Selecting a Residency

Selecting a residency program is an important decision.  You will be there for at least three years, and suffering through a bad fit for that long is not pleasant.  What you could tolerate for a year in an internship becomes intolerable over three years.  Moreover, the program has to prepare you to successfully to and pass your specialty board exam.  So how do you go about selecting the best residency program for you?

I believe there are some key variables you should consider when selecting a residency: boards pass rate, number of mentors, academic vs. private practice, and personal variables.

Boards Pass Rate

Arguably, the main purpose of a residency is to train you to be a specialist and prepare you to take the board exam.  Some specialty colleges also require credentials (e.g. case log, publication), which can be a hold-up for some people.  You should definitely know the credential acceptance rate and board pass rate for any residency to which you want to apply.  I know some programs which have terrible credentials acceptance rates because they don’t get their residents’ research projects completed in time.  Remember to compare the program’s board pass rate with the average.  In some specialties, the board pass rate may be 50%- if the program’s former residents have a first-time pass rate of 50%, I would call that pretty good.

Number of Mentors

I think one of the strengths of a residency is the number of perspectives you get during the residency.  There’s rarely one “right” way to do something in medicine, so learning a variety of different ways is helpful.  I think the best residents learn from all their mentors and take the rationales/explanations that work best for them.  In a program with two or- worse- only one mentor, you may not get a variety of perspectives and your clinical practice and education may be constrained as a result.  In the worst case scenario, if a program loses some or all of the mentors, you may not be able to complete the residency.  This is more likely with 1-2 mentors than 3-4.

Academia vs. Private Practice

I think you can get a great education in either setting, and I believe either setting can prepare you for the other (i.e. residency in private practice and then get a job in academia or visa versa).  One is not “better” than the other.  But there are important differences you need to consider.  In academia, you may get a graduate degree with your residency and, therefore, more formal classwork and training in research.  In academia, there are usually more specialties with which you can interact.  In private practice, the caseload is often higher and you get more hands-on experience.  In academia, you are expected to teach students and interns.  Consider what kind of environment you enjoy working in and which would be better for you.

Personal Variables

This includes a wide variety of considerations, like how much direction/direct mentoring do you want, if you are OK shoveling snow 7 months of the year, how expensive the town is, and what the personality of the mentors and other residents is.  The more you know about the program, the better decision you can make as to whether it would be a good fit for you or not.

I strongly suggest you do not take a “residency at any cost!” approach to selecting a program.  I really don’t think it is worth being miserable for three years of your life.  I think you should carefully consider the above variables before choosing where to apply or accept a position.  As always, be honest with yourself and try to reflect on what would make you happy.