tips on residency selection

從AAFP上看到一些好東西。
附件裏是AAFP提供的tips on residency selection，其中很多麵世及match的技巧對今
年的同學們很實用，其他tips就是明年的同學們要留意的了。

更多相關信息參見
http://fmignet.aafp.org/online/fmig/index/residency/research.html

以下是其中一篇
Selecting Your Residency Program

Written by Jeff González, M.D., Resident, Department of Medicine, Hospital
of the University of Pennsylvania; MAC Governing Council, Resident and Fellow
Section Representative

This topic is directed both at deciding which residency programs to apply to
, as well as choosing a program after your interviews have been completed. For
most of us this is a very personal decision with many variables. However,
these variables can be broken down into four categories. These include: 1) Program
Characteristics 2) Career Goals 3) Location and 4) Family. I hope that after
looking at these sections you will have a solid framework in deciding which
program offers you the best opportunity to advance your career while at the
same time enjoying your residency.

Program Characteristics
On the interview trail, you will find many applicants busily taking down
notes, asking questions, and sifting through brochures while others do none of this
. I leave this up to you but there are several things that you should keep in
mind or jot down, given your preference, about programs.

Stability. First, look at the stability of the program and the institution.
In the current times of cutbacks, decreased reimbursements and mergers, it is
vital that you are familiar with the finances and outlook of the institution
at which your are considering training. The last thing you want to happen when
you arrive to start your training, is to find that the community hospital you
were hoping to spend much of you time at has been sold.

There are various ways to gather this type of information. I would start by
just asking the residents. If you are not familiar with the city’s health
care environment, they can tell you about recent events that have occurred in the
area. During your interviews, ask about the stability of the health system
and any changes that are foreseen in the future. Inquire as to the strength and
weaknesses of the department and hospital. However, don’t just look at the
financial stability; find out about the educational stability as well. Is
there a permanent department chair? Are there any top departmental administrative
changes that have occurred or are expected? How long have the program
director and department chair occupied their positions?

Support. “We are here to support you!” As an applicant, this is what you
are looking for -- a program that cares about your education and future. Look
for evidence that a program cares about its residents. You can judge this by
looking at the quality of fellowships attained, turnover rate in the program
(how many residents leave/transfer after the first year), availability of
mentors, number of residents that stay at the institution to complete
fellowships, and departmental response to resident complaints as examples.

Flexibility. How much is there in the program? Although most programs have
set schedules, some are more flexible than others. Many of you will have
significant others who are also residents and who you would like to be see
as much as possible during your residency. Does the program match call nights,
vacation, and elective time? There are other things to look for. How
amenable are they in allowing residents to change schedules to attend a conference?
For residents who become pregnant during their residency, how hard was it for
them to get time off?

Institutional Climate. I am referring to the political/social/work climate
at an institution. We all come from varied backgrounds and we should expect
institutions to have a myriad of backgrounds as well. You will find
institutions that are very conservative in their ways and therefore very
unresponsive to change. This could be manifested by very poor relations with
the surrounding community or a lack of community outreach programs. There
are other institutions, which are much more liberal, for a lack of a better word
, in their actions and relationships with neighbors. If you come from a
medical school that is very progressive and proactive, you might not be happy at a
program where you hit a wall every time you come up with a new initiative or
idea.

I have not spent much time in this discussion on finding out about call
schedules, holiday breaks, vacation time, number of elective months, free
meals, call rooms, parking, etc. After about interviews, they all start
blending together. I’m not saying that these variables are not important,
because they can be. But, most applicants do not decide to pick one program
over another based on whether a television is available in every call room.

Know Your Career Goals
By the time you start looking at residencies, most of you will have started
to form some kind of consensus/idea of where you would like your career to lead
. The program you end up choosing will play a large role in helping you
achieve these career goals. Therefore it is imperative that you plan and keep your
options open.

