Guidelines for Pursuing a Residency Program

Introduction I Selecting a Program I Selecting an Advisor I Obtaining Information I Suggested Curriculum I ERAS Information I Personal Statement I “Right Number” of Programs I Letters of Recommendation I Interviews I Final Match List I Important Deadlines I Interview Expenses

Introduction

We are pleased that you are interested in applying for residency training in Obstetrics and Gynecology.

Included in this section of Comprehensive Women's Health: A Career in Obstetrics and Gynecology are suggestions concerning selection of individual residency programs, selection of an advisor, requests for program information, time deadlines, organization of the senior curriculum, preparation of the Electronic Residency Application Service (ERAS) application and personal statement, and guidelines for planning your interview schedule.

In an effort to help you get started, please think about the questions entitled, “Selecting a Specific Residency Program.”

Selecting a Specific Residency Program

 “Food for thought”:

• Where do you want to live?
  • Are there family ties or issues pertinent to a spouse or significant other, which will affect where you want to live?
  • Can your spouse or significant other continue developing his or her career or educational goals in the community you are considering?
• What size and type of program do you want?
  • Large versus small
  • University center verse community hospital
• What are your career goals and lifestyle preferences after residency?
  • Private practice: solo or group
  • HMO or multi-specialty group
  • Academic medicine
  • Subspecialty training
• Do you have a secondary plan?
  • What will happen if you do not match? Are you considering a secondary specialty if you fail to match in Obstetrics and Gynecology?
  • If you do not match, do you want to wait to see what programs are unfilled and then “scramble” (very low yield) or are you willing to do a transitional year and then reapply for obstetrics and gynecology?

Factors to be weighed in selecting a residency program are varied and highly dependent on individual interest. Following are some things to consider when evaluating a residency program:

• Commitment to education (eg, number of formal teaching conferences, implementation of a structured 4 year curriculum)
• Ratio of full-time teaching faculty to residents
• Emphasis on subspecialty education (gynecologic oncology, reproductive endocrinology, maternal-fetal medicine, and urogynecology) versus private practice or primary care
• Quality of staff/resident and upper-level resident/lower-level resident interpersonal relationships
• Availability of adequate surgical training in both gynecologic and obstetric procedures (whether you do 500 or 1000 deliveries does not make much difference, but if you only get to do three vaginal hysterectomies, it will make a huge difference in your ability to practice independently after graduation from residency)
• Variety of training options offered in the program, eg, operative Laparoscopy and laser surgery, obstetric and endovaginal ultrasonography, and genetics
• Stability and status of the program
• Degree of change in department staff and leadership over time.
• Number of fellowships attained by graduates
• Requirements of the call schedule, particularly the coverage at affiliated hospitals
• Availability of research opportunities and specialized facilities
• Availability of funds to attend extramural postgraduate courses and present papers at scientific meetings?

Guidelines for Selecting an Advisor

Following are guidelines for selecting an advisor. Important deadlines to note when meeting with your advisor are listed in Table 4. Deadlines for residency applications are listed in Table 5.

• Select an individual from the same field of specialization you plan to enter.
• Select an established faculty member rather than a resident or fellow.
• Select an individual who has demonstrated a strong commitment to student education, who is knowledgeable about the residency application process, and who clearly is interested in your professional development.
• Select an individual whose schedule is flexible enough to readily consult with you as needed.

Obtaining Information

You will be writing to many programs for information. Some programs send large packets of information, and some send basic letters with very little information. More and more programs also are using the Internet and have home pages you can review. Following are other sources of information:

• The latest edition of the APGO Directory of Residencies in Obstetrics and Gynecology provides a reasonable complete database.
• The Graduate Medical Education Directory, published by the American Medical Association, also provides an excellent description of the training programs. The directory is also called the Fellowship and Residency Electronic Interactive Database Access (FREIDA) and is available at www.ama-assn.org.
• Surveys and questionnaires completed by students in classes ahead of you may be quite valuable.  Also, check with you Alumni Affairs office for information from former students.
• Talk to your advisors and mentors.
• Talk to other OB/GYN department members.
• Talk to residents in the department.  They have completed this process recently.  Talk especially with HO 1s and HO 2s from other medical schools.  Did they want to stay at their schools?  Where did they interview and why?
• Talk to the students ahead of you who are currently doing electives, having interviews, and submitting their match lists.
• Call former students who are currently in residencies you are considering or former students who have completed residencies and are now in practice.
• Seek advice from physicians who now are in practice.  However, be sure their knowledge is current about the program in question.

