Match 103:Where Do We Go From Here?

CHRIS WOLEBEN, MD, FAAPASSOCIATE DEAN OF STUDENT AFFAIRSVCU SCHOOL OF MEDICINE2 December 2013

BackgroundInformation

On TheMatch Process

Match Overview• System by which medical students are paired with residency

training programs

• Administered by National Resident Matching Program (NRMP)• www.nrmp.org

• Applications to residency programs through AAMC Electronic Residency Application Service (ERAS)• www.aamc.org/eras

NRMP Algorithm• Designed to favor students• All applicants are treated equally (U.S. M.D. and D.O. students;

physicians; IMGs)

• Computer matches students in six minutes based on student and residency training program Rank Order Lists (ROLs)• The Match is complete when all applicants have either been

matched with one of their choices or all the programs listed by the applicants have filled their positions

Participating Specialties• Most residency positions are offered through the NRMP using

ERAS:• Ophthalmology, Urology, programs have separate matching

process• Neurosurgery first used NRMP in 2009• Child Neurology first used NRMP in 2011

• Intern positions (PGY-1) include:• Categorical• Preliminary• Transitional

Categorical PositionsDesigned for broad specialty trainingDo not require preliminary trainingOptimal for those who wish to remain in the same program

throughout their residency: Family Medicine Internal Medicine Pediatrics Emergency Medicine Obstetrics and Gynecology General Surgery Pathology Other programs

Advanced Programs• Programs available to senior medical students above the PGY-

1 level

• Students must also match into a preliminary year – you must check with each individual program to determine its requirements

• Examples of programs that may require a preliminary year include:• Anesthesiology, Diagnostic Radiology, Neurology• Dermatology, Ophthalmology, Radiation Oncology• Physical Medicine and Rehabilitation

Preliminary Programs• Designed for students needing a year of clinical experience

prior to completing another specialty

• Available in two program types:• Internal Medicine• General Surgery

• If you apply to an advanced program, you must also apply separately for a preliminary position

Transitional Positions• Generally designed for students who cannot decide upon a

medical specialty

• Year closely resembles the M3 Clerkship requirements

• May serve as substitute for a preliminary year for some advanced programs

What ShouldYou BeDoingNOW?

Decisions, decisions …• 60% of our students decide what specialty they want to

pursue during their M3 year• 20% decided prior to starting medical school• 15% figure it out during M1/M2 years• 5% figure it out during the M4 year• 60% of our students change their mind about specialties at least

twice during their M3 year• Ask resident and attending physicians about their career

choices• Seek out opportunities to explore fields outside the required

clerkships

Once you’ve decided …• Seek out a mentor in the department you have chosen

• “Official” advisor assignments will be made in January by the Student Affairs office

• Use multiple advisors based on who you trust for advice• May allow you to gain some research experience, particularly for

competitive programs• Career specific advice about scheduling your M4 year, planning

for away electives

Scheduling M4 Year• Overview of M4 Year:• There are eight 4-week time periods during the M4 year

Time Period Month

1 July/August

2 August/September

3 September/October

4 October/November

5(4 weeks reserved for interviews)

November/December/ January

6 February

7 March

8 April

Scheduling M4 Year• Requirements:• Step 2 CK Study Period / Exam (prior to November 1, 2014)• Step 2 CS (prior to November 1, 2014; schedule EARLY!)• Two Acting Internships

• One of these may be at another institution

• Critical Care Elective• At least four months of “clinical” electives• Update Course• Interview travel

• Electives:• Pick things you think will help prepare you for your intern year

Scheduling M4 Year• M4 schedules are determined by a lottery process

• Lottery requests are due on May 9, 2014• Detailed information about the lottery process will be sent by

Nancy Jackson in the Curriculum Office in January

• The schedule you receive in the lottery process is not set in stone!• Changes can be made if you change specialty tracks or change

your mind about elective experiences

Scheduling M4 Year• Meet with Nancy Jackson in the Electives Office for scheduling

tips and advice getting what you want in the lottery

• Meet with your assigned advisor to help plan your schedule:• Please schedule an appointment to meet with your advisor early

• Do not wait until the last minute• You will be given information as to how your advisor would like to be

contacted by the Student Affairs office when your advisor assignment is made

• Their signature is required prior to submitting your lottery requests• If you are unable to meet with your advisor, please contact Dr.

