Anesthesia Interest Group Residency Application Advice from 4th Years Questions: How many letters of recommendation do you

need and who did you request letters from? Did you do any away rotations? If so, where and was it useful? Any tips for preparing/looking good on anesthesia/SICU rotations? Suggestions for writing the personal statement? Timing of application process - when did you submit your application? When did you start hearing back from programs? when were most of your interviews scheduled? What is a good number of programs to apply to? How many interviews should you hope to have? What is a good number of programs to rank? What were interviews like? Any tips for preparing for interviews? Questions to prepare for? What are your thoughts about categorical vs. prelim surgery or medicine vs. transitional year? What additional letters of rec are required for prelim or transitional years? Are these interviews scheduled at the same time at anesthesia interviews? Any recommendations about specific programs - good/bad experiences, programs you really liked?

Student #1: My advisor was Dr. Ashley Shilling- AWESOME amazing wonderful human being. I recommend her as the top choice to anyone who can grab her first. Didn't do any away rotations, aren't really necessary unless there's one place you REALLY want to go to, if you want to do them for fun, or if you feel like your application has a weakness that you'd like to help cover up by being a superstar a the away rotation. Tips for the anesthesiology rotation- learn the card I made for your class, show interest, and do some reading in the baby Miller's if you can. That's pretty much it, as long as you show interest and it's genuine, they'll know. SICU rotation- get in early every morning and KNOW your patients, know all line changes, etc. Read about every single condition your patient has, as well as bad things that can happen in the ICU like VAP. Treat it like you did your third year rotations and it'll be a breeze. Personal statement- my advice is to always be yourself. If you're a different person on your interview than what your personal statement represents you as, then you're already not off to a good start. So be honest, you're all more than likely wonderful people, so need to present yourself as anything other than you! :)

Student #2: Who was your advisor? Vic Baum How many letters of recommendation do you need and who did you request letters from? I got more than I used. One from Peds Anesthesia attending Terry Yemen One from SICU Director and Surgery Attending Rob Sawyer Two From Peds Sedation Service Attendings (Julie Haizlip and Patricia Scherrer) One from Cardiologist Amy Tucker for my Prelim Medicine Year One from Anesthesia Chair (George Rich)- I only got this because Wake Forest made me submit it. I didn't ever work with him. Did you do any away rotations? If so, where and was it useful? No Any tips for preparing/looking good on anesthesia/SICU rotations? Review pharmacology of anesthetics. Read Miller chapters they provide you with. Suggestions for writing the personal statement? People will tell you different things. My thinking is that you should write a statement that tells the interviewer something about yourself beyond what they can read in the application. I wrote about coaching lacrosse in college and related it to why I would be a good anesthesiologist. Interviewers seemed to like this because it was different. Dean Pearson thought it was too long but I got good feedback from the programs. Timing of application process - when did you submit your application? When did you start hearing back from programs? when were most of your interviews scheduled? I submitted it the first day ERAS would accept it. I started hearing in the following week. My first interview was in late October and my last interview was in late January. The bulk of my interviews were in late November and early December. What is a good number of programs to apply to? How many interviews should you hope to have? What is a good number of programs to rank? I applied to too many. I would say interviewing at 8 places would be ideal. If you rank 9 programs, I think your chances of matching are something like 95% according to NMRP data. What were interviews like? Any tips for preparing for interviews? Questions to prepare for? I never got any curve balls in interviews. People say to be yourself. Know what you wrote in your application and be able to answer questions from that. Everything was really straightforward for me. Why Anesthesia? Why Medicine? What would you do if you couldn't do anesthesia?

Tell me about your research. What was the hardest thing you had to do in medical school? Tell me about a difficult time interacting with people. What do you do outside of medicine? What are your thoughts about categorical vs. prelim surgery or medicine vs. transitional year? What additional letters of rec are required for prelim or transitional years? Are these interviews scheduled at the same time at anesthesia interviews? Hard to say. I matched into a prelim medicine year. I think a categorical position is ideal followed by a transitional year. Prelim Surg and Medicine are too narrowly focused and leave fewer elective options (I can't even do an anesthesia rotation next year as a medicine intern). Categorical positions will ensure that your intern year is filled with rotations that will benefit you as a future anesthesiologist. Any recommendations about specific programs - good/bad experiences, programs you really liked? Of the places I looked: top tier: Stanford, Mayo Clinic (Rochester), OHSU (Portland), UNC, Mass General There are some programs I didn't rank but that was more of a weird feeling I got on interview day or not liking the city. No real bad experiences anywhere.

