Comprehensive Women’s Health Care:
A Career in Obstetrics and Gynecology
Developed by a Joint Committee:
Association of Professors of Gynecology and Obstetrics
and
Council on Resident Education in Obstetrics and Gynecology
Comprehensive
Women’s Health Care: A Career in Obstetrics and Gynecology was developed by the joint
APGO–CREOG Committee on Career Counseling. This monograph, which combines two
documents developed by the committee, provides a comprehensive overview of
information relating to the specialty of obstetrics and gynecology. Divided
into two sections, the first relates to selecting a career in obstetrics and
gynecology; the second section is a guide for medical students interested in
pursuing a residency in obstetrics and gynecology.
The Committee would like to
extend a special thank you to Drs. Patrick Duff and Jose Pleigo for their
additional work on the guidelines for medical students.
Committee
Martin Gimovsky, MD, Chair
Dwight Cruikshank, MD
Patrick Duff, MD
Dee Fenner, MD
Douglas Laube, MD
Frank Ling, MD
Jose Pleigo, MD
Kathleen McIntyre-Seltman, MD
DeAnne Nehra
Donna Wachter
For more information
contact:
Council on Resident Education
in Obstetrics and Gynecology
409 12th Street, SW
PO Box 96920
Washington, DC 20090-6920
or
The Association of Professors
of Gynecology and Obstetrics
2130 Priest Bridge Drive
Suite #7
Crofton, MD 21114
CREOG and APGO would like to thank the ACOG Development Fund for its contribution to the production of this document.
Copyright © 1999 by the
American College of Obstetricians and Gynecologists. 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.
Contents
Foreword v
Women’s
Health: A Career in
Obstetrics
and Gynecology 1
Choices to
Consider 1
Patterns of
Practice 2
Private Practice 3
Academics 5
Public and Community
Health 6
Health Maintenance
Organizations 7
Guidelines
for Pursuing a Residency
Program in
Obstetrics and Gynecology 9
Selecting a Specific Residency
Program 9
Guidelines for Selecting an
Adviser 10
Obtaining Information
11
Suggested Senior Curriculum
and Electives 13
Preparing Your Electronic
Residency Application 15
Service
(ERAS) Information
Suggested Format for the
Personal Statement 15
Guidelines for Choosing the
“Right Number” 16
of Programs
Guidelines for Soliciting
Letters of Recommendation 16
Guidelines for Residency
Interviews 17
After the
Interview 21
Budgeting for
Interviews 21
Preparing Your Final Match
List 23
Foreword
A career in women’s health
care is extremely rewarding and gratifying. We are pleased that you are
considering residency training in obstetrics and gynecology.
Obstetrics and gynecology has become one of the most competitive specialties over the past 10 years. Despite the disadvantages of erratic work schedules and high malpractice premiums, applications for residency training continue to increase. According to the National Residency Matching Program, obstetrics and gynecology has one of the highest fill rates, second only to orthopedics and general surgery. In recent years, about 15% of students applying for obstetrics and gynecology residency positions have failed to match. In many instances, this has been a result of unrealistic expectations and poor planning. This information is presented to you, not to make you change your mind about obstetrics and gynecology as a career, but to provide you with accurate guidelines for applying to obstetrics and gynecology residency programs.
Residency training in obstetrics and gynecology is 4 years in duration. Rotations during these 4 years will usually be divided between obstetrics, gynecology, gynecologic oncology, reproductive endocrinology, and ultrasonography. Under guidelines established by the Residency Review Committee for Obstetrics and Gynecology, specific educational experiences for the primary and preventive care role of physicians must occupy the equivalent of at least 6 months of the 4 years of residency and may be addressed in any of the 4 years. The primary care rotations will emphasize ambulatory care and will require knowledge and skills in the areas of health maintenance, disease prevention, risk assessment, counseling, and the use of consultants and community resources. These rotations typically include family medicine, internal medicine, emergency medicine, geriatrics, and continuity care clinics.
Included in this booklet are suggestions concerning selecting individual residency programs, selecting an adviser, requesting program information, meeting important deadlines, organizing senior curriculum, preparing the Electronic Residency Application Service (ERAS) application and personal statement, and planning your interview schedule, as well as information concerning careers in obstetrics and gynecology.
We hope this information
will assist you in preparing for a career in obstetrics and gynecology. To help
you get started, please think about the questions in the section entitled,
“Selecting a Specific Residency Program.”
Women’s
Health: A Career in Obstetrics and
Gynecology
It’s time to make the
important decision that will determine the course of your future practice. What
medical specialty will you choose for your postgraduate training? As a student
of medicine, you must carefully examine your personal interests and goals in
making this commitment to postgraduate education and choice of career.
