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The Road to Residency

How to Transition From Medical School to Residency
Michal Bednarek/123RF.com

After getting into a medical school, it’s time to relax, celebrate, and momentarily enjoy your accomplishments. Once medical school begins, most medical students’ minds wander to the next challenge – residency. While some may come to medical school with their dream job in mind, the majority of medical students arrive only with a small idea of what type of medicine they eventually want to practice and an even smaller idea of what the steps are along the way to their dream residency.

What medical residency should I choose?

This is one of the toughest, but most important questions to ask at the beginning of your journey towards residency. Medical students are extremely good at breaking down goals and working towards them. The natural tendency with a goal this significant, this massive, is simply to attach to the first clear thought that comes to mind and just work towards that. Resist this urge to simply ‘get to work’ and instead focus on truly understanding, the best way that you can, what kind of doctor you want to be and what residency suits you the best. There are many factors that go into this decision, so many in fact, that we have dedicated a separate article to the process of selecting a residency.

Further Reading on Selecting a Medical Residency: How I Learned to Stop Worrying and Choose My Medical Specialty

Identify a mentor early

Just like the journey to medical school, a crucial first step on the road to residency is identifying someone who has done it before and has a vested interest in your success. Mentors will not only help to motivate you during this long process, but they can provide guidance as to how certain aspects of your application will be viewed by a ‘typical’ physician of that specialty. This insight is helpful for every step of the process from selecting research opportunities to crafting your personal statement (Yes, you need to write yet another personal statement!).

Research your desired specialty

Now that you have a firm handle on the residency you’re pursuing and you have the support of a mentor, the next step is understanding the typical profile of an applicant to that specialty. Every specialty is different, and the ideal attributes vary significantly from fields like radiation oncology and neurosurgery, which place a huge emphasis on research during medical school, to fields like family medicine and psychiatry, that focus more on a holistic review of the candidates applying rather than their specific academic accolades. Some specific points to consider include: USMLE scores, research emphasis, and sub-internships.

USMLE scores and residency

Every medical student knows that the USMLE Step 1 and Step 2 exams are crucial parts of the residency match process. Scoring well on both exams is an important way to demonstrate academic competence and your potential for future success to residency program directors across the country. How good is good enough? Instead of listening to friends or advisors, go directly to the source. The National Residency Match Program (NRMP) releases a new report after every year’s match detailing the overall match statistics as well as breaking down the statistics by specialty. With this goal in mind, plan your USMLE preparations around ensuring that you meet or exceed the average Step score associated with medical students who match into your desired specialty.

Further Reading on USMLE Step 1: Top Tips to Pick the Best Answers for USMLE Step 1

Research Experiences

A quick review of the NRMP report will highlight just how variable research experience is depending upon your chosen specialty. While almost every specialty looks favorably on research, some view it as necessary to your success and others view it simply as a bonus.

Surgical subspecialties and radiation oncology tend to emphasize a significant research experience. If you are planning to apply to any of these residencies, you should seek out and establish research experiences early in your medical school career. Additionally, ensure that these will be productive experiences, resulting in poster presentations, podium presentations, and publications. Also, be cognizant of the different requirements for different types of research. If you are applying to a specialty with an average of 18 research presentations, keep in mind that likely this signifies that most applicants are participating in shorter clinical projects, rather than time-consuming basic science research. While most programs will look more favorably on basic science, it may be in your favor to have one main basic science project as well as a few smaller clinical projects. By doing this, you are mitigating the risk of having ‘too few’ research experiences on paper, while ensuring you have robust exposure to basic science and clinical research throughout medical school.

No matter what, choose projects that are intellectually interesting to you. You will always end up contributing more and getting more out of projects you are invested in. Additionally, being personally invested in a project comes across during residency interviews, and program directors and faculty will identify with applicants who are obviously interested and engaged with their academic endeavors.

Sub-Internships

Away rotations and sub-internships can be amazing experiences that allow you to see how medicine is practiced across multiple types of hospitals and geographic locations. While not necessary for most residencies, they are considered important in surgical subspecialties, where there are not many programs and the program directors or chairman may all know each other. If you are considering applying to one of these smaller surgical specialties, doing well on your sub-internships is of extreme importance.

The sub-internship experience itself allows you to see how medicine is practiced and all of the inherent variability in the art and science of medicine. This experience, in and of itself, is amazing and reassuring that there is ‘more than one way to skin a cat’ and that wherever you end up for residency will likely teach you excellent patient care skills. Speaking personally, by rotating at some of the ‘biggest name’ institutions in the country, and then comparing those to where I matched, I learned that truly neurosurgery was practiced in a very similar fashion regardless of the name or location of the hospital.

In addition to learning more about the practice of medicine, sub-internships allow you a unique opportunity to demonstrate your intellect and skills to faculty and residents who are ‘neutral’ in the residency process and not necessarily invested in your success. By performing well in this situation and getting excellent letters of recommendation, you solidify yourself as a hard-working applicant to the programs you will be applying to in the NRMP. These letters can weigh heavily in the decision-making process and are a key step along the road to residency.

Conclusion

The road to residency is long, and for many medical students, it begins within months of starting medical school, allowing little time for rest and relaxation. Once you’ve spent the time to know what specialty you intend to pursue, find a mentor to help shepherd you along the path. Next, do your research and learn what the objective measures for success are to match into your chosen specialty, and then set out to meet or exceed those standards!

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About James L West, MD

Dr West is a graduate of the Florida International University Herbert Wertheim College of Medicine. He obtained his undergraduate degree in Agricultural and Biological Engineering from the University of Florida. He is currently a neurosurgery resident and has written a number of medical journal articles, most recently discussing neurosurgical resident education and resident wellness.