A D.O.

Student’s Guide
to Residency
Where Does It End?
Draion M Burch, DO
Council of Interns and Residents
American Osteopathic Association 1
Disclaimer!
• The goal of this lecture
is not to persuade any
osteopathic medical
student to pursue any
particular specialty,
residency program or
D.O./M.D. postgraduate
training. The purpose of
this lecture is to help you
make an informed
decision. The
information in this
lecture is subject to
change!
 Outline

• 2nd year
• CV
• Portfolios
• Research
• Academic File
 Outline
• 3rd year
• Unique Rotations

• Evaluations on Rotations

• Choosing a specialty

• 4th year
• Budgeting

• Scheduling and Applying for Elective Rotations

• “Audition Rotations” and Acting/Sub-

Internships 4
 Outline
• 4th year (con’t)
• Boards- (COMLEX Level 2/ USMLE Step 2)

• Tips for selecting a residency programs (AOA vs.

ACGME)
• Preparing to Apply for Residency
• Electronic Residency Application Service (AOA vs.
ACGME)
• Residency Interviewing Skills
• The Match and Scrambling Processes (AOA vs.
ACGME)
• Requirements to Start Residency (AOA vs. ACGME)
5
 Outline

• Post-doctoral
• Medical Licensing/Board Certification (AOA vs.
ACGME)
• Osteopathic Approval of ACGME Postdoctoral
Training Programs -Resolution 42
2nd year
7
 By the end of your 2nd year
• Update Curriculum Vitae
• Start Portfolio
• Conduct Research
• Student Researchers are more desirable
to competitive residency programs!
• Review Academic File
• Make copies of items in your academic
file for your portfolio!
 Curriculum Vitae Essentials
• Identification • Professional
Information Affiliations
• Education • Military
• Work Experience • Volunteer Activities
• Leadership • Honors & Awards
• Research • Special Skills
• Publications, Poster • Hobbies & Interests
Competitions,
Presentations • References
• Professional
Experience
 Portfolio Essentials
• Title Page with • Honors
identification • Top 10% letters,
information, Scholarship Awards,
objective… Certificates, etc…
• Table of Contents • Research
• Curriculum Vitae • Publications,
Posters, Protocols,
• Personal Statement Papers not
• Evaluations published, etc…
• Clinical evaluation • Lectures
summary,
recommendation
• Public Relations
letters, etc… • Newspaper articles
3rd year
11
 Unique Rotations To Consider

• Research Rotation

• International Rotation

• International Research Rotation

Do a research rotation at a residency program of interest!

12
 Evaluations On Rotations
• During your clinical years, you will receive
grades per rotations.

• Try to earn HONORS on all of your clinical

rotations- especially in your specialty of
choice.

13
 By the end of 3rd year
Time to Choose a Specialty

• You should have narrowed down your choices

of specialties to 1-2 .
• You can apply to more than one specialty
via ERAS!

• If not, don’t worry…yet! The earlier you

decide, the easier this process will be for you.

• Once you have decided on a particular

specialty, apply for out rotations/electives in
either this field or in one of its subspecialties. 14
4 th year
15
 Budgeting
• Expenses during 4th year include:
• Boards USMLE Step 2 &/or COMLEX Level 2
• COMLEX Level 2 Physical Examination/Clinical Skills
+ Travel expenses to testing site
• Elective Rotations
• Application Fees, Travel expenses
• ERAS application
• The number of programs you are applying to
• The number of specialties you are applying to
• Transcripts (COMLEX/USMLE and Medical
School)
• Interviews
• Travel expenses such as flights, hotels, rental cars,
meals
• Costs can range from ~$100-$5,000 16
 Elective Rotations
• Visit potential residency programs by applying to do
elective rotations or acting internships (AI)/Sub-
internships (Sub-I).
• Try to rotate in these residency programs between
July-Dec. Try to interview while you are rotating
there!

• Pursue a well-rounded medical education…this is

your last chance to truly see anything and everything
before you begin your residency or internship.

17
 Elective Rotations
• Elective rotations are just what they say. You get to
choose what you want to do.

• Complete rotations that will help you get a well-

rounded education.

• Use this time to see various residency programs.

• If a program director is in a specific subspecialty,
do an elective rotation in that subspecialty!
18
 Elective Rotations

• Check hospital websites for:

• Intern and residency programs (Graduate
Medical Education Links)
• Application requirements and deadlines for
elective rotations
• Student (Extern) Rotation Application
Form- may be an online application
process.

19
 Elective Rotations
• Apply for elective rotations 3-6 months in
advance.

• Hospitals will fill these rotations with their

home medical school students before they
place students from outside schools.
• However, if you apply early you will be on
the top of the “outside” school pile.

• Some hospitals charge an application fee

• $20-250

20
 Elective Rotations

• Some hospitals do not provide housing, travel

expenses, or meals.

• Apply to 2-3 rotations for the same month.

• You may be rejected from an elective rotation.

• Cancel a rotation if you have another scheduled

that you plan on completing so other students can
have the same opportunities as you.
21
 Elective Rotation Paperwork
• Hospital Student Application Form
• Immunization Records
• Letter of Good Standing
• Professional Liability Insurance Certificate
• Copy of Transcript
• Copy of USMLE Step 1/COMLEX Level 1
• CV or resume
• Criminal Background Check/Fingerprint Analysis
• Additional paperwork specific to the hospital may
be required.
22
 Elective Rotations
• Most students will agree that you should try to
schedule one or both of the following:
• ICU rotation

• Acting/Sub-internship
 Elective Rotations
• Most students will agree that you should try to
schedule one or both of the following:
• ICU rotation

• Acting/Sub-internship
 Acting/Sub-internship
• You and another student are paired up for the month. The
two of you equal one intern. You assume the
responsibilities of an intern in terms of call, admissions,
and discharges.

