applying / interviewing for residency

For most specialties, you need four letters. One is from your PhD advisor. One is usually from your sub-I (or another setting where you displayed patient management skills). Many specialties require a separate department letter. So most students only need to obtain one or two extra letters. These letters can be from clinics or from research, e.g. members or chairs of a thesis committee, co-mentors, rotation mentors. Someone who has seen you in both clinical and research worlds - although hard to come by - can be a great letter writer. Note that the Dean’s letter (MSPE - Medical Student Performance Evaluation) does not count toward one of your four letters.

When you ask for a letter, give a copy of (or e-mail) your updated CV and your personal statement to your referee. This will help him or her tremendously. This also means you should start working on your personal statement early (e.g. Spring/Summer of your "3^rd" year).

It is acceptable to obtain (a few) more letters than you need. You may have to (repeatedly) remind attendings to turn in your letters, which can be awkward. It is best if you can get the letters in by Sept 1 for ERAS applications.*

July 1 - ERAS application opens up

Sept 15 - ERAS application can be submitted

Many programs require a secondary application for a physician-scientist track. Some programs will e-mail you for the secondary, while others will expect you to find it online, so always always READ THE WEBSITE. They generally ask for (1) a short paragraph describing your research and its impact on the field, (2) what are your sub-specialty and career goals, (3) contact info for your research advisors / references, and (4) a list of investigators at that specific institution that you want to meet (and maybe work with). Note that item (4) is different for each institution and will require some thought, prep time, and organized notes to take with you on interview.

When to take Step 2 Clinical Knowledge (CK) and Step 2 Clinical Skills (CS) will vary based on individual circumstances and advising. If you need to improve on your Step 1 score based on what is competitive for your chosen specialty, taking Step 2 CK early could be important. Different programs will want to see a passing score for Step 2 CK and/or Step 2 CS by different dates, anywhere from mid-February through graduation. To be safe, taking both Step 2 CS and CK by the end of December would be best. As of 2016, scores would not be automatically released to programs if the exams were taken after Sept. 15, but again check with the Office of Student Affairs. Some students found it easier to take both parts of Step 2 before November to avoid conflicts with interviews, especially in fields where individual programs may have only one or two research interview days per year.

Many programs require a secondary or supplemental application for the physician-scientist track. Some programs will email you with the application, while others will expect you to find it online, so always always READ THE WEBSITE. They generally ask for (1) a short paragraph describing your research and its impact on the field, (2) your subspecialty and career goals, (3) contact info for your research advisors / references, and (4) a list of investigators at that specific institution that you want to meet (and maybe work with). Note that item (4) is different for each institution and will require some thought, prep time, and organized notes to take with you on interview.

• Each specialty has a different interview format for future physician scientists, e.g. (1) the standard residency interview, (2) a separate research interview day, or (3) requiring applicants to give a “job-talk” (like you would for a post-doc).
• Develop a coherent story about what you have done, what your interests are now, and where you see yourself going (e.g. how will you blend your science and your medicine?). This does not mean you have to have your first R01 ready to be submitted, but do give some details (what field of science and subspecialty) about your plans for the future. No one will hold you to this or be upset if your interests change during residency.
• Leverage your science as much as possible: you are a rare and desirable commodity as a physician-scientist.
• Identify and explain how you match up well to the strengths of the program.
• Know your thesis work cold. Be able to give the elevator speech or a detailed 5-minute summary depending on your interviewer. Practice talking about your research with clinicians who are not scientists.
• Penn MSTP alumni are a great resource along the interview trail. Many will reach out to you when they learn that you will be interviewing at their program. They can fill you in on what to expect at their home programs.
• Plan and prepare for travel scheduling and associated expenses. This topic is not really different for MD-PhD applicants so you can refer to the general advice for residency application and matching.

While residency programs often have an official start date as July 1st, many programs start clinical responsibilities mid-to-late June, which means orientation may start in the first week or two of June. So ask the GME (Graduate Medical Education) Office of your hospital before planning that vacation abroad!

