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Iserson's Getting Into A Residency A GUIDE FOR

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Iserson’s Getting Into A Residency
A GUIDE FOR MEDICAL STUDENTS

Ninth Edition
Kenneth V. Iserson M.D., MBA, FACEP, FAAEM

Richard Amini M.D.

Galen Press, Ltd. • Tucson, AZ

Copyright © 2019 by Galen Press, Ltd. All Rights Reserved.

Copyright © 1988-2013 by Kenneth V. Iserson. All Rights Reserved.

No part of this book may be reproduced or transmitted in any form or by any

means, electronic or mechanical, including photocopying, recording, or by any
information storage and retrieval system, without permission in writing from the
Publisher.

First Published 1988

Second Edition 1990

Third Edition 1993

Fourth Edition 1996

Fifth Edition 2000

Sixth Edition 2003

Seventh Edition 2006

Eighth Edition, 2013

Ninth Edition, 2019

Bulk purchase terms are available. Please contact our special sales department.

GALEN PRESS, Ltd.

P.O. BOX 64400 TUCSON, AZ 85728-4400

PHONE (520) 577-8363 • FAX (520) 529-6459

Sales@galenpress.com • www.galenpress.com

ISBN 978-1-883620-41-7 (softcover)

ISBN 978-1-883620-42-4 (e-book)

FREIDA is a registered trademark of the American Medical Association.

Windows is a registered trademark of Microsoft, Inc.

Library of Congress Cataloging-in-Publication Data

Iserson’s getting into a residency: a guide for medical students / [authors]

Kenneth V. Iserson, Richard Amini – Ninth edition.

p.; cm.

Rev. ed. of: Getting into a residency / Kenneth V. Iserson. 8th ed. 2013. Includes
index.

ISBN 978-1-883620-41-7 (pbk.)

1. Residents (Medicine)–Selection & appointment–United States.

2. Medical education–United States.

I. Title: Getting into a residency. II. Iserson, Kenneth V. Getting into a

residency. III. Title.

IV. Amini, Richard, author.

[DNLM: 1. Internship and Residency–United States. 2. Education, Medical,

Graduate– United States. W 20 I78i 2013]

RA972 .I74 2013 610’.71”550973–dc2

Printed in the United States of America.

