From MS4 and ERAS to PGY-1: The Difference a Year Makes!

[MidwestMD2015]

Good luck to all the MS4s putting finishing touches on ERAS applications!

I can hardly believe that exactly one year ago, I was in your shoes.

From reading a handful or 'what are my chances?' posts to wondering how to figure out 'the perfect program', I can remember the number of possibilities for my future seeming almost overwhelming.

A few highlights to look forward to:

1) Meeting amazing psychiatrists and future-psychiatrists on the interview trail was more interesting than I could have imagined. It's a glimpse into the world of psychiatry training with such a broad view...when do we get an opportunity like that again?

2) Most of you will match somewhere! One of the places you visit, you'll be there...less than a year from now. You'll be in patient rooms! Putting orders in! Pushing your knowledge and skills in ways you can hardly imagine!

3) All of my friends and colleagues who matched in psychiatry seem to love their programs. I genuinely enjoy being where I am and coming to work every day almost 3 months after orientation started. Most of you will too! The Match seems to work pretty well, in some ways!

4) Often, people say that fourth year is an 'easy' year. I don't completely buy that--instead, I'd say that it has unique challenges (logistical, financial, trying to put together what your professional future will be like...) So don't be caught off guard. I'm not usually the kind of person who keeps a calendar/planner, but it sure helped last year.

5) Match Day will be here before you know it! Love the process or hate it, the stress of figuring everything out this year seems to make clocks run faster or something because it literally seems like last month that I was making sure my last letter writer finally got her letter into the system...

The best part of all of this is that suddenly you'll be an intern, all set as a PGY-1 being called 'Dr.' left and right. Despite sometimes having a tough schedule, I am continuously surprised by how quickly learning happens when you have this responsibility. Even when exhausted, something exciting inevitably happens every day, and I cannot believe the amazing stories and things that my patients have taught me.

Saying all of this, I'm sure the PGY-2/3/4 folks out there, the attendings, the program directors, the fellows...they probably have some fond (or not so much) memories of being in exactly the training level I am right now. Perspective is a funny thing. Can't wait to look back and realize how much I didn't know all the way back when I was an intern.

The bottom line is, we're lucky to be in this field, to take up the mantle of caring for patients who are in such need, in a way that can make a significant difference.

Best of luck submitting your ERAS applications, good luck in the interview process, and I can't wait to meet some of you at dinners starting in a month or so.

If anyone has any questions or anything, there are quite a few people who gave some great advice on this forum and I'm happy to add my voice too!

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[sojourner1856]

Thank you for such a kind post. Perspective is so helpful, particularly in times when the "little details" and stages of the process makes us forget the bigger picture.

 

[Dharma]

Awesome post @MidwestMD2015 ! Thank you!

 

[shan564]

Agree completely. I felt exactly the same way two years ago as the OP feels today.

 

[MidwestMD2015]

Agree completely. I felt exactly the same way two years ago as the OP feels today.

And I definitely met you during the interview trail last year (at the Christmas party!) You're a great advocate for your program.

 

[koikisi]

I am so happy that there are people who are enjoying there program.

Just a word of advice to those who are beginning the interview trail, make sure you investigate the programs thoroughly as you go to them, if anything smells fishy during interview day, such as disorganized staff or PD, that should be a red flag. Also, if most of the residents are from India or Pakistan and are FMG's, that should be a red flag as I have learned.

Not to sour this thread, but I thought I would put this out there as advice to those going forward.

 

[shan564]

And I definitely met you during the interview trail last year (at the Christmas party!) You're a great advocate for your program.

Ha, thanks... I love my program and I always try to put an active effort into recruiting, but I hope that I don't give it a "too good to be true" flair when I advertise it to applicants...

Just a word of advice to those who are beginning the interview trail, make sure you investigate the programs thoroughly as you go to them, if anything smells fishy during interview day, such as disorganized staff or PD, that should be a red flag. Also, if most of the residents are from India or Pakistan and are FMG's, that should be a red flag as I have learned.