Choices to
Consider
In making your choice it will
be helpful to know about the various and diverse career paths within the specialty
of obstetrics and gynecology. The purpose of this section is to give you, the
medical student, an overview of the approach to women’s health care taken by
obstetricians and gynecologists. It also is our intention to describe the
variety of professional situations, eg, private practice, academics, public
health, and research within the clinical and basic sciences, that are
encompassed by the specialty. Of particular note is that women’s health care
encompasses a wide range of clinical, academic, and research endeavors within
the specialty of obstetrics and gynecology.
For many medical students, the principal obstetrician–gynecologist role model has been a full-time faculty member in an academic setting. However, this is only a small part of the picture, comprising approximately 10% of those who practice within the specialty. Most obstetrician–gynecologists are in general practice in the private sector. Many obstetrician–gynecologists provide medical care for women throughout their complete life cycle and, therefore, play a critical role as a life-long counselor. In the course of this relationship, obstetrician–gynecologists facilitate the prevention, diagnosis, and treatment of health-related issues. Obstetrics and gynecology clearly presents a unique opportunity to provide both primary and reproductive health care services for women.
Patterns
of Practice
The diversity of the specialty
of obstetrics and gynecology is apparent in all practice settings. Concerns
ranging from acute and chronic medical conditions, to common aspects of
behavioral problems, as well as the maintenance of health during pregnancy and
the adoption of healthy lifestyles are addressed within the enduring
physician–patient relationship. Operative gynecology, pregnancy and delivery,
adolescent gynecology, infertility, endocrinology, urogynecology, and oncology
are examples of the breadth of issues faced by the obstetrician–gynecologist.
Most of the physicians who complete residency training in obstetrics and gynecology enter either a single or a multi-specialty group practice (Table 1). Solo practice is fast becoming a limited approach to health care provision in this era of managed care. Practice patterns vary according to local needs, but the constraints imposed by managed health care tend to funnel new obstetrician–gynecologists into established group practices.
TABLE 1. Practice Type Reported by Ob-Gyns in Practice Less Than 5 Years*
Practice Men (%) Women (%)
Solo
practice
16.1
8.2
Single specialty
group
34.8
43.9
Multispecialty
group
10.7
12.2
Salaried HMO
employee
5.4
8.2
Salaried hospital employee
12.5
18.4
Salaried university
employee 13.4
13.3
Salaried state/local
government employee 1.8
1.0
Salaried federal government
employee 2.7 2.0
Salaried group practice
employee 1.8 16.3
Other salaried
employee 10.7
8.2
Active military
duty
6.3
4.1
*Data from 1994 ACOG
Socioeconomic Survey of Fellows.
Note: Columns total more than
100% because some respondents reported more than one type of practice.
A higher percentage of
female obstetrician–gynecologists reflects the new balance in medical schools
and residency education programs in the United States (Table 2). However, male
students should not be discouraged from choosing obstetrics and gynecology as a
career; there are numerous practice opportunities for competent clinicians of
both sexes.
The number of U.S. medical
school graduates entering residency programs in obstetrics and gynecology
peaked at 1,218 in 1993 (7.9% of current year U.S. medical school graduates).
There has been a slow decline over the past 6 years, in both numbers and percentage
of graduates, to a level comparable to 1986 (Table 3).
TABLE 2. Women in Obstetrics and Gynecology
Years*
Status
1975–1976
1986–1987
1995–1996 1997–1998
1998–1999
Residency
1st
Year 207
(16%) 580
(51%) 743
(60%) 800 (67%) 795
(68%)
2nd
Year 156
(13%) 538
(47%) 733
(59%) 803 (65%) 810
(66%)
3rd
Year 118
(11%) 476
(42%) 726
(59%) 737 (59%) 777
(65%)
4th+
Year 68
(13%) 472
(40%) 676
(55%) 725 (59%) 722
(59%)
Total 549 (13%) 2,066 (45%) 2,878 (58%) 3,065 (63%) 3,104 (65%)
ACOG
Jr.
Fellows 420 (9.9%)
2,417 (35.1%) 5,103 (53.5%) 5,671
(58%) 5,576
(58%)
Fellows
503
(4%) 1,578
(8.1%) 5,908 (21.5%) 6,988
(24%) 7,256
(27%)
Total
923 (5.5%) 3,995 (15.2%) 11,011
(29.7%) 12,659
(32%) 12,835 (33%)
*Data since 1975 from CREOG
Resident Data Bank and AMA annual reports.