Most major academic IM residencies offer a Physician Scientist Pathway (referred to below as a PSP, even though every institution calls it something different). Like MSTPs, no two are exactly the same. However, they tend to share common attributes: Generally, these programs start with the goal of attracting medical students with significant research background to an institution for residency, typically using the ABIM research pathway (a.k.a., the short track). Of particular interest to the applicant is the extent to which these programs may ease access to fellowships at the same institution. This is a huge point of variation, with some programs offering guaranteed fellowship slots and some offering no preferment at all (or a guarantee of some fellowships but not others). Most programs also provide mentorship and molecular medicine oriented seminars, to help keep the science part of the brain working during residency. You can access program-specific information on the Residency Program website that you are interested in and this should be done early in the application process to help you refine your list. Importantly, your match obligation into a PSP program does NOT require that you do a fellowship at the same institution, and pretty much across the board you will have the option of switching from a fast 2-year to a normal 3-year IM residency if either you are not comfortable clinically or the program is not comfortable with you clinically. However, this is not the intent of the pathway, and programs will be expecting that your intention at least at the time of application is to do the “fast-track” (2 years of residency) and stay at that institution for fellowship.

How to Apply

Here is another major point of variability. There are three basic admissions structures: (1) you apply to a unique PSP ERAS match number , (2) you apply to the categorical IM program and are accepted or not to the PSP concurrent with matching there, and (3) you apply to the categorical IM program and then apply for the PSP while you are an intern/resident.

It's a good idea to get acquainted with the PSP of interest’s website pretty early in the game. Often, they will ask for things like extra letters (beyond the 4 through ERAS) or statements of research interest. There is generally no downside to also contacting the PSP administrator to let them know that you are interested if the structure of the program is not clear from the website.

When should I take step 2?

It depends where you want to apply and what your step one score was. It’s important to collect information about the specific programs you are applying to, but generally west coast and Harvard programs like to see it while most others do not care. If these programs are not the most important on your list, then for the 2016 cycle, IM advising suggested that students with step I score greater than 235 not take step 2 prior to applying, thus allowing you the option of hiding your step 2 score if it isn’t what you were hoping for.

Interviewing

Most PSPs have a second interview day, typically with a normal IM interview day either before or after. Some places only have a limited number of days on which PSP applicants interview, so it’s not a bad idea to know when those are before you start scheduling trips. As a PSP candidate, you will end up interviewing with some combination of these 4 types of people: IM residency interviewers, fellowship program interviewers, PSP administrators, and potential post-doc mentors. Not surprisingly, each group is looking for something slightly different in an applicant, and it is probably important not to be overly unidimensional. Also, pretty much everyone who is clinically active will ask you about short-tracking (doing 2 years of residency instead of 3). People seem comfortable with intent without certainty (ie, "That sounds like the kind of thing I might want to do, but I'd like to try to make it as an intern for a bit before I commit.")

In this vein, many clinical interviewers are wary of MD-PhDs being overly devoted to research and not being good clinicians, and they will ask probing questions to see whether you'd blow off residency, especially if you short-track. It often helps to let them know up front that you enjoy clinical work, LOVE patients, and plan on taking residency seriously, as this could be your last chance at a rigorous clinical training. Similarly, a lot of programs will arrange your "scientific" interviews with people in your field, so they will ask detailed questions about experiments, hypothetical future projects, etc, not unlike a thesis committee member. You'll want to come across as the expert and have thoughtful answers ready.

Things to think about

PSPs share a backbone (IM residency followed by some advantage for fellowship), but there are a number of things that make the programs quite distinct. Both for the shared and distinct aspects, there are a fair number of things that you will probably want to have a good handle on before you show up.