• Glimpse of intern year while still having someone looking

over your shoulder.

• Chance to shine and show a particular program what you

are capable of.

• Great way to get a good letter of recommendation, which

carries more weight. 25
 “Audition” Rotations
• Remember: rotations at hospitals you will be applying
to for residency should be considered “Audition”
rotations.

• Show the program why they should take you. Get

your face seen and known. This way when they
receive your application they will remember the
impression you left.

26
 Boards
By now, you have completed and passed USMLE
Step I and/or COMLEX Level 1. Many students ask:

• Do I need to take step 2/level 2 before I apply for

residency?

• Do I need to take the USMLE to apply to an

allopathic program?

27
 When to take USMLE
Step 2/COMLEX Level 2?
• You should take the your second set of boards
(including the PE) by the late summer/early fall!

28
 Do you need to take step 2/level
2 before residency applications?
• Most residency programs would like to see step 2
before they make their official rank order list.
• Therefore you should take the boards (including
the PE) by the late summer/early fall.

• Some programs may not rank you until you have

completed both parts of step 2 (CK and PE)!

• Make sure to check with the programs you are

interested in as these requirements are program-
dependent. 29
 Do you need to take the USMLE to apply
to an allopathic program?
• Answer: yes & no.

• No program can deny your application if you just

submit your COMLEX scores; however, they may
choose to not consider you.
• This is program dependent. At some programs, your
chances may be increased if you take the USMLE.
• Choosing to take only COMLEX depends on how
competitive an applicant is and how competitive
their specialty choice is!

30
 Reasons Not to Take the USMLE
• COMLEX is based on the COMS curriculum while
USMLE is based on the LCGME curriculum.
• A D.O. must pass all 3 parts of the COMLEX only to
be licensed as a D.O.
• If you fail any exam and the state licensing board
inquires, you must report your results- which becomes
part of your permanent record that your state licensing
board keeps!
• You double the cost, preparation time, etc. by taking
both exams.
• Some ACGME programs will accept candidates with
COMLEX only. 31
 Board Preparation
• Common resources for Step 2/Level 2:
• First Aid for Step 2

• Boards and Wards- great resource for rotations

• Crush for the Boards

• Usmleworld.com or Kaplan Question Bank

• OMT Review

• Savarese

• W. Crowe COMLEX Review

• http://www.md-
do.org/NewOMMBoard%20Review02-REV.htm 32
 Miscellaneous Info about Boards

• You can take the USMLE Step 2, without taking

USMLE Step 1.
• There is not a consensus if this is helpful,
however, I would like to make you aware of
this option.

33
Residency

34
 Allopathic Positions you may apply to
• Categorical
• programs that begin in the PGY-1 year and provide the
training required for board certification in medical specialties.

• Advanced
• programs that begin in the PGY-2 year after a year of
prerequisite training.

• Preliminary
• one-year programs beginning in the PGY-1 year that provide
prerequisite training for advanced programs.

• Physician
• programs that are reserved for physicians who have had prior
graduate medical education. Physician programs are not 35
available to senior U.S. medical students.
 Osteopathic Positions you may apply to

OPTION 1 (OGME-1 Resident)= Specialty Track

• The first postdoctoral year will be the first year of

residency. This is the same as the current specialty track
model. All trainees will receive residency credit for this
1st year of training. These positions will be known as
OGME-1 Resident.

36
 Osteopathic Positions you may apply to

OPTION 2 (OGME-1 Preliminary)= Special Emphasis

• The first postdoctoral year is not included in the

residency, but is a specific preliminary entrance
requirement into the specialty to produce an enhanced
educational opportunity for that specialty. The trainee
will have been accepted into the OGME-2 specialty
while a senior in osteopathic medical school. These
positions will be recorded by the AOA as Preliminary
interns and be known as OGME-1 Preliminary.

37
 Osteopathic Positions you may apply to

OPTION 3 (OGME- 1 Traditional)= Traditional

Rotating Internship

• This first postdoctoral year is not included in the

residency, but is available in the format of a Traditional
Rotating Internship. It may be utilized by any
osteopathic graduate uncertain of residency plans or
those who want a single year program. These positions
will be recorded by the AOA as OGME-1 Traditional.

38
39
40
Choosing a Residency…Factors To Consider

• Location and proximity to family

• Didactics
• Volume (Surgeries, Deliveries, Procedures)
• Fellowship opportunity
• Program Reputation/Rankings
• Program atmosphere (residents/attendings/facility)
• Research opportunities
• Night float vs. overnight call
• Amount of scutwork
• Board pass rates
• Amount of autonomy 41
 Information about Residency Programs
• FREIDA Online Website
• http://www.ama-assn.org/ama/pub/category/2997.html
• DO Online Website “Opportunities”
• http://www.do-online.org
• Student Doctor Network Website
• http://www.studentdoctor.net/
• SCUTWORK Website
• http://www.scutwork.com
• Washington University SOM Website
• http://residency.wustl.edu/
• Great website with helpful information about residency
• MDsecrets
• http://mdsecrets.com
42
• List of unfilled allopathic residencies
 How do you know if a
program is “DO Friendly”?
• Look at the programs websites and see what their specific
requirements are- also look to see if there are any DO’s in
the program.
• Some programs require passage of USMLE Step 1 to
apply for their residency program!