I definitely took "disorganized staff/PD" as a red flag, since it suggests to me that the culture of the program is less organized and less resident-centric if they can't even manage to put together a good interview day. I'm not questioning their competence, but if the interview experience is subpar, I'm guessing the reason is because the PD and other faculty members are busy with other duties and don't have as much time for residents. Ther are many programs where revenue-generating clinical activities take priority over education. I'm lucky to be at a program where that's absolutely not the case, and that fact was very clear from the amount of attention that we received on the interview day.

For instance, at the program that I ranked #1 (and eventually matched there), there were 3 administrative staff members AND a chief resident who were actively involved in walking us around the facility so that we don't get lost, even though there were only 3 people interviewing that day. I also interviewed at another program (which I ranked near the bottom of my list of 17 - would have ranked them last if not for the location) where there was 1 program coordinator coordinating a group of 12 interviewees (they have a joint psych/neuro program, so there were 6 psych applicants and 6 neuro applicants), so after each faculty interview, they asked us to wait outside the faculty member's office for the PC to come by with the whole group to pick us up, and then walked the whole group to each office to drop people off. Also, at my program, I had 5 (or was it 6?) individual interviews, most of which made me feel like they were trying to give me a feel for the program rather than trying to interrogate me. Most of those interviews were with very senior faculty members (including three full professors and two executive faculty members). Most applicants interviewed with the department chair also, but I happened to interview when he was on vacation, so I met the Vice Chair for Education instead. At many of the programs that I found disappointing, there were only 2-3 interviews, some of which may not even have been with faculty members (at one program, I had a joint interview with the PD and APD, and then a separate interview with two residents, one of whom wasn't very enthusiastic about the program).

As for the FMG India/Pakistan thing - I might call that more of a yellow flag than a red flag. Some programs are just more open to IMGs than others, which isn't necessarily a red flag if they're doing it because they're trying to get the best applicants from around the world rather than just the best applicants from the US. Other programs are full of IMGs because they can't manage to attract local applicants. I interviewed at at least one program where they actually liked IMGs because they're in a multiethnic community and they actually benefit from the cultural diversity among their residents. I interviewed at another program where 90% of the residents were international, but we didn't meet any of them - we were only introduced to two of the few Americans in their pool.

Also, pay attention to how many residents you meet during the interview process. If you're only meeting 4-6 residents, then you should wonder why more of them aren't coming to advertise their program to you. Is it because they're inundated with scutwork? Is it because they don't like the program enough to be motivated to sell it? Is the interview day structured in a way so that you don't have an opportunity to meet them (suggesting that the PD either doesn't trust them to give you a good impression or the program isn't willing to give them the flexibility to come and meet you). There was one program where "meeting residents" constituted lunch in the cafeteria with two residents, where they just gave us a meal voucher to get normal cafeteria food. At my program, they book out a conference room and order catering in order to encourage more residents to come and meet you, and you'll probably see at least 10-12 residents during that lunch plus another 5-6 at dinner the night before.

 

[Nymphicus]

Looking forward to finishing with ERAS and moving on to interviews, or anything else than ERAS really.

 

[MacDonaldTriad]

Really, “only 4-6 residents”? If I left my office right now and went in search of residents not in a class or rounds, it would take me the better part of an hour to find 4 – 6. We line up a lunch with a few and an interview with a chief or senior resident. If that makes us appear to hide residents from applicants, we are going to be giving that impression. Our residents may or may not love their program, but they definitely are not jumping over one another trying to interview applicants. I’m just saying that selection committee energy isn’t the only measure of resident happiness.

 

[Doctor Bagel]

Really, “only 4-6 residents”? If I left my office right now and went in search of residents not in a class or rounds, it would take me the better part of an hour to find 4 – 6. We line up a lunch with a few and an interview with a chief or senior resident. If that makes us appear to hide residents from applicants, we are going to be giving that impression. Our residents may or may not love their program, but they definitely are not jumping over one another trying to interview applicants. I’m just saying that selection committee energy isn’t the only measure of resident happiness.