Suggested Senior Curriculum and Electives

• Use your fourth year to develop a broad base of medical knowledge. This may be the last opportunity you have in your education to get experience in a variety of areas of medicine. You will have your entire career to focus on obstetrics and gynecology.
• Suggested Electives
  • ”Audition Elective” in obstetrics and gynecology - at another institution
  • Subspecialty elective in obstetrics and gynecology
  • Dermatology
  • Emergency Medicine
  • General medicine - emphasis on outpatient management
  • Gerontology
  • Infectious diseases - special emphasis on adult sexually transmitted diseases
  • Neonatal Intensive Care Unit
  • Radiology - imaging of the abdomen and pelvis
  • Obstetric anesthesia
  • Surgical Intensive Care Unit

** Additional electives in obstetrics and gynecology are recommended only if you are uncertain of your career choice.

• November and December are not good months for out-of-town electives. During these months many faculty members and residents may be on vacation, and surgery schedules may be curtailed.
• Write early to the programs where you want to do electives.  Some elective slots fill quickly and the program may not be able to accommodate you in the time frame you want. Keep your schedule flexible enough to allow rearrangement of your electives.
• Be realistic about where to do electives. If you rank in the middle of the class, do not spend a month at a program that only takes Alpha Omega Alpha (AOA) graduates.
• When completing out of town rotations in other fields, remember to visit the obstetrics and gynecology department and gather personal information by talking to faculty and residents. Request permission to attend teaching conferences so that department members will recognize you, and get to know you on a personal basis.
  • Make an effort to do electives with faculty who are key people in their departments and who have input into their department's residency selection. If you are unable to do electives with key people, make an effort to meet them while you are there.
  • Go out of your way to meet all of the faculty and residents. If you are doing an obstetrics elective, do not ignore the gynecologic physicians or generalists. Be sure to meet the chair, program director, curriculum coordinator and other key people in the department. Find out from your faculty if anyone knows any of the faculty there. Many faculty have friends and contacts across the country.
  • Gather information and be observant during your elective. Observe faculty, resident, and student interactions and the “scut work” and “dogging” demanded of interns and junior residents. Does everyone pitch in or is the hard work delegated downwards while the choice assignments remain at the top? Observe medical and support staff interactions. Look for anything that sets off “alarm bells” or makes you feel uncomfortable.
  • Appear interested and excited about being there. Remember, that the best letter of recommendation is the one you write yourself by your good performance and hard work. 

Preparing Your Electronic Residency Application Service (ERAS) Information

• Be sure information is presented concisely but inclusively. Remember to include work experiences and volunteer experiences; these show that you are a diverse person with interests, activities, and talents outside of medicine.
• List membership in medical organizations.
• Provide a description of academic honors (eg, Dean's List, Phi Beta Kappa, Alpha Omega Alpha). Indicate the criteria for a specific scholarship (ie, need bases versus merit based).
• Describe meaningful research experience. Indicate the name of the supervisor and the specific purpose or title of a research project. Be wary of exaggerating your role in a research project. Your superficial knowledge of a subject may become evident during the interview.

PLEASE NOTE: Be certain your faculty advisor reviews your ERAS application before you submit it.

Suggested Format For The Personal Statement

• Provide a brief description of your background, ie, place of birth, occupation of parents.
• Explain why you originally became interested in medicine.
• Explain why you developed a specific interest in obstetrics and gynecology.
• Discuss what makes you unique as an individual.
• Explain unusual constraints in selection of a residency program, eg, couples match, special geographical considerations, career opportunities for partner (if applicable).
• Discuss your future plans:
  • Preferred geographical location
  • Private practice versus academic medicine
  • Type of private practice (solo, group, multi-specialty group)
  • Fellowship interest
  • Describe extracurricular activities - what you do to preserve balance in your life.

PLEASE NOTE: Be certain your faculty advisor reviews this document before you submit it.  Poorly written personal statements may detract from an otherwise excellent application.

Guidelines for Choosing the “Right Number” of Programs

It is difficult to determine the “right” number of programs to which a prospective resident should apply. The decision depends on a number of factors related to individual circumstances. Previous scholastic achievement in medical school and the competitiveness of the program must be taken into consideration. In general, the higher your ranking in the graduating class, the stronger the likelihood of your acceptance in a highly competitive program. Choices should include a range of 15 - 25 programs that provide a mixture of highly, moderately, and less competitive programs. 

Your advisor will be able to help you decide which programs are highly, moderately, or less competitive based on your individual academic record and the experience of former students at your school who applied to specific programs. Be realistic about the number of programs to visit. Visiting programs can be a laborious, time consuming process, and expensive process, especially if they are in separate geographical areas.