• If they list resident contact information (email address),

contact the residents especially if there are DOs.

• Don’t hesitate to contact the program directors or

program coordinators if you have any questions! 43
 What if I choose not to do an
Osteopathic Internship?
• There are five states (PA, OK, FL, WV, and MI) which
require completion of an osteopathic internship in
order to be licensed to practice in that state.

• Without this internship or osteopathic approval you are

unable to participate in a residency, fellowship, or
practice in these five states.

44
Documents Needed for ERAS Application
• Regardless of whether you are going to pursue osteopathic or
allopathic postgraduate training there are specific documents you
must have.

• You will need:

• 3-4 good letters of recommendation
• (1 from your specialty choice)
• Updated CV
• Personal statement
• Dean’s Letter
• USMLE/COMLEX Transcripts
• Medical School Transcripts
45
• Photo
 Letters of Recommendation
• You will need at least 3-4 good letters of recommendation.
• Don’t get them all in one specialty. Programs want to see that
you are a well-rounded candidate (not only did you do well in
Pediatrics, but also Surgery and Psychiatry)

• Get an early start- ask for letters during your 3rd year!
• Don’t wait until a few weeks before you plan on applying on
ERAS.

• Consider completing an acting internship for a final letter of

recommendation.

46
 Letters of Recommendation (LOR)
• Each LOR will be accompanied by an ERAS
coversheet, which includes your information, the
physicians information, and your option to waive your
right to see the LOR
• You may want to waive your right on the cover
sheet. This will allow the physician to give you a fair
and unbiased evaluation.

47
 Packet for Preceptors to help
them write your LOR
• Curriculum Vitae
• Personal Statement
• Their evaluation of you during your rotation
• Thank you letter
• ERAS coversheet
• Small envelope- stamped, addressed to your address in
case preceptor wants to mail you a copy
• Large envelope- stamped, addressed to Student Affairs
for ERAS application

48
 Personal Statement (PS)
• Don’t underestimate the importance of your personal
statement!

• Don’t procrastinate!
• Start writing it as soon as you choose a specialty.

• Have several individuals review your PS-your

advisors, residents in your specialty, the residency
program director at your medical school!
49
 Websites to help you write
your Personal Statement
• http://u101.com/articles/med-school/residency-
personal-statem.shtml

• http://www.rushu.rush.edu/studentlife/career/medpst
ate.html

• http://www.ama-
assn.org/ama/pub/category/6700.html

• http://www.residencyandfellowship.com/page3.html50
 Medical School Transcripts
• Request copy of transcripts for yourself and for
Student Affairs (for ERAS).

51
 COMLEX &/or
USMLE Transcripts
• On MyERAS, you must release your COMLEX
transcripts!

• On the other hand, you do not have to release your

USMLE transcripts!
• May be changing for future classes. Make sure you
look into this if you took the USMLE.

52
 Dean’s Letter
• Now known as the Medical Student Performance
Evaluation (MSPE)

• Your Dean’s letter is a formal institutional reflection of

your academic background and achievements.

• It is NOT a personal letter of recommendation.

• Your medical school’s student affairs uses your Personal

& Academic File along with your Curriculum Vitae to
write your Dean’s Letter. 53
What does your Dean’s Letter contain?

• Confirmation of good academic standing

• Anticipated Date for D.O. degree
• Your undergrad/grad degree
• Degree, year, where conferred

• Undergraduate Activities Descriptions

• Volunteer work, research activities, clubs,
honors, teaching, etc.
 What does your Dean’s Letter contain?

• Explanation/Description of curriculum

• Grading system

• Academic achievements

• Activities Descriptions
• Volunteer work, research, clubs, tutoring,
professional associations, honors, awards,
fellowships
 What does your Dean’s Letter contain?
• Facilitator Comments

• Board Exam Completion (percentile included if in top

30%)

• Rotations to date, including:

• Positive comments from each rotation
• Final assessment: marginal to honors

• Closing paragraph to summarize and recommend

 Request a copy of your Dean’s Letter

• Request a copy in early Fall of Senior Year

57
 Photo
• Use a picture of you in your business attire- it
looks more professional. Remember- you are
interviewing for a job!

58
 ERAS

https://services.aamc.org/eras/myeras2009/59
 What is ERAS?
• ERAS is a service that transmits residency, fellowship
and osteopathic internship applications, letters of
recommendations, MSPEs, medical school transcripts,
USMLE transcripts, COMLEX transcripts, and other
supporting credentials from you and your designated
Dean's Office to program directors using the Internet.

60
 4 Components of ERAS
• MyERAS Website
• This is where you complete your application and
personal statement, select programs to apply to, and
assign documents to be received by those programs.

• Dean’s Office Workstation (Student Affairs)

• This is ERAS software used by staff at your
designated Dean's Office. From this software they
create the ERAS Token that applicants use to access
MyERAS. They also use this system to scan and
attach supporting documents to your application,
such as photograph, medical school transcript,
61
MSPE, and letters of recommendation.
 4 Components of ERAS

• Program Director’s Workstation (Hospital

Graduate Medical Education Office)
• This is ERAS software used by program staff to
receive, sort, review, evaluate, and rank applications.

