Student Guide

Helping you put the pieces together

Careers in Medicine is a program of the Association of American Medical Colleges

www.aamc.org/careersinmedicine

For more information about the Careers in Medicine Student Guide, please contact Careers in Medicine, 2450 N Street, N.W., Washington, D.C. 20037. Phone number: 202-862-6210 Fax number: 202-862-6060 To order additional copies of the guide, please fax your request to 202-828-1123. (CIMSTUD11) Careers in Medicine Student Guide: $3.00 per book plus shipping and handling. Copyright 2011 by the Association of American Medical Colleges. All rights reserved.

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Careers in Medicine (CiM) Timeline
Class Year
Year 1

Careers in Medicine Phase

Suggested CiM Activities and Tasks

Orientation to Careers in Medicine Seek out an advisor or mentor

Understanding Yourself Attend CiM workshops Begin completing self-assessment exercises Year 2 Continue self-assessment Complete self-assessment exercises Review completed Personal Profile with your advisor Exploring Options Begin gathering basic information about specialties of interest through CiM Specialty Pages, other Web sites, and library research Attend specialty panel and information group sessions provided by your school Compare your self-assessment information to the information youve gathered about specialties. Narrow your interests to 34 top choices Plan your third-year schedule Take USMLE Step 1 Year 3 Begin clinical rotations; record your reflections using the Clinical Rotation Evaluation Review the Charting Outcomes in the Match data to assess qualifications and competitiveness for different specialties Conduct informational interviews or participate in preceptorships Contact associations and specialty organizations

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Class Year
Year 3

Careers in Medicine Phase

Choosing a Specialty

Suggested CiM Activities and Tasks

Meet with your advisor to discuss your top choices Complete the Specialty Indecision Scale if youre having difficulty making a decision Complete Choosing Your Specialty exercise

Year 4

Getting into Residency Research residency training programs through the AMAs FREIDA Online or Graduate Medical Education Directory (i.e., the green book) Define your preferences using the Residency Preference Exercise Begin reviewing and comparing residency programs Register with ERAS and begin preparing residency applications (i.e., CV, letters of recommendation, personal statements) Register with the NRMP for the Main Residency Match Register for early Match programs, if applicable

Complete applications and designate programs to which your materials will be submitted Take USMLE Step 2 MSPE released November 1 Interview with residency programs Rate programs using the Residency Preference Exercise Early Match deadline earlymid January Rank your selections for the NRMP Main Residency Match Match Daythird Friday in March

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Table of Contents
INTRODUCTION: PUTTING THE PIECES TOGETHER ........................................ 1 Careers in Medicine four-step career-planning process ............................................. 3 STEP ONE: UNDERSTANDING YOURSELF ............................................................ 5 STEP TWO: EXPLORING OPTIONS ......................................................................... 9 Specialty training paths ............................................................................................... 12 Getting personal........................................................................................................... 14 Competiveness ............................................................................................................. 15 STEP THREE: CHOOSING A SPECIALTY .............................................................. 17 How do I make this decision? ..................................................................................... 17 Changing your mind ................................................................................................... 19 STEP FOUR: GETTING INTO RESIDENCY............................................................ 21 Researching residency training programs .................................................................. 21 Applying for residency ................................................................................................ 23 Writing a curriculum vitae (CV) ................................................................................ 25 Writing your personal statement ................................................................................ 25 Letters of recommendation ......................................................................................... 26 Medical Student Performance Evaluation (MSPE) ................................................... 27 The interview .............................................................................................................. 28 The Match .................................................................................................................... 30 State of the Match ........................................................................................................ 31 Preparing your rank order list (ROL) ........................................................................ 32 The Supplemental Offer and Acceptance Program (SOAP)..................................... 33 Planning for the future ................................................................................................ 34 SUGGESTED READING ............................................................................................ 37

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Putting the Pieces Together

Who in the world am I? Ah, thats the great puzzle. Lewis Carroll Choosing a medical specialty is one of the most significant decisions youll make, and the process can be daunting. With the constantly evolving world of medicine and myriad specialty options and practice settings, determining where you belong can be one of the hardest tasks of your career. No one can prescribe the best specialty(ies) for you, and the answer wont magically appear. Making a good specialty decision requires you be proactive. In fact, youll best position yourself to confidently choose a specialty and successfully match in that specialty if you start considering your physician career now. As you consider your career, youll encounter many decisions: How do I learn about the available specialties and practice settings? How do I narrow my options to those that may be right for me? How do I decide among my top choices? How do I know if Im competitive for the specialty(ies) Im interested in? 4 How do I prepare for a successful Match? 4 4 4 4 But dont worry, you canand shouldget help for this process. Thats where Careers in Medicine (CiM) and the career advising program at your school enter the picture. The Association of American Medical Colleges (AAMC) created CiM, a career-planning program available to you and your medical school that guides medical students as they 4 identify career goals, 4 explore specialty and practice options, 4 choose a specialty,
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4 select and apply to residency programs, and 4 make good career decisions. CiM was developed and evolves in collaboration with medical schools and employs tried-and-true career-development theory used throughout higher education. Our goal: help you determine where you fit in the field of medicine and learn how to make good career decisionsin choosing a specialty and throughout your career as a physician. A thoughtful career-planning process, while not easy or quick, will help ensure good decisions and ultimately, your satisfaction as a physician. The Web site (www.aamc.org/careersinmedicine) is CiMs main attraction, featuring extensive, detailed information and interactive tools to help you choose your specialty, apply to residency, and plan your physician career. U.S. M.D. students can register on the site using their AAMC login; the same login used for MCAT, AMCAS, and other AAMC systems. Canadian and D.O. students must contact their schools CiM liaison or student affairs office to receive an access code that will allow them to register. CiM works in conjunction with the career advising program offered by your school. Each school designates a CiM liaison, usually the associate or assistant dean of student affairs. The liaison is responsible for coordinating the career-planning and advising activities in your school and providing access codes for the CiM Web site. Your liaison is a resource for assistance and information. A current list of school liaisons is available on the CiM Web site. Your medical school may sponsor various workshops and events as part of its CiM program. Attend as many of these functions as you can, particularly specialty interest groups and panel sessions, self-assessment workshops, networking receptions, alumni functions, and preceptorship opportunities. Gathering information and receiving feedback from advisors, mentors, and other faculty, staff, and physicians are crucial to making an informed, realistic, and satisfying specialty choice and positioning yourself to be as competitive as possible. Advisors can be faculty, staff, student affairs officers, alumni,
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family, or friends to bounce ideas off or provide reality checks. Your initial advisor isnt required to be a physician in a specialty youre consideringor even a physician at all. Rather, choose someone whos familiar with the complexities of the decisions youre making and the stage of medical education youre in, and can guide you. Consider working with several advisors who can help you at different steps of the process. Ask your medical school about their advising program. Schools are required to provide advisors, formally or informally, to help you plan your academic and professional careers. In the 2011 CiM Student Survey, 90 percent of third-year students reported feedback from residents was helpful in their career decisions. But dont stop there when discussing your options, experiences, and goals and otherwise vetting your career decisions. Also actively collaborate with one or more advisors or other faculty or staff to benefit from their broader knowledge of career resources and overarching perspective about the field of medicine.

