Medical Student Advice for making your Match List

[ARRO official 2018]

Please be sure to sign up for Member in Training on the ASTRO website. You will get updates and our ARROgrams!

From January 2019 ARROgram:

Match day is almost upon us and with that comes the, at times, dreaded ranking process. The most common internships for radiation oncology residents are internal medicine and general surgery. The American Council for Graduate Medical Education (ACGME) accredits residency programs across the United States. This accreditation process brings standardization to programs across the nation. In theory, an intern training in Seattle should have the same educational experience as an intern in Miami. Patient population, environmental factors, and disease prevalence may be different between the two cities, but medical training should be similar. Below are a few things to consider in a program when making your list:



1- Collegiality: It may be difficult to get a feel for the training environment from the interview day alone. It may be easier for those who complete an away rotation, since you will likely observe the interactions between radiation oncology residents and consulting services. For most, the first year of residency will be a challenging transition. That transition can often be difficult given that students are going from a less demanding final year in medical school to a highly structured intern year. It is important to select a program that you believe will have enough support for its interns whether categorical or preliminary/transitional.



2- Training environment: Students who complete away rotations may have a better idea about the training environment at an institution. Keep in mind interactions that were witnessed between radiation oncology residents and consulting services (internal medicine, medical oncology, surgery, etc). Current radiation oncology residents may offer good insight into the local preliminary year. An ideal preliminary year should be demanding enough to prepare you to transition from being a medical student to a practicing resident requiring moderate to distant supervision.



3 - Didactic structure: Make sure that the program you are considering values your education. Unlike medical school, residency is a job. As a job, you are expected to provide a service to your employer. Nonetheless, residency is also a period for you to further your graduate medical education. It is important to find a program that will strive to have a balance between service and education. Your intern year is a year of transition. The goal is to transform you from being a medical student to a resident who can practice with distant supervision.



4- Location: It may seem trivial, but location is also something to take into account. Many would rather match at an internship that is within the same medical center as their radiation oncology residency, while others would rather select an internship close to relatives etc. Unlike what some may believe, you will have some free time. Some months will be lighter than others and therefore will allow you to have time to explore your surroundings. Others would rather pick a place where the cost of living is low in order to live more comfortably. Whatever the reason may be, make sure to take all these variables into account.



For some, putting together a rank order list may be a very easy process due to certain specific needs. Others may have more flexibility, which could make the decision process more difficult. Make sure to go over notes you have taken over the course of the interview season; whether they were mental notes or notes actually jotted down right after each interview. You should not rank a program that is an absolute misfit. However, make sure that you rank enough programs to have an internship lined up for July 1st.

Best of luck with obtaining your first job as a physician

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[Gfunk6]

Allow me to retort with my alternative tips for RO rank order listing:

Phase 1: Rank something higher than RO
Phase 2: ?
Phase 3: Profit

 

[RO2019]

holy thread derailing.

from a moderator no less.

 

[PointA]

The above info from ARRO is too generic to be of much help. Here are my tips:
-If you are dead set on an academic career then go to the biggest name program you can match at.
-If you don't care about academics or want to work in a specific part of the country then match in that location because the personal connections you make with local docs will be much more valuable than the MDA/MSK/Harvard name.
-Consider doing an internal medicine prelim instead of transitional in case you decide rad onc isn't right for you. I know of a couple residents in more competitive specialities that decided they want to go back to IM.
Good luck.

 

[Neuronix]

holy thread derailing.

from a moderator no less.

Gfunk is an emeritus moderator since he stepped down a little while back.

However as a current moderator:

The above info from ARRO is too generic to be of much help.

Agreed

Allow me to retort with my alternative tips for RO rank order listing:

Phase 1: Rank something higher than RO
Phase 2: ?
Phase 3: Profit

 

[Gfunk6]

In my opinion, if you want realistic advice for how to handle your rank list, this thread is pretty good:

Maneuvering the Rank List

 

[evilbooyaa]

The above info from ARRO is too generic to be of much help. Here are my tips:
-If you are dead set on an academic career then go to the biggest name program you can match at.
-If you don't care about academics or want to work in a specific part of the country then match in that location because the personal connections you make with local docs will be much more valuable than the MDA/MSK/Harvard name.
-Consider doing an internal medicine prelim instead of transitional in case you decide rad onc isn't right for you. I know of a couple residents in more competitive specialities that decided they want to go back to IM.
Good luck.

This is good advice.

In case you are undecided on certain things (like location) , some of ARROs points are salient.

I'm confused though, are they talking about intern year or RO residency? The points about collegiality seem to be about intern year.

 

[Radiator20]

-Consider doing an internal medicine prelim instead of transitional in case you decide rad onc isn't right for you. I know of a couple residents in more competitive specialities that decided they want to go back to IM.

Agree with all of PointA's post but want to put in a particular plug for this. There are no prizes for picking the hardest intern year per se, but it's only one year and I do think it's worthwhile to pick the best one that makes sense logistically (e..g, no point in moving twice). With a true prelim year, you've completed 1/3 of IM already and can always go back if you find you love IM/hate rad onc, plus you'll generally be learning from strong IM residents and faculty. With a TY, you won't have completed anything leading to its own board certification; quality of education can also be variable depending on the setting. Intern year is the last chance you're ever going to get to be a real general doctor. Might as well make the most of it and give yourself the best foundation you can for the rest of your career.