• ERAS Post office

• This is a central bank of computers which transfers
the applications. You can monitor the activity of
your files in the ERAS Post Office on the Applicant
Data Tracking System (ADTS).
62
 How does ERAS work?
• Applicants receive an electronic Token from their
assigned Dean's office, and use it to access the
MyERAS Web site.

• Applicants complete their ERAS application, select

programs, assign supporting documents, and transmit
their application to programs.

• Schools receive notification of completed application,

and start transmitting supporting documents:
transcripts, letters of recommendation, photos, MSPEs.
63
 How does ERAS work?

• Examining boards receive and process requests

for score reports.

• Programs contact the ERAS Post Office on a

daily basis to download application materials

64
65
 ERAS Timeline
• Mid June- Download ERAS Applicant Manual will
be available for PDF download by chapters or in its
entirety on the Web site.

• Late June- Schools may begin to generate and

distribute MyERAS tokens to applicants.

66
 ERAS Timeline
• July 1st- MyERAS website opens to applicants to
begin work on applications.

• July 15- Osteopathic applicants may begin selecting

and applying to Osteopathic Internship programs
ONLY. Osteopathic Internship programs can begin
contacting the ERAS Post Office to download
application files.

67
 ERAS Timeline
• September 1st- Applicants may begin applying to
ACGME accredited programs. ACGME accredited
programs may begin contacting the ERAS Post
Office to download application files.

• November 1st- MSPEs (aka Dean’s Letters) are

released.

• December- Military Match

68
 ERAS Timeline
• January- Urology Match

• February- Osteopathic Match

• March- NRMP Match results will be available.

• May 31st- ERAS Post Office will close to prepare

for the next season.
69
 Application Process Guideline
• Step 1:Research/Contact programs of interest to
find out their requirements and deadlines.

• Step 2:Request your token from your designated

Dean's Office and download your applicant manual.

• Step 3:Register on MyERAS.

70
 Application Process Guideline
• Step 4:Register for your Match.

• Step 5:Obtain documents and send them to the

designated Dean's Office to be scanned and uploaded.

• Step 6:Create your Profile and MyERAS Application.

71
 Application Process Guideline
• Step 7:Create personal statements, create a list of
recommendation writers, and authorize transmission of
your USMLE and/or COMLEX transcripts.

• Step 8:Search/Select programs of interest.

• Step 9:Assign documents to programs.

72
 Application Process Guideline
• Step 10:Certify and submit your MyERAS application
then apply and pay for programs.

• Step 11:Check the status of your applications.

• Step 12:Adding programs/Updating assignments and

keep your Profile current.

73
 Using MyERAS- Overview

Account • Page Five - Experience

• Profile • Page Six - Publications
• Checklist • Page Seven - Exams
• Messages
• Page Eight - Licensure Info
• Password
• Page Nine - State Medical
Licenses
Application
• Home
• Page Ten - Race
• Page One - General Info • Page Eleven - Ethnicity
• Page Two - Education • Page Twelve - Misc Info
• Page Three - Medical
Education
• Page Four - Previous
Residency/Fellowship
 Using MyERAS- Overview
Documents Programs
• USMLE Transcript • Search Allopathic
Programs
• COMLEX Transcript
• Search Osteopathic
• Personal Statements
Programs (Visible to
• Letters of Osteopathic Applicants
Recommendation only)
• Programs Selected
• Programs Applied To
• Preview Invoice
• Apply to Programs
• Invoice History
• Assignments Report
 ERAS Application Fees
Number of Programs Per SpecialtyAAMC Fees

• Up to 10 $60
• 11-20 $8 each
• 21-30 $15 each
• 31 or more $25 each
 ERAS Application Fees
• Example 1: An applicant applies to 30 emergency medicine
programs, AAMC fees are $290. (60 + (10 x $8) + (10 x
$15)).

• Example 2: An applicant applies to 20 OB/GYN

programs, and 10 family practice programs. The fees are
$200. ($140 for OBGYN and $60 for family residency
programs).
 ERAS Application Fees

• Example 3: An applicant applies to 23 internal medicine

programs, and 7 radiology programs. The fees are $245
($185 for internal medicine programs and $60 for
radiology programs).

• Example 4: An applicant applies to 12 internal medicine

programs, 10 emergency medicine, and 8 family practice
programs. AAMC fees are $196 ($76 for internal medicine
programs, $60 for emergency medicine programs, and
$60 also for family practice).
 ERAS Application Fees

• Example 5: A military applicant applies to 5 military

family practice programs, 3 military internal medicine
programs, 2 military surgery programs, and 7 civilian
pediatrics programs. The fees are $120 ($60 for the 10
programs consolidated under the military and $60 for the
7 civilian programs).
 ERAS Application Fees
• Special Instructions for Osteopathic Graduates:
Although the ERAS 2008 fee structure is the same
for osteopathic and allopathic programs, it is
administered differently. For osteopathic
internships, the fee is applied based on the total
number of programs applied to, regardless of the
specialties to which the applicant applies.
Applicants applying to allopathic programs are
assessed based on the total number of programs
applied to within a specialty.

80
 Miscellaneous Fees
 US (Allopathic and Osteopathic) and
Canadian Applicants
The National Board of Medical Examiners
(NBME) charges a flat $50 fee to US and
Canadian applicants who request transmission
of USMLE and/or NBME to programs,
regardless of the number of transcripts
requested. The NBME fee is included on your
invoice and collected by the AAMC.