Academics? If you have just spent eight years getting your Ph.D. then you
likely will not be looking for a rural primary care program. If you have
decided to serve under privileged communities then a very academically
geared program might not suit you. What do you do if you are not sure? I suggest
keeping your options open by looking at a more academically oriented
institution. It is always easier to transition from an academic institution
to a rural community practice. It is much more difficult to complete a
residency at a community hospital and then try to get into a competitive fellowship at
Johns Hopkins for example. It is not impossible but very, very difficult.
Prestige/Advancement. This goes hand in hand with the above advice. A well
known and regarded program will give you a better opportunity to attain a
higher ranked fellowship.

The End Game. In looking at your goals in medicine I suggest that you try to
start figuring out where you want to end up practicing and in what
environment. If you want to settle down in New York city as a pediatric nephrologist, it does not matter much where you do your residency; you can complete it
anywhere. But it is in your best interest to complete your fellowship in NYC. The main
reason -- increased contacts and networking. It is easier to look for a job
after fellowship if you know those working in your specialty in that area.
Many job offers are not posted nationwide but disseminated within a closed circle
in a community. If you are coming from Texas, you might be out of the loop.

Community Outreach. Most of us entered medicine to give back to our
communities and participate in their health care. You would think that all hospitals
would feel the same, but this is not always the case. For various reasons a sense
of mistrust can develop between a hospital and it’s surrounding community.
This can make your attempts to develop community programs or even simple events
difficult. I suggest speaking with the staff at an institution: secretaries,
cafeteria workers, nurses, etc. as they can sometimes be much more honest
about these issues than those within a program.

Is Location Important?
This can be a straightforward variable in your decision making process, but
many applicants do not analyze all the advantages and disadvantages of a
specific location. Let us look at some now:

Cost. This boils down to two things: How much will you make? vs. How much
are you going to spend? You have to enjoy your residency and the free time that
you have during it. If you are prohibited from doing this because of
insufficient funds then you are doing yourself a disservice.

Outside Activities. What is there to do in the city? Do you have access to
trails if you are into mountain biking? Do they have a music symphony /
opera house if you like the arts? If these or other questions such as these are
important to you, then take time to consider them carefully. Remember there
is life outside of the hospital.

Patient Population. I found this to be a very important part of my decision
in choosing a residency. In medical school I was involved in outreach to
underserved populations in my city and wished to continue to have this
opportunity as a resident. I therefore looked to train in a city where there
was a large minority population and resources to work with them. Although
the Mayo clinic in Rochester, MN would have given me excellent training it would
not have provided me with the patient make up I was looking for.
Along with population demographics, I also recommend taking a look at the
percent of minority residents and attendings in the program. Make an effort
to speak with them regarding their experiences. Do they feel appreciated? Have
they felt discrimination? Would they choose the same program given what they
know now?

Family Issues
As residents in training we are making decisions on a program which will
affect everyone in our family circle. Their needs are also important to focus on
when making your decision.

Significant Other. Although we try to be “strong” trainees when it comes
to how long we work and stay in the hospital, we have to think about our families.
Most of us will have loved ones back home who miss us and don’t like us
spending thirty-six hours without seeing us. Therefore, when it comes to
looking at programs it is necessary to look at time off. Are you going to
have one day off a month for the next five years?
Your family also has to live in the city where you end up in. Will they have
job opportunities in their chosen profession? Will they like the city? The
main thing to remember is that you will not be happy in your residency if your
significant other is not!

Children. Do you want your children to grow up in this city? Are you going
to be able to afford child care? Does your institution offer reduced/free child
care services? What is the quality of the public school system? These
questions can affect which neighborhood you will choose to settle down and live in and
also affect your commute.

Camaraderie. Remember that you will be spending a large portion of the next
several years with a small group of people many of whom will become very
close friends. It is hard to figure out the dynamics within a program from a short
interview day. I would encourage you to look further. Ask friends who are at
the same institution, whether or not they are in your same specialty, to
give you the “scoop” on the residents there. It is always wise to talk to any
resident who went to your medical school. They are more frank with their
answers. They can give compare the program with that which you have
encountered in your medical school. Make an effort to contact them either on your
interview day or afterwards.

Last updated: Feb 18, 2008
Content provided by: Minority Affairs Consortium
http://www.ama-assn.org/ama/pub/category/6710.html