Woleben to review and sign off on your schedule

Scheduling Step 2 CS and CK• Step 2 CS:• About a week of study prep ideal, based on how well you

perform on OSCE’s during the M3 year• Good dates to take it:

• 2/22/14 – 2/24/14 (Spring Break #1)• 4/19/14 – 4/21/14 (Spring Break #2)• Sometime during your Step 2 Study block during the M4 year

• Step 2 CK:• About 2 to 3 weeks study time

• Perhaps more or less time needed for preparation depending on how well you are doing on shelf exams during the M3 year

• Low step 1 score? Taking it early may help your application

Acting Internship• How to Choose an AI:• Make a logical choice that will broaden your knowledge of a

particular career field• Get exposure to areas that may challenge you during residency• Opportunity for a strong Letter of Recommendation

• It is not necessary for it to be in the field you will be entering• Listen to the advice provided by your career specific advisor• Optimal time to complete your AI is in Time periods 1, 2, or 3

• Alternate months reserved for Board preparation, other clinical electives

• Early AI’s MUST be approved by Dr. Ryan and are usually reserved only for fields you do not get exposure to during the M3 clerkships

Away ElectivesExcellent opportunity to evaluate a program you are interested

in attending in depth Get to know residents Get to know hospital, medical record system Get to know region where you may be living

Make an excellent impression on the residency program you are visiting

They will remember you when it comes time to making their ROL if you display a solid work ethic and demonstrate excellent clinical skills – a no-risk applicant who completed a 4-week on-the-job interview!

One away elective is sufficient for most specialty fields Usually time periods 3 and 4 are ideal during the M4 year

Away Electives• Decide on a program and research their website for

application details• Visiting Student Application Service (VSAS)

• Central application service• Usually start applying to programs in late March or early April (after

Match Day)• Follow instructions on AAMC website

• Non-VSAS application process varies per program• Some competitive programs start offering applications as early as

January

• Nancy Jackson in the Student Affairs Office will help you with both application processes

Scheduling M4 YearTime Period Month Activity

1 July - Aug AI / Elective / Step 2 Study

2 Aug - Sept AI / Elective / Step 2 Study

3 Sept - Oct AI / Away Rotation / Elective

4 Oct - Nov Away Rotation / Elective

5 Nov – Dec - Jan Travel for Interviews / On-line Elective / Reading Month

6 February Elective

7 March Elective

8 April Elective

9 April - May Update Course

ERAS ApplicationHaving a complete and updated CV will greatly assist you in

completing the ERAS application Demographic, educational history Pertinent activities from medical school, especially those with

leadership positions Complete list of publications, research efforts Pertinent past work and clinical experiences Personal statement

Indicate programs where you would like application sent May transmit letters of reference, updated grades and board scores

at later date Can Submit ERAS application on September 15, 2014

Personal StatementStart thinking about writing this once you decide what field

you are entering Think about what you want to tell residency program directors

Start with a story about yourself or a patient that will be memorable and catch the reader’s attention

Keep a log of memorable patient encounters – detailed descriptions of past patient encounters can help programs tell what type of physician you may become

Understand your personal career goals What will you get out of the residency training? What will you contribute to the residency program?

Use excellent writing style Have multiple people read your personal statement, some for content,

some for grammar/spelling

Letters of RecommendationAsk those who you feel know you well if they can write you a strong letter of reference: Longer inpatient or outpatient rotations Those who have written good comments about you on

evaluations Acting Internships and away electives early in M4 year

You need at least two letters from those in the field in which you wish to match Each program may have different requirements

Some require department chair, clerkship director letters … make appointments early with these individuals

Better to have too many letters on file – Janet can help you pick and choose which letters to submit

Letters of RecommendationSend ERAS cover letter indicating waiver of right to see the

contents of the letter to the letter writer: See email attachment Also available in the Student Affairs office (MMEC 4th floor)