CiM four-step career-planning process

Through the career-planning process, and the CiM Web site, we want you to 4 learn who you are; 4 determine how you want to practice medicine; 4 identify the specialties, practice options, and residency programs that meet those characteristics; 4 understand how to position yourself as competitively as possible; and 4 wisely apply for residency. The Web site is organized using CiMs four-step career-planning process. Understanding Yourself (Years 12) Assessment activities largely constitute the first step because honest selfassessment is the foundation for and critical to making good career decisions. The assessment instruments CiM offers guide you through self-reflection to help you understand your interests, values, skills, and level of career indecision. Your assessment results provide specialty and practice options for you to consider that match your personal characteristics. The better you
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understand yourself, the more efficiently and effectively youll determine the specialties and practice options that fit you best. Exploring Options (Years 23) The goal of career exploration is to discover the qualities and qualifications of various specialties, how they match your personal characteristics, the training paths, and the possible practice settings and alternatives available. Choosing a Specialty (Years 34) This step involves analyzing what youve learned about yourself and about specialties and determining where you might fit well. Through this step, you should develop an objective framework for making your specialty decision. Getting into Residency (Years 34) Determining whats important to you in a residency training program and selecting programs that will meet your educational and career goals is the final step. Specifically, this step addresses applying to residency, interviewing, and creating a rank list for the Match. These activities are integral to implementing your specialty decision. Each of the four steps includes numerous activities and exercises available on the CiM Web site or through programs, workshops, and advising sessions at your school. CiMs newsletter Choices, published quarterly on the CiM Web site, also presents information and advice addressing all four steps. Specifically, Choices features profiles of various specialties and practice settings and describes the experience of working in those options; guides students through common specialty and residency decisionmaking dilemmas; provides timely data, information, and resources for students to become as competitive as possible; and highlights tools useful for choosing a specialty. Receive alerts when new issues are published by e-mailing subscribe-choices@lists.aamc.org.
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Understanding Yourself
There are three things extremely hard: steel, a diamond, and to know ones self. Benjamin Franklin Self-assessment is the process of learning who you are and determining who you want to be. While understanding yourself is a lifelong process, the more familiar you are with your interests, values, personality, and skills, the more you can make career decisions that reflect your preferences. This self-knowledge will also help you maximize your clinical experiences, present yourself more confidently in residency interviews, and plan your future work and personal life.

During your first and second years, you may feel compelled to study rather than consider your specialty choice, but youll become even busier once your clinical rotations begin. And discovering who you are and identifying what you want for your future requires much thought.
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So the earlier you begin thinking about specialty choice, the more you can maximize the opportunities medical school provides. Begin taking the selfassessments by the second semester of your first year or the beginning of your second year. And designate ample time for completing the assessments, purposefully consider your response to each statement, and answer as honestly as you can without regard to what you think others may expect of you. Your results are completely confidentialinaccessible to the faculty and staff at your school. By taking the self-assessments early in medical school, you have a baseline to compare to as you gain clinical experience during your rotations. And, youll feel more prepared and less stressed about your specialty decision when the time arrives to apply to, interview for, and rank residency programs. CiM provides self-assessments, activities, and exercises in the following domains to help you understand yourself. Some self-assessments are specific to the medical field while some are general: Specialty indecision. The Specialty Indecision Scale (SIS), Second Edition, uses your responses to 35 statements to indicate where you may be experiencing difficulties in choosing your specialty. Interests. The Medical Specialty Preference Inventory, Revised Edition (MSPI-R), uses your responses to 150 statements to measure your interest in various activities, tasks, and experiences found in the field of medicine. Your responses are compared to those of medical students who have since entered residency in their chosen specialty. The results will indicate your broad medical interests and the likelihood youll enter into each of 16 major specialties. Values. The Physician Values in Practice Scale (PVIPS) provides a quick and reliable measure of your values as they relate to the practice of medicine. Using your responses to 60 statements, the results prioritize six core values: Prestige, Service, Autonomy, Lifestyle, Management, and Scholarly Pursuits. Personality type. CiM employs the Myers-Briggs Type Indicator and the Keirsey Temperament Sorter to help you identify who you are and how you relate to others.
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Skills. CiM uses two exercises to help you identify what you do well and what skills you want to use in your medical practice. Personal influences. CiM prompts you to consider who or what influenced you to pursue a career as a physician and identify your top five influences. Educational experiences. CiM prompts you to identify the activities, subjects, and environments you enjoyed during medical school. Environmental factors and practice needs. CiM provides a list of aspects of practicing medicine that can affect work satisfaction to help you identify which ones are important to you. As you complete the assessments, your results will be saved in a confidential Personal Profile, and compatible specialties you may want to explore will be displayed where data is available. First, work on each assessment area individually, then step back and use your Personal Profile to determine whether any picture, pattern, or theme appears. Also share your assessment results with your advisor or student affairs staff as they can help you notice any patterns or offer ideas you may have missed.