TABLE 3. First-Year Residents
in Obstetrics and Gynecology
U.S.
Graduates
Entering
Year*
U.S.
AIMG
IMG
USIMG
Total Ob-Gyn
(%)
1968–1969 433 326 759 5.4
1974–1975 742 288
1,030 6.4
1978–1979
931
178
54 1,163 6.5
1986–1987
1,081
26
28 1,135 6.7
1992–1993
1,218
50
21 1,289 7.9
1996–1997
1,182
41
27 1,250 7.4
1997–1998
1,121
49
25 1,195
7.1
1998–1999
1,086
42
16 1,161 6.7
*Data prior to 1975 from
AMA annual reports on Medical Education; data since 1975 from CREOG
Resident Data Bank and AMA
annual reports.
Abbreviations: AIMG, Alien International Medical Graduates; IMG, International Medical Graduates; USIMG, U.S. International Medical Graduates.
Private
Practice
Recent
studies have revealed that the typical workweek for the
obstetrician–gynecologist in private practice ranges from 41 to 60 hours, with
48 weeks out of the year devoted to practice. In a typical week there are
approximately 85 patient contacts (80% seen primarily in the office and 20% in
the hospital). Although the specialty encompasses women of a wide age range,
nearly 80% are 15–45 years old.
Approximately 70% of those patients cared for by an obstetrician–gynecologist receive most or all of their medical care from that physician only. This need is reflected by the increased emphasis on curricula devoted to the clinical ability of the obstetrician to provide primary care, as well as the more traditional approach to the practice of obstetrics and gynecology as a specialty devoted solely to women’s reproductive health care needs.
The general obstetrician–gynecologist in practice can serve as a consultant and as a primary care physician. Although there is probably no “average” day in the life of the obstetrician–gynecologist, a daily scenario may look like this:
7:30 to 9:00 AM
Surgery/Hospital rounds
9:00 to 11:30 AM Office
hours
11:30 AM to 1:30 PM
Surgery/Lunch (often used for returning phone calls, attending hospital committee or educational meetings)
1:30 to 5:00 PM Office
hours
5:00 to 6:00 PM
Telephone calls, office administrative
duties, and hospital
rounds
Great flexibility exists within this traditional framework. Depending upon the number of partners and nature of specific practice requirements, time can be made available for family and personal needs. Many practices build in a day off each week. The unpredictability of obstetrics obviously affects such a schedule because in addition to “on call” time (which varies as a function of coverage needs), two or three evenings per month for medical societies, committees, and other medically related activities can be anticipated.
Many obstetrician–gynecologists in private practice maintain teaching positions as members of clinical faculty. Such teaching assignments range from maintaining daily contact with students and residents to attending regularly scheduled clinics, rounds, or operating room assignments. Most clinical faculty consider their personal enrichment from such contacts to be equal to that of the students or residents. In addition, there are some physicians who limit their private practice to a particular facet of obstetrics and gynecology. Subspecialty fellowships in obstetrics and gynecology can include advanced training in maternal–fetal medicine, endocrinology and infertility, gynecologic oncology, and urogynecology.
Private practice usually offers the widest latitude in selecting a lifestyle or practice mode suited to an individual’s specific needs. Among other factors that add to the “satisfaction index” achieved by obstetrician–gynecologists are the long-term relationships with patients, the opportunity to practice preventive medicine, and the challenge of providing a diversity of health care that encompasses a wide spectrum.
Academics
Nine percent of all
board-certified obstetrician–gynecologists are full-time medical school faculty
members, many of whom are certified in the subspecialties of gynecologic
oncology, maternal–fetal medicine, or reproductive endocrinology.
Responsibilities of full-time faculty members include 1) teaching of medical
students and house staff, 2) direct patient care, 3)
research, and 4) administration.
Teaching new physicians is an exciting challenge. There is a long-standing tradition of teaching at the “bedside” in obstetrics and gynecology by practicing obstetrician–gynecologists. Clinical education by full-time faculty members takes place at both the undergraduate and the graduate medical education levels. Care of referred patients with complicated problems is an important component of academic medicine. Faculty physicians with particular expertise may choose to limit the range of patient problems they manage.
A key motivation for many physicians in academic medicine is the opportunity for research. The orientation of the studies may be either basic science or clinical medicine.
Academic medicine is a unique discipline with its own standard of rewards that differentiates it from private practice. Financial rewards tend to be less, although they are more competitive now than they were previously. An academic department that functions in a complex medical school or community hospital environment thrives on strong teamwork and a commitment to the common good. In this regard, with the increase in managed care consolidation, it is not dissimilar to a health maintenance organization (HMO) or group private practice setting. Nevertheless, for those obstetrician–gynecologists strongly motivated to add research and teaching to patient care responsibilities, an academic career should be considered carefully.