10 9 8 7 6 5 4 3 2 1
 Table of Contents
1. The Big Picture 1

Your Challenge 1

The Process 3

2. The Specialties 7

The Choices 7

Specialty Choice 11

The Future of Graduate Medical Education 18

The Future of Medicine 19

3. Core Specialties & Fellowships 29

4. Choosing a Specialty 135

Your Personal Aptitudes—Assess Them Honestly 135

Matching Your Interests to Those of Specialists 140

5. Important Factors in Choosing a Specialty 145

The Factors 146

Difficulty of Getting a Residency Position 156

6. Starting the Process 159

Choosing an Adviser/Mentor 159

Testing Your Specialty Choice 164

7. Grades, Clerkships, Research, Awards, & Summer Work 171

Putting Your Effort Where It Counts, Part 1 171

Honor Grades 171

Arranging Your Senior Schedule 182

 Finding & Applying for Away Electives 184

Subinternship 185

Research 186

Awards 190

Summer Work 192

8. Examinations 195

Putting Your Effort Where It Counts, Part 2 195

United States Medical Licensing Examination (USMLE 196

Comprehensive Osteopathic Med Licensing Exam (COMLEX-USA) 219

Licensure 229

Special Purpose Examination (SPEX) 232

Importance of Passing the Tests 232

Tips for Taking USMLE-Type Examinations 236

If You Don’t Have to Take the USMLE 238

Objective Structured Clinical Examination (OSCE) 239

9. Delaying Your Specialty Decision 241

The Fine Art of Procrastination 242

Taking Time Off 243

Win-Win Decisions 243

Advantages & Disadvantages of a Transitional Year 245

Quick Decisions & Forty Years of Sadness 247

Switching Careers 248

Dangers of Indecision 249

10. Gathering Information 251

11. Finding Programs That Meet Your Needs 263

The First Cut 263

 What Do You Want in a Program? 264

Factors to Consider 270

Narrowing the Choices 303

12. Playing the Odds: How Many Program Applications? 309

How Competitive Is the Specialty You Want? 309

How Competitive Are You? 310

What Do You Have to Lose? 311

13. Buffing Your File: The Paperwork. 315

Your Name 316

The Application 318

The Résumé 336

The Personal Statement 346

MSPE/Dean’s Letter 352

Letters of Recommendation 358

A Picture? 364

The Medical School Transcript 365

Timing—It’s Your Future at Stake 367

14. Special Situations 369

Women 370

Sexual Harassment 374

Marriage, Pregnancy, & Children 375

Couples Matching 382

Shared-Schedule & Part-Time Positions 383

Sexual & Gender Minorities 384

Underrepresented Minorities 386

Psychological Disabilities 392

 Applicants with Disabilities 393

Osteopathic Physicians 396

Older Applicants 402

Public Health Service. 404

Military Service 406

15. International Medical Graduates 415

ECFMG Certification 421

Tips for All IMGs 427

Non-U.S./Non-Canadian Citizens (Non-USIMGs) 428

Visas 429

U.S. International Medical Graduates (USIMGs) 432

Canadian Citizens 434

16. Preparing for the Interview 435

The Mock Interview 435

Timing 438

Wait-Listed 441

Travel Arrangements 441

Updating Information about the Programs 450

Communicating with the Programs 451

17. Looking the Part: Interview Attire 453

Men. 454

Women 457

Clothing Tips—Putting It All Together 460

Packing 461

18. The Visit... 467

Comportment & Body Language. 468

 Behavior during Social Gatherings. 470

Timeliness 472

Confirm Your Interview. 472

Do Your Research. 472

How Well Do You Communicate? 476

Be Organized. 477

19. The Perfect Applicant 483

20. Optimizing Your Interview 489

Sell Yourself 490

Interview Formats 490

Control the Interview—Gently 494

Reasons Why Interviews Fail 495

Things Not to Do 498

Things Not to Ask Interviewers 501

21. The Interview—Your Questions 505

Know Your Questions 505

Confirm Questionable Points 506

Questions to Ask Faculty 507

Questions to Ask Residents 518

22. The Questions—The Answers 527

Presenting Yourself 528

Types of Questions 530

Interview Techniques 532

Illegal Questions 532

Questions & Answers 536

23. Post-Visit Follow-Up 567

 Thank-You Correspondence 567

Telephone Follow-Up? 571

Specific Information 571

Analyze Your Visit 571

Ranking the Programs 572

Go for the Gold 575

24. The NRMP & Other Matches 577

The NRMP Match 578

NRMP Match Rules—General 529

Matching as a Couple 600

Canadian Residency Matching Service (CaRMS) 603

Military Appointments 604

Don’t Believe Anything You Are Promised 605

What to Do if You Don’t Match 606

Matching in Advance (PGY-2 & Above) 612

Not Using a Match 615

Osteopaths & Matching Programs 619

25. You’ve Matched—Now What? 623

Contact the Program 623

Post-Purchase Dissonance 624

Contracts 625

Debt Management 626

Your New Home 626

Conclusion 629

A New Beginning .629

Glossary 631
Medical Organizations’ Websites & Contact Information 637

Index 643

List of Figures
Fig. 1.1 Getting a Residency—The Component Parts 4–5

Fig. 2.1 Essentials of Specialty Selection 9

2.2 The Process of Choosing a Specialty 10

2.3 Personality Traits Associated with Choosing a Specialty 13

2.4 Reasons why Students Choose Primary Care/

Non-Primary Care Specialties 16

2.5 States with the Most Physicians per Capita 17

2.6 States with the Fewest Physicians per Capita 18

2.7 ABMS-Approved Specialty Boards, Certifications, & Special

Qualification Categories 22–5

2.8 M.D., D.O. & IMG Physicians Practicing by Specialty 26–7

Fig. 4.1 Number of PGY-1 & Entry-level Specialty Positions offered in 2016 &
Predicted Change in Number of Clinicians 138

