I’ve been writing as Survivor DO since January and I thought I had picked off most of the low hanging fruit, the “basics” if you will. However, a visitor over at Ask.FM recently pointed out that I hadn’t yet delved into how to choose a residency program! Since this is one of THE most important decisions you will make during your career I think we better hurry up and address this! Below are the most important things to consider when choosing a residency program. The audition rotation Remember, residency selection works both ways. Not only are YOU looking for a program that fits YOUR needs but the programs are looking for excellent candidates to fit THEIR needs. Visiting a program on interview day is kind of like a first date. Everyone is on their best behavior and putting their best face forward. You’ll hear all of the good and none of the bad. The TRUE way to get to know a program is by actually going and spending some time there. Two to four weeks is more than enough to determine if a particular program may be a good fit. I would encourage you all to do audition rotations at programs you think will be high on your list; it will either seal the deal or open your eyes to the dirty little secrets that you otherwise wouldn’t have been privy to. The size of the program Programs come in all sizes from tiny (1 resident per year) to huge (10 + residents per year) it is important to consider where you want to fall on this spectrum as there are benefits to both sides. Small programs have a more intimate feel and you will get to know your attendings VERY well. You must consider, however, that you are going to be seeing a LOT of everyone involved. If you and another member of the program don’t click then you are going to have to find a way to work together whether you like it or not. Large programs can certainly make you feel like you get lost in the shuffle but there are a lot of benefits as well. You will always be working with new attendings this is good in that you get to see a variety of ways to manage the same problem or perform the same operation. Additionally, large programs can offer more flexibility in terms of scheduling because of the greater pool of residents to choose from and they tend to have more educational resources/funding. The didactics This is one of the areas I feel varies greatest between programs. There are, of course, requirements set forth by the accrediting bodies for an allotted amount of protected education time. How programs utilize this time varies greatly. I would advise looking into programs that really capitalize on formal education. It is great to learn by doing and see how it is done in the “real world” but you also have to consider matching into fellowship programs and passing your professional boards. This is a big deal and it is hard to make up for a weak educational base. Fellowship match rates Whether you want to pursue a fellowship or not, the fellowship match rate can give you great insight into the reputation of the program. At the very least you want to consider where previous residents from the program have ended up. Do they go out and practice independently? Do they match into prestigious fellowships? Do they fall off the face of the earth? It is a lot easier to continue a legacy of success than create one! Location Residency is going to be some of the hardest years of your life, you might as well do it in a location that works for you! There are lots of considerations here: Pay versus Cost-of-Living Proximity to significant others/family Opportunity to partake in your hobbies The weather I would encourage you to make a pros and cons list taking into account the factors above for every program you are considering. In the end a computer algorithm gets the ultimate say in where we end up for residency but by creating a well thought out rank order list you put some of the power back in your hands. source