Public and
Community Health
Obstetrics and gynecology has
assumed a leading role in preventive medicine and public health; indeed, much
of contemporary obstetric–gynecologic practice includes preventive care. Examples
of widely used preventive health services include prenatal care, detection of
sexually transmitted diseases, Pap test screening, and family planning. In
public health the “community” (ranging from towns to states to nations) is the
“patient.” Public health obstetrician–gynecologists apply their skills toward
preserving and improving the reproductive health of women in these communities.
At the city, county, and state levels, obstetrician–gynecologists work as planners, consultants, and administrators in health agencies. Opportunities may include direct patient care or academic appointments at teaching hospitals or schools of public health.
At the federal level,
obstetrician–gynecologists function in a wide variety of health care
enterprises such as the Centers for Disease Control and Prevention. Others
provide direct patient care to Native Americans through the Indian Health
Service or work in underserved areas through the National Health Service Corps.
Still others coordinate delivery of maternal and child health and family
planning services through the Maternal and Child Health Bureau. At the
international level, obstetrician–gynecologists play an important role in
planning and implementing maternal and child health and family planning
services. Thus, through research, patient care, administration, and
consultation, obstetrician–gynecologists in public health services are helping
to improve the health of women, children, and families in the United States and
throughout the world.
Although not strictly public
health service, other obstetrician–gynecologists elect to practice while
serving in one of the branches of the armed forces where a broad range of
practice activities is available.
Health
Maintenance Organizations
Certified obstetrician–gynecologists
usually participate in prepaid managed care plans, such as HMOs and preferred
provider organizations (PPOs). Health maintenance organizations are organized
systems providing comprehensive health care to a voluntary enrolled consumer at
a fixed premium (capitation). Preferred provider organizations agree to offer
discounted flat rates or specific charges to a company or group. The company in
turn agrees to channel patients to PPOs. The growing influence of HMOs, PPOs,
and other third-party payers means doctors are no longer the sole decision
makers in health care provision.
Advantages to joining prepaid groups are the potential for a rapid build up of patients referred for care. The obstetrician–gynecologist also may have the option of accepting HMO and PPO patients into his or her own private practice base, or joining the staff of a specific managed care organization and working exclusively for that particular health care delivery system. The physician would then be in a salaried position with set hours and responsibilities. This option also may be attractive to those physicians who desire a delineated work schedule and may be more consistent with a physician’s goal of finding a balanced lifestyle.
Lastly, the student should remember
that obstetrics and gynecology is arguably the most socially involved and
socially exciting specialty that one can choose. Issues such as contraception,
population control, comprehensive women’s health care, sexuality, abortion,
assisted reproduction, and cancer continually keep the specialty as “front page
news.”
This section addressed the
numerous career options available to you within the specialty of obstetrics and
gynecology. The information in the next section is provided to assist and inform
you as you begin the residency program application process.
Guidelines for Pursuing a Residency Program in Obstetrics and Gynecology
Selecting
a Specific Residency Program
• Where do you want to live?
— Are there family ties or
issues pertinent to a spouse or significant other that 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 versus
community hospital
• What are your career
goals and lifestyle preferences after residency?
— Private practice: solo or
group
— HMO or multispecialty group
— Academic medicine
— Subspecialty training
• Do you have a secondary
plan?
— What will happen if you do
not match? Have you considered 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” 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 interests. 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 1,000 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 obtained 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 Adviser
Following are guidelines for
selecting an adviser. Important deadlines to note when meeting with your adviser
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 a 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.
TABLE 4. Meetings with Your Adviser: Important Deadlines
Meeting
Approximate
Year
Number
Deadline
Purpose
3rd
1
March–May*
Select an adviser; plan senior
curriculum.
4th
2
July
Prepare preliminary list of residency
programs.
3
August
Review initial draft of ERAS application
information and personal statement.
Identify faculty members to write letters
of recommendation.
4
Late September Select final
list of residency
programs. Review final draft
of personal statement and
application information.
5
November
Plan interview schedule.
6
Late January
–early February Review
interview experience.
7 Early–mid February Prepare and submit final rank list.
*Deadline will vary depending upon requirements at each medical school.
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 an excellent database.
• The Graduate Medical Education Directory, published by the American Medical Association, also provides an excellent description of the training programs. This directory also is 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. Check with your Office of Student Affairs for information from former students.