I do agree with Shan that applicants probably like to meet more residents -- at least I think I did, but I also agree with you that's it's probably not a true indicator of program quality. I think at UCLA-Harbor, I met maybe 2 residents because they didn't have an applicant dinner or happy hour. At Dartmouth, there were 2 residents at dinner, but then, I was the only applicant at dinner, so I guess that ratio worked. Both are (I think) solid programs that aren't knowing for being particularly malignant. Thinking back, Shan's program did do a really good job at getting residents to attend dinner and lunch, and UCLA/NPI had a happy hour that was attended by a lot of residents. I remember at my program, it was a struggle to get people to attend dinners, which was really a logistics issue -- the dinner was at a wonderful restaurant but in another part of town. If you then lived in even another part of town, it could make for a long day. Unfortunately, it also introduced applicants to the hell traffic around where my training was.

Anyway, I'm rambling, and I'm also a bit of a pessimist about our ability to spot red flags. In the end you'll be making this decision on gut feelings, which might or might not be useful. I'd advocate prioritizing location. Personally I'm also glad that I trained at a place where psychodynamic ideas were appreciated, which requires support for having a lower volume outpatient clinic.

 

[Doctor Bagel]

Looking forward to finishing with ERAS and moving on to interviews, or anything else than ERAS really.

It's super exciting to start getting interview invites. I think that was about the highlight of my medical school years.

 

[MacDonaldTriad]

We did try and organize an applicant dinner, but our institution’s grad education policy precludes any work function from even acknowledging the existence of alcohol. It seems our school was successfully held liable for a trainee’s DUI that precluded that person’s getting licensed in our state. It isn’t that we can’t get residents to come to a dry dinner as much as that the faculty would be required to police the activity to a point that it is better just to avoid the issue.

 

[shan564]

We did try and organize an applicant dinner, but our institution’s grad education policy precludes any work function from even acknowledging the existence of alcohol. It seems our school was successfully held liable for a trainee’s DUI that precluded that person’s getting licensed in our state. It isn’t that we can’t get residents to come to a dry dinner as much as that the faculty would be required to police the activity to a point that it is better just to avoid the issue.

Yeah, maybe I was being a bit too pessimistic when I said "only 4-6 residents." In my limited experience, the programs where I met more residents turned out to also be the programs that later gave me a positive impression with more experience in academia. It's probably easier at some programs because of the size of the program.

You posted that it would be hard to find residents who weren't in class or rounds at that moment - that would also be the case at my program before noon, but my program schedules interviews in such a way as to minimize such conflicts. We usually have 5 residents at dinner, at least 10 at lunch, one who guides applicants from the hotel to the interview in the morning, a chief who gives a tour (although those two may also have been at dinner/lunch), and one who interviews applicants.

But yeah, I didn't mean to imply that it was a red flag. But as an applicant, before I commit to spending 4 years somewhere, I'd want to hear positive feedback from multiple people who are training there.

It sounds like that alcohol policy is an unfortunate restriction. Our program pays for alcohol at the dinner, so it's easier. I go to more interview dinners than any other resident, even though I don't drink... but I can understand the issue about needing faculty to monitor the activity. But wouldn't it be possible to hold the dinner at a place that doesn't serve alcohol? I'm sure that such a place exists.

Dr Bagel - why on earth would they hold an interview dinner in a different part of town? That sounds like a silly reason to potentially annoy a good applicant. As an applicant, if that happened, it would lead me to believe that the program is not in a part of town where residents would want to live or socialize. We love to show off the neighborhood in which our hospital is located.

That said - by no means would I judge a program solely on the amount of energy exerted by the selection committee. I would just take it as one of many peripheral indicators that is only meaningful if several other peripheral indicators are present. It's like seeing a patient with a history of several incarcerations - I won't assume that they're a sociopath based on that one fact, but it'll drive me to look hard for other indicators.

 

[Doctor Bagel]

Dr Bagel - why on earth would they hold an interview dinner in a different part of town? That sounds like a silly reason to potentially annoy a good applicant. As an applicant, if that happened, it would lead me to believe that the program is not in a part of town where residents would want to live or socialize. We love to show off the neighborhood in which our hospital is located.