Early in the second half of your first year of medical school, you should begin making summer plans. You have a choice: 1) take a break and relax, or 2) use this time to explore specialties. And some specialties recommend research experience or other prerequisites when applying for residency. The demands of your future course schedule may mean fewer opportunities to do research or gain other experience unless you take time off to do so. Even though we encourage you to wait before committing to a specialty, if youre interested in conducting research or a specialty requiring additional experience, try to fit it in during the summer break.

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Exploring Options
You may already have some specialties in mind or even be fairly confident youve determined the type of physician you want to be. But how much do you really know about those career options? Furthermoreand regardless of whether you have a specialty in mindyoure more likely to identify the specialties or subspecialties that fit you best if you start by broadly considering a range of alternatives, then narrow your options systematically.

Exploring specialty options should begin in your second year, after youve completed your self-assessment. Completing your self-assessment and doing some specialty research before you begin clinical rotations will allow you to employ a critical eye during your rotations and compare each specialty with whats important and interesting to you, maximizing your clinical experiences. At the end of your second year, youll take the USMLE Step 1 exam. Its important to prepare and use any resources for studying your school may provide. Youll continue your specialty research into your third year with more hands-on exploration and clinical experience.

Ultimately, youll want to identify the career options that feature your preferences and lack as many undesirable elements as possible. Start by considering the specialties that currently interest you or the specialties indicated by your assessment results. Look for general characteristics or activities, such as providing diagnostic-oriented care vs. performing procedures or providing short-term vs. continuous care, that draw you to those specialties. Use your results from the self-assessments and other preferences youve identified as
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the criteria to broadly sort through specialties youre interested in. For each specialty youre interested in, youll want to thoroughly understand the work physicians do and the lifestyle they lead and gather that information from various reliable sources. Here are several reliable sources where you can find detailed information about specialties and subspecialties: The Specialty Pages on the CiM Web site feature more than 125 specialty and fellowship areas with training accredited by the Accreditation Council for Graduate Medical Education (ACGME) (www.acgme.org), including 4 4 4 4 4 4 4 4 specialty descriptions, personal characteristics, residency and training requirements, Match statistics, competitiveness data (e.g., USMLE scores, rank order list length), workforce statistics, salary data, and links to more than 1,000 specialty societies, associations, journals, and publications.

Your school likely offers programs, panels, workshops, and other opportunities to learn about specialty options. Attend as many sessions as possible. If your school does not offer a panel on a specialty youre considering, organize one yourself. Ask your student affairs or alumni office to help you identify potential panelists and contact these individuals. Youll gain great one-onone exposure and networking opportunities. The American Medical Associations (AMAs) FREIDA Online (www.amaassn.org/go/freida) is a searchable database of residency and fellowship training programs by specialty, geographic location, and other criteria. You can use the training statistics to compare specialties on length of training, program size, number of faculty, resident work hours, and compensation. You can also access FREIDA Online through direct links by specialty on the CiM Specialty Pages.

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Careers in Academic Medicine on the CiM Web site is where you should visit if research or teaching and supervising medical students, residents, or fellows after becoming licensed might be work you find interesting. Specialty Information Links and Readings on the CiM Web site provides a comprehensive list of online resources by specialty. This guide also includes a list of suggested reading. Use the resources mentioned above to answer as many of the following questions as possible about each specialty youre considering. aInformation about the nature of the work 4 What systems, diseases, and patient types do these physicians treat? 4 What, if any, procedures do they perform? 4 What are the doctor-patient relationships like? 4 In what settings is this specialty practiced? 4 Do physicians work with a variety of common medical problems, or singular, specialized problems? 4 Do physicians regularly work with consultants, referral specialists, or allied health professionals? aCharacteristics of physicians in the specialty 4 What values, interests, skills, and personality types are common among physicians in this specialty? aTraining and residency requirements 4 How long is the training for this career path? 4 How competitive is this option, and can I compete (e.g., grades, USMLE scores)? 4 What residency training programs are available, and where are they located? 4 What are the options for fellowship or subspecialty training?

