Residency Rank Order List: What Factors Should You Consider?

Rank order lists must be certified by February 24th, 2010. My residency clients are asking me how to rank programs so I decided to blog on this topic. What are some important factors to consider?

1) Geography
Not only should you be happy in the city where you train, but a large percentage of residency graduates ultimately take jobs or fellowships in the same geographic area where they complete residency. This is not to say that if you train in New York, for example, that you can't obtain an excellent job in California. However, you will make contacts throughout residency so it is often easier to obtain a job or fellowship in the city where you complete your training. Many programs also hire their own graduates.

2) The Residents
Ask yourself if you would enjoy working and socializing with the residents whom you met on your interview day. Did residents seem happy?

3) The Faculty
The attendings under whom you train will be your role models and educators. If you want to pursue a career in academic medicine and research, for example, going to a program where none of the faculty have research funding might not be your best choice. Also, did you like the faculty whom you met? Do you envision working well with them?

4) Patients and Clinical Settings
To become the best clinician, you must see a diverse group of patients in a variety of settings. Where do residents rotate? Do they see a variety of patients with a wide range of diseases? If you are entering a surgical or procedure-based specialty, do residents obtain enough exposure to become skilled?

5) Teaching, Didactics and Curriculum
Evaluate the quality of the teaching that residents receive at the bedside and during formal didactic sessions such as morning report and conferences. Do residents have flexibility to pursue electives?

6) Overall Fit
I have a vivid memory of my interview day at the program where I matched. I had spent some time in the emergency department the evening before my interview, felt immediate rapport with the residents and faculty whom I met and had a great "gut feeling" about the program. I ranked the program #1 and matched there. Listen to your "gut feeling" seriously.

7) Your Personal Preference
Every year applicants are swayed by the positive feedback and communications they receive from programs and consider changing their rank order list in light of this feedback. Applicants cannot manipulate the match algorithm and there is a common misconception that how you rank the programs from which you received positive feedback will somehow improve your odds of matching. Rank your programs based on where you believe you will be happy and receive the best training. Also, never rank a program that you do not want to attend; your match is binding!

Good luck in the residency match this year!

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