05-18-2011, 12:18 PM
BECOMING WORTHY OF A GREAT RESIDENCY
by Daniel W. CollisonVolume 52, Issue 5
If you’re like most future physicians, your internship and residency will guide your career and success even more than your medical school experience ever could. So how do you prepare to obtain a great residency in an increasingly competitive world? I think an important mindset is to consider that medical school is simply a microcosm of life and just as in life, there are no guarantees. This is meant as a liberating thought—as the theologian Reinhold Niebuhr wrote in The Nature and Destiny of Man, “Man is most free in the discovery that he is not free.” With this in mind, a few principles and practical tips may help you flourish.
1. Understand and accept that life isn’t fair. Students you know who are card-carrying jerks might get great residencies. Your Gandhi-like friend might not. Once you accept this, do the best you can through principle, fair play and smart work (e.g., form a study group with your Gandhi friend).
2. Understand the lay of the land. Some students arrive at medical school with the next 50 years planned out month by month. Others have no idea what next week will entail. Perhaps it’s healthiest to be somewhere in between. Don’t miss out on opportunities through ignorance. Learn the basics (including timelines) for applying to residencies within the first months of medical school. You will need time to explore options, network, achieve top performances (especially for competitive residencies) and engage in dues-paying activities (such as conducting research). In all of this, please be kind to yourself and fellow students—don’t become a gunner. Your best sources of information about opportunities and timelines include the dean’s office and the students ahead of you, especially seniors.
3. The surest way to get a great residency is to be worthy of one. The good and bad news is that there are no shortcuts. Your dean’s letter summary of your performance will be the most important document in your residency application folder. Don’t worry too much about a poor grade from the attending from hell. As in Olympic scoring, I tend to throw out the very lowest and very highest marks (after all, some attendings can be fooled). I will also discount the assessment by someone who doesn’t know the student well, so don’t bother getting a letter of recommendation from someone prestigious unless it pertains to your performance. Consistently good evaluations are bankable. “Excellent student, self-aware, well-motivated, good team member, loves kids and knows pediatrics is for him” is the summary of how a good dean’s letter might read.
4. Set the stage for great letters of recommendation. Provide great service on the wards (see the “MedMentor” column in the March 2003 issue of The New Physician), and find mentors as soon as you can, in year one if possible.
5. Gather intelligence from current residents in the specialty of your choice. God bless the residents at my medical school, one of whom told me about a program I hadn’t considered but added to my list and matched at. Other good resources: faculty members from young (more likely to have information about current conditions) to old (perhaps have better perspective and peer networks). Conversely, regard residency information from fellow medical students with respectful skepticism. I still hear students repeat the same false dictums I heard as a student years ago, such as choosing a program with the same population mix as that you wish to settle in. The fact is, if you choose to get the best training, you will be better equipped to practice with any patient group or population.
6. Choose “away” rotations with caution. If you want to match at the University of Utopia’s program, it may be better to do your rotation in Shangri-La, get their rave support and let the folks in Utopia try to catch you on the open market. The unknown applicant is often more enticing than the known. Also, be wary of doing a rotation at a place that takes a lot of outside students—you may not stand out from the crowd.
7. Make sure your curriculum vitae (CV) tells the story you intend it to. Use the personal statement to help connect the dots or to provide a few new dots that entice interest. The reader of a well-written CV should be able to connect the dots thus: “A candidate with tremendous promise for a career in (fill in the blank).” Here’s another example: “Worked for his achievements, took risks, didn’t waste opportunities, paid back to the community and explored medicine and the wider world.”
Another analogy: If you were a stock someone would want to invest in, your CV should be a graph where the overall tendency is upward. A CV or personal statement with an isolated downturn or two is just fine. In fact, I find it useful to learn how an applicant deals with adversity. (If it’s pertinent to your story, the personal statement may be the natural place to mention how you responded to a challenge.) One of the great thrills for residency program directors is to find promising but overlooked applicants and see them develop into blue-chip physicians.
8. He who lives by the CV dies by the CV. Not only should you never make false statements, but if you list something on your CV, be prepared to discuss it. Grandiose or padded CVs are detestable. Your CV entries should be pertinent to your story.
9. Dream often, plan early and work always. Luck is what happens when preparation meets, recognizes and acts on opportunity. Harvey Mackay, a motivational speaker and author, once said, “A dream is just a dream. A goal is a dream with a plan and a deadline.”
10. Jumping through hoops is a poor substitute for life. Whenever I see the residency application of an accomplished hoop-jumper, I mourn the waste of life. Students who have shown they are learning the discipline, craft and art of medicine while keeping their inner hearth fires burning are the ones I want as my residents (and, I might add, as my physicians). The philosopher Jiddu Krishnamurti wrote in Think on These Things, “The function of education is to eradicate, inwardly as well as outwardly, the fear that destroys human thought, human relationship and love. The function of education is to help you from childhood not to imitate anybody, but be yourself all the time. You may learn to…pass all your exams, but to give primary importance to these superficial things…is like cleaning and polishing your fingernails while the house is burning down.”
The best students are those who are mastering their profession and who have made the decision to develop and share their inner lights with patients and colleagues.
Fortunately, they are becoming more common; we are lucky to live at the dawn of yet another Golden Age in medicine.
