I was
truly undecided through basic science years. During my clerkships,
I felt strongly attracted to surgery, OB/Gyn (especially the Gyn-Onc
aspect), and medicine. By end of 3rd year, I narrowed my choices
to general surgery (because I really enjoyed vascular and trauma)
and medicine. I made the final decision after doing a surgical AI
month and infectious disease visiting elective.
How
did you prepare yourself for application to your chosen specialty?
I definitely
did not do the gunner approach with regards to doing years of research
with a surgeon, training as a scrub tech, etc. etc. I talked extensively
with the attendings I had interacted with on my clerkships the month
after I finished the clerkship so that they remembered who I was.
I did surgery for my first clerkship so I had the luxury of time.
I set up a meeting every quarter with 3 attendings who I had identified
as potential mentors. I'm not sure if this would work at every school
but our attendings are very encouraging.
Who
wrote your letters of recommendation for your application?
The three
attendings (chief of vascular surgery, chief of GI surgery, and the
chairman). For general surgery, a chairman's letter is a must. If
you are applying to academic programs, definitely look for professors
who publish and have a national reputation. For community programs,
your letter-writers do not have to be so high powered. Surgery is
a field where personal connections help immensely so if you have
a dream program, definitely try to find faculty at your school who
have trained at your target program and build a relationship with
those attendings. Alternatively, identify the attendings in your
department who have a regional or national office in the various
surgical societies; for example, my chairman serves on the Residency
Review Committee and at every interview, every chairman I met with
would ask me how my chairman was doing.
Which
programs did you apply to and why?
I was
a less than ideal candidate, with very low grades during my pre-clinical
years, but with a solid Step 1 score. I also was fortunate to have
shined on my surgery and medicine clerkships. I had taken some time
off to do wound healing research which helped immensely. I chose
large university programs primarily in the Midwest (Chicago, Wisconsin,
Minnesota, Iowa) and the Southeast (Alabama, Georgia, Texas). I have
family or close friends in these areas; my wife and I just had a
daughter so family support became paramount. I was looking for academic
programs with multiple hospitals (at the minimum, a VA, a county,
and a university hospital) that had at least two "strong" specialty
departments and at least 5 residents per year. I also looked for
programs with a number of fellowships. Though I had heard in the
past fellows take cases from chief residents, I felt that programs
with fellowships are better networked to send their graduates to
fellowships at other places.
What
kinds of questions did programs tend to ask you?
-- Every
program asked me about my opinion about the 80 hr work week and effects
on resident training/education.
-- 1 question about my political activities (I worked on the campaign
for a Republican candidate for governor between MS-1 and MS-2).
-- Multiple questions whether I would really leave my home program.
I was ready to but my school has a history of keeping many of its own
home students (last year 5 out of 7 residents were from home!)
-- Chairman interviews across the board were uniformly short - 5-10
minutes max so not much more time than to give the standard 90 second
spiel and to ask a couple of questions.
What
would you have done differently in applying?
Considering
my mixed record, I think I made the most of my candidacy and landed
a number of interviews at places I did not expect to. In retrospect,
this was probably due to my chairman who I found out had put in a kind
word for me at a number of places. Definitely get on your chairman's
good side - this can make or break!
What
was the most difficult part of the application process?
The most
difficult process was the scheduling - it gets kinda crazy after
a while trying to cluster interviews especially if they come in later.
Most interviews are polite and encouraging - very different from
the horror stories I had heard.
What
should I look for on my interview and tour day?
1) Residents
- General Surgery is 5+ years, and you want to make sure you can
work, eat, breathe, and share sleeping quarters with the residents
around you. Different programs have very distinct "cultures" and
it is imperative to make sure you are comfortable with the prevailing
attitudes.
2) Administration stability - For programs who train smaller number
of residents / year (any surgery program), the chairman and program
director are crucial. My chairman cautioned the students at my school
to carefully consider the stability and longevity of the chairman and
PD. It's a balancing act - a program with a chairman who has been there
30 years may not be changing quickly enough to adapt with the times,
but a program that has changed chairmen 2 times in the past 5 years
can't move forward either.
3) Laparascopic training/facilities - This varies surprisingly across
programs. Check the quality of the surgical skills labs - some places
have rudimentary skills labs at best while others have invested millions.
Lap training is key as patients definitely prefer the laparascopic
approach when possible.
4) Subtle things like how many residents show up for the lunch or tour;
the atmosphere of grand rounds; the interactions between nurses and
residents as you tour. At some places, there was definitely some hostility
either between residents or between residents and staff which is a
big red flag.
What
questions should I ask of residents, faculty, and program directors?
Refer
to Iserson's for some good standard questions in general.
I always asked the faculty about their interactions with residents
and how much they had helped trainees attain fellowships or jobs. After
all, residency is partially an apprenticeship to groom you for a job
ultimately. I found it surprisingly illuminating to ask the PDs what
the future directions of the program were. At a couple of programs,
the PD didn't really have a solid plan and my impressions were further
confirmed after talking to residents about leadership drift.
How
did you form your rank list?
After
I completed my interviews, I met my faculty mentors and solicited
their advice. I then made my initial list based purely on my emotions,
and limited myself to 1 week of intense consideration, moving programs
up and down depending on the notes I had taken which I reviewed many
times.
What other advice can you give
seniors applying in your specialty?
Don't give up hope! General surgery is competitive
again but programs really look for applicants with the right characteristics
- hard work, extreme honesty, reliability, socialibility, evidence
of dexterity (e.g. music). Recommendation letters can be huge! I did
not do any visiting electives and in general, visiting electives seem
to be less helpful in applying for general surgery than in other more
competitive fields (only exception being if you are applying for a
top-tier program like Harvard, Hopkins, UCSF, etc. and you come from
a less competitive school, then you need to establish your "bona
fides" so that they will consider you seriously.) At my school,
all of the gen surg applicants who had the "fire" for the
field matched well while those who wavered and were less sure either
did not match or matched poorly. Chairmen, PDs and residents really
look for enthusiastic future colleagues.