That is actually kind of true. The hospital where I trained is in a very unique geographical area, which is lovely and safe with endless gorgeous views. However, it's not particularly lively -- there aren't many nice restaurants nearby. You can certainly live nearby if you want to be close to work, be in a beautiful area and just forgo being able to walk somewhere. So the area is somewhat of a sell for the program, but not in that it's close to nice places to feed a bunch of applicants because it's not unless you want to go the hospital cafeteria, which is actually really nice for a hospital cafeteria, but it's still a hospital cafeteria. With the traffic near the hospital, again worsened due to its unique geographical location, it takes 30 minutes to get from there to most restaurants regardless. So yeah, it made dinner a bit of a conundrum.

 

[Merovinge]

First of all, great thread, I felt almost that exact same way as an intern and good to know that it exists more broadly.

That said - by no means would I judge a program solely on the amount of energy exerted by the selection committee. I would just take it as one of many peripheral indicators that is only meaningful if several other peripheral indicators are present. It's like seeing a patient with a history of several incarcerations - I won't assume that they're a sociopath based on that one fact, but it'll drive me to look hard for other indicators.

Don't sell your point short just because of 1 point speaking to the contrary (can only assume MDT's institution is great based on his presence). It should absolutely raise flags if people can't find a way to get psych residents to lunch. We've actually had to ask less folks to come to some lunches as the food only supports about a dozen of us. Neurosurgeons at my institute all come to the dinner and lunch (admittedly they are forced) for recruitment and their department survives, so I am absolutely sure psychiatry can find a way. Resident participation in these events absolutely speaks to moral, and that may end up being one of the most important parts of your experience in residency.

 

[MidwestMD2015]

I remember last year thinking quite a bit about "best fit", the "culture" of a residency, and how to figure that out!

We only have a few data points in the process that even give a clue to whether a program would be right for us.

Before we apply, we look at things like this forum and read anecdotes and ratings and reviews. This is more 'information gathering' and you only get a glimpse of an institutional culture, and the quality of the information is often suspect...

You can read information, hear about the call schedule and curriculum and the special sites and electives...and then?

The interview day is the best quality information about 'fit' and 'culture'. You have to figure out if this is a place with people that you'd want to work with. It's professional AND personal. Many of these people will become your friends, you will learn from them and spend more time with some of them than you will even spend with a significant other.

So is it important to meet residents during the interview day? Of course. It's absolutely critical to meet a few residents. The more that you get to meet, the more complete you can characterize the program community. No amount of outside reading or investigating online is going to give you that.

Is an interview dinner the best way to get to know the residents? You know, it's hard to say, but thinking back on the 10 interviews that I did last year, it certainly counted for a disproportionate level of my overall impression. Really amazing residents and community wouldn't raise a program I initially thought of as 'low' on my list to the top of my list, but it certainly made a difference of 1 to 2 places.

The program where I matched was one of four programs that I felt a really strong connection with the residents, faculty, and program philosophy on my interview day. All had interview lunch/dinners attended by 8-12 residents.

So if I could be 'in charge' and prepare an applicant's visit with no constraints, I most certainly would want to expose them to as many residents as possible (within reason) so that they knew what they would be getting from their colleagues. The flip side is, I can think of plenty of reasons why a program would want to minimize contact with residents if morale was low or their institutional community wasn't strong--prospective applicants think about that too!

Anyway, I'll be making an effort to get to as many applicant dinners as possible once we start up with all of that here. I love my program, and I can't wait to tell the coming batch of applicants all about it in person.

 

[Armadillos]

As an applicant it's reassuring to see more residents in general just because it helps you to get a better feeling for the overall personality of the class. If you only meet 2 residents then you have that fear that they are hiding the weird residents from you or nobody gives a crap about the future of their program

 

[koikisi]

Ha, thanks... I love my program and I always try to put an active effort into recruiting, but I hope that I don't give it a "too good to be true" flair when I advertise it to applicants...


I definitely took "disorganized staff/PD" as a red flag, since it suggests to me that the culture of the program is less organized and less resident-centric if they can't even manage to put together a good interview day. I'm not questioning their competence, but if the interview experience is subpar, I'm guessing the reason is because the PD and other faculty members are busy with other duties and don't have as much time for residents. Ther are many programs where revenue-generating clinical activities take priority over education. I'm lucky to be at a program where that's absolutely not the case, and that fact was very clear from the amount of attention that we received on the interview day.