Student #3 Advisor: John Rowlingson Ended up using three or four anesthesia letters and one or two medicine letters for prelim year Did away at Beth Israel Deaconess in the SICU. Was useful for me because I ended up matching there, but I was a little worried about my application. Wouldn't recommend doing one if you are a very strong applicant - it's a lot of hard work and somewhat stressful Read up beforehand, for the most part just act interested and be pleasant and not too intense. The ICU Book is a good book for the ICU, it helped me on my away in the SICU Not much to say about the personal statement, I just wrote about an interesting case and then talked about all the reasons I like anesthesia Submitted shortly after ERAS allowed you to, started to hear back in late September but heard from most programs in mid-October, scheduled interviews throughout Nov, Dec, and Jan I applied to like 25 programs total including intern year programs, ended up doing 16anesthesia interviews and 7 intern year interviews, ranked all of them except one (I would rank anywhere that I would be willing to work) Interviews were pretty chill for the most part especially if you prepare well, some of the top programs were a little more stressful with behavioral questions ie tell me about a time that you saw something inappropriate by a superior and how you handled it. Make sure you read interview feedback on SDN I think prelim medicine or transitional is the best way to go if you up doing an advanced program, prelim surgery programs are usually much more difficult (at least that is the case at UVA, can't say I know for sure bc I didn't apply to any). You'll need a letter or two from a medicine attending for prelim medicine, and some programs will also require a letter from the UVA internal medicine clerkship coordinator which takes a little bit of work to set up. These interviews are usually scheduled separately so it is up to you to try to put them together in the same city, which often didn't work ie I went to Chicago like three times Really liked UChicago and UCSF and was pleasantly surprised by GWU and UMaryland. Don't bother applying to BU if you're looking at Boston programs.

Student #4 Who was your advisor? Marcel Durieux How many letters of recommendation do you need and who did you request letters from? I would recommend 2 anesthesia, 1 medicine and 1 surgery . I got one from my advisor who I had done research with and who know me well and the other anesthesia ones were attendings who I consciously tried to work with during my anesthesia rotation (and felt I got to really know them in the OR). The medicine and surgery ones were from SICU and medicine electives from 4th year. Did you do any away rotations? If so, where and was it useful?Yes - at Johns Hopkins. It was great I would have done it again. I decided I didn't like the program as much as I thought I was going to but still would have been happy matching there. In the end alot of it was the program breakdown and the location that I didn't like but it is a very strong program. I would repeat it as an away rotation if I had the choice though because they really let me do a ton of procedures and I had time to read some anesthesia material. I think that goes for alot of what other people who did aways said too - as an away student they sort of assume you want to get involved and will let you do alot of stuff. If I had the choice I would have done it there again and at another place. I wish it was encouraged more at UVA because I think you get a great experience and if it's a place you end up really liking it's a great way to get your foot in the door. Any tips for preparing/looking good on anesthesia/SICU rotations? There is a Miller's Anesthesia book they give you on Anesthesia that is what the residents use when they first start. Anesthesia Secrets is good too but I don't think it is really necessary to buy any supplementary stuff at all. I wouldn't buy any pricey books at all as you get them for free as a resident.Taking Step 2 before SICU is probably the best prep for that rotation but in general, when you pick up patients, I would just get to know their disease/diagnosis really really well so you can look like a star on rounds if you get pimped. I found this site that I used to read up on shock or ventilators, etc: http://www.ccmtutorials.com/ Suggestions for writing the personal statement? Just get as many people to edit for you as possible. Content and punctuation. I don't have great advice about the actual content as it really just depends on what you want to get across to the admissions committee. Just know that they read 1,000's of applications so don't go the generic route (just like for med school apps)

