what's up everybody my name is max feinstein and i'm an anesthesia resident
at the mount sinai hospital in new york city
i'm just now celebrating my two year anniversary since
i applied for residency and anesthesia i thought this would be the perfect
opportunity to share my insights into how i chose the residency programs that
i applied to, why i applied to nearly a hundred
programs, and lastly how i made the very difficult decision
of choosing my number one program and why i made it my number one choice
if you find this video interesting or helpful i'd really appreciate it if you
liked it and subscribe to the channel let's get started
so if you are not familiar with how the residency application process works i'll just
briefly explain it which is that fourth year medical students who are in their
last year of medical school submit applications to as many residency
programs as they'd like to apply to the residency programs can then extend
invitations to interview to these medical students. after the
interviews have taken place the medical students sit down and they
make a list of the places where they've interviewed
in order of preference for where they'd like to go.
at the same time, the residency programs also make their own list of preference
of students that they'd like to have as their incoming residents. then after
both the students and the residency programs have made
their list of preferences all of them nationally get put into one
big computer algorithm which crunches all these numbers and
tries to figure out the best way to maximize
everybody's happiness, and then *boom* spits out the residency match
then on match day, which happens in May every year, students are told where
they've matched and that's where they go for residency
the reason why i even feel qualified to make this video is because due to some
extenuating circumstances which i'll explain
i applied to an outrageous number of residency programs which totaled nearly
100 and by the end of residency interview
season i'd actually interviewed at approximately 25%
of all of the anesthesia residency programs nationally so i feel like i've
got a pretty good basis to talk about the range of programs that are out there,
the different factors to consider, and what i've seen at the different programs
that i applied to. the reason why i applied to nearly a
hundred anesthesia residency programs which is just
a crazy number and not something that i would recommend unless you have
extenuating circumstances, but the reason that i did that is
because my wife and i were applying to the match together,
and specifically she was applying to dermatology which interviews much later
than the anesthesia residency programs. so what ended up happening is that i had
already completed literally half of my interviews before
she had even started receiving interview invitations, so at the
beginning of the interview season i had absolutely no idea what cities i should
or shouldn't be interviewing in so i took the approach of interviewing
at practically all of them. i will say that this was a very
expensive approach, it was very stressful, there was a lot of traveling
but the alternative was having a higher likelihood of
not matching to the same city as my wife which sounded way worse than just having
a difficult and expensive interview season. and i'm very happy to say that it
worked out well we both live in the same place
and i would do it a hundred times over to make sure that we ended up with the
same result. that being said, i think that if there
aren't any big red flags on your application and you're not participating
in any sort of difficult couples match, then it's reasonable to apply to maybe a
couple dozen programs. to help you pick those programs, i want
to go over a lot of factors that you can consider as you weigh which programs you
want to apply to and then how you rank them
as far as factors to consider when applying for residency and making your
rank list there are a whole lot of things to think
about. i'm picking just a select few here which i think are a little tricky to
navigate sometimes and worth commenting on.
so the first thing that's worth saying is that location has been shown to be
the number one factor that applicants care about the most
beyond that, one of the things that incoming
residents care about is how many hours they're going to be working
i think it's important to strike a nice balance. if you're working too many hours
i think that's probably an indicator that the residency program has
inadequate staffing, and it also is not good for your mental health to be
working so much that you don't have time to
enjoy your life outside of the hospital. on the other hand if you go interview at
a place that tells you that the residents are working 45 hours a week
and they're out by 3 p.m every day that should raise some red flags for you
in terms of thinking about whether you are going to feel prepared as an
attending physician after four years when you're in the operating room by
yourself. compare a resident who worked 45 hours a
week for four years-- they're clocking in just over 8,600 hours over that
four-year period compared to a resident who works on
average 65 hours a week over a four-year period
they're clocking in over 12,400 hours. that resident who worked more has
literally worked fifty percent more during their training
which means they're at least fifty percent better prepared for what's
coming to them as in attending. that all being said i
think it's important to find somewhere that strikes a nice balance and isn't
too much or too little in terms of hours worked
another factor that's very specific to anesthesia is whether residents are
relieving CRNAs or whether CRNAs are relieving residents
and this really speaks to a prioritization issue for the department
which is: do the departments prioritize resident
education? if so they're going to be relieving
residents to go home at a reasonable hour in the evening
so that they can study. or if the program doesn't prioritize
resident education, then the residents are going to be used
to relieve CRNAs and so the residents are essentially
there to provide a workforce, which in some sense is true
but in a very important sense they're also there to be educated so it's
important that a department values that. another tricky
subject to look into is research a lot of programs will
say that they have research opportunities, which may be true, but
there's really a question about how accessible those research
opportunities are to residents. so there are some programs that have big
names in the field they're pumping out a lot of research
but it's really difficult as a resident to link up with those researchers and
actually get involved. other programs make it a lot easier for
residents to pursue research if that's something that they want to do
another factor worth mentioning is looking at fellowship matches. so for
residency programs that send their own residents to their own
fellowships it's a little bit concerning that other fellowships
nationally aren't interested in taking those residents. it's important to try to
get your hands on a fellowship match list and see where
do residents go once they've graduated, and if they're
not going to a fellowship see if you can try and figure out where
they got employed as attending anesthesiologists i think that figuring
out where residents went after they graduated is a great way to approximate
how the residency program is perceived in the field and how the resident
training quality is perceived. another factor that applies to
anesthesia but not necessarily all the medical specialties out there is whether
a residency program has moonlighting opportunities that are available,
specifically moonlighting opportunities in that specialty itself.
