Advice for ranking programs

CHOOSING A RESIDENCY PROGRAM

The decision about which residency program to choose is a complex one. You must ask yourself questions about your interests, desires, and potential comfort with a program in order to reach the best decision for you. The decision process for choosing a residency generally has three parts: (1) Assessing the preliminary factors, (2) Visiting the program, and (3) Making the final decision.


ASSESSING THE PRELIMINARY FACTORS

Program Statistics

Considering quantitative and qualitative aspects of the prospective program is an important preliminary step. This can help you narrow your selection field very rapidly if you have definite desires in these areas. Some of the factors to weigh include:

Program size
Number of residents
Community involvement
Diversity of clinical population served
Presence of other education programs for residents or medical students
Location

Some students wonder if it is better to remain in the same area where they attended medical school or go elsewhere. Others want to know if they should train where they plan to practice. The answer, of course, is that it depends on your particular interests and the residency programs available. While there is some greater ease of starting practice or finding a position in the area where you have completed a residency, there are many job and practice opportunities available all over the country, and location of training is not vital. However, if you are interested in practicing in a rural area, you should consider a program that provides some on-site rural community experience, even if the program itself is located in a metropolitan area.

Other factors to consider with respect to location:

Size of the city
Geographic location
Climate of the city
Your probable commute
Cost of living relative to salary
Program Content and Structure

The Accreditation Council for Graduate Medical Education (ACGME) sets standards for all graduate medical training, so all programs in a given specialty will be somewhat similar. However, you may want to consider the following general aspects of program content and structure when determining your preferences:

Program orientation and focus
Highly organized procedures vs. more informal atmosphere
Formal didactic conferences vs. more one-to-one teaching
Active and/or required research programs
University affiliation
Availability of experiences in subspecialty areas
Program Quality and Prestige

Opinions vary about program quality and prestige, but you should be able to get a general feeling by doing a few small things.

Talk to your medical school's Director of Medical Student Education, Residency Director and/or Chairperson about the program.
Speak with people who have trained or worked in a variety of programs.
Consult a faculty member who is familiar with a variety of residency programs.
If you know someone who is in the residency program, write or call him/her.


VISITING THE PROGRAM

After weighing all the preliminary factors, prepare a list of programs that you want to visit. When visiting a program, schedule an entire day so you will be able to experience one day in the life of that program.


Meet with People Currently Affiliated with the Program

The flavor of the program is important, so you should speak to people who are currently affiliated with or participating in the program. They will be able to provide the best insight on the current state of the residency. While there, be sure to:

Meet with current faculty.
Talk to residents (without faculty present) who have been in the program for a while. And try to talk with more than one resident, to be sure you aren't hearing an idiosyncratic viewpoint.

During these meetings, try to find out some of the following information:

Are the residents happy?
Are the residents valued by the Department?
Where does clinical work occur? Are the first year residents "sent away"? If so, what is the contact with the main program?
Do residents work in a general medical service in a state or community facility?
Where do recent program graduates go after graduating?
What kind of work do graduates tend to do?
Are there training opportunities in a variety of settings?

Also, when meeting with faculty, be prepared to discuss a patient with whom you have already worked. Program directors are interested in your experiences and interests in psychiatry. They also may ask questions regarding your personal experiences as a way of getting to know you better.

Attend a Seminar/Session/Presentation

Note the quality of teaching, the interest, enthusiasm, and participation of the residents, and the degree of depth and/or sophistication of the presentation. Look carefully at the interaction between students and faculty. Ask yourself the following questions:

How does the faculty interact with the students?
Is there give and take between faculty and residents?
Are the residents free to question or challenge?

Remember, these people will be your colleagues, and you learn from other residents as well as the faculty. If there is a case presentation, try to get some sense of the way patients are regarded.

Is the patient treated respectfully?
Is there a sufficiently broad orientation with regard to diagnosis and treatment possibilities?
Will you be comfortable taking care of a patient in this manner?

Work Conditions

Learn about the working conditions. Ask pointed questions about the following areas:
What's the on-call schedule like?
What back-up is there (both other residents and faculty)?
Is there sufficient ancillary staff?

Benefits

Benefits are very important because they help you increase your quality of life while working as a resident. Be sure to learn as much as you can about the following areas:

Health insurance including psychotherapy coverage - you and also your family
Liability insurance
Paid maternity/paternity and sick leave
Vacation time
Conference attendance
Support groups, advisors, and other support services

Program Flexibility

Ask about flexibility and options, not only in program content and electives, but also in timing.
Are there provisions for schedule modification, part-time or other approaches?
How do the faculty and staff regard these modifications?
Do they seem as if they will be responsive to individual needs?
Are there sufficient elective opportunities to explore your special interests?

Program Facilities

Learn about the facilities. Although the quality of the setting may be relatively unimportant to you, environment can certainly influence learning.
Is the library easily available?
Will you have a private or shared office?
Are there provisions for safety and transportation?
Does the administration seem responsive to aspects of creature comfort?
Are the on call rooms comfortable and quiet? (Be sure to look at one of the rooms.)
Other Considerations
While none of the following factors is usually the determining factor, these features relate to the support system you will encounter during your residency.
What is the policy on supplemental income (moonlighting)?
What are the housing possibilities? - some programs offer apartments at modified rent, but you must ask about them; others provide housing assistance
Are on call meals provided?
Are there provisions for your family, significant other or a guest to join you at meal time?


MAKING THE FINAL DECISION

After visiting all of the programs in which you were interested, it is time to make your final decision. Do not base your decision on just one aspect of the program. A one-day visit is only a single slice of the program; you may have sat in on the worst or best seminar in the entire program; the resident with whom you talked may have had a particularly discouraging or elating experience. Use others to confirm your impressions and make your decision based on all of the information available to you.

Most importantly, evaluate how comfortable you feel with the program and whether this is a good "fit" for you. There are many excellent training programs in psychiatry and this may be a decision better made with your "heart" than with your "head."

Finally, feel free to talk with the psychiatry faculty at your school or contact the APA Office of Graduate and Undergraduate Education at (202) 682-6126 if you have any questions or need additional information. We want to assist you in making a choice that you will be pleased with, and one which will yield optimal personal and professional development.

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