• Talk to your advisers and mentors.
• Talk to other ob-gyn department members.
• Talk to the residents in the department. They have completed this process recently. Talk especially with PGY1s and PGY2s 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 currently are doing electives, having interviews, and submitting their match lists.
• Call former students who currently are in residencies you are considering or former students who have completed residencies and now are in practice.
• Seek advice from
physicians who now are in practice. However, be sure their knowledge is current
about the program in question.
TABLE 5. Deadlines for Residency Applications
Year Deadline Goal
3rd March–May
Select faculty adviser.
End
of May
Finalize senior schedule.
4th End
of
July
Meet with adviser to prepare or review
preliminary
list of programs.
End
of
August Request information from residency
programs.
September 1 Arrange
for letters of recommendation from faculty.
Prepare
ERAS information and personal statement for review by adviser.
October
15
Complete submission of applications through ERAS.
November–early
December Plan interview schedule.
February
1
Complete interviews.
Mid-February
Prepare match list.
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 to get experience in a variety of areas of
medicine.
• Suggested Electives
— “Audition Elective” in
obstetrics and gynecology—at another institution (if you have a strong interest
in that single program)
— Subspecialty elective in obstetrics
and gynecology at your institution (helpful in confirming your career
choice)
— 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
• 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 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 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
downward 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 based 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.
• Provide a list of publications.
Please note: Be certain your faculty adviser 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 the selection of a residency program, eg, couples match, special geographical considerations, career opportunities for partner (if applicable).
• Discuss your future plans
(to the extent that they are known):
— Preferred geographic
location
— Private practice versus
academic medicine
— Type of private practice
(solo, group, multispecialty group)
— Fellowship interest
• Describe extracurricular activities—what you do to preserve balance in your life.
Please note: Be certain your faculty adviser 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. As a general rule, choices should include a
range of 10-15 programs that provide a mixture of highly, moderately, and less
competitive programs.
Your adviser 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, and expensive process, especially if they are in separate geographic areas.
Guidelines
for Soliciting Letters of Recommendation
• The “Dean’s Letter of
Evaluation” 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 adviser. 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 absolutely essential, if the person writing the letter is known at the institutions 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 from faculty members.
• When soliciting letters, provide faculty members with copies of your curriculum vitae and personal statement, and with information concerning your cumulative GPA, performance on clinical rotations, and class rank. Inform the faculty member of any special constraints you may have, such as a couples’ match or narrowly defined geographic preference.
• Provide faculty members with your information at least 4–6 weeks before the letters are due. Usually, you will want these letters to be submitted via ERAS 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 about 10 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 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 interviews carefully. Be aware of the dangers of inclement weather in certain states during the months of December and January.
• 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. A navy blue blazer combined with gray slacks also is acceptable attire. Avoid brightly colored or unusually dark colored shirts. Women should wear a conservative dress or business suit. Avoid miniskirts, 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 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, e.g:
— How have former residents
performed on the CREOG In-Service Training Examination and the written and oral
board examinations?
— How have residents from the
program fared when applying 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 at 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 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
parental 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?
— How did you become
interested in the specific discipline of obstetrics and gynecology?
— What strengths do you think
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, and
research?
— What activities do you
pursue outside of medicine to maintain “balance” in your life?
— What role did you play in
the research projects cited in your curriculum vitae? What is your
understanding of the purpose and major findings of the research studies?
— 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 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 an alcoholic beverage 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 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 for 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 Interviews
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 Table 6 are reasonable estimates for
lodging, food, airfare, 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 round-trip coach ticket.
• To obtain the lowest airfare, try to make your airline reservation 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 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 and relocation expenses.
TABLE 6. Estimates for Expenses Incurred for Residency Program Interviews
Expense Amount
Average expense for one night
in a comfortable, but not elegant,
hotel (hotels in large cities
may be almost twice as
expensive)
$50–75
Average expense for breakfast, lunch, and dinner $30
Average round-trip airfare
for a single trip (assuming midweek travel
with no over-Saturday
stay) $400
Average cost of a single-day car rental $30
Average cost per mile for travel by automobile (gas, oil, tolls) $0.30-0.35
ERAS fee (dependent upon number of applications) $200–300
Preparation and printing of resume and photograph $100
New clothing for interviews
(suit, overcoat,
shoes) $300–500
.
Preparing
Your Final Match List
• Be sure to include an
appropriate number and mix of programs based upon your qualifications and
specific geographic 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.
• Most importantly,
remember that the match process is intended to be fair and to produce a “good
fit” for both program and applicant. Trust in the essential fairness of the
process.