Practical advice for choosing a residency

An updated guide describes the explosion of Internet information, electronic testing, clinical skills assessments for IMGs and updated tips on the all-important interview.

By Jay Greene, amednews staff. Feb. 14, 2000.

Ryan Grabow has an important decision to make. The fourth-year student at the Medical College of Ohio, Toledo, is weighing the pros and cons of 16 orthopedic residency programs.

Grabow is one of approximately 21,000 candidates for 7,600 residency programs this year. He also is one of nearly that number who have read Iserson's Getting into a Residency: A Guide for Medical Students to help him choose a program that fits his personality and style.

Since 1988, Kenneth V. Iserson, MD, professor of surgery at University of Arizona Health Sciences Center, Tucson, has authored four editions of the resource book. A spokesman for Galen Press, Tucson, Ariz., which publishes the book, said nearly 200,000 copies had been sold. Not bad considering similar books are also available. Dr. Iserson's fifth edition will be available in March.

"There are an amazing number of new things in this edition," said Dr. Iserson, who also is director of the Arizona Bioethics Program. "The big thing this time is the introduction of online references and computerized testing. I also added new interview questions and answers applicants need to make or sometimes not ask."

Grabow, who praised the book for its practical advice and organization, said he had drastically changed his opinion of programs after visits.

"Two programs that were high on my list before interviews went down on my list after I talked with directors and residents," said Grabow, chair of the Medical Student Section of the American Medical Association. "Other programs I didn't hear about as much moved up more in my mind. Some programs look good on paper; others do a poor job at marketing. They all were good, but I need to pick the one that is best for me."

Choose a specialty early

Dr. Iserson said two of the biggest mistakes med students make are choosing a specialty and selecting a program. "It is very important for students to prepare early for residency," he said. "The practicing doctors who are dissatisfied with their chosen field don't take the time early to really think about what kind of medicine best fits their personality."

Grabow agreed. "I am different, I know, in that I decided as a first-year medical student that I wanted to go into orthopedics and surgery. I had exposure in college working as a nursing assistant. Most students change their minds from their second to third year. It is rare to keep a first choice."

Dr. Iserson said the best source of information on a program is from doctors who went through it.

"Doctors tell me they went into a specialty because they had this great teacher as a medical student," Dr. Iserson said. "This is not a good reason. Advisers try and steer students to their own specialty, and they sometimes disparage other specialties. It is important for students to talk with residents who are part of that program. It takes effort, but take the opportunity to find out about work and education situations."

The 500-page book contains more than 20 chapters, including "Choosing a Specialty," "Preparing for the Interview," "The Visit," and "You've Matched -- Now What?"

One chapter that provides insight into special problems for nonwhite, nonmale students is "Special Situations." For example, women medical students can review a chart on the percentage of female faculty who teach in various specialties. Surveys have shown that more than 25% of female residents have reported sexual harassment or discrimination by patients, peers or attending physicians.

"Programs that have reputations have them for reasons," Dr. Iserson said. "There is discrimination at medical schools just like any place. One issue that is of particular concern is discrimination against students with physical impairments."

The "situations" chapter also provides information for students who have children or who become pregnant and require leave. Other advice is presented for minorities, international medical graduates, older applicants and those with disabilities.

"The book does a good job at pointing out little things," Grabow said. "How to introduce yourself to faculty and resident staff, how you can hurt yourself by saying the wrong thing in an interview, how to put together a CV and how to put together an application for ERAS [Electronic Residency Application Service]."