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aLifestyle and salary 4 What is the average number of hours worked per week? 4 What is the on-call schedule like? 4 What salary range can I expect? aIssues facing professionals in the field 4 What are the current issues facing physicians in this specialty? 4 What research questions are being studied? 4 How interesting are these topics to me? 4 Is the demand for physicians in this specialty expected to grow or decline? aContacts and leads for networking and informational interviewing 4 With whom can I speak to gain more insight into this specialty? aAssocations and organizations for more information 4 Who are the professional groups for this specialty? 4 What other information should I obtain about this specialty to help me in my decision? An ebb and flow occurs regarding what specialty areas are hot. Lifestyle issues, workforce needs, population demographics, and other factors contribute to this evolution. Remember practice setting, group size, and how a medical practice is configured greatly influence some of these issues, particularly lifestyle and salary. But most specialties maintain enough flexibility to accommodate different lifestyle values.

Specialty training paths

As you contemplate specialties, consider the training path and length of time to complete residency and any potential fellowships. The most common residency training paths for many of the major specialties are diagrammed on the following page. The length of each bar represents the years of training required for certification. These are unofficial assignments and are offered for reference only.

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1 EMERGENCY MEDICINE FAMILY MEDICINE INTERNAL MEDICINE

4 SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES

6-7

INTERNAL MEDICINE-PEDIATRICS (COMBINED) NEUROLOGICAL SURGERY OBSTETRICS/GYNECOLOGY ORTHOPAEDIC SURGERY OTOLARYNGOLOGY PATHOLOGY (ANATOMIC OR CLINICAL) PATHOLOGY (ANATOMIC AND CLINICAL) PEDIATRICS PREVENTIVE MEDICINE PSYCHIATRY GENERAL SURGERY UROLOGY PRELIM MEDICINE or PRELIM SURGERY* ANESTHESIOLOGY DERMATOLOGY NEUROLOGY NUCLEAR MEDICINE OPHTHALMOLOGY PHYSICAL MEDICINE AND REHABILITATION RADIOLOGYDIAGNOSTIC RADIATION ONCOLOGY SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES SUBSPECIALTIES

*Many specialties indicated as starting at the PGY-2 level may offer categorical tracks, which include the first year. Some specialties, such as anesthesiology and urology, require you complete a preliminary year of training, usually in internal medicine or general sur-

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gery. Other subspecialties, such as cardiology and pulmonology, require you complete training in a major specialty first, which usually lasts three or four years. Information about these training prerequisites can be found in the CiM Specialty Pages, where youll also find links to official training requirements established by the ACGME.

Getting personal
You can only glean so much information from the internetand that includes the CiM Web site. Once youve created a list of your specialty preferences, the next step requires you gain firsthand exposure to your top specialty areas to answer your questions a book or Web site cant. You can do a clinical rotation, shadow a practitioner, conduct informational interviews, assist with a research project, or volunteer with a student-run clinic or project. Core rotations will likely occur at your own institution, but you may also be able to arrange clinical rotations in the community or with other academic medical centers. Consider how you want to schedule your rotations through different specialty areas. There may be some required specialty areas youd like to experience earlier or electives that may require prerequisites. Talk with your advisor about the optimal schedule for you. These hands-on clinical experiences are your chance to learn the nitty-gritty of what its like to practice. To maximize these experiences, develop a list of questions or concerns about that specialty to ask the physicians youll work with or to learn on your own. The Informational Interview Questions on the CiM Web site will help you start your list. Your advisor or student affairs office may be able to help you contact faculty who teach or practice in your areas of interest. You can also contact specialty organizations to identify physicians in your geographic location. Contact and interview as many of these physicians as possible. During these hands-on experiences, you might discover a specialty is not what you previously thought or another may be more appealing. You might
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also wonder whether clinical practice is a good fit for you. Alternative career paths exist that utilize some knowledge gained during medical school. However, a medical degree alone is rarely enough for success in these fields. Many of these positions require a license and some clinical experience. Therefore, skipping residency and licensure will severely limit your job options and salary. Visit Alternatives to Traditional Clinical Practice on the CiM Web site and discuss alternative career paths with your advisor. But dont choose a specialty or abandon clinical practice based on one experience or clinical rotationa mistake many medical students make. If you are interested in a particular area and have a bad experienceor a phenomenal one, analyze it realistically. Did specific personalities influence your opinion? Should you try another experience to clarify your feelings and thinking? Complete the Clinical Rotation Evaluation on the CiM Web site to help you gather your thoughts, feelings, and reflections on each specialty.

Competitiveness
You must research the competitiveness of the specialties youre considering. Highly competitive programs will likely require strong clerkship grades and USMLE scores. You must realistically assess your qualificationsand you may be more qualified than you think. But dont rely on the student grapevine for this important information. Match statistics for the most recent years (where available) are provided on the CiM Specialty Pages and indicate the competitiveness of each specialty. Also contact your student affairs office for school-specific profiles of where previous students have matched and their qualifications. Last, review the joint AAMC/NRMP report Charting Outcomes in the Match. This report provides USMLE step 1 and 2 scores, number of publications, participation in research projects, length of rank order list, and membership in Alpha Omega Alpha medical honor society for matched and unmatched applicants in each of 19 specialties. Specialty-specific data and the complete report can be accessed through the CiM Specialty Pages.

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Choosing a Specialty
With all the information youll have gathered about yourself and your options, you should be well equipped to confidently choose your specialty. However, that doesnt mean the final decision will be easy. It requires you compile all youve learned and seriously analyze where you best fit. Prioritize your personal characteristics and preferences as well as your career goals, and assess how well the specialties youre considering meet those needs.

Aim to choose your specialty late in your third year. Doing so will provide extra time to research residency programs, complete your application materials, and prepare for your fourth year, when all your hard work will come to fruition. Dont worry if youre still undecided though you can use the first part of your fourth year to complete clerkships or electives in the specialties youre considering. Also talk to your advisor or student affairs staff, who can help you sort through your ideas.