• Things to think about early:
  • Do I actually want to do residency and fellowship in the same place? For many a thirty-ish MD/PhD, the idea of a fixed location for the next 6+ years is quite appealing. While no PSP can block you from leaving after residency, this may be awkward depending on the program and situation. If a fellowship is not guaranteed, consider how you’d feel about applying for fellowship early in residency.
  • How sure am I that I know what I will want to do as a fellow? PSPs offer differing degrees of flexibility in when you have to commit to a fellowship. If you want time to think about it as a resident, make sure you’ll get it.
  • It's dangerous to go to an institution with one mentor in mind – you never know if that person might leave or your interests might change.
• In the application:
  • The OSA gives a formula for writing the personal statement that seems to work out well. Just as they suggest mentioning your subspecialty field of interest, it’s probably a good idea to highlight that you have research interests. But just as it’s best not to seem totally obsessed with a subspecialty, it’s probably best to discuss research interests briefly, and only in how they might inform your perspective on medicine.
  • It’s not a bad idea to keep in mind that not every program has a PSP, and that you may be invited to interview for residency at institutions where you are not also invited to interview for the PSP. Make sure that your application is appealing to residency program directors. Note that it is possible to send different personal statements to different programs.
• Program-by-program questions:
  • Will your clinical training be limited? Many of these programs, in a not-unreasonable attempt to speed the path to starting your postdoc, will limit your options as a fellow (for example, some heme/onc programs do not allow their “lab fellows” to double board).
  • How does the residency program help you find your way into fellowship/the lab? Residency and clinical fellowship are both full time jobs, so it’s helpful to have people making sure you stay on track.
  • Are physician scientist fellows valued at the institution? You’ll be rusty after your clinical time, so you want to make sure that the labs you’d be excited about will want to take you. Sometimes programs sweeten the deal for PIs by giving funding your salary for a couple of years in the lab.
  • Can PSP fellows work in any lab in the institution? What about affiliated nearby institutions?
  • Ask about the sequence of research. For instance, some programs promote research before the clinical training during fellowship. Most favor the model of clinical training (1-2 years pending which fellowship) and then the research years but it’s important to ask this questions because it can vary between institutions.
  • Ask about mechanisms of support during the research years. For instance, if your K-award is initially not funded and you need more time based on circumstances, does the institution have other mechanisms of support?
  • If you plan to sub-sub specialize (i.e EP, adult congenital, etc) when does the institution encourage the training? Do they allow you to complete before the research years so you can bridge straight from fellow to junior faculty or is it after the research years?
  • Some institutions you match into a certain fellowship, others say you are guaranteed any fellowship. Some guarantee all but cardiology. If you are between two or more fellowships, it is very important to know the intrinsic details of this before ranking. 
• Interview questions:
  • Can’t overemphasize the importance of having an answer prepared about short tracking.
  • Always be prepared to justify your interest in the specific program you are interviewing for: figure out what makes them the best the coolest and the most special. This is the part that will likely require the most preparation for each program once you have been to a couple and are confident about the narrative you will tell about yourself.
  • For the residency interviews –
    1. Consider that most advising/mentorship for residents is focused on helping them find a subspecialty and do research during residency. You probably won’t want/need either of these things. What does the program offer for a candidate like you?
    2. A lot of residency programs have cool components that you won’t participate in (primary care tracks, international health programs, etc). Will you be able to benefit from the diversity in your residency class?
    3. Elective time during residency can be particularly helpful if you are trying to figure out what your subspecialty will be. If you already know, can you use the elective time for to get a little bit more rigorous training, if you’re only going to be there for two years?
  • For the fellowship interviews –
    1. Most of these issues have been discussed above, but it’s important to keep an eye on how welcome physician scientists are in your area of interest, and how academic the program is overall.
    2. As mentioned before, if your sub-specialty choice has further sub-sub-specialization (EP vs. cath vs. heart failure, etc.), find out if your research interests limit your access to areas outside of your focus, or require you to accelerate your decision of what to focus on.
    3. While you don’t want to give the impression of avoiding work, you probably want to know out if your lab time is pretty well protected.
    4. All of the other typical questions apply here – clinical mentoring, junior faculty outcomes vs. percent going into practice, etc…

The great majority of research-oriented residents decide to do either AP-only or CP-only residency as this cuts residency by 1 year and lets you begin clinical and/or research fellowships earlier. Fellowships after or during residency are optional but increasingly common, since clinical duties are limited if subspecialty fellowships are not done. For instance, clinical duties as an attending would be limited to autopsy if doing AP-only residency and no fellowship.The majority of clinically oriented residents apply to combined AP/CP residency followed by fellowships of interest. Jobs opportunities in private practice are limited for AP-only and CP-only residents or for residents that have not done fellowships. By contrast, a growing number of residents committed with certainty to academic pathology switch to AP- or CP-only pathways during training as they specify their interests. Combined AP-CP residency length: 4 years total (2.5 years of clinical requirements as specified by the AP Boards + 1.5 years of CP requirements). 4th and 5th years would be used for fellowships. AP/CP training program electives can include research time but these are usually limited to 4-6 months.