 

[Chartreuse Wombat]

It was a long time ago but I did TY and it was outstanding. I had 4 months of surgical subspecialties (GYN, Uro, H/N and Onc) where in many cases I was the first assistant to the surgeon. I found this firsthand experience very helpful for understanding anatomic relationships and gaining insights into how surgeons think. The poor surgical interns were stuck on the floor managing stuff; I had more OR time than they did.

 

[Neuronix]

It was a long time ago but I did TY and it was outstanding. I had 4 months of surgical subspecialties (GYN, Uro, H/N and Onc) where in many cases I was the first assistant to the surgeon. I found this firsthand experience very helpful for understanding anatomic relationships and gaining insights into how surgeons think. The poor surgical interns were stuck on the floor managing stuff; I had more OR time than they did.

I second this. I had a similar experience.

 

[Radiator20]

Glad to hear you both had good experiences and I think if one can find a TY that offers substantial OR time with good surgeons, that would be worth considering. MSKCC TY also comes to mind, though it has its own downsides from what I hear and no idea how much if any OR time they have. That being said, I do wonder how many TYs offer that kind of exposure (vs just community hospital general floor medicine, which seems low-yield).

I guess what I would say is... if you want to pick a TY because you think it offers better training for some specific reason (like one of the above examples), that's one thing. If you want to pick a TY because you think it's the easiest option, that's another. Don't do the latter. Whatever you do with PGY1, make it worthwhile.

 

[ARRO official 2018]

Attention 4th Year Medical Students please read:

A Letter to Fourth-Year Med Students

 

[Neuronix]

I'm sorry in advance because I can't think of a nice way to put this.

Your letter would benefit from proofreading.

 

[udrag14]

Attention 4th Year Medical Students please read:

A Letter to Fourth-Year Med Students

In my opinion, this letter really missed its mark. A majority of radiation oncologist will become clinical radiation oncologist. My advice for medical students is to rank the program that will give you the best clinical training. Most jobs are not looking for the best research resident, but one who is proficient at doing many procedures like SBRT and brachytherapy.

 

[seper]

I'd also put something like "you'll need geographical flexibility to find employment".

 

[thecarbonionangle]

I don’t think it is bad advice. It is not great or like conprehensive but not bad. I think finding good mentorship is very important and finding a place where attendings are truly involved in your education and your sucess is key and hard. If research is important, find a place which truly supports it. if you see a place where residents mostly teach themselves with little to no faculty involvment, run far far away. This is a huge red flag and surrogate for other deep issues in the program, i guarantee you!!. There are many places out there like this. it truly is a shame.

 

[KHE88]

I don’t think it is bad advice. It is not great or like conprehensive but not bad. I think finding good mentorship is very important and finding a place where attendings are truly involved in your education and your sucess is key and hard. If research is important, find a place which truly supports it. if you see a place where residents mostly teach themselves with little to no faculty involvment, run far far away. This is a huge red flag and surrogate for other deep issues in the program, i guarantee you!!. There are many places out there like this. it truly is a shame.

Correct. Few med students ever ask about this important question. A program that forces residents to prepare most or all of their own didactics (or listen to recorded lectures from other institutions) that faculty don't participate in or show up to is a harbinger of more serious program problems and overt malignancy.

If academic doctors won't do the most basic and fundamental of their job functions, that is educate residents, do you think they will do all of the rest of their job functions without relying on residents? Do you think they will support your independent research endeavors or decision to focus on clinical education instead of research if you don't want an academic career, or will they mandate what research you will be doing and use you to pump out their chart reviews and bolster their publication list numbers for promotion?

Pick a program that gives you the tools you need to succeed. A strong up-to-date clinical education where all residents pass their boards and have PD and chair support in their career development and job search without any prejudice or bias as to what environment you want to practice in.

I think common mistakes are focusing on program location and research time. Sure, there are programs that give you a full 12 months of research. Being out of clinic for a full year isn't always exactly a good thing, especially if you're not shooting for an academic career like most, or have no guidance or support in the research you're doing, or if you are force fed garbage retrospective studies to churn out to throwaway journals. Worry about location for your permanent job. Residency goes by fast. Going to a malignant program to be next to the beach or in a top 5 city is a bad deal IMO.

The comments about travel, international outreach, and advanced degrees are somewhat irrelevant. This is not college. Residency is technical training, not a liberal horizon-broadening multidisciplinary enrichment experience. I'm not saying there's not any value to extracurricular enrichment experiences in residency, but a tiny percentage of residents do things like get MPHs or MBAs (and and even tinier fraction use them to any meaningful degree) or travel to Uganda to help set up brachy programs. For the rest of us, your time in training, scope of training, and efficiency of training are most valuable. If people are taking a year of their residency education do to stuff like this in addition to research, you really need to look at those other 3 years and how much training you are getting. Otherwise, we really need to take a step back and think about why we even have a four year residency when you can easily do it in three. I will concede the point about travel to national meetings is somewhat important. Don't rank programs based on how many meetings you get to go to. The meetings are not vacation (especially ASTRO's and ASCO's locations) unless you just blow off the sessions, they're annoying, low yield education-wise, and very expensive. It sucks to go to a program that mandates residents to submit something to ASTRO each year (which typically consists of attendings throwing you something to write up), but then doesn't provide you with adequate financial support to go to the meeting and makes you take vacation days, costing you a lot of your own time and money in the end.

 

[thecarbonionangle]

It is also very important to find a place with a good PD, one that actually cares about residents and their concerns. A place willing to change to improve education is key. Many places out there where resident concerns essentially end up in trash bin.