How do I make this decision?

Decision-making has no known magic formula. Different people have different approaches for making important decisions. In deciding something as important as your specialty, its helpful to review available decision-making strategies. The Choosing Your Specialty exercise on the CiM Web site can help you objectively consider your decision. It encourages you to choose the most important personal characteristics (e.g., values, interests, skills, personality, environmental factors) from your self-assessments and compare those
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attributes with the information youve gathered about each specialty. Its not a computer-matching process, but rather a decision-making matrix that will help you identify whats important to you and how your specialty options match. Everyones matrix will be different. You can also add any other factors beyond your personal characteristics you feel may be important. Another strategy, particularly if youre struggling between two options, is a parallel thinking approach based on Edward de Bonos book Six Thinking Hats (1999). The goal of this strategy: examine your options from multiple angles and perspectives, including using data, intuition, and emotionall of which play a role in decision-making. Ultimately, this strategy aims to make your argument for your final decision more sound and well-considered. Each thinking hat embodies a different style of thinking. While wearing the 4 white hat, consider the facts and information youve gathered about your options. 4 black hat, consider the negative aspects or outcomes associated with each option. 4 yellow hat, consider the positive aspects or outcomes association with each option. 4 red hat, consider your emotions and feelings regarding each option. 4 green hat, creatively consider each of your options, brainstorming ideas and generating solutions to some of the negative aspects or outcomes you identified. But youve made difficult decisions before, so also consider the strategies you used then that worked well for you. And whatever strategy you choose, your decision should be based on information as well as intuition, not one or the other. If youre having a difficult time making a decision, consider taking or retaking the Specialty Indecision Scale assessment. It can help you pinpoint the possible cause of your indecision and provide suggested activities to help you progress.

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Finally, ensure youre realistically assessing your top specialty preferences and your competitiveness for each of these specialties. With rising medical school enrollments and stagnant growth of residency training positions, competition for residency positions is increasing. Discussing your decision with an advisor or faculty member can inspire new ideas or opinions. These folks can ensure youre realistically evaluating your options and competitive in the specialty youve chosen as well as discuss back-up plans and strategies for success in the Match.

Changing your mind

While its possible to change your specialty during residency, it can be difficult. One reason: currently, the funding a teaching hospital receives for your graduate medical education is based on the length of your initial residency program. If you change specialties after entering residency and the length of residency is longer for the new specialty, a stipend may not be available for those additional years of training. Some teaching hospitals may consider this when evaluating your application to transition into their residency programand others may not. Many factors other than reimbursement contribute to residency decisions. The brochure Medicare Payments for Graduate Medical Education, available on the AAMC Publications Web site, explains in detail the funding implications of switching specialties after youve entered residency. Ultimately, you must do whats best for you and your career as a physician. Hopefully, by seriously considering this decision now, you can progress toward a happy and satisfying career.

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Getting into Residency

Implementing your specialty choice is overwhelming, but understanding the steps will make it easier.

Researching residency training programs

Begin by researching residency programs and reviewing physician workforce data through the Program Search tool and Specialty Pages on the CiM Web site as well as FREIDA Online. Also consult the AMAs Graduate Medical Education Directory (i.e., the green book), published yearly. (Most student affairs offices house copies.) Each of these resources lists the approximately 9,000 accredited programs and their Web site and contact information by specialty. Use them to find the residency programs youre interested in, then research programs, including 4 program characteristics, specifically size, position type(s) offered, and training sites or facilities; 4 program quality, specifically accreditation status, percentage of residents who have completed the program, board pass rates, and future plans of graduates; 4 educational structure, specifically required and elective rotations, formal curriculum, informal learning opportunities, and other support; 4 program type, specifically academic or community, hospital-based, or ambulatory; 4 clinical duties, specifically call schedule, supervisory structure, and ancillary support; 4 research and teaching opportunities; 4 evaluation process, specifically timing and structure of resident evaluation; and 4 location, specifically housing, cost of living, proximity to family, and input from significant others. The AAMC Organization of Resident Representatives (ORR) publishes a brochure Dont Forget to Ask: Advice from Residents on What to Ask During
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the Residency Interview (www.aamc.org/members/osr/residencyquestions. pdf), which contains a more extensive list of questions to research and ask about the programs youre considering.

Begin researching residency programs in the spring of your third year or beginning of your fourth year. Doing so will provide plenty of time to learn about the programs and narrow your options before starting the application process. Spring of your third year is also the time to plan your fourth-year electives. Elective time may be used to take clerkships that will enhance your performance in residency and broaden your knowledge base. You can also use elective time to experience areas of medicine youll lack time for during residency, address areas of weakness, or experience medical practice in another country. Aim to take electives that offer a variety of experiences. Senior year can be used to confirm your career interests and experience institutions youre considering for residency. If youre undecided about career direction, your electives provide an opportunity to explore two or more fields to help you make this decision. If youre planning to use your elective time to confirm your career interests, schedule these electives in the summer or fall of your fourth year. Visit Planning Your Fourth Year on the CiM Web site for detailed advice.