Timing of application process - when did you submit your application? When did you start hearing back from programs? when were most of your interviews scheduled? I submitted mine in the first week. I remember everyone was stressed out about sending it in like on the first day but the is totally overkill. I actually submitted mine 2-3 days after you first could because the website was so slow from people logging in that I didn't want anything to get messed up in submitting it . I think what the general rule was to get it in the first 2-3 weeks but not sure. What is a good number of programs to apply to? How many interviews should you hope to have? What is a good number of programs to rank? I would say apply to all the program you think you would go to (location wise , weather wise, etc) and dont ever leave a program out because you think you wont get an interview - big mistake. I knew a ton of people who were surprised by the interviews they got. I applied to about 15 anesthesia position, and about 5 preliminary medicine/transitional places and I had to cancel about 5 of these in the end as I wanted to do a categorical spot and didnt want to be in certain states. I would rank whatever programs you liked and wouldnt mind matching into. I think a safe list would be 8-10 places but people do much less or much more. What were interviews like? Any tips for preparing for interviews? Questions to prepare for? Very very laid back. Was asked nothing about college research (it was lab stuff) and got a few questions on med school research things I had done but it was very easygoing. I would know the answer to why you want to do anesthesia, what professsion you would pick if you weren't in medicine, and what you think of crnas (I got asked all of these a few times). I had 2 interviewers ask me sort of these wild card questions that you really cant prepare for and that they change around for everyone: name one person you admire and tell me why, what is the hardest thing you ever had to do etc... The good thing is this is more rare and they sort of expect you to not have a contrived answer. SDN has an interview feedback site for residency applicants that I read that I thought was helpful here and there. I think just be nice to everyone on interviews (including the coordinators - some of them actually sit in on the post interview meetings), get to know the other applicants and what they think of their home programs and other programs and have fun because it really is a laid back interview season.

What are your thoughts about categorical vs. prelim surgery or medicine vs. transitional year? What additional letters of rec are required for prelim or

transitional years? Are these interviews scheduled at the same time at anesthesia interviews? I am doing a categorical spot b//c I didnt want to move twice and also b/c I wanted to get to know my program departments well before beginning the CA1 year. But alot of people want to go somewhere else for the first year so most programs have spots for both with a few exceptions (Columbia, for example, only has categorical positions). I think it depends on what you want out of your first year: I wanted to know medicine really well so I did transitional and prelim interviews at smaller community hospitals (in geenral the big academic giants have very hardcore first year medicine and surgery preliminary years so I avoidied those but lots of people do interview there). I ended up matching at a place where I do a year of medicine and surgery so that I get to know fellow residents and attendings in different departments well . Any recommendations about specific programs - good/bad experiences, programs you really liked? In general, dont take what any one says or what you read as set in stone about a program. I think I was surprised how differently people viewed programs after I interviewed there and made my own judgment. Also there are some reputations that stick to a programs that are hard to shake even after they implement changes so go with what the residents say more than what a former resident says. The interview dinner will make a big impression on you but so will the actual interviewers. Places I really loved were UVA, Brigham and Beth Israel, Penn, UNC, Columbia . There is no place I thought was so bad I didnt want to rank it but location wise there were some places I didnt want to live in.