81
 Miscellaneous Fees
• US Osteopathic Applicants
Osteopathic applicants may request an
unlimited number of COMLEX transcripts to
be sent via ERAS for $50. Applicants who
request USMLE transcripts via ERAS also pay
a $50 fee to the NBME for an unlimited
number of electronic transcripts. Transcript
fees are included on your invoice and are
collected by AAMC.

82
 Payment Method
• You may use your VISA or MasterCard to pay for
your ERAS fees online. This is the safest and
fastest way to process your application.

• You also have the option to pay your ERAS fees by

selecting the check/money order option, printing
out the invoice in the payment module, and
sending your fees by check (U.S. currency only) to
the address on the invoice. Your application(s) may
be withdrawn if payment isn't received within two
weeks.

• All fees are payable in U.S. funds on U.S. banks

ONLY. 83
 Payment Method

• If your check is returned for insufficient funds, you

submit partial payment, or there is a problem with
your credit card payment, ERAS will endeavor to
collect fees owed and your application may be
withdrawn.

• If ERAS withdraws your application due to

nonpayment, your application will be withdrawn
from each program to which you applied.

84
 ERAS Use During the M.D.
Scrambling Process
• From 12 noon on the third Tuesday in March, until 12 noon on
the third Thursday in March each year, there is a "Scramble"
period. This is before the NRMP Match Day results are revealed.

• During this period, applicants who did not match to a position

attempt to fill remaining positions. ERAS is available to
applicants to apply to a maximum of thirty (30) programs free
of charge who meet the following criteria:
• The applicant must have participated in ERAS during the
regular season. This means you must have applied to (and
paid for) at least one program.
• The applicant's account must be paid in full no less than two
weeks prior to the Scramble period.
85
Additional “Scramble” Information
• FindAResident is a company created by the
AAMC to help applicants find open residency
positions.
• http://www.aamc.org/students/findaresident

• It is an effective resource if you wish to:

• Change specialties

• Change location

• Switch residency or fellowship programs

86
 Osteopathic Match Application
• The osteopathic match occurs through the National
Matching Services (NMS).

• You will sign up in Sept. for this match after you are
provided a pin number from your medical school.

• The initial fee is $60 to sign up for this match!

• http://www.natmatch.com/aoairp/

87
Always Register for the OSTEOPATHIC Match!
 Allopathic Match Application
• The allopathic match occurs through the National
Residency Matching Program (NRMP).

• You will sign up on Sept. 1 for this match after you

receive your AAMC number.

• The initial fee is $45 to sign up for this match!

• http://www.nrmp.org/
88
 Interview Schedules
• Interviews at osteopathic programs typically occur
from Sept.-Dec.

• Interviews at allopathic programs typically occur

from Nov.-Jan.

• Make sure to schedule rotations and vacation time

accordingly.

89
 Interviewing Skills

• Before you interview, try to go through a “mock”

interview with a faculty member.

• Review the list of potential questions to ask during

your interview.

90
 Other Interviewing Tips
• Schedule rotations appropriately for interview season.
• Choose rotations which have lighter schedules.

• Cluster interviews-if within the same city

• i.e. CCF/Metro/UH

91
 Other Interviewing Tips
• Interact with the residents during the interview day.
• They are the best source for information. Keep in
mind some residency programs allow their residents
to serve on the committee so act appropriately with
the residents.

• Schedule interviews, even if its not at the top of your

list.
• A program can feel different in person. Don’t base
your decision on their website or literature provided.

92
 After Interviews
• You should send a “Thank You” note in a
timely manner.

• This can be in the form of an email, phone

call to the program director, or a hand written
thank you note.

93
 After Interviews
• You can choose whomever you like to thank, but
most applicants thank their interviewers and the
program director.

• Make sure to get business cards from all of your

interviewers. After each interview write down
some highlights from the interview that you can
mention in your thank you note. This will help
you stand out and will not look like a generic
thank you.
94
Letter of Intent

95
 Letter of Intent

• After you have finished interviewing some suggest that

you write a letter of intent to your top one to three
choices.

• State why you want to be there are what this residency

program offers that makes you want to train there.

96
 Letter of Intent

• Do not lie and say to all three programs that you are
ranking them #1, just say “highly ranked” to #2 & #3

• This is a great way to keep in contact with a program

• Residency programs typically rank applicants in late

Jan/ early Feb.
• Some programs rank applicants immediately after
you interview!
97
 After Interviews

• After you have completed the interview season, you are

now challenged to create a Rank Order List (ROL)

• When creating a rank list remember to rank the

programs that you want to go to in the order YOU
want them and not based on your “chance” of
matching there.

98
 Rank Order List (ROL)
• The Rank Order List (ROL) is your preferred
rankings for the residency you are pursuing.

• For the D.O. match, your ROL is created on the

AOA Intern/Resident Registration Program website
• www.natmatch.com/aoairp/

• For the M.D. match, your ROL is created on the

NRMP website
• www.nrmp.org/

99
 ROL
• You can rank as many or as little programs as you
like. The rankings are free for programs 1-30, after
which you will be charged a fee for additional
rankings.

• Applicants will have a greater chance of matching if

they rank more programs.
• You can only rank programs you interviewed at.