Types of positions
There are different position types in training programs depending on your specialty choice. 4 Categorical positions begin in post-graduate year one (PGY-1) and provide the training required for board certification in a specialty.
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4 Preliminary positions are one- or two-year positions that begin in PGY-1 and provide prerequisite training for advanced programs. Preliminary positions generally occur in internal medicine and general surgery. 4 Advanced positions begin in the PGY-2 year, after one year or more of prerequisite training, and include the necessary training required for board certification in a specialty. 4 Transitional-year positions occur during the PGY-1 year and allow residents to rotate through numerous specialties with a combination of required and elective rotations, but lack the training required for board certification in a specialty. What type of position you pursue will depend on the specialty youre going into and the program options available in that specialty. For example, neurology requires four years of training; one broad year of clinical experience in general internal medicine and three years of neurology training. If youre going into neurology, you might apply to a four-year, categorical program that fulfills both the broad (preliminary) year of training and the three years of neurology. Or you might prefer an advanced program, which provides the three years of neurology training, but lacks the first, preliminary year. In this case, you must also apply for a preliminary, PGY-1 position to complete your neurology training. You can apply for both categorical and preliminary/ advanced positions, depending on your program preferences. Once youve researched residency programs, youre prepared to apply for residency.

Applying for residency

Applying for residency generally involves three steps: completing an application, compiling requested materials, and conducting interviews. Depending on the specialties and programs to which youre applying, you may be required to complete several forms of application and participate in more than one match.

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Electronic Residency Application Service (ERAS) (www.aamc.org/eras). ERAS provides a central application and document service that allows students and schools to transmit applicant information and documents electronically to residency programs. More than 95 percent of the U.S. residency programs in most specialties use ERAS to receive residency applications. ERASs extensive Web site lists participating programs and detailed information about the residency application process. The MyERAS applicant Web site opens on July 1 to begin working on your application. On September 1, applicants may begin selecting and applying to M.D. residency programs. Military applications. Each military service has their own application and process for graduate medical education selection boards. Application submission begins in September and interviews must be completed before November, well prior to the civilian match. Visit www.militarygme.org for more information about military graduate medical education. The Central Application Service. Sponsored by the San Francisco Match, this is the application service for some programs in ophthalmology. Program-specific applications. A few programs may use their own applications. As such, review each programs Web site or contact them to verify their application process, since theyre the only authority on whats acceptable.

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Writing a curriculum vitae (CV)
To begin gathering your credentials to apply to residency programs, craft a curriculum vitae (CV).While youre not required to send a CV with your applications, most of the information included on a CV will be required for your residency application. Having the information in one place eases the application process. Youll also provide a CV to faculty members wholl write you letters of recommendation, and your school might request one for preparing your Medical Student Performance Evaluation (MSPE). Creating a CV takes time, but its a tool physicians use throughout their professional life to present a complete but succinct summary and highlight of your qualifications. Its a living document that represents you; properly constructed and with periodic updates, the CV you develop now will evolve throughout your career. Writing a Curriculum Vitae (CV) on the CiM Web site features formatting tips and numerous samples to help you get started.

Writing your personal statement

A good personal statement should focus on your specialty choice and other career objectives. Omit a rehash of why you applied to medical school or a summary of your CV. Rather, write a succinct statement of your career goals that reflects your personality and style to distinguish you among similarly qualified candidates. Your student affairs office may have sample personal statements you can review for additional ideas. Also visit Writing a Personal Statement on the CiM Web site. Once written, ask your advisor or other faculty or staff to proofread your personal statement. While a good personal statement wont earn you a residency position, a bad one can torpedo your candidacy.

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Letters of recommendation
You must act early to secure letters of recommendation from appropriate referencesgenerally, faculty who know you and have worked with you in a clinical setting. Whenever possible, ask faculty for letters as you complete your rotations so they write your letter when your work ethic, personality, and performance are recentrather than distantmemories. Most programs require three letters of recommendation. Secure at least one letter from a physician in your chosen specialty who can attest to your interest and fit. Many programs also require you secure a letter from the department chair or clerkship director at your institutionor both. ERAS allows you to store an unlimited number of letters and designate different letters for each program, but no more than four letters can be sent to an individual program. Provide your letter writers with as much information about you as possible, including a current CV and your personal statement, as well as instructions or an ERAS cover sheet about how to submit the letter. Set clear and specific deadlines and diligently track and follow up with your writers to ensure theyre submitting your letters. Touch base often with your student affairs or deans office since they help collect and submit your letters of recommendation and other supporting documents. Also visit Getting Letters of Recommendation on the CiM Web site.

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Applications should be submitted by mid-August of your fourth year for early Match specialties (ophthalmology and urology) or late September for ERAS specialties. More programs are selecting students for interviews using first come, first served, so the sooner you submit your application, the better. During the fall of your fourth year, youll take the USMLE Step 2 exam, which includes both a clinical knowledge assessment and a clinical skills assessment. Most U.S. medical schools require students to at least take, if not also pass, Step 2 prior to graduation. Increasingly, residency training programs are interested in students Step 2 scores.

Medical Student Performance Evaluation (MSPE)

The MSPE, or its previous incarnation, the Deans Letter, has been a part of medical school for decades. Not to be confused with a letter of recommendation, the MSPE is a synthesized evaluation of a medical students academic performance and professional attributes. The document is written in the fall of your fourth year and is used by residency programs to objectively compare your performance to that of your peers. Your school will advise you on its MSPE process and timeline.

Number of programs
The number of programs to which you should apply depends on your credentials and the competitiveness of the specialty and residency programs. You should apply to several programs at different levels of competitiveness: highly competitive, moderately competitive, and safety programs. Your faculty advisor (ideally, someone in your chosen specialty) can be invaluable in

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helping you identify an appropriate number and mix of programs. Ask him or her for feedback and guidance so you can realistically assess how competitive you are and optimize your likelihood of securing interviews and ultimately matching. You can also review Charting Outcomes in the Match data for rank order list length of matched students to extrapolate a ballpark figure. Apply to enough programs so that you have options. Its better to cancel interviews than to not have enough scheduled. As you consider your list of programs, use the Residency Preference Exercisea decision-making matrix similar to the Choosing Your Specialty exerciseon the CiM Web site to ensure the programs will meet your needs. First complete a residency preference profile, which helps you assess your desired characteristics for a residency program, including educational opportunities, clinical experiences, coworkers, and work environment. Then you can search for, save, and compare residency programs to your Preference Profile results. It provides an objective framework for narrowing your list of programs to apply to and rank.