Student #5 Who was your advisor? My advisor was Dr. Rich. He was very helpful and gives a good perspective on what programs are looking for from a department chair's perspective. The only down side is that he is very busy and it can sometimes be tough to get an appointment to see him. My personal advice on choosing an advisor is that if you already have a close contact or someone you like or have worked with, then it might be good to make them your advisor. That way you get more time/exposure to them for a possible letter of recommendation and hopefully they will be able to accommodate you as far as meeting up with them for questions and concerns you may have. If you do not already have a contact in the department, Dr. Rich and Dr. Nemergut are good choices given their positions as department chair and program director, respectively. How many letters of recommendation do you need and who did you request letters from? All the programs I applied to required 3 letters of recommendation (there may be programs that ask for more, but if so, I am not aware of them- 3 is generally the standard). The general rule for anesthesia is to get 1 letter from an anesthesia attending, 1 from medicine, and 1 from surgery. I know some people that didn't necessarily stick to that rule and did just fine. It is really more important to just get 3 good letters, but you definitely need 1 from anesthesia. The other big question is how to get your anesthesia letter and whether you should use a chair's letter or someone else that you worked closely with. I used Dr. Rich's letter (chair's letter) as my anesthesia letter of recommendation. I felt comfortable doing this because he was my advisor, I had worked with him on my anesthesia rotation, he had all of my evaluations from my anesthesia rotation (and could write somewhat of a consensus eval/recommendation), and I felt he had gotten to know me. In general, however, I would recommend against using a chair's letter unless you really get to know the chair and feel it will be personal to you. Chair letters tend to be somewhat long and form-written and therefore may not always be read by the programs you send it to (this statement is supported by Dr. Nemergut). It is probably better to ask someone that you worked very closely with on your anesthesia rotation or doing anesthesia research. You can really just choose an attending you want to work with and work with them in the OR for a few days before asking them for a letter. You also get a solid week at the pain clinic, which will provide some continuity with an attending and provide an opportunity for a letter. Did you do any away rotations? If so, where and was it useful? I did not. If there is one program you are REALLY interested in, it may be a good idea to do an away rotation there (IF you are going to be a good rotationer there; otherwise it just hurts you). In general, though, away rotations are not at all necessary for matching well in anesthesia. Any tips for preparing/looking good on anesthesia/SICU rotations? I dont really have any magic suggestions here. Its pretty much the same as any other rotation- show interest, work hard, read, and be on time. The last point is of

particular interest for anesthesia. Get there early and offer to help draw up the drugs, set up the anesthesia machines, get the room ready, etc. Also, on both anesthesia and ICU rotations, try to seek out procedures everywhere you can, whether its an IV, central line, intubation, or whatever. This can be tough to do at times, but between inducing and waking up the patient, there oftentimes is not a lot going on and it may be a good time to see if there are any IVs that need to be placed, intubations that need to be done, or regional anesthesia procedures going on in other rooms. Suggestions for writing the personal statement? I dont really have any advice to offer on this that you cant find in a google search or residency guide. It is generally recommended to play it pretty safe with the personal statement. The old adage is that you are probably not going to help yourself all that much, but you could possibly hurt yourself by going out on a limb and trying to stand out. Playing it safe means talking about why you chose anesthesia, what will make you a good anesthesiologist, your future plans, blah, blah, blah If you talk to Dr. Rich, he hates this mentality and will tell you not to spend much time talking about all that stuff I just mentioned above, but to talk about what makes you interesting as a person (youre a marathon runner, a star athlete, a musician, you had an interesting experience or trip, or whatever). Im guessing his different viewpoint is because he is one who actually has to read all the personal statements, and I cant promise department chairs and program directors at other programs will have the same mentality, so you just have to decide for yourself what path you want to take there. Timing of application process - when did you submit your application? When did you start hearing back from programs? when were most of your interviews scheduled? Try to submit your ERAS application as soon as possible, because some programs will start reviewing applications and offering interviews pretty early on. I believe I started hearing back from programs sometime in October. Programs will send you a list of dates (some will give you a ton of dates from November to January to choose from, others may only offer a handful of dates to choose from). I had my interviews pretty spread out between mid-November and late January. Other people condense their interviews into a period of a couple weeks to a month or so. It just depends how you want to do it. I felt like having them spread out, I was fresh for each interview and didnt get too burned out, but if youre the kind that is going to stress about it until its all over, it might be better to schedule them all early and get them over with. What is a good number of programs to apply to? How many interviews should you hope to have? What is a good number of programs to rank? This really just depends how competitive a candidate you are and how competitive the programs are that youre applying to. I would probably talk to your individual advisors to get a feel for that. Personally, I was looking within a confined region and did not care about matching at a top tier program, so I only applied to 16 programs and interviewed at and ranked 6 programs. To be safe, it is good to apply to 20-30 programs and interview at 8-10.

