Postgraduate Medical Education

After the first postgraduate year comes specialization. The function of this extended period of training has changed greatly since its start a century ago. At that time a residency was a special period of additional clinical education for a few promising and scholarly young physicians who wished to become the teachers or leaders in medicine. Residency training since the period after World War II has become standard for the average physician and more than 1,500 American hospitals offer such programs. Completing an approved residency and passing a written and/or oral examination given by a specialty board are the basic requirements for certification as a specialist.

In the early 1900s, nearly half of all medical school graduates entered general practice. By the 1960s this figure had shrunk to about 20%. A recent study concerning medical specialization showed that there has been a significant increase in interest in primary care/family practice over the past several decades (see page 393). Economic factors are comparatively minor in determining medical specialization, while up to 87% of the sampling indicated intellectual interests to be a major determining factor. Most recruits are entering internal medicine, surgery, psychiatry, obstetrics/gynecology, and pediatrics. Women physicians have generally favored fixed-schedule specialties (anesthesiology, radiology, psychiatry, pediatrics, public health) and work settings (state hospitals and industry).

The length of residency training varies among the different specialties and is indicated in Table 12.1; their characteristics are outlined starting on page 430.

It is possible to apply for a residency in a manner comparable to AMCAS. This is by means of the AAMC-sponsored Electronic Residency Application Service (ERAS). Offices of Deans of Students at medical schools (both allopathic and osteopathic) can provide the necessary material needed to apply. Canadians can also use ERAS.

It should be noted that many of the specialties listed have subspecialties that may require two to three years additional fellowship training beyond that listed in Table 12.1.

Securing a Residency

Appointments to residency positions are competitive and usually made through the Resident Matching Program (page 428). Your ranking by the Resident Program Director largely depends on three considerations:

1. medical school performance;
2. summary of recommendations from clinical clerkship supervisors; and,
3. residency interview performance.

The success of the interview can impact decisively on your future career. For this reason, we offer advice on preparing for your residency interview in this section.

Obtaining a residency appointment is not a hit-or-miss affair. Careful planning can avoid many pitfalls and improves your chances for success. Medical students frequently underestimate the importance of residency selection. The training program determines the specialty tract, and within the program, the curriculum and its monitoring staff can profoundly influence your career path. In addition, each program has its own philosophy and work environment. In selecting a program, a determination is made as to the amount of time that you will have to devote to meet the program's requirements over a period of several years. The residency interview provides a possible means of enhancing your chances for securing a house staff appointment as well as finding out if it is the right one for you.

The following are important suggestions to help you secure a suitable position. Many of the pointers noted in the premed interview discussion (see page 108) are relevant here as well.

Do Your Homework

Familiarize yourself with the program for which you are being offered an interview. It is risky to go unprepared, since you can make poor choices of places to visit and appear uninformed at the interview. Carefully study published residency program material that was sent to you or a classmate or is on file at your medical school. Such material could provide information concerning facilities, faculty-resident ratio, and the philosophy, curriculum, work hours, and support staff at the teaching hospital.

Setting up a card file on all prospective interview sites is useful. It will help you refresh your memory just prior to a visit. Add new information and your impressions after each visit for possible future reference. Sequence your interview schedule so that the interviews are not so close that you do not have time to recover from one before you present yourself for another and you can arrive fresh and enthusiastic for each interview. A “practice” interview at a program low on your acceptance list is a good way to develop self-confidence. Your highest priority interview should be scheduled in the middle of your interview cycle. By that time you should have an adequate amount of experience and will not be physically drained by this demanding process. Remember that making a good initial impression can be enhanced by a firm handshake and proper grooming.

Know Yourself

It is important at the outset of the entire interview process to define your goals career-wise. Completion of a personality test and discussion with faculty members with whom you are close about your goals, interests, and strengths can be helpful. After this process you should be able to clearly articulate your career plans and defend your choices. This should include knowledge of your choice of a clinical or academic career and the type of the residency you are seeking.

Anticipate Obvious Questions

Although interviews vary widely, many questions asked are standard ones. Among the most favorite ones are:

1. What are your short- and long-range goals?
2. What are your strengths and weaknesses?
3. Why do you seek admission to this program?
4. What do you want out of life?
5. Why did you choose medicine as a career?
6. What have been your most important accomplishments so far?

Practicing answers to these questions is advisable so long as they do not sound rehearsed when you deliver them. Mock interviews with fellow students can prove useful in preparing for the real ones.

Ask Tactful Questions About the Program

You should seek to learn about the program in the context of the interview session by inquiring as to the program's commitments to education versus service obligation. Tactful questions are appropriate; therefore, rather than asking about a program's weakness, phrase your question as an inquiry. You may wish to ask the interviewer if the program has received an unrestricted grant, what areas it would be invested in. The most appropriate questions to ask are those relevant to education and the quality of patient care. In any case, the questions you ask should be determined by the position of the person to whom you are speaking. In other words, when being interviewed by a department head, an inquiry relevant to salary or housing would not be appropriate but should be directed to a resident. Questions about the philosophy and curriculum of a program should obviously be presented to the program director and would suggest a more meaningful interest. Try to leave a positive and memorable impression on your interviewer.

Sample the Residency

The best way to evaluate a program is to spend a senior year rotation at the hospital in which you might consider doing your residency. When this is not feasible, you may be able to spend a day as an observer with residents, following them on rounds (if possible, dressed in whites). First-hand observation on the wards and in the clinics will provide a good window to assess the value of the program. Questioning residents is useful.

Present a Team Player Image

The residency is quite different from medical school; therefore, it is desirable to leave an impression that you can make the transition from working independently to being part of a team. Projecting the sense that you will fit well into the existing team will enhance your chance of securing the residency appointment you are interested in.

Be Yourself

While making a strong effort to project a favorable image, you should also strive to be sure that it is a realistic one. You must balance your desire to get the appointment with a candid assessment of whether the position will fill your own needs. When you leave the interview, you should go away with a positive feeling that this is the place you would like to spend the next several years training, to attain the proficiency you will require in order to succeed in your profession.