What Determines Your Chances in Getting into Residency Training?
Sunday, October 03, 2010
The ultimate goal of most of our candidates is to secure a residency training position in the United States.
Now, getting in is not due to random acts. You need to be deliberate and take the right steps. There are certain factors which can influence your chances of getting into medical residency in the United States. If you are aware of these factors, you can do something about them.
THE SEVEN MOST IMPORTANT FACTORS THAT DETERMINE CHANCES OF A RESIDENCY POSITION
1. USMLE Scores
Your USMLE scores are by far and away the most important factor in determining your chances of getting a residency position in the United States. Some programs will not even bother to invite you for an interview, irrespective of other accomplishments that you might have, if you do not meet their minimum USMLE score requirements.
In study after study, it has been shown that a candidate’s scores on the USMLE tests (particular step 1) are predictive of their chances at passing the specialty board examinations [1]. Thus, it stands to reason that many program directors will use the USMLE scores to screen their prospective residents.
Best Approach: If you have not taken your USMLE tests, you should ensure that you prepare very well with the aim to obtain the best possible scores. It is not enough to have a “passing score”; make it your goal to score the maximum possible. A very good USMLE score will be between 216-230 irrespective of the field of study. With that, you have one less thing to worry about. Sometimes, it is better to postpone your test to a later date if you think you are not well prepared. If however you have already taken your tests, and your scores are not that fantastic, all is not lost. You can still get a residency position, though your chances are correspondingly less.
2. Number of Attempts
Very closely related to your absolute scores on the USMLE tests are the number of times it took you to obtain those scores. The higher your number of attempts, the less your chances are of getting into a residency program. Many students with high numbers of attempts can readily attest to this. Although they might eventually obtain respectful scores after many attempts, the residency programs are often not impressed.
Closely related to multiple attempts are those scores called “bad passes”. A bad pass is a very low passing score where the scores are so low they hinder rather than help. Unlike outright failure, you cannot retake a previously passed step on the USMLE, except it expires.
While both are undesirable, a first-time bad pass is actually better than great scores after several attempts.
Best Approach: Your best bet to avoid this problem is to study well and score high at the very first time. Never take the USMLE tests until you are ready. Never go into the examination just to “try it out”. Always go with the sole aim of passing, and passing extremely well. If you must retake a test, ensure that you do not attempt each step more than twice. This means, if you have failed a step once, your second attempt must be a do or die affair. A bad pass or multiple attempts can cost you many years, and countless applications as you struggle to get into residency training.
3. Number Of Years After Graduation
Most programs have a five-year cut-off from graduation year. Although most American medical graduates will get into a residency program within this period, the story is not similar for foreign trained medical graduates who have much more to contend with. Thus, unless you have a truly genuine reason to defer your residency training after medical school (e.g. further academic pursuit), you should apply for a position as quickly as possible after graduation. Moreover, since rules and passing scores always change for the worse (for the applicant), it is all the more urgent that you apply for a position as soon as you can, and get your training over with. That said, many residency programs will still accept a candidate who meet other criteria (e.g. good scores and few numbers of attempts).
Best Approach: Apply for residency training position as soon as possible after graduation from medical school. Again, if you have left the medical school more than five years ago, you still stand a good chance of getting a residency position, provided your scores are good and number of attempts is reasonable, as stated above.
4. Program And Field Of Pursuit
Another important factor that affects your chances of getting into a residency position in the United States is your field of pursuit. Generally speaking, certain fields, such as dermatology, surgery, ENT and radiology are much more competitive than pediatrics, internal medicine and psychiatry. Also, some programs are naturally more competitive, irrespective of the field of study. For instance, it is harder to get a residency position at Harvard than, say, Bronx-Lebanon hospital in New York. If you are an international medical graduate (IMG), know that surgical specialties more competitive. Also, first-rate residency programs are naturally more competitive.
Best Approach: Understand that for all practical purposes, unless you are interested academic medicine, you do not need to train at top programs to have a successful career. If you must apply to competitive programs, apply to less competitive ones also for backup, just in case.
5. Your Interview Success
How many interviews do you need to get a residency training position? Only one!
An important factor in getting a residency position is how well your interview process went. Unlike in other parts of the world, interview is very important in the US. You can greatly increase your chances at an interview by following some simple guidelines. Please see the article “Ace That Interview!” for further information.
8. Location of your medical school
This is what determines whether or not you are an IMG or not. If your medical school is located outside the US, you are considered an IMG, irrespective of your place of birth or nationality. Consequently, your chances of a residency position are less compared to those of an American medical school graduate. That is just how it is.
Approximately 80% of residency positions in the US are reserved for American trained medical graduates. The remaining 20% or so positions are open to IMGs. That automatically brings up competition.
6. Personal statement
Although your personal statement is important, it is heavily dependent on other factors. Most programs would like to know why you like their program; why you think you are qualified and what you plan to do with your training at their institution. Your personal statement is your opportunity to convince them that you are a good candidate, and that you stand a good chance of passing the boards after your training. Further details about the Personal Statement is covered separately.
7. Success In the USMLE Step III
This is more applicable to the IMGs. It is also desirable for those American graduates who plan not to go into core medical specialties. The USMLE step III test has now become a major hurdle for residents in the US. We have learnt of many residents have been kicked out of their programs and several others who have completed residency trainings cannot get state licensures because of their failure to pass this test.
Reasons for failure are traceable to the lack of time to prepare during residency training, as well as lack of familiarity with the American healthcare system. The use of the Passfirst’s Complete USMLE Review for step III is quite adequate and enough for success.
Other Less Important Factors
There are other less powerful factors that may affect your chances either way. These factors include, but not limited to:
· How active you have been in medical practice: this is important for those who have graduated from medical school for a long time. Be ready to explain any prolonged breaks during your interview. Sometimes, it is best to address this head-on through your personal statement.
· Who you know in the program: You really don't need to know anyone before you are accepted into a residency position. If, however, your application standing (e.g. scores and number of attempts) is somewhat weak, you might need the help of someone in the program to present your case to the selection committee. Although program directors are somewhat powerful, the chairman of the program may be more powerful in other programs. Knowing members of the faculty may not be enough, because in some programs, candidates are selected as a team effort. But it does not hurt to know people who may be of help when the need arises, particularly for the relatively weak candidate.
· Citizenship status: Permanent residents have certain advantages because some programs will not accept any candidates without these qualifications. However, the possession of permanent residency of US citizenship is a small factor in the grand scheme of things if all the other factors are not in place.
· Clinical Experience within the US: this is desirable but actually not very important. If you have excess time on your hands, endeavor to pursue a postgraduate program (e.g. Master of Public Health, or Master of Healthcare Administration), rather than looking for observerships. If however you would do clinical observerships, a maximum of 3 to 6 months should be enough. Under no circumstances should these be substituted for sitting for the Step III or getting good grades on the USMLE tests.
· Spoken/written English: non-native speakers pose a challenge both to patients and to colleagues. It is desirable to be fluent both in written and spoken English, particularly if you hope to practice within the US after training
David B Olalekan, MD, MS