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The Residency Application: Information and Procedures

Written by Ugo A. Ezenkwele, MD, Resident, Department of Emergency Medicine, Hospital of the University of Pennsylvania

To provide direct patient care in the US, students of medicine are required to complete training in a three to seven year graduate medical program that is accredited by the Accreditation Council for Graduate Medical Education (ACGME).  By now, you have probably completed three to four years of medical school and are ready to choose a residency training program that is compatible with your career goals. Congratulations!

The earlier you start this process the better.  Most students will start sometime during their third year or early fourth year.  By this point you should have finished writing your personal statement, and have identified faculty members who will write letters of recommendations for you.

If you are like most medical students, you will find the decision process daunting. After several clinical rotations, numerous discussions with fellow classmates, faculty members and family, you will probably still be unsure of which career path to choose. You will find yourself wondering whether you will ever make up your mind between different specialties. Don’t worry, you are not alone. The key is to get started. Hopefully after reading the various topics in this booklet, the process will be made less daunting.

This chapter will be divided into three sections; 1) Before the Application, 2) The Application and 3) The Aftermath – Interviews and Life on the Road.

Before The Application
Once you have decided on which residency track you are going to pursue, go and pay a visit to the residency director and/or program director at your institution. This is a fact-finding mission and should involve an in-depth look at the kind of people who are going to be your future colleagues. An honest assessment is required here. Ask for and find out the advantages and disadvantages of the respective career path. You may be surprised at what you find out after talking to several individuals. Talk to fellow classmates who share similar interests. After all, these will be your future colleagues and even if you end up in different training programs, chances are you will meet them in the future, either at national conferences, lectures, or even at your institution. The worst that you may decide after all these conversations is not to enter that field. Or you may end up deciding that you had made the right decision all along. One other thing to keep in mind, some Deans’ offices keep phone numbers (and other contact information) for recent graduates who have undergone the application process in your field of interest. Find out the number, call, email and talk to them. Often the information you receive will add to your perception of the field as it comes from an unbiased source outside of your institution.

Furthermore, take time to talk to others who are not in the same field. During medical school, you may have developed a relationship with a faculty member who would like you to enter his/her career path. Even if you may not be interested in their field, now is the time to converse with them and figure out their opinion on your desired field. If they have your best interests at heart, they should be able to offer an insight that may prove helpful as you commence the intensive, money-draining exercise called "the residency application".

Before the process and after you have decided on your career path, remember that the personal statement and your letters of recommendations are the most important aspects of your package. Your statement should be written, revised and continuously upgraded to reflect your interests in the field. Letters of recommendation should be obtained from faculty whom you have a close interpersonal relationship with. Although, it would be great to get a letter of recommendation from the chairman of the department you are interested in, remember that a glowing letter from a junior faculty which wholeheartedly endorses you, goes a long way.

Another source of information that will make life easier for you is the Fellowship and Residency Electronic Interactive Database (FREIDA). This database compiles information on approximately 7500 graduate medical programs and 200 combined specialty programs that are accredited by ACGME. It provides statistics summarizing each specialty and sub-specialty with specifics on: faculty, work hours, resident breakdown, compensation and work environment. I highly recommend you spend some time perusing this database. It may ultimately help you decide whether a specific residency program is the right one for you. This database can be located at the American Medical Association (AMA) website

Other sources of information include the American Medical Association Graduate Medical Education (AMA-GME) Directory, the National Resident Matching Program (NRMP)  and the American Association of Medical Colleges Council of Teaching Hospitals (AAMC-COTH) Survey of Housestaff Stipends, Benefits & Funding. The AMA-GME Directory lists the addresses of all accredited programs. A descriptive brochure of a particular residency program can be obtained directly from the program you are interested in. Most programs now have this brochure on-line and by calling the program you can get the URL.

Preparing Your Application
Now that you have decided on which residency track to pursue, it is time to begin the process. Fortunately, certain aspects of the process have been made relatively straightforward and require only several hours of on-line time and patience.In 1992, the AAMC developed an electronic system for the transmission of student’s applications, personal statements, Dean’s letters and transcripts from medical schools to residency program directors. Known as the Electronic Residency Application Service (ERAS), it is used by most residency programs (a full listing can be obtained through your Dean’s office) and has substantially reduced the amount of time you will dedicate to the actual application process. Remember it is your duty to find out whether a program you are interested in uses ERAS.

ERAS is available to all US medical students through their respective Deans offices. For students and graduates of foreign medical school, it is available through the Educational Commission for Foreign Medical Graduates (ECFMG) which acts as the designated Dean’s office. Once you have contacted your Dean’s office, the rest of the application process can be done online at the AAMC ERAS website. Last year, the cost was $60 which covered registration and application for up to 10 programs in each discipline. Additional costs are incurred once the initial 10 programs have been exceeded. When choosing the number of programs, use a systematic approach. Apply to different programs – top tier to middle tier, and include location of programs as a contributing factor. For instance, do not apply to a program in the Northeastern United States if you have no desire to work in a cold climate. For foreign medical graduates, an additional application fee of $75 is added. The fee is calculated automatically and charged directly to you. Remember that once the total fee has been paid, it is not refundable. Therefore, double check the list of programs to which you would like your application to be sent to. Once your Deans’ office and you have sent off the completed application, it is time to wait. Generally, within four to six weeks you should start hearing about interviews. If you don’t, contact ERAS (via the USMLE/ECFMG identification number assigned to you) and inquire about the status of the application.

Your most important task prior to submitting applications is to determine the application deadlines for the various programs you are interested in. Generally, the earlier you start the process, the less likely you are to encounter problems. Remember that in some instances there is a match outside the NRMP for certain disciplines – Neurology, Neurosurgery, Ophthalmology, Otolaryngology and Urology. The key for these disciplines is to start early. If you are applying from overseas, take into account the extended time for overseas mail delivery.

Furthermore, it is your responsibility to review the eligibility requirements, and employment policies of the residency programs you are applying to. There is absolutely no reason for you to waste time and money applying to a program that is not accepting PGY1 applications. Also, if the residency program requires an official United States Medical Licensing Examination (USMLE) transcript, it is your responsibility to make sure this happens. Fortunately, for a fee of US$50, AAMC ERAS will provide this service.

The Aftermath – Interviews and Life on the Road
Finally, your first batch of interview requests have arrived in the mail or via email. Before you promptly write back to confirm or schedule an interview, wait a few more days to see how many interviews you get.This is important because smart scheduling will help you save money. You should aim to schedule as many interviews as possible in the same area of the country. If you have three or more interviews in New York City, it makes sense that you would schedule them for the same week as opposed to sporadically. The only way to avoid this, is to be patient and contact programs you have applied to and explain your situation. Most programs will try to move up the evaluation of your application or fit you into an interviewing day if you explain your circumstances.

For couples attempting to go to the same program, your constraints are further heightened. A recurring word of advice is to start early and plan well.

Once you have interviewed and narrowed your list to a few programs, you may return for a "second look". Remember, the next few years (generally, hard ones) of your life will be spent at that program. It is imperative that you choose wisely. Not only for yourself, but for your family and spouse as well.

After the interview, a letter of thanks and intent may be sent to the residency director. Keep it brief, tell them what you thought and let them know of your desires. Do not commit and do not fall into the trap of restricting your match list based on any promises that may have been made to you during the interview. Good luck and remember that ultimately, most medical students end up at a residency-training program. So start early, be methodical, diligent and most importantly, have fun!