Guidelines for Soliciting Letters of Recommendation

• The “Dean's Letter” is a must for all residency programs.
• Some programs require a letter from the student clerkship director.
• Some programs require a letter from the department chair. Most chairpersons will require a brief interview before writing the letter. Contact the chairperson's secretary or administrative assistant to arrange this interview.
• When other letters are required, one of them should be written by your faculty advisor. Others should be written by faculty members who know you well, who have worked with you, and who can comment in detail on your personal and professional qualities. These faculty members do not necessarily have to be obstetrician-gynecologists.
• The higher ranking the faculty member who writes the letter, the better. It is helpful, but not necessary, if the person writing the letter is known at the institution to which you are applying.
• Do not submit more letters than requested by the individual program.
• Do not solicit letters from residents. Although they may know you well, their recommendations will not be as influential as those of faculty members.
• When soliciting letters, provide faculty members with copies of your curriculum vitae and personal statement with information at least 4 - 6 weeks before the letters are due. Usually, you will want these letters to be mailed by mid-October.
• Approximately 2 weeks before you want your letters transmitted, verify with the appropriate faculty or staff member that the letters have been entered into the ERAS program.

Guidelines for Residency Interviews

As an interviewee, you are primarily a salesperson. The product you are selling is yourself, and the assets of the product consist of your experience, skills, knowledge and personality. You communicate your experience and skills in your resume, but your personality comes across in the interview. Do not underestimate the impact of the interview. It can open or close the door for you.

The invitation to schedule an interview is a clear indication that you are competitive for the residency program. However, most programs will interview 10 - 20 candidates for every available position. Therefore, prepare carefully for each interview. Use the interview as an opportunity to demonstrate that you are a mature, articulate and affable individual who has developed realistic, clearly defined career goals. The following guidelines should be helpful to you as you begin this exciting process. In addition, your medical science library or public library should have several good books on interviewing techniques that may be of assistance to you (eg, Medley HA. “Sweaty Palms: The Neglected Art of Being Interviewed”).

• Be consistently respectful and courteous to the administrative staff who schedule your interview. A negative comment from an offended staff member can quickly sabotage an otherwise excellent application.
• Schedule your interview carefully. Be aware of the dangers of inclement weather in certain states during the months of January and February.
• If you plan to drive for your interview, be certain that your automobile is in good working order. Consider renting a newer automobile that is in excellent mechanical condition. Plan your route so that you are not driving through deserted areas late at night.
• Arrange reservations in safe hotel or motel facilities. If you do not know the city, ask the residency program coordinator to recommend convenient facilities. 
• Be certain that you are on time for the interview. If you are uncertain of directions, do a “trial run” on the evening before the interview.
• Dress appropriately for the interview. Men should wear a conservative business suit with a light blue or white shirt. A navy blue blazer combined with gray slacks also is acceptable attire.  Choose a muted rather than a loud, splashy tie. Avoid brightly colored or unusually dark colored shirts. Women should wear a conservative dress or business suit. Avoid mini-skirts, spiked heels, and excessive jewelry and makeup. Extremes of dress style or hairstyle will detract from the professional image you want to convey.
• During the actual interview, the most important rule is relax and be you.
• Be animated and attentive through the interview, and show excitement and interest in being there. Learn and remember the names of the people who interview you.
• Be certain that you have several questions to pose to each faculty member and resident with whom you interview. Do not hesitate to ask the same questions of different interviewers. Do not be timid in asking pointed, pertinent questions of the people you meet, but avoid confrontation.
• Watch your body language: how you sit, how you stand, where you put your hands. Eye contact is very important. Have a firm handshake. Try your very best to avoid an appearance of indifference or fatigue, particularly at the end of the day.
• Do your homework. Have some knowledge of the program you are visiting and be able to explain why you chose to apply to that institution.
• Develop a list of prepared questions to ask the residents and faculty members:
  • How have former residents performed on the CREOG In-Service Training Examination and the written and oral board examinations?
  • Have any residents from the program been accepted for fellowship training?
  • Do all members of the faculty participate actively in teaching the residents?
  • How many formal didactic sessions are presented to the residents each week?
  • Does the department provide an allowance for purchase of textbooks or attendance of medical meetings?
  • Does the department require that a research project be completed during residency training? What type of administrative and laboratory support is available for resident research projects?
  • Is a night float system in operation?
  • How frequently are the residents required to be on call?
  • Do the residents seem to have good camaraderie?
  • What are the strong points of the program?
  • What are the weak points of the program?
  • Is any faculty turnover expected, particularly at senior administrative levels (ie, chairperson, program director, or division director)? If so, what impact will these personnel changes have on the department?
  • Does the program have a parenteral leave policy?
  • What career opportunities are available for the applicant's partner?
• Be prepared to answer the following questions that faculty members may pose to you:
  • What is your background: birthplace, type of education, occupation of parents?
  • What individual(s) do you consider to have been most influential in your life?
  • How did you become interested in medicine? What strengths do you think that you would be able to bring to a residency program?
  • What do you consider to be personal weaknesses that you would like to correct?
  • What are your plans for the future, ie, private practice, fellowship training, academic medicine, research?
  • What activities do you pursue outside of medicine to maintain “balance” in your life?
  • What role did you play in the research project(s) cited in your curriculum vitae? What is your understanding of the purpose and major findings of this research project?
  • What is your attitude toward abortion?  Answer this question forthrightly. Program directors have a firm obligation to be respectful of varying points of view on this subject.
• Throughout the interview, be on your very best behavior. Avoid jokes. Avoid assuming too great a familiarity with the residents.  Avoid overly casual comments. Avoid any appearance of impropriety (eg, cursing, ordering a mixed drink at lunch, flirting with another medical student).
• Be humble. Avoid any trace of arrogance.
• Avoid inconsistencies in your responses to different interviewers.
• If you decide to cancel an interview, be certain to notify the program director's office either by telephone or in writing. Failure to do so is an extremely discourteous act which reflects badly on you and your school. It denies another applicant the opportunity for an interview and inconveniences faculty members and administrators who have set aside time to meet with you.