100
 Match Algorithm

At first look it may seem like a

foreign language, but with
careful observation the match
really gives the applicant the
advantage.

101
Not the real match algorithm!
 The Match Algorithm
• The match favors the applicant!

• Here are the websites explaining the algorithms:

• M.D.
• http://www.nrmp.org/res_match/about_res/algorit
hms.html

• D.O.
• http://www.natmatch.com/aoairp/ (click on
“match process”) 102
 Match Algorithm Example

• If your number one ranks you highly (ex. if they have

12 spots and you are within the top 12) you will match
at your number one.

• However, what happens if you are number 16 and the

first 12 applicants all have this hospital ranked as their
number one. Then you don’t match there and you
continue to your number 2.

103
 Match Algorithm Example

• If your number 2 has you listed highly (again if there

are 12 spots, and you are listed within the top 12) you
will match.

• Note: Even if the 12 spots are filled by other

candidates you can “bump off ” the last candidate if
you are ranked higher.

104
 The Match Algorithm

• This is why you should always rank your list based on

where YOU want to go.

• You can find another example involving several

theoretical applicants at:
• http://www.nrmp.org/res_match/about_res/algorit
hms.html

105
 Osteopathic Match Timeline
JUNE
• Beginning in June, students can download the Agreement form for
participation in the AOA Intern/Resident Registration Program (the
"Match") from this web site. To register for the Match, each student
must return a signed Agreement to National Matching Services Inc.
accompanied by the appropriate registration fee.

JULY - JANUARY
• Students must apply to programs independently of the Match (via
ERAS). Programs receive applications and interview students
independently of the Match. Application deadlines for programs
vary, therefore students should check with programs regarding their
deadline dates. 106
 Osteopathic Match Timeline
AUGUST - SEPTEMBER
• Each institution offering osteopathic internship positions
beginning in 2007 must provide to National Matching
Services Inc. information on the program(s) being offered by
the institution in the Match.

OCTOBER
• Recommended date by which students should return their
Agreements and registration fees to National Matching
Services Inc.

107
 Osteopathic Match Timeline
Early NOVEMBER
• By this date, a Listing of Programs participating in the Match will be
available on this web site.

Late NOVEMBER
• By this date, instructions for submitting Rank Order Lists and
obtaining Match results will be provided to registered students and
programs.

108
 Osteopathic Match Timeline
Late JANUARY
• Final date for submission of student and program Rank
Order Lists. No Rank Order Lists or Agreements can be
accepted after this date.

Mid FEBRUARY
• Results of the Match are released to all participants in the
Match (students and institutions), as well as to the colleges
of osteopathic medicine.

109
 Osteopathic Match Timeline

• Institutions must complete an institutional contract for each matched

student, and send it within 10 working days after receipt of the
Match results to the student for signature. Each matched student
must sign and return the contract to the institution within 30 days
after receiving the contract from the institution.

110
 Allopathic Match Timeline
Mid August
• Applicant registration begins at 12:00 noon eastern time.

September 1
• Institution / program registration begins at 12:00 noon eastern time.

December 1
• Applicant registration deadline (Note: Applicants may register after
this deadline by paying an additional late registration fee of $50.00
when registering after 11:59 PM eastern time.)

111
 Allopathic Match Timeline
Mid January
• Rank order list entry begins. Applicants and programs may
start entering their rank order lists at 12:00 noon eastern
time.

Late January
• Quota change deadline. Programs must submit final
information on quotas and withdrawals by 11:59 PM eastern
time.

Late February
• Late registration deadline.

112
 Allopathic Match Timeline
Late February
• Rank order list certification deadline. Applicants and programs must
certify their rank order lists by 9:00 PM eastern time. CERTIFIED
applicant and program rank order lists and any other information
pertinent to the Match must be entered in the R3 System by this
date and time.

Early March (3rd Monday in March)

• Applicant matched and unmatched information posted to the Web
site at 12:00 noon eastern time.

113
 Allopathic Match Timeline
Early March (3rd Monday in March)
• Filled and unfilled results for individual programs posted to
the Web site at 11:30 am eastern time.

Early March (3rd Tuesday in March)

• Locations of all unfilled positions are released at 12:00 noon
eastern time. Unmatched applicants may begin contacting
unfilled programs at 12:00 noon eastern time.

Mid March (3rd Thursday in March)

• Match Day! Match results for applicants are posted to Web
site at 1:00 pm eastern time.

114
 Allopathic Match Timeline
Mid March
• Hospitals send letters of appointment to matched applicants after
this date.

• Note: Any contact between programs and unmatched applicants (or

their designees) prior to 12:00 noon eastern time Tuesday, March 13,
2007, is a violation of the Match Participation Agreement. Contact
between programs and matched applicants prior to the general
announcement of 2007 Match results at 1:00 pm eastern time
Thursday, March 15, 2007, also is a violation of the Match
Participation Agreement.

115
 Can you participate in both matches?
• YES. As a D.O. applicant you can choose to apply to both
the D.O. and M.D. match, the D.O match, or the M.D.
match. The D.O. match occurs before the M.D. match.

• If you apply for both matches and you match into an

osteopathic residency program you will automatically be
withdrawn from the match. This match is a binding contract.
Therefore you cannot break it to try to match in the M.D.
match.