Dermatologic surgeon Daniel W. Collison is the former chief and residency program director of dermatology at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire
For PS, CV, LOR
info@road2residency.com
by Daniel W. CollisonVolume 52, Issue 5
If you’re like most future physicians, your internship and residency will guide your career and success even more than your medical school experience ever could. So how do you prepare to obtain a great residency in an increasingly competitive world? I think an important mindset is to consider that medical school is simply a microcosm of life and just as in life, there are no guarantees. This is meant as a liberating thought—as the theologian Reinhold Niebuhr wrote in The Nature and Destiny of Man, “Man is most free in the discovery that he is not free.” With this in mind, a few principles and practical tips may help you flourish.
1. Understand and accept that life isn’t fair. Students you know who are card-carrying jerks might get great residencies. Your Gandhi-like friend might not. Once you accept this, do the best you can through principle, fair play and smart work (e.g., form a study group with your Gandhi friend).
2. Understand the lay of the land. Some students arrive at medical school with the next 50 years planned out month by month. Others have no idea what next week will entail. Perhaps it’s healthiest to be somewhere in between. Don’t miss out on opportunities through ignorance. Learn the basics (including timelines) for applying to residencies within the first months of medical school. You will need time to explore options, network, achieve top performances (especially for competitive residencies) and engage in dues-paying activities (such as conducting research). In all of this, please be kind to yourself and fellow students—don’t become a gunner. Your best sources of information about opportunities and timelines include the dean’s office and the students ahead of you, especially seniors.
3. The surest way to get a great residency is to be worthy of one. The good and bad news is that there are no shortcuts. Your dean’s letter summary of your performance will be the most important document in your residency application folder. Don’t worry too much about a poor grade from the attending from hell. As in Olympic scoring, I tend to throw out the very lowest and very highest marks (after all, some attendings can be fooled). I will also discount the assessment by someone who doesn’t know the student well, so don’t bother getting a letter of recommendation from someone prestigious unless it pertains to your performance. Consistently good evaluations are bankable. “Excellent student, self-aware, well-motivated, good team member, loves kids and knows pediatrics is for him” is the summary of how a good dean’s letter might read.
4. Set the stage for great letters of recommendation. Provide great service on the wards (see the “MedMentor” column in the March 2003 issue of The New Physician), and find mentors as soon as you can, in year one if possible.
5. Gather intelligence from current residents in the specialty of your choice. God bless the residents at my medical school, one of whom told me about a program I hadn’t considered but added to my list and matched at. Other good resources: faculty members from young (more likely to have information about current conditions) to old (perhaps have better perspective and peer networks). Conversely, regard residency information from fellow medical students with respectful skepticism. I still hear students repeat the same false dictums I heard as a student years ago, such as choosing a program with the same population mix as that you wish to settle in. The fact is, if you choose to get the best training, you will be better equipped to practice with any patient group or population.
6. Choose “away” rotations with caution. If you want to match at the University of Utopia’s program, it may be better to do your rotation in Shangri-La, get their rave support and let the folks in Utopia try to catch you on the open market. The unknown applicant is often more enticing than the known. Also, be wary of doing a rotation at a place that takes a lot of outside students—you may not stand out from the crowd.
7. Make sure your curriculum vitae (CV) tells the story you intend it to. Use the personal statement to help connect the dots or to provide a few new dots that entice interest. The reader of a well-written CV should be able to connect the dots thus: “A candidate with tremendous promise for a career in (fill in the blank).” Here’s another example: “Worked for his achievements, took risks, didn’t waste opportunities, paid back to the community and explored medicine and the wider world.”
Another analogy: If you were a stock someone would want to invest in, your CV should be a graph where the overall tendency is upward. A CV or personal statement with an isolated downturn or two is just fine. In fact, I find it useful to learn how an applicant deals with adversity. (If it’s pertinent to your story, the personal statement may be the natural place to mention how you responded to a challenge.) One of the great thrills for residency program directors is to find promising but overlooked applicants and see them develop into blue-chip physicians.
8. He who lives by the CV dies by the CV. Not only should you never make false statements, but if you list something on your CV, be prepared to discuss it. Grandiose or padded CVs are detestable. Your CV entries should be pertinent to your story.
9. Dream often, plan early and work always. Luck is what happens when preparation meets, recognizes and acts on opportunity. Harvey Mackay, a motivational speaker and author, once said, “A dream is just a dream. A goal is a dream with a plan and a deadline.”
10. Jumping through hoops is a poor substitute for life. Whenever I see the residency application of an accomplished hoop-jumper, I mourn the waste of life. Students who have shown they are learning the discipline, craft and art of medicine while keeping their inner hearth fires burning are the ones I want as my residents (and, I might add, as my physicians). The philosopher Jiddu Krishnamurti wrote in Think on These Things, “The function of education is to eradicate, inwardly as well as outwardly, the fear that destroys human thought, human relationship and love. The function of education is to help you from childhood not to imitate anybody, but be yourself all the time. You may learn to…pass all your exams, but to give primary importance to these superficial things…is like cleaning and polishing your fingernails while the house is burning down.”
The best students are those who are mastering their profession and who have made the decision to develop and share their inner lights with patients and colleagues.
Fortunately, they are becoming more common; we are lucky to live at the dawn of yet another Golden Age in medicine.
Dermatologic surgeon Daniel W. Collison is the former chief and residency program director of dermatology at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire
For PS, CV, LOR
info@road2residency.com