The interview
Once you send your application and supporting materials to your designated programs, the interview process begins. Programs may begin contacting you for interviews as early as October or as late as December. Timing is completely dependent on the program, although youll find some specialties generally offer interviews earlier than others or wait until the release of the MSPE on November 1. The amount of notice program directors provide when inviting students for interviews varies and you should respond to interview offers as quickly as possible. It also requires you remain mentally and financially flexible to accept and schedule travel for an interview with as little as a few days noticeor less.

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Residency interviews usually occur October through January of your fourth year, with December and January being the busiest interview months.

Most interview visits are fairly lengthy. Programs frequently host a social event for candidates one evening, followed by a half or full day of interview activities. Youll likely meet with numerous people, including the program director, faculty, and residents. Be enthusiastic and show your interest in their program; if you have done your research and are truly interested, this should be relatively easy. Your goal: find the best match between you and a program. The key to successfully navigating the interview trail and nailing each interview is preparation: 4 schedule interviews and travel strategically so you maximize your invitations, time, energy, and budget. 4 research each program so you can thoroughly discuss its attributes and needs and how you would address those needs. 4 research your chosen specialty so you can discuss the trends and hot topics. (You can start with the CiM Specialty Pages.) 4 know your background so you can describe any line on your CV or claim in a letter of recommendation. 4 know what questions are appropriate so you show interest in the program and can determine how you fit. Visit Residency Interview Basics and Acing the Interview on the CiM Web site for detailed advice about preparing for residency interviews, including frequently asked interview questions. Also refer to the ORRs brochure Dont Forget to Ask: Advice from Residents on What to Ask During the Residency

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Interview. Your school may also offer workshops or mock interview sessions to help you prepare. Capture your impressions as soon as possible after each interview. As you travel the interview trail, sorting through your reactions becomes increasingly difficult and the programs start to look alike. You can use the Residency Program Evaluation Guide to rate programs or continue comparing programs using the Residency Preference Exercise, both available on the CiM Web site. Rate each new residency against previous ones and regularly update the rankings.

The Match
The Match process provides an impartial venue for matching applicants preferences for residency positions with programs preferences for applicants. Four matching programs are currently available for all medical students: 4 National Resident Matching Program (NRMP) (www.nrmp.org), the main residency Match 4 San Francisco Match for ophthalmology and some positions in plastic surgery (www.sfmatch.org) 4 Urology Match, operated by the American Urological Association (www.auanet.org/content/residency/residency-match.cfm ) 4 Military Match, for Army, Air Force, and Navy residency positions Each year through the NRMP, approximately 16,500 U.S. M.D. seniors and 15,000 graduates of D.O., Canadian, and international medical schools compete for approximately 26,000 residency positions, making it the largest of the residency match programs. Residency applicants must apply directly to residency programs through ERAS (or other application services) in addition to registering with NRMP for the main residency Match.

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After applying and interviewing for residency, youll review your notes, decide which programs are most attractive, and compile a rank order list (ROL) of those programs. At the same time, residency programs are reviewing applicants and making their selections. Applicants and program directors then submit their rankings to the Match, where a computer program matches applicants to the highest program on their list that has, in turn, ranked the applicant. When you submit your rank order list, you can rank programs from different specialties as well as different position types (e.g., categorical, preliminary, advanced), depending on your preferences.

Youll register for one or more matches in the beginning of your fourth year. Early Match deadlines usually occur in early January, with results announced midJanuary.

State of the Match

Overall, 2011 was a record-breaking year for the NRMP as the total number of positions topped 26,000 (up by 638), and the number of U.S. medical school seniors who participated increased by 489 to 16,559 compared to the 2010 Match. Also, the match rate for U.S. seniors rose to more than 94 percent. As class sizes continue to expand and new medical schools continue to open, the number of applicants has been growing at almost twice the rate of residency positions. While the 2011 Match was generally positive for U.S. seniors and the increase in the number of positions offered is helpful, the Match remains competitive.

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Nowhere is this more evident than in the 2011 Scramble. The Scramble is the process in which students who do not match to a program on their rank order list have the opportunity to scramble for an unfilled position. According to the NRMP Advanced Data Tables, in this most recent Scramble, 971 U.S. medical school seniors and 7,232 other applicants competed for 1,035 positionsabout 400 of which are categorical positions. So while the Scramble used to be a viable back-up plan in the event a student didnt Match, its not anymore. So whats the best approach to ensuring you Match?

Preparing your rank order list (ROL)

Be realistic about your competitiveness, apply broadly, and rank a range of programs. Though, within that broad framework, you should rank programs based on 4 criteria important to you (e.g., location, career goals, work environment, setting), 4 your true preferences, not where you think youll most likely match, and 4 your willingness to attend. Remember Match agreements are binding and if matched, you must attend. Ranking all programs at which you interviewed that youre willing to attend reduces your likelihood of not matching and is especially important in competitive specialties. Visit the NRMP Web site for extensive information about applicant rank order lists. Also visit Going Through the Match and use the detailed Match timeline on the CiM Web site for advice. Last, and most important, spend time reviewing your ROL with your advisor.