The bottom line: if you are absolutely committed to a future as a physician-scientist or a research-oriented academic pathologist, you are likely to benefit from applying in AP- or CP-only. If you are unsure, or are harboring thoughts about possibly going into private practice, then AP/CP is for you.

Anatomical Pathology, AP-only applicants

Length: 3 years total (2.5 years of clinical requirements as specified by the AP Pathology Boards + 0.5 years of research elective). Research-oriented programs may let you fudge these requirements and do only 2 years of core clinical requirements. Third year could then be used entirely for research or for completing a clinical subspecialty fellowship before a formal post-doc. Exception to the latter is sub-specialities that require an additional subspecialty board examination besides the general AP boards (Dermpath, Neuropath, Hemepath). These fellowships required 3 yrs of AP and passing of general AP boards before entering into these fellowships. AP boards seem to be required before entering surg path fellowship, which means 3 years of residency/research before becoming a surg path fellow. Note: board requirements seem to change year-to-year and it may be worth checking them when applying.

After 3 years of residency/fellowship, during a formal research post-doc, most research-oriented programs guarantee 1 to 3 years of salary support or until obtaining a K08 grant at the corresponding PGY level if the resident/fellow decides to do a formal post-doc. This funding support seems to make residents/ fellows more attractive to join the lab in terms of the PI's perspective. Some programs have formal names for this kind of pathway, and the number of years that are guaranteed depends on the program.

Clinical Pathology, CP-only applicants:

CP is comprised of transfusion medicine/blood bank, coagulation, clinical chemistry, molecular and genomic diagnostics, hematopathology, immunology, and microbiology rotations. Some of these rotations may be combined depending on the program.

While there are many fantastic pathology programs around the country, those with dedicated CP-only pathways and a track record of producing CP physician-scientists are fewer. You should ask around to develop your own list. However, programs known for their especially strong CP and where CP-only residents have had past success include: Penn, Wash U, Yale, MGH, Brigham, Stanford, UCSF, University of Washington, Mayo, UTSW, and Cornell. Please note that this list is not comprehensive.

Length: 3 years total (2.5 years of clinical requirements as specified by the Pathology Boards + 0.5 years of research elective). Research-oriented programs let you fudge these requirements and do as little as 15 months of core clinical requirements while most require 18 months and some require up to 24 months. Program-specific policies on the length of core clinical training are important to consider when evaluating programs. The balance of second and third years are often used entirely for research, or for completing a clinical subspecialty fellowship during second year before a formal post-doc in third year and beyond. Most programs will not let you start a board-eligible fellowship such as transfusion or hemepath until after your PGY3 year. Non-board eligible fellowships (micro, chemistry) can be started during PGY2 or PGY3. Some programs will let you fudge this requirement for even board eligible fellowships and let you complete the majority of your fellowship clinical work in your PGY2 year to enable uninterrupted lab time. This is highly program-dependent and negotiable but would still entail doing 10-20% clinical time during what is on paper your PGY4 fellowship year. For strong CP only applicants, there may be some negotiating room in extra guaranteed research time, salary support, guaranteed fellowship spots, etc. Don’t be shy to ask. The programs are all small which makes it easier to make exceptions.

Most research-oriented programs guarantee salary support during research years at the PGY level. This can represent a $10,000/year boost (or more) above NIH post-doc salaries, so it’s important to confirm this support from any program purporting to provide a physician-scientist pathway. As for AP only, some programs have formal names for this kind of pathway, and the number of years that are guaranteed depends on the program. Salary funding during a formal Post-doc after the 3 years of residency/fellowship at the corresponding PGY level is similar to the description for AP-only residents mentioned above.

Note: Hemepath fellowship requirements are changing and it may be worth checking them before applying. For instance, most Hemepath programs will require passing of general AP or CP boards before entering into this fellowship, which would mean 3 yrs of residency + 2 yrs of fellowship.