For instance, at the program that I ranked #1 (and eventually matched there), there were 3 administrative staff members AND a chief resident who were actively involved in walking us around the facility so that we don't get lost, even though there were only 3 people interviewing that day. I also interviewed at another program (which I ranked near the bottom of my list of 17 - would have ranked them last if not for the location) where there was 1 program coordinator coordinating a group of 12 interviewees (they have a joint psych/neuro program, so there were 6 psych applicants and 6 neuro applicants), so after each faculty interview, they asked us to wait outside the faculty member's office for the PC to come by with the whole group to pick us up, and then walked the whole group to each office to drop people off. Also, at my program, I had 5 (or was it 6?) individual interviews, most of which made me feel like they were trying to give me a feel for the program rather than trying to interrogate me. Most of those interviews were with very senior faculty members (including three full professors and two executive faculty members). Most applicants interviewed with the department chair also, but I happened to interview when he was on vacation, so I met the Vice Chair for Education instead. At many of the programs that I found disappointing, there were only 2-3 interviews, some of which may not even have been with faculty members (at one program, I had a joint interview with the PD and APD, and then a separate interview with two residents, one of whom wasn't very enthusiastic about the program).

As for the FMG India/Pakistan thing - I might call that more of a yellow flag than a red flag. Some programs are just more open to IMGs than others, which isn't necessarily a red flag if they're doing it because they're trying to get the best applicants from around the world rather than just the best applicants from the US. Other programs are full of IMGs because they can't manage to attract local applicants. I interviewed at at least one program where they actually liked IMGs because they're in a multiethnic community and they actually benefit from the cultural diversity among their residents. I interviewed at another program where 90% of the residents were international, but we didn't meet any of them - we were only introduced to two of the few Americans in their pool.

Also, pay attention to how many residents you meet during the interview process. If you're only meeting 4-6 residents, then you should wonder why more of them aren't coming to advertise their program to you. Is it because they're inundated with scutwork? Is it because they don't like the program enough to be motivated to sell it? Is the interview day structured in a way so that you don't have an opportunity to meet them (suggesting that the PD either doesn't trust them to give you a good impression or the program isn't willing to give them the flexibility to come and meet you). There was one program where "meeting residents" constituted lunch in the cafeteria with two residents, where they just gave us a meal voucher to get normal cafeteria food. At my program, they book out a conference room and order catering in order to encourage more residents to come and meet you, and you'll probably see at least 10-12 residents during that lunch plus another 5-6 at dinner the night before.

I originally thought the same way too, that they wanted cultural diversity. However, that is not the case in my experience in my own program, which is nearly 90% foreign grads (of which the majority are of Indian/Pakistani/South asian descent). These docs were trained in their own countries and went to medical school at a young age. They have a different style and system of learning which is entirely different from the rest of the world and it is very disorganized (in my opinion, being trained at a US Medical school). A lot of these doctors were attendings in their country and when they got a visa sponsorship to live in the US, it was a dream come true for them due to the greater financial prospects available in the US. They have a very submissive culture where they tolerate outrageous amounts of scutwork easily. Programs that are filled with them, in my experience, are forced to take these candidates because they do not have better options elsewhere and have an extremely difficult time getting US graduates (either from MD or DO schools, and even big name Carribean schools e.g. Ross, SGU) because either the program is in a poor location, or it is known to be a workshop.

On the upside, from a PD's point of view, these FMG candidates rarely say anything, keep their mouth shut and do their work without any questions asked. They may have some language issues, but eventually with time, they get better with that as well and develop excellent documentation skills.

Bottom line, when you go to your interviews, after going there, make sure you ask yourself, "Can I work in this system? Will I be able to work with these people on a regular basis?" Even if the workload is a lot, it makes a tremendous difference when you have a cohesive and friendly working environment. I feel it becomes more educational and less political. That's just my opinion however.

EDIT: also remember to go with your gut feeling as well when it comes time to ranking places. Don't just solely go off of location.