and when looking at anesthesia you'll find that there are programs that are
out there that will pay residents to stay later in
the evening or to come in on weekends or holidays to work
the important thing to think about when considering moonlighting isn't the money
itself, although that's obviously a nice bonus, but to consider what it means that
a residency program values your time enough to pay you money
to stay late. this really goes back to the same
idea of whether a residency program sees you as somebody who's there to work
or somebody who's there for them to educate. i would definitely not base the
decision to go to a residency program on whether or not it has moonlighting
available, and i also really wouldn't make the decision based on any one
factor in particular but it's just another thing to think about
as far as factors to consider for applying to residencies i've saved the
most taboo for last, which is the F word... F for
fun which is-- wait, no, sorry, the B word which is
the best program how do you figure out what is
the best program is it the program that shows up as number one on Doximity's
reputation ranking list? or is it the program that
rhymes with starbird? does it rhyme with starbird? i
don't think it rhymes with starbird. whatever starbird doesn't really rhyme
with harvard but kind of does you get what i'm saying what it comes
down to is that a lot of medical students simply want to apply
to the program that is perceived as the best
in their field and this is a really tricky question to answer because it
calls into question a lot of different factors and not
everybody is going to agree on what the term best means. there are at
least two publicly available ranking resources that i think are worth
mentioning the one is u.s news and world report
which ranks not every specialty but quite a few
specialties and they do this in a way that is
somewhat objective. they use a lot of hospital metrics
in order to come up with figures about patient safety,
morbidity, mortality. i think it's difficult to convert these numbers
into a direct translation of the quality of the residency program
but it may be a place to start looking at some figures that are
more or less objective. that being said only a minority of specialties are
actually represented in u.s news and world reports rankings and anesthesia is
not one of them so that didn't even apply to me
the other ranking resource that's commonly used by medical students is
Doximity's reputation list which allows you to sort
most specialties by reputation. at first blush this is really appealing because
it seems like a centralized way to see what is the
best residency program. but as i went through the interview season during
fourth year and i was talking with other applicants
about what the Doximity ranking list even meant
i kept hearing people say over and over again that it was really just more of a
popularity contest and the Doximity's rankings just
reflected how many people voted for them. this is actually a testable hypothesis,
that residency program size is associated with residency
program ranking. i got so obsessed with this when i was a
fourth year medical student that i actually put together a study that
answered the question of whether Doximity ranking
is simply a reflection of a program size and i found that overwhelmingly for
every single field that i analyzed, this was true.
i actually published the results of that study in the journal for graduate
medical education and i bring it up here because i think it's important for
medical students to consider what goes into the reputation rankings
for Doximity and what that actually means. personally i found Doximity to be
a pretty unreliable source of information as far as reputation for a
residency program so i started to look elsewhere for ways
to gather information about indicators of quality for a residency
program. i've divided that up into objective and subjective resources. as
far as objective non-biased information the best sources
that i can recommend that you look at are the following
one of these resources that you can use is the ACGME's website. so the ACGME
is the accreditation council for graduate medical education, and the only
thing you need to know about the ACGME is that they are the ones who
accreditate all residency programs and so they collect a lot of information
about residencies, some of which is publicly available through their website
so that's worth checking out. one of the things that you won't be able
to get your hands on very easily is the ACGME
residency satisfaction survey which is handed out
every year to all residents of all programs and all specialties
and in this survey one of the questions that's asked is on a scale from one to
five how happy are you with your residency?
now don't you think as an applicant it would be
really wonderful to know what the answer to that question is for a residency
program? well you probably won't find out unless
the program director decides to share it with you
on interview day. i wouldn't recommend that you ask a program director for that
information-- that's pretty sensitive and potentially could land you in a really
uncomfortable spot if they have a low score. but just be aware of
the fact that there are at least several programs that are out there that do
share their residency satisfaction scores on interview day and i think
that's a really nice thing to see. another place that you're able to find
objective information also mixed in with subjective more biased information is a
residency program's website. so make sure that you're checking out
individual programs websites because you're often going to be able to find
information about programs that you're not going to be able to find anywhere
else. as far as subjective resources are
concerned the best place that you can go is the actual residency program itself
by either doing an away rotation there or if it's your home institution just
doing a rotation there. obviously that's much easier said than done and
especially with COVID that's a lot more difficult to do these days.