CP-only interview days are usually a combination of more directed interviews with key department leadership and informal, research-oriented discussions with investigators (not unlike your MSTP interviews). CP interviews are almost always loose and friendly and need not be stressful for applicants. Most interviewing faculty are assessing your fit with that particular program more than your “worthiness,” per se. Programs will want to see well-thought-out career goals, a record consistent with moving toward those goals, and a clear idea of how their CP-only residency helps you achieve them. Many but not all programs with physician-scientist tracks have moved to two-day interviews, allowing more time for you to meet with research investigators. Most programs will solicit a list of research faculty with whom you will want to meet; be sure to give many names (8-12), as faculty schedules tend to be tight. A handful of programs also ask for you to give a seminar to the department ranging in length from 15 to 60 minutes. This can be based entirely on your thesis work, but remember to adjust your story for length (going over time is bad form) and for audience (many non-expert clinicians are in the audience).

Four key questions in evaluating CP-only physician-scientist programs:

1. Is their physician-scientist track the real deal or lip service? Ask about PGY-level salary support, length of training before most trainees return to the lab, what oversight and advising structures exist for the transition to post-doc work. If their values in combining your research and clinical goals remind you of Penn’s MSTP, you’re more likely to do well.
2. What are current residents/previous graduates doing now? Look into how many are still on a research track (vs. full-time clinical), how many complete post-docs and apply for faculty jobs, and (very importantly) how many have successfully acquired a K08 or equivalent grant to launch their research careers.
3. Can you see yourself doing a post-doc there? Remember that you’re choosing a post-doc institution as well as a residency, and this training will likely be just as important in shaping your future career. Is there a deep bench of investigators with whom you’d be overjoyed to work? Is there a track record of research success among past CP residents?
4. Are the residents actively involved in clinical service? Because CP-only is a fairly rare and research-heavy specialty, there can be some variation among programs in how actively engaged residents are with day-to-day service. When you visit, try to get a sense of whether residents are important for the daily functioning of the major CP services or if they’re just studying/watching the fellow do most the work. CP clinical training is relatively brief; you’ll likely benefit from a more active, resident experience-dense program if you want to continue in a CP clinical role later.

Pediatrics is a field that has traditionally been enthusiastic about research, but its residency programs do not tend to have as many MD/PhD applicants as Medicine or Pathology. In recent years, there have been only about 60 applicants with PhDs nationwide. Therefore, you will be a big fish in a small pond, and you should certainly use this to your advantage. Large academic programs are eager to have MD/PhDs, and it is likely that you will be heavily recruited. In general, much of the advice listed above for Internal Medicine applicants applies to Pediatrics and you should refer to it for specifics on applying and interviewing. You will get specific, personalized advice during your one-on-one pediatrics advising sessions about how many and which programs to apply to.

Pediatrics seems to be 10-20 years behind adult institutions when it comes to training and supporting physician-scientists, making the application and interview process for the physician scientist less well established and streamlined and as in Medicine or Pathology, and there are fewer programs that can accommodate and nurture physician scientists. Pediatrics residency programs for Physician Scientists also exhibit considerably more variability than those for Medicine and Pathology, ranging from allowing a few months of elective time to be used for research to providing supplemental pay, formal mentorship, retreats, journal clubs, and molecular medicine oriented seminars. This information is typically available on program websites, which you should research early in the application process. Several of the large academic programs have dedicated scientific interview days, during which you will have an opportunity to hear about a program’s research, get tours of the labs, and meet with investigators of your choice. Even if there is not a dedicated scientific interview day then you may be interviewed by at least one physician scientist. At some programs, you will meet with faculty, program directors or division chiefs in your fellowship specialty field. You should identify the dates of the dedicated scientific interview days when applying and setting up your interviews as many programs only offer a couple of dates, which often overlap with the dates offered by other programs. Note that General Pediatrics programs are typically run by clinicians who are not basic scientists, and you should identify program leadership who clearly support research if you like the program but the director seems less focused on that agenda. It is also important to note that most smaller Pediatric residency programs cannot support resident research even if they state that resident research is an emphasized part of their program (they may consider one month during third year an emphasis) and many such programs exhibit a general apathy towards research candidates, which may help in narrowing one’s list of programs considerably early in the application process. If you have a specific reason to apply to such a program (family close by, a significant other’s job opportunities, etc), make that very clear during the interview.