Follow-Up Reminders sometimes help procrastinators Ask early to avoid any potential delay

If you are applying to more than one residency field, it is appropriate to ask certain letter writers to write more than one letter on your behalf

Send a thank-you note to letter writer once letter is submittedLetters are only kept on file for current application cycle

MSPE (Dean’s Letter)• Standardized letter written by Dr. Wood for each student –

released October 1, 2014 to programs• Not actually a letter of recommendation• Indicates your academic performance across each year with

comparison to class means• Provides narrative descriptions of your performance in each

clerkship• Describes any irregularities in your academic history• Section written by you includes list of important activities and

accomplishments you wish to have included in the letter• Summary statement written by Dr. Wood• You should review this letter for content error

Residency InterviewingSome programs fill up all interview spots well before MSPE is

sent to programs Early application increases chance of securing interviews

Try to cluster interviews together in geographic regions to minimize travel costs

Utilize alumni network to find FREE housing

Timing of interviews is controversial Selection process is unique to each program

Interview Format quite different than medical school interviews

Utilize mock interviews!

InterviewStreamwww.vcu.interviewstream.com

Rank Order Lists• Four Key Elements:• List your first-choice programs first.• Consider how many programs you should list.• DO NOT rank a program where you would not want to be

trained.• DO NOT believe a single word that residency programs tell you

about your position on their ROL• You have no idea what they are telling every other applicant• Take their information with a grain of salt!!!

Rank Order ListsApplicants consistently do better if they list their top choices

first Then rank programs in the order of desirability to you … not in the

order in which you think you are acceptable to the programs

For highly competitive programs, a long ROL increases the odds a student will match

Especially true for California programs The most common reason that applicants do not match is that they

do not list enough programs on their ROL

Determine if you would rather take your chances in the Supplemental Offer and Acceptance Program

Important Dates• Through the End of the M3 Year:• Specialty Decisions!

• Contact Dr. Woleben if you are stuck for a career counseling session

• Update your CV

• Plan your M4 schedule• Meet with your advisor and Nancy Jackson

• Apply for away electives• Some competitive programs may start taking applications as early as

January; most start taking applications after Match Day in March/April

• Start thinking about writing your personal statement

Important Dates• May – July 2014:• ERAS user guide and tokens will be distributed by Janet Mundie• MyERAS website will open for students to start completing

residency application

• M4 Orientation (July 7 - 11, 2014):• Dr. Woleben will conduct ERAS / NRMP workshops in CIRC

• Page by page look at ERAS application• Tips for writing personal statement• Review of timeline for application process• More thorough description of interview process, scheduling

considerations

Important Dates• September 15, 2014:• You can start to submit applications to individual residency

programs via ERAS

• October 1, 2014• MSPE goes out

• September – November, 2014:• Dr. Woleben will offer individual mock interviews – contact Janet

Mundie to schedule

• October 2014 – January 2015• Interviews are conducted

Important Dates• Mid-January 2015• Rank Lists can be entered – deadline for submission of Rank List

is usually the last week of February

• Match Week – March 2015• Monday 3/16/15 at noon: Unmatched students and Unfilled

programs notified• Monday – Tuesday: Unmatched students can apply to unfilled

programs by ERAS only; Programs can contact student by phone for interview

• Wednesday – Friday: Eight rounds of offers for unmatched students through the Supplemental Offer and Acceptance Program (SOAP)

• Friday 3/20/15 at noon: Match Day Ceremony

Confused? Stressed?

Resources• nrmp.org• Good source for data and statistics• Charting outcomes in the Match• Yearly Match statistics

• https://www.aamc.org/students/medstudents/eras/• ERAS application

• https://www.aamc.org/students/medstudents/vsas/• Visiting student application service

Confused? Stressed?• Please schedule an individual advising session with Dr.

Woleben!• Not mandatory but HIGHLY recommended!!• Contact Janet Mundie to set up a time for us to meet:

• 828-9791• jhmundie@vcu.edu

• Special Groups that MUST schedule advising sessions sometime during the Spring Semester:• Couples Match• Early Match