4.2 Characteristics Strongly Associated with the Practice of Some

Major Specialties 141–4

Fig. 5.1 Percentage of Physicians Satisfied with Their Chosen Specialty 146

5.2 Factors Influencing Medical Students’ Specialty Choice 147

5.3 Questions to Ask Specialists in the Field 150

5.4 Average Annual Salary of U.S. Physicians 153

Fig. 6.1 Maslow’s Hierarchy of Needs 170

Fig. 7.1 Questions to Ask about Clerkships 173

7.2 Percentage of Students Doing Audition Electives in

Various Specialties 177

Fig. 8.1 Recent USMLE Pass Rates 205

8.2 USMLE Step 1 Content 209

8.3 USMLE Step 2CK Content 210

8.4 USMLE Step 2CS Content 214

8.5 USMLE Step 3 Content 215

8.6 COMLEX-USA Examination Blueprint 227

8.7 Examination Pathways for U.S. Licensure 230

8.8 Graduate Education Requirements for Licensure 231

Fig. 9.1 Win-Lose Decision-Making Model 244

9.2 Win-Win Decision-Making Model 245

Fig. 10.1 Questions to Ask about Requirements for Specialty Certification 253

Fig. 11.1 “Must/Want” Analysis—The Instructions & the Form 266–8

11.2 “Must/Want” Analysis, Example 269–70

11.3 Percentage of Residency Programs & Residents by

Geographic Region 217

11.4 Percentage of Institutions Offering Health Benefits to

Housestaff & Dependents 295

11.5 Non-Health Benefits for First-Year Housestaff 297

11.6 Percentage of Programs in Various Specialties
Offering Childcare Benefits 299

11.7 Additional Benefits Provided by Teaching Institutions 301

11.8 “Must/Want” Analysis, Example #1 304–5

11.9 “Must/Want” Analysis, Example #2 305–6

11.10 “Must/Want” Analysis, Example #3 307–8

Fig. 12.1 Applicants & PGY-1 Positions, 1952–2018 310

12.2 Median Number of Applications Submitted to Programs in

Various Specialties 313

Fig. 13.1 Requirements for Applications to Different Programs, Example 320

13.2 M.D. Specialties Using ERAS for Residency Positions,

2019 323
13.3 D.O. Specialties Using ERAS for Residency Positions,
2019 324
13.4 M.D. Fellowships Using ERAS, 2019 325

13.5 D.O. Fellowships Using ERAS, 2019 326

13.6 Résumé Disaster Areas 339

13.7 Action Words for Your Résumé 340

13.8 A Résumé Checklist 341

13.9 Sample Résumé, the Disaster 342

13.10 Sample Résumé, Style #1 343

13.11 Sample Résumé, Style #2 344

13.12 Two Other Acceptable Résumé Formats 345

13.13 Sample Personal Statement, Poor 349

13.14 Sample Personal Statement, Good 350

13.15 Alternative Style Personal Statement, Good 351

13.16 Information in MSPE/Dean’s Letters 353

13.17 MSPE/Dean’s Letter, Example 354–6

13.18 Disparaging Comments about Applicants 358

13.19 Elements of a Letter of Recommendation 363

Fig. 14.1 Women’s Representation in Selected Specialties 371

14.2 Gender of Medical School Faculty, by Rank 372

14.3 Women M.D. Faculty in Various Specialties 373

 14.4 Relative Incidence of Sexual Harassment 375

14.5 Reproductive Complications in Female Physicians 379

14.6 Complications of Pregnancy in Physicians & Non-Physicians 381

14.7 Minority Representation on Medical School Faculties 388

14.8 Osteopathic Internships & Residencies 398

14.9 DOs in ACGME-Accredited Residency/Fellowship Progs 400–1

14.10 JSGMESB Point System 410

Fig. 15.1 IMGs Practicing Medicine in Various Specialties 417

15.2 Types of Applicants Filling PGY-1 Positions in NRMP Match 420

15.3 Requirements to Practice Medicine, Do Post-Graduate Training, or Be a

Clinical Research Fellow in the U.S. (Patient Contact) 423

15.4 Citizenship & Visas of IMGs in Residency Training 430

Fig. 16.1 Air Travel Made Easier 444

16.2 Exercises for the Airplane 446

16.3 Pre-trip To-Do List 449–50

Fig. 17.1 Packing Checklist for Interview Trips 462–3

17.2 Packing a Suitcase 465

Fig. 18.1 Elements in the Communication Process 476

18.2 Interview Notes 480

18.3 “Must/Want” Analysis as an Interview Checklist, Example 481–2

Fig. 19.1 Importance of Academic Criteria When Selecting Residents 485

19.2 Relative Importance of Factors When Ranking Applicants 486

19.3 Items in an Applicant’s History That Worry Residency Directors 487

Fig. 20.1 Factors Influencing an Interviewer’s Behavior 490

20.2 Personality Traits Interviewers Seek 491

 20.3 Interviewer’s Rating Form, Example 492
20.4 Guidelines for Effective Listening 496

20.5 Warning Signs for Interviewers 498

20.6 Body Language Do’s & Don’ts 499

Fig. 21.1 Typical Interview from the Interviewer’s Viewpoint 506

21.2 ACGME Requirements for All Programs’ Resident

Duty Hours 523

Fig. 22.1 Illegal Questions—Sexual Discrimination 533

22.2 Other Questions—Legal & Illegal Forms 534

22.3 Specialties Most Often Asking Illegal Questions 535
22.4 Residency Applicants Asked Illegal Questions
during Interviews 536

Fig. 23.1 Follow-up E-mail Template 569

23.2 Follow-up Letter Format 570

23.3 How Applicants Evaluate Residency Programs 573

Fig. 24.1 PGY-1 Training Accepted by Various M.D. Specialties 582

24.2 Specialties, Programs, & Entry-Level Positions

Offered in NRMP-run Matches 583–7
24.3 Average Number of Programs listed on Applicants’ ROLs 592
24.4 NRMP Rank-Order List Decision Tree 593

24.5 Important Dates in the NRMP Main Match & SOAP 596–7

24.6 NRMP Couples Match Results, 1991–2018 600

24.7 Example of a Couple’s Worksheet 601

24.8 Example of the Rank-Order Lists for a Couple 602

24.9 Unmatched Applicants Eligible to Participate in SOAP 609

24.10 Positions available in Non-NRMP Matches 614–5

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