers is yes, you really can’t go wrong and you just start choosing between lots of other great options. That’s not the case for everyone, but it’s really amazing to be in that position.
Oves: When I do interviews, I try to feel their vibe and see if we vibe together. If we can hold a conversation for 20 minutes and it’s a good conversation, I’ll definitely add that to my spreadsheet.
Piggott: The last thing I wanted to say is that I realize that every medical student comes from a different institution with various levels of support for doing family medicine and various levels of support for advising. If you come from a place where you have less support, I’m sorry, but know that there are lots of other people in the world of family medicine – alumni, other universities, the AAFP — who are happy to support you in your journey, and you don’t have to do this alone.