What were interviews like? Any tips for preparing for interviews? Questions to prepare for? Interviews can definitely vary between programs and interviewers. For the most part, they are very laid back and they are just trying to get a feel for your personality and how you would fit into their program. I feel like at just about every program, there was at least 1 tough interview where the interviewer really pushed on some theoretical situations (not necessarily knowledge-based, but more problem-solving or character type questions). The general schedule for an interview day is roughly from around 8am-2pm with of the day for interviews and the other for lunch with the residents and tour of the hospital. There were usually 4 or 5 interviews at each program (1 with the dept. chair, 1 with the program director, 1 with the chief resident, and 1 or 2 with other faculty members). There are some questions youll hear over and over again: Why anesthesia? Why did you choose to go to medical school? What are your plans after residency? Why did you apply to this program? The tougher questions are going to be ones that are tough to prepare for and will often be situational or character based questions. One that I heard at least some variation of at several interviews was where you were put in a situation where something was being said or done that was incorrect regarding patient care and I was asked what I would do and how I would do it. Just remember that you always do whats best for the patient (this seems obvious I know, but it is good to keep in your mind going into interviews for questions like this). The only other advice I would give is to read about and learn about the program you are interviewing at before going there. This will help you to get all you can out of the interview day in familiarizing yourself with the program, and it will also show in your interviews and will show the interviewers that you are truly interested in the program. I even had a couple of interviews where the interviewer had virtually no questions and wanted me to ask questions about the program. It is good to be prepared for these kinds of interviews. Also, the residents are a great source of information and are more impartial than the attendings and interviewers. Ask lots of questions and even ask the same questions to different residents. If you are getting inconsistent answers or if residents seem indifferent in their answers, it may not be the program or the environment in which you want to work. What are your thoughts about categorical vs. prelim surgery or medicine vs. transitional year? I was adamantly opposed to the idea of possibly moving twice and going on a bunch of unnecessary interviews, so I pretty much only applied to categorical residencies. Some programs, like UVA, offer mostly categorical spots and a few advanced positions. To prepare for the slim chance that I match in one of these advanced positions, I did apply to prelim medicine positions at UVA and VCU. If I hadnt matched in those, there are always prelim surgery spots available through the scramble. I dont know if I should be endorsing this strategy, but if youre like me and are really only looking at categorical programs, it is probably okay. What additional letters of rec are required for prelim or transitional years? Are these interviews scheduled at the same time at anesthesia interviews?

Amy Tucker of the medicine department scheduled meetings with everyone applying to categorical or prelim medicine programs. She spent about 20-30 minutes getting to know some things about people that she could include in a letter of recommendation. Other than her letter, I used all the same letters of recommendation as well as the same personal statement (although I did include a few sentences to a paragraph in my personal statement about why I was choosing prelim medicine for my intern year before going into anesthesia). My interviews were separate from my anesthesia interviews at these programs, but I think if you are traveling a long distance to the interviews, you can contact the programs to try and better coordinate them. I am not the best person to ask about this, though. Any recommendations about specific programs - good/bad experiences, programs you really liked? It really just depends what you are looking for. Like I mentioned earlier, I did not care about going to a top tier program. In fact, I was more impressed and thought I was a better fit in some of the less prestigious programs. If you are looking to go into academic medicine, a bigger name and research are more important. However, for private practice, the training you get at some of the middle and lower tier programs may actually be better and more applicable to your future practice. I cant really say there were any programs that I had bad experiences with or I thought were particularly bad, they just may have not been as good a fit for me. The best advice I can give is to keep an open mind with any program youre going to. And again, talk to as many residents as possible. Do they seem happy? Are their personalities similar to yours? These factors are as important as just about anything.

Contact Info: Carter McAllen Peatross CA John McNeil MA Logan Reeves Lexington, KY Reza Salajegheh Charlottesville, VA peatross@gmail.com Stanford Univ, Palo Alto,

johnsmcneil@gmail.com Beth Israel Deaconess, Boston, lreeves@virginia.edu rs5su@virginia.edu Univ of Kentucky,

Univ of Virginia SOM,