After The Interview:

• Inquire whether or not you are expected to communicate again with the residency program director. Some residency directors will expect you to contact them if you remain interested in the program.  Other residency directors do not expect further communication prior to the match.
• Remember to send thank you letters to both elective experiences and interviews immediately after you return home. Do not wait until the end of the interview process.
• Let the people you interviewed with know exactly what it was that you liked about their program.
• If you find a program that you particularly like, do not hesitate to return for another visit to talk to additional faculty and residents. If you cannot return for a visit, at least call some of the residents and talk further. They may provide you with additional insight concerning the quality of the training program.

Budgeting For The Interview:

Interviewing for residency programs is an expensive undertaking. Your total financial outlay obviously will depend upon the number of programs to which you apply and their proximity to your home institution. Listed in the Table 6 are reasonable estimates for lodging, food, airfares, application fees and clothing.

Consider the following suggestions for reducing your expenses:

• Drive to as many interviews as possible.
• When making airline reservations, try to use only a single carrier.  Join that carrier's “frequent flyer” program if you are not already a member. Depending upon the number of airline trips you make, you may earn enough mileage credit to qualify for a free roundtrip coach ticket.
• To obtain the lowest airfare, try to make your airline reservations at least 14 days in advance and stay over a Saturday night, if possible.
• If air travel is required, try to group together as many interviews as possible. As long as you depart from, and return to, the same location, additional stops in between are surprisingly inexpensive.
• Take advantage of the hotel promotions offered by the airline travel programs. 
• Inquire as to whether the department you are visiting has any discount arrangement with a nearby hotel.

The American Medical Student Association (AMSA) offers low-interest loans to medical students to assist with interview expenses (maximum of $5,000) and relocation expenses (maximum of $3,000).

 

Preparing Your Final Match List

• Be sure to include an appropriate number and mix of programs based upon your qualifications and specific geographical and personal constraints.
• Do not rank any program in which you absolutely would not like to train! However, do not exclude a good program just because of its geographic location. Look for a program that will give you a good education. Do not simply look for a “great place to live.” Remember, that residency is only 4 years!
• Rank programs entirely according to your preferences. Follow your feelings. Do not attempt to guess how programs will rank you or to negotiate arrangements outside of the match.
• Be honest with any programs that you positively “wrote off” your list. Let these programs know that you enjoyed your visit but that you will not be ranking them. They will appreciate your honesty.
• Most importantly, remember that the match process is organized to be consistently fair and to produce a “good fit” for both program and applicant. Trust in the essential fairness of the process.

Meeting with your advisor: Important Deadlines

 

*Deadline will vary depending upon requirements at each medical school.

Deadlines For Residency Application

 

*Deadline will vary depending upon requirements at each medical school.

Estimates for Expenses Incurred for Residency Program Interviews

 

Copyright © 1999 by the American College of Obstetricians and Gynecologist.  All rights reserved.  No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.