The American Board of Pediatrics does not offer “fast-tracking” in the sense of reducing the total number of years in residency and fellowship. There are, however, two formal pathways to replace clinical time with research training while maintaining the same six-year total for residency and fellowship. Historically, fewer MD/PhDs in Pediatrics tend to take advantage of these pathways when compared to those in Internal Medicine.

The American Board of Pediatrics supports the following pathways for physician scientists during residency training: 1) Accelerated Research Pathway (ARP) – This pathway allows you to exchange one year of residency for an additional year of fellowship. The extra year is primarily research, which you would probably need anyway before applying for a faculty position, though you may have some clinical responsibilities during this year as well (likely to be very variable based on the fellowship program and institution). This pathway requires you to apply to fellowship a year earlier than your co-residents, the fall of 2nd year for most specialties and the spring of intern year for Cardiology and Heme/Onc (the remaining specialties participating in the Pediatric Specialities Spring Match as of 2016, but check as fellowship match dates have been changing significantly recently).. 2) Integrated Research Pathway (IRP) – This pathway allows you to do up to 12 months of research in place of clinical work during your residency, though not always in a single continuous block. There is considerable variability in how this works in practice at different programs. Some programs can realistically only offer as little as six months of research, and only some make an effort to keep the research months continuous. In general, the smaller the residency program, the less flexibility there is, though some smaller programs actively emphasize research with separate tracks. This research time may also not be fully protected, so you may still have some clinical responsibilities, such as sick-relief/Jeopardy and every fourth night overnight call while on your research blocks. Your funding for the research time is also not provided by the clinical training program or department at some pediatrics residencies. Unlike your fellowship research years, where you would be supported by a training grant initially, the 12 months here would require support from your mentor and/or grants you acquire.

It is important to note that support for these pathways varies considerably at different programs with some programs emphasizing support for one pathway over the other, so if the ability to follow one of them is important to you then you should make a point to ask about them during your interviews and research the programs on their websites. Also ask how many residents have successfully completed one of these pathways. Some programs may offer research tracks on paper but have not had a single resident enrolled in them in years.

Combined Pediatrics training programs are available in Neurology, Medical Genetics, and Psychiatry that decrease clinical training by typically one year. Unlike the research pathways above, these combined programs lock you into a particular specialty and usually are at a single institution. At most programs, each of the combined programs has a separate match number and you will be able to match both their categorical and combined pediatrics programs separately. 

Child Neurology

Child Neurology is a 5 year program. It is a growing field and really excited to capitalize on the advances in neuroscience so it is very MD/PhD friendly, although still working on how to best integrate research into a traditionally clinical heavy specialty. The American Academy of Neurology runs most of the show here, although the pediatrics side of things does have some input. There are 2 kinds of programs:

1. The most common program requires completion of the first 2 years of general pediatrics training and subsequently 3 years training as a neurologist. The 3 neurology years are divided into adult neurology training for 12 months (although that may go down to 6-9 months over the next few years) and 2 years child neurology and electives. How this adult neurology time is divided varies widely between programs. Some favor mostly inpatient adult neurology services and others use more outpatient blocks (ie Alzheimer's clinic) as their adult time. Some make you do the time in 12 consecutive months and other spread it out. For now the adult time is there because you actually take the same Neurology boards as the adult folk. At the end of this you are eligible for double board certification in General Pediatrics and Neurology with Special Qualification in Child Neurology. Depending on the program there will be 3-9 months of elective time you can use for research.
2. The AAN has also approved a second, vastly more rare research pathway known as the Basic Neuroscience Track. This is 1 year of general pediatrics and 1 year of basic neuroscience research before or after the neurology training, plus the same 3 years of neurology as outlined above, including the same elective time for research. Some programs without the official neuroscience track are willing to let you use some of the peds time for research if you ask, but that is also rare. If you cut out any time from the 2 years of peds, you are not eligible to be board certified in General Pediatrics. 

