Last month I wrote about the early part of 4th year as a kind of second-look for medical students – an occasion for confirming specialty choice, or perhaps changing one’s mind altogether. For me, it has been an enjoyable and enlightening process to revisit the specialties I was most interested in and examine them more thoroughly, paying attention to finer details as I considered what a career in that specialty would entail beyond the years of residency. The specialty decision is often made on just a few weeks of exposure and may be highly influenced by observing residents, but it is important to remember that residency is relatively brief in the context of a career, and thus it is imperative to get opinions on the field of choice from practicing attending physicians. I have been grateful for opportunities to do just this; rotating through a field a second or third time has enabled me to make this aspect more of a priority. Now I have reached a point that feels, in some ways, like the crux of my medical education, or at least the crux of the past 15 months of clinical rotations. My “third year differential” has changed quite a bit over the last year; innumerable experiences have affected my decisions to this point, and I am finally applying for residency. In this article, I want to briefly summarize the process of applying for residency and address an important component of completing the application: namely, even the process itself can be a contributing factor to choosing a medical specialty. Undergraduate and Graduate Medical Education A quick synopsis for the uninitiated: undergraduate medical education (UGME, otherwise known as medical school) lasts four years and culminates with the degree of Medical Doctor (MD) or Doctor of Osteopathy (DO). These degrees signify that a student has mastered the knowledge necessary to be a physician, but this degree alone does not grant one the right to practice medicine in the U.S. This is a more complex process, involving licensing through the USMLE (Steps 1, 2, and 3) and completion of residency training. Historically, physicians could complete four years of medical school and then a single internship year and become a general practitioner without specializing . Now, MD and DO graduates typically complete a residency between three and seven years in their specialty of choice. Applying for Residency: ERAS Applications for residency programs, then, are completed by 4th year medical students for the following year. Since I will be graduating medical school in May 2018, I will be seeking to start residency in July 2018, and this application process begins in September of the year prior, with applications submitted on September 15th. Like the application for medical school, the residency application is completed through a central service, ERAS (a division of the AAMC). The application is quite long and involved. It requires listing and describing extracurricular activities (work, volunteer, and research), publications, professional memberships, awards, and hobbies into an online application as well as writing a personal statement, managing a variety of extra documents (photo, transcripts, letters of recommendation) and finally, selecting which programs will receive the application. The Residency Application as Self-Reflection Because the ERAS application is long and detailed, students work on it for several months in advance of September 15th, meaning that the process of applying really begins near the end of third year. Because of this, students may not have yet decided on their specialty – they may be mostly decided, or may be trying to choose between two options. Both types of students might begin filling out their application, finding that the process of applying is often a key part of clarifying one’s specialty choice. There are two components of the application, in particular, which help clarify: the personal statement, and the selection of specific training programs. Personal Statement: Putting Yourself in Writing The most involved part of the application process for most students is the personal statement; there is no list of boxes to check and no set formula, so each student is forced to articulate the essence of him- or herself and why he/she is applying to the specialty. For this reason, many recommend beginning with the personal statement. I found this approach to be helpful; as I sat down and began to write, mainly just trying to get ideas on paper, I quickly discovered a theme to the topics I was writing about, and the components of my personal statement – my meaningful experiences, interests, and career goals – all pointed towards one specialty. The initial drafting of my statement helped bring to the surface values which drew me to the specialty; several rounds of revising and editing furthered strengthened my feelings about my specialty of choice. Digging Deeper: Evaluating and Selecting Specific Residency Programs The selection of specific programs to which a student may apply is a lengthy process, because it generally requires deep reading into each program’s website. Although some systems exist to help sort and narrow down programs (such as Student Doctor Network forums, Scutwork.com, AMA’s FREIDA, and Doximity’s Residency Navigator), these are not centralized by the AAMC and therefore are subject to misinformation or bias. Additionally, these sources provide very little data beyond basic demographics that would help a student evaluate the quality and fit of each program. Instead, sorting out what makes a program unique, what that program emphasizes, and what nuances might affect one’s decision to apply requires visiting the program’s website (and eventually, the program itself, during an interview). This process, although tedious, is also helpful for clarifying one’s specialty choice. Reading about many programs’ approaches to education and training, as well as the subtle (or sometimes significant) differences in academic and clinical curricula, may help students sort out what they are looking for in residency. Becoming familiar with the patterns of the curricula is helpful for evaluating the specialty as a whole; particular rotations or required experiences may stand out as being especially interesting, further confirming the choice of specialty. Conversely, researching more thoroughly the actual residency curriculum of one’s chosen specialty may lead a student to realize that the specialty isn’t as appealing after all, and lead him/her to consider alternatives. In conclusion, the process of applying to residency is a central and challenging component of each student’s journey to becoming a practicing physician. Fortunately, the application is more than an inconvenient hurdle – it can and often is another useful opportunity to help choose a medical specialty. For many students, it is the last step in the process of choosing – once the application is submitted, that student has officially decided on a specialty and begins the process of interviewing, ranking and matching. I’ll write more about that process, as well as some comments about students who don’t make their final decision with the submission of ERAS, in a future column post – so stay tuned! Source