• If you don’t match at a D.O. spot, and you applied to both

matches, you will then be entered in the M.D. match.
116
 Can you participate in both matches?
• You can match to a D.O. intern year and then match into
an M.D. program if that program requires a prelim year
(i.e. anesthesia, PM&R, path). You will apply to the M.D.
match for a PGY-2 spot.

• If you choose to pursue just the allopathic match you

should withdraw from the D.O. match on natmatch.com.
There is an option for withdrawal that states you will be
competing in the M.D. match.

117
 Can you participate in both matches?
• There is one exception in regards to residency
requirements. If you want to pursue an allopathic
residency in ophthalmology, you MUST do an allopathic
transitional year.
• The Ophthalmologic board does not recognize an AOA
internship year and therefore you will not be granted board
certification because you failed to complete the necessary
requirements.

118
 Pre-Match Contractions?
• Prematches are residency position offers outside of the
match.

• Prematches are available to D.O.s and FMGs applying

to the allopathic match.

• As a D.O., you can accept a prematch from an

allopathic residency program. However, if you pursue
this route, make sure you have a signed contract. Do
not skip the match based on a “verbal agreement”.
 Pre-Match Contracts?

• Also you may want to have an attorney look over the

contract for any loopholes.

• If you accept a prematch, you must withdraw from the

match.

• Prematches occur before Jan. 31, which is the last day

programs have until they have to notify the NRMP of
the number of seats (quota) available for the match
 What if you don’t match…

• If for some reason you do not match you can always

scramble.

• The “scramble” is a brief period of time that is set

aside for those applicants who did not match. The
Scramble gives applicants an opportunity to contact
unfilled programs and possibly secure a position.

• Both matches (D.O. and M.D.) have post-match

scrambles for applicants who did not match into a
perspective residency program.

121
 Osteopathic Scramble
• Students who fail to match initially are provided with
information on programs with available positions for them
to contact.

• Likewise, programs with available positions are provided

with information regarding unmatched students to contact.
Thus, opportunities to obtain a position may still exist
after the Match.

• Unmatched students may receive emails from programs

that did not fill.
If you have to scramble, go back to your medical school in order for them
to help you! 122
 Allopathic Scramble

• Unmatched applicants who submitted a certified rank

order list will be given access to the Dynamic List of
Unfilled Programs at 12:00 p.m. EST on Tuesday of
Match Week. Applicants may not contact unfilled
programs prior to 12:00 p.m. EST that Tuesday. The list
is updated by the NRMP every hour to reflect the
number of remaining unfilled positions.

123
 Allopathic Scramble

• If you have already applied to a program, but that

program still has unfilled positions, you may contact the
program and inform them that you wish to be
considered a Scramble applicant. That program will not
count towards your thirty (30) Scramble programs on
MyERAS. Also, during Scramble, you may NOT apply
to more than thirty (30) programs using MyERAS, even
if you wish to pay for them.

124
 Allopathic Scramble

• During this period, applicants who did not match to a

position attempt to fill remaining positions. ERAS is
available for applicants to apply to a maximum of thirty
(30) programs free of charge who meet the following
criteria:
• The applicant must have participated in ERAS
during the regular season. This means you must have
applied to (and paid for) at least one program.
• The applicant's account must be paid in full no less
than two weeks prior to the Scramble period.

125
 Requirements to Start Residency

• Each residency has its own requirements. There are also

state requirements that must be completed for a
training license.

• When applying through ERAS, check with your

residency program for the necessary requirements prior
to the start of residency.

126
 Licensing vs. Board Certification

(A.T. Still’s original medical license)

127
 Licensing/Board Certification

• Do not get these two terms confused.

• Your license is state dependent.

• Your certification is based on your residency training.

128
 Licensing

• You will be licensed by the state you are training in.

• At the beginning of your residency you will be issued a

“training license”

• By the end of your residency you will apply for a full

practicing license.

129
 Licensing
• When thinking about licensure there is one special
caveat all osteopathic students need to consider.

• There are 5 states that require an osteopathic internship

or its equivalent for licensure purposes. (PA, MI, WV,
OK, FL)

• Without this internship year, you can NOT train or

practice because you will be denied a license from the
associated state osteopathic association.

• There are options, which we will get to later. 130

 Certification
• Your certification is based on your residency training.

• If you pursue osteopathic training you will be boarded by

an affiliated osteopathic board
• (i.e. IM will be boarded by the American Board of
Osteopathic Internists [ABOI])

• If you pursue allopathic training you will be boarded by an

affiliated allopathic board
• (i.e. IM will be boarded by the American Board of
Internal Medicine [ABIM])

• States have no regulation over your certification 131

 Certification

• Should you choose to train in an allopathic residency

program or practice in those 5 states and you are unable
to complete an osteopathic internship year, you can
seek to get approval of your first year of residency.

132
 Importance of AOA Certification
• You can't be a COM Dean, Program Director, or
DME without AOA certification!

133
 “Resolution 42”

• If you decide to pursue an allopathic residency

program there is a path you can pursue to get
AOA approval of your intern year.

134
 What is this “Resolution”?

• Some students who pursue allopathic training will

mention Resolution 42.

• This is a resolution created by the American

Osteopathic Association to help osteopathic physicians
remain connected to the AOA.

• These resolutions require certain criteria to be met

during the intern year.

135
 History of these Resolutions
• These resolutions began because the number of
graduates of colleges of osteopathic medicine out-
numbered the available osteopathic residency positions.