Medical Genetics

Pediatrics/Medical Genetics combined residency is a 5 year program. The first year is a traditional Pediatrics internship. For the second, third, and fourth years, medical genetics training is integrated into the training, varying from 3-6 months each year. Some programs evenly split those years with 6 months of peds and 6 months of medical genetics. Other programs start with 3 months of medical genetics the second year, 6 months of medical genetics the third year, and 9 months of medical genetics the fourth year. Medical Genetics training includes experiences in Pediatric genetics, adult genetics, prenatal genetics, cancer genetics, and the diagnostic laboratories. The fifth year is 80% research time, with some continuing call and outpatient responsibilities. After the 5 years you are eligible for double board certification in General Pediatrics and Medical Genetics. Many programs allow additional research years to be added to the end of the program, transitioning to a post-doc type position to enable optimal positioning for K award applications. There are approximately 15 combined residencies available throughout the country and around 12 applicants/year, making application not very competitive. However, programs are typically content to not fill their spot for the year and prefer to have the right trainee rather than simply make sure their clinical service is covered.

Triple Board

Triple Board residents spend 5 years in an integrated training program focused on pediatrics, general psychiatry, and child and adolescent psychiatry. Residents in triple board programs train for 2 years in pediatrics, 1 ½ years in adult psychiatry training and 1 ½ years in child and adolescent psychiatry. At the end of the training, residents are board-eligible in all three disciplines. The Triple Board program actually saves 3 years, with categorical training in each field requiring a total of 8 years. Most applicants are ultimately interested in child psychiatry and are more clinically-focused than typical MD/PhDs.

Psychiatry is another field that is very welcoming to physician scientists. An MD/PhD is heavily recruited, particularly if his/her stated goal is to return to basic sciences. Many of the interviews are done by physician-scientists, eager to talk to about your research and to try to recruit you to do theirs as well. Essentially all of the top programs offer some sort of research track, though there is a lot of variability. Some have a separate match number, others have a limited number of spots in their program, and others let anyone who wants to be on the track. The concept of a research track within psychiatry residency training is rather new, with most programs having a track record of only 1-5 years - this means that many are still working out issues/concerns and it's difficult to know where previous graduates have ended up. However, the newness of research in residency also allows for an enormous amount of freedom to craft your own residency training and research balance. Generally speaking, programs allow 2 months of research in the 2nd year, approx 20-30% of research time during the 3rd year (spread throughout the entire year, so usually 3 half days each week), and anywhere from 50-100% time during the 4th year. Unlike medicine programs, the psychiatry research track does not necessitate or feed into fellowships and there is no “short-track” program. Fellowships in Psychiatry are rarely required, although many residents do pursue extended training (such as Child & Adolescent Psychiatry). However, you will not be applying for Psychiatry fellowships at the time of your residency interview. You should ask programs if they offer a 5th year of residency training/pay as part of the research track (this is often competitive based upon funding and interest of the 4th year class), wherein you would have 100% research time but guaranteed funding.

How to Apply

The best thing to do is check the program’s website for specific application information. Some programs have a separate match number and you indicate your interest when you submit your ERAS application. Other schools ask that you email the program coordinator to indicate your interest. Rarely, there is a single application pool with no preference/concern for your research interests at the time of application - these schools are more likely to have you enter the research track after 1-2 years of residency. It is important to make note of the different ways that residency programs handle the research track - you want to make sure that if you want to do research and you do attend that program with research in mind that they can pay for you to do so!

Interviewing

At some places, interviews are much different than the standard Psychiatry resident interview. However, at others, interviews for research-track Psychiatry programs typically span two days and they may have 2 or 3 set dates for “research-track only” residents. You will meet with program coordinators and psychiatry faculty but there will likely be 1-2 research oriented interviews as well - these are often in addition to your others as they rarely replace the interviews required for admission to the residency programs. Research interviews are designed to give you a chance to learn about research you may be interested in that institution and are often with PIs that you have requested at the time of your application. Otherwise, your interview day/schedule is similar to other applicants. Most research-track residencies will ask you to make a list of 3-6 specific PI’s you would want to meet with in addition to a general statement of your research interests. This request may be buried within an email from the program coordinator, so make sure to look closely. Some places might invite you back for a second look, if you express strong interest in the program. This can be a valuable time to meet with additional research faculty members and students to get a better feel for the program.