however if you do have an opportunity to rotate at a program, i don't think that
there's a better way to figure out if it's a good fit for you.
the other very valuable subjective resource
is simply talking with residents who are at that program.
so you can either reach out to the program director to ask him or her to
connect you with residents, or if you know residents directly then
get in touch with them. but getting candid opinions from residents can be a
really good indicator of what the quality of their program is,
how happy they are there, whether they would go there again if they were given
the choice, and so forth. when residency interview season rolls
around and you're going out to pre-interview dinners or pre-interview
zoom calls or whatever they end up doing, it's also important to take stock of how
many residents show up. it can be an indirect indicator of some
type of red flag if not that many residents show up. is it
that the residents in the program were too busy to show up for dinner because
they're working so much? or they just don't have anything
positive to say about the program and so they didn't want to show up?
so i think it's usually a good sign of residency program health if a lot of
residents show up to a pre-interview event. there are a couple
of talking points i want to give you a heads up about that you're probably
going to hear about a lot on every interview day for every program
that you go to. one of those talking points is that the program where you're
interviewing is taking care of the sickest of the sick.
what this comes down to is that taking care of a lot of sick patients is going
to be good for your education because you're going to leave residency with a
very good understanding of how to take care of the most complex patients that
you're going to encounter. having said that, many
programs will pretty much lay claim to taking care of the sickest
people in the entire world. and it's not a bad thing that they're
boasting about this, but just be aware of the fact that
you're going to hear this from a lot of people
dude our patients at our program are so sick
they're like the sickest of the sick!
nah bruh, our patients are even sicker okay they're all ASA 4s and 5s,
literally all our patients ASA 4s and 5s
oh yeah well all the patients at our program are ASA 6s
they're all literally dead
dude, what is wrong with you guys?
the other talking point that you're probably going to hear a lot is that residents get
so much autonomy at this program. autonomy is also one of those things
that's very helpful for education because of course you want to be able to
get your hands dirty, be able to do some thinking by yourself,
treat patients by yourself, not have your attending holding your
hand the whole time, right? i would just urge you to carefully listen when
residents describe exactly how much autonomy they have
and this is one of those things that i think you need to be sort of goldilocks
about-- you need to have not too much but not too little because
if you have too little autonomy obviously that's not
going to be helpful but if you have too much autonomy then
is there anybody that's teaching you there to begin with?
bro we have so much autonomy in our residency program
that our attendings leave us alone so early on
brah we have more autonomy than you. our attendings leave us alone
literally two weeks after we start CA-1 year
no no no no dude on day one of CA-1 year we are actually the attending
dude what is wrong with you guys
in this video i've talked about quite a few factors and some resources that you can
look at when you're thinking about how to
pick out the best residency program. the question then becomes what do you do
with all these factors and information once you've collected it? there are
several different decision making strategies that i'm familiar with and i
think that they sit on a continuum. on one end of the continuum is the gut
decision category where you don't actually
really weigh all these factors, you don't think too much about it, you just think
"what's your gut feeling about a program?" i'm gonna rank that one number one.
i think this is a pretty unreliable way of figuring out best fit for residency
program it doesn't explicitly consider some of
the factors that i think are really important to consider
on the other end of the spectrum is making a list of literally every factor
that's important and then going through every residency program and assigning a
number value to how well they stack up with that factor,
coming up with a cumulative number and then just applying to the residency
program that has the highest number. if this approach works for you then
that's great, but i would caution you and say
this does seem like a very granular way of looking at things where you might
sort of miss the forest for the trees. so my question when i was applying for
residency was: how do i arrive somewhere in the middle of these two extremes?
ultimately i ended up calling my mentor and asking him how to break the tie
between the two places that i was debating ranking number one
the advice that he gave me is worth passing along to you which is the
following: he said pick the place where you think
you're going to be the happiest, because not only will you enjoy the four
years that you spend in residency, but if you are the happiest version of
your resident self you're going to learn the most, you're going to become the best
attending physician, and you're ultimately going to become the best
anesthesiologist possible. what it all comes down to is trying to
look for as much information as possible about the residency programs that you're
interested in and see how they stack up with each
other and if you need to break any ties then go back to thinking about how are
you going to arrive at the program where you are going to be the happiest
well that wraps up this video i hope you found it helpful
i know that applying for residency can be really exciting but also very
stressful at the same time so i wish you the best of luck and if you have any
questions or feedback i'd love to hear in the comments below
thanks very much for watching and i'll see you next time
bye