• In 1986 Resolution 65 was developed. The AOA

allowed graduates from the classes of ‘87-’89 AOA
approval of their first year of training as long as they
participated in the AOA match, but did not match and
then pursued ACGME training.

• In 1996 the AOA replaced Resolution 65 with

Resolution 22.
136
 History of these Resolutions

• Resolution 22 allowed AOA approval of the first year

of ACGME training if there were “special
circumstances” and if the applicant completed the
rotational requirements of an osteopathic internship.

• In 1998, Resolution 19 replaced Resolution 22.

137
 History of these resolutions

• Resolution 19 did not require an osteopathic curricular

component for approval.

• In March of 1999, the AOA suspended Resolution 19.

• In July of 2000, the AOA passed Resolution 42.

• Resolution 42 was designed to clarify the meaning of

“special circumstances”. It also required a commitment
to osteopathic principles and practice and it allowed
current and past trainees a route for AOA approval.
138
 Resolution 42

• Resolution 42 is the latest idea created by the AOA for

approval of the first year of ACGME training.

• Resolution 42: "Approval of ACGME Training as an

AOA-Approved Internship" is a policy to grant AOA
internship approval for appropriate ACGME training.

139
 Resolution 42
• Like previous training approval policies, the new
"Approval of ACGME Training as an AOA-
Approved Internship" policy maintains a consistent
theme. That is, to be eligible for AOA internship
approval of ACGME training the osteopathic
physician must complete all six of the traditional
rotating internship’s core rotations:
• 2 months internal medicine, 1 month emergency
medicine, 1 month family practice, and two additional
core rotations (internal medicine, surgery, OB/GYN,
pediatrics, family practice, or emergency medicine) so that
a total of 6 months in these core rotations are completed.

140
 Resolution 42

• Unlike previous policies, the new "Approval of

ACGME Training as an AOA-Approved Internship"
policy responds to the needs of current and past
trainees who have completed their first year of training
in an ACGME-accredited program.

• Like the superceded Resolution 19, special

circumstances must be present to request approval of
ACGME training as equivalent to an AOA internship,
as indicated in Resolution 42.

141
 Changes in Resolution 42

Special circumstances has been Eliminated!

 Results of Resolution 42

• Not everyone that applies for Resolution 42 is

approved.

• As of November of 2005, a total of 937 applicants

have applied under Resolution 42.
• 557 (men), 380 (women)

• 544 applicants received approval (58%)

143
 Resolution 42

• For more information regarding Resolution 42, you can

call the AOA Division of Postdoctoral Training at
• (800) 621-1773, extension 8276.

• Bulger, J. “Approval of ACGME Training as an AOA-

Approved Internship: History and Review of Current
Data.” JAOA. Vol. 106 (No. 12). Dec. 2006. 708-713.

• You can also check out the AOA website :

• https://www.do-online.org/index.cfm?PageID
=sir_postdocabtres42
144
 So what does this mean?

• Resolution 42 will allow approval of an allopathic

intern year to be counted as an AOA-approved
internship year.

• This will allow students to pursue training or

practice opportunities in the states (PA, Fl, WV,
Ok, MI) requiring the osteopathic internship.

145
 Additional Requirements for
Resolution 42 Approval
• The trainee must be a member in good standing of the
AOA.

• Trainees are responsible for negotiating rotational changes

with their programs.

• A trainee may attend an AOA annual meeting, state

osteopathic annual meeting, specialty college annual
meeting or prepare and conduct an osteopathic clinical
presentation to satisfy the educational activity requirement.

• All osteopathic clinical presentations are reviewed and

subject to approval or disapproval by a representative of
the Program and Trainee Review Committee. 146
Miscellaneous Info
Can an Osteopathic Trained Resident obtain
an Allopathic Fellowship?

YES!
Can an osteopathic physician who has
ACGME Board Certification bill for
treating patients with OMT?

YES!

149
 What to do with this information?
 Although it may seem overwhelming now, keep
this PowerPoint presentation tucked away in a safe
place until you are beginning your 4th year, which
is when I hope it becomes a very valuable
document.
Disclaimer!
• The goal of this lecture
is not to persuade any
osteopathic medical
student to pursue any
particular specialty,
residency program or
D.O./M.D. postgraduate
training. The purpose of
this lecture is to help you
make an informed
decision. The
information in this
lecture is subject to
change!
 For more information…
• www.do-online.org
• Here you can find the list of D.O. residency programs:
go to For Students then Opportunities

• http://www.ama-assn.org/ama/pub/category/2997.html
• Freida online listing of M.D. residency programs:
• go to Residency/Fellowship Training Program
Search

• http://www.mdsecrets.com
152
 For more information…
• www.scutwork.com
• A peer review of residency programs

• www.studentdoctor.net
• A students/resident online forum

• Iserson, K. “Getting into a Residency: A guide for medical

students”

• Desai, S. “The Residency Match: 101 Biggest Mistakes

and How to Avoid Them” 153
QUESTIONS?

154
 Contact Information
Draion M Burch, DO
Region III Trustee
Council of Interns and Residents
Vice Chair Intern-Resident Committee
Michigan Osteopathic Association
Resident Representative Board of Trustees
American College of Osteopathic Obstetricians and Gynecologists
Dept of Obstetrics and Gynecology
Statewide Campus System
Michigan State University College of Osteopathic Medicine
St John Health System Osteopathic Division
Macomb-Oakland Hospital, Macomb Center
dr.draionmburch@gmail.com 155