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Rank order lists for the NRMP Main Residency Match can be submitted to the NRMP in mid-January, with final certification of your list by late February. Match Week is the third week of March with Match Day ceremonies at your medical school at 12 noon, EST on Friday.

The Supplemental Offer and Acceptance Program (SOAP)

Beginning with the 2012 Main Residency Match, the NRMP will replace the former scramble process with the Supplemental Offer and Acceptance Program (SOAP). The new Match Week schedule begins at 12 noon ET on Monday with the simultaneous release of the unfilled programs and unmatched applicant information. Applicants who did not match can then begin applying to open positions through ERAS, which will be the required method for both applicants to send and programs to receive application materials. A time-out period will occur until Wednesday at 12 noon ET, during which programs cannot offer any positions, allowing students to fully consider their options and apply to unfilled positions. This break also allows programs time to review applications and conduct telephone interviews. Programs will then submit preference lists of applicants to whom they would like to offer a position to the NRMP. Beginning at 12 noon ET on Wednesday, program offers will be electronically sent to students, who are provided a two-hour window to accept or decline a position. If a student declines a position, the next student on the programs preference list will be contacted during the next two-hour offer period.

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Under SOAP, applicants can receive multiple offers, and once a position is filled, itll be removed from the list of unfilled programs. Also, the NRMP Match Participation Agreement continues in effect, so once a student accepts an offer, an electronic handshake binds the deal. Programs will continue to offer remaining positions on Wednesday, Thursday, and Friday. Match Day ceremonies will shift to 12 noon ET on Friday to provide enough time for as many applicants as possible to match. Your deans office will typically make staff and advisors available to assist students who participate in SOAP. Every medical school follows a slightly different protocol for contacting and assisting students who do not match. Contact your deans office before the Match to inquire how they help unmatched applicants. In the event you go unmatched, youll know what to expect.

Planning for the future

As you complete the Match and near the end of medical school, youll face finishing your coursework and preparing to graduate. As you begin to transition from student to resident, also plan for your fiscal future. Your medical training is a significant investment that can cost you more or less over the long run based on the financial decisions you make. FIRST for Medical Education (www.aamc.org/FIRST) offers a full range of Financial Information Resources, Services, and Tools for applicants, medical school students, and residents to help medical school borrowers expand their financial literacy, make smart decisions about student loans, and manage their student debt wisely. securing licensure. Only state medical boards can grant a license to practice medicine, and each maintains specific rules and requires specific documentation in following state licensure regulations. Your medical school and residency program are important partners in applying for your medical license. However, its ultimately your responsibility to obtain the license required to

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deliver medical services. Contact the state medical board(s) (www.fsmb.org) in those states of interest to you for detailed licensure information.

Getting started
A successful career involves not only planning your career, but also maintaining it and considering the future. Career planning and development is an ongoing, lifelong process. Personal and professional satisfaction are closely tied; ideally, youll designate time each year to reassess your career, set new goals, and work toward them. Keep this guide handy during your medical school career to stay on track. Dont forget to use the resources and programs provided by your school to help you through this process. Now that you know the basics of whats ahead of you, its time to get started. Sign in to the CiM Web site (www.aamc.org/careersinmedicine) for more information on all of the steps and start working toward your career in medicine.

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Suggested reading
American Academy of Family Physicians. (Annual). Strolling Through the Match. Kansas City, MO: American Academy of Family Physicians. American Medical Association. (Annual). Graduate Medical Education Directory. Chicago, IL: American Medical Association. Association of American Medical Colleges (2007). Roadmap to Residency: From Application to the Match and Beyond. 2nd Ed. Washington, DC: Association of American Medical Colleges. Au, M. (2011). This Wont Hurt a Bit: (And Other White Lies): My Education in Medicine and Motherhood. New York: Grand Central Publishing. Freeman, B. (2007). The Ultimate Guide to Choosing a Medical Specialty. 2nd Ed. New York: Lange Medical Books/McGraw-Hill. Green, M., Jones, P. & Thomas, J.X. (2009). Selection Criteria for Residency: Results of a National Program Directors Survey. Academic Medicine. 84(3):362-367. Iserson, K.V. (2006). Isersons Getting into a Residency, A Guide for Medical Students. 7th Ed. Tucson, AZ: Galen Press, Ltd. Katta, I. & Desai, S.P. (2009). The Successful Match: 200 Rules to Succeed in the Residency Match. Houston, TX: Md2b. Le, T.,Bhushan, V., & Shevni, C. (2010) First Aid for the Match: Insider Advice from Students and Residency Directors. 5th Ed.McGraw-Hill/Appleton & Lange. Marion, R. (2001). The Intern Blues: The Timeless Classic About the Making of a Doctor. 2nd Ed. New York: Perennial.

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Nash, D.B. (1993). Future Practice Alternatives in Medicine. 2nd Ed. New York: IGAKU SHOIN Medical Publishers, Inc. National Resident Matching Program (2010). Results of the 2010 NRMP Program Director Survey. Washington, DC: National Resident Matching Program. National Resident Matching Program, Association of American Medical Colleges (2009). Charting Outcomes in the Match: Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2009 NRMP Main Residency Match. Washington, DC: National Resident Matching Program/Association of American Medical Colleges. Taylor, A.D. (2003). How to Choose a Medical Specialty. 4th Ed. Philadelphia, PA:W.B. Saunders Company. Tysinger, J.W. (1999). Resumes and Personal Statements for Health Professionals. Tucson, AZ: Galen Press, Ltd.

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