Things to think about

Research in psychiatry is still very new, this means that your career options are wide open, so it pays to think about the possibilities a bit before writing your personal statement. Residency programs are looking for your level of commitment and current thought processes, but they do not require an absolute commitment to a fellowship program, a research laboratory or “x” number of months dedicated to research once you have been accepted.

• Things to think about early:
  • Do I actually want to keep going as a physician-scientist? For psychiatry, this question really means “do you plan on contributing to science while being a psychiatrist?” Most programs are almost ridiculously accommodating in terms of what this means to you - either full time clinician with some research on the side versus someone who is in the lab full time and avoiding all patient contact. Which programs you apply to should absolutely be influenced by which end of the spectrum you fall on, but there is a place for you in psychiatry regardless of your preferences. Just be honest about it and find the program that will help you get there.
  • Do I actually want to do residency and fellowship in the same place? As mentioned above, fellowships are not required for psychiatry although from a planning standpoint, it would behoove you to consider one. While not required to get an attending position at most places, a fellowship would allow a psychiatrist interested in research to take an extra 2 years in which you could be paid to be 50% clinical and 50% research - this gives you specialized training, funding for research time and allows you to get a K-award for when you look for faculty positions. Your fellowship years don’t have to be at the same place as your residency training, but you will have a more difficult time developing a fundable K award if you pick up and move, although it certainly wouldn’t be impossible.
• In the application:
  • The personal statement for psychiatry can be either a statement and/or personal - it doesn’t have to be boring or fit a certain structure like other specialties. However, keep it tasteful. Mention why you are interested in the field, your research interests and where you want to go with your career. Do something to keep it a bit interesting as well, it will make interviews less painful if they get a sense of who you are and where you want to go.
• Program-by-program questions:
  • What is the research track? Is it a pathway to get you to a K-award? How have previous graduates handled the program and where are they now?
  • What clinical training time do you “get out of” to do your research? If you are interested in some of this training, can months be swapped out? Does the program have mandatory electives that you must complete in 4th year or is it 100% research? Get a break down of available research time by % per year.
  • Is there an available 5th year of funding for residents on the research track? Generally, these are 100% research time and available on a competitive basis for 1-2 residents/year.
  • Are psychiatrists valued at the institution? Do they have a strong commitment to training physician scientists in psychiatry? Is this a departmental priority? How many students a year are in the research track and do they stay for fellowships or faculty positions?
• Interview questions:
  • For the residency interviews –
    1. Most of the psychiatry residency interviews are about them getting a sense of who are as a person, why are you interested in the field and how you see yourself contributing to it in the future. They are varied and unpredictable in many ways. Be yourself, be sincere, tell them what interests you and how you would like things to be in an ideal world.
  • For the scientific interviews -
    1. If this is someone you might be considering for a postdoc mentor, it’s helpful to find out if they have any connection with the department you’ll be a fellow in (and if that’s necessary).
    2. If you’d like to have a translational component to your research, but are looking mostly at basic science labs, it’s helpful to make sure that collaborations have occurred in the past, and that the PI you’re considering is comfortable with it.
    3. Has the PI ever worked with a physician-scientist before? Do they understand your limited time commitment compared to their other post-docs? Do they understand your goal for a K-award and the time line for accomplishing it?

Why EM as a MudPHudder? All of the usual reasons to do EM (procedures, fun, broad base of knowledge, diagnostic acumen, good teaching, fun people) plus a schedule that is extraordinarily good for balancing research with clinical medicine. As an attending, there’s no call, no phone calls to make, no 6 weeks per year of inpatient medicine all lumped together. You really can work a shift per week and spend the rest of your time doing research.

EM is in transition, from a new field composed of rebels to a mature pillar of the house of medicine. Partly because it is a new field, it has a powerful residency credentialing body which has ensured that there is no one “best” program because so many programs are so strong. Many of the programs that are considered very strong are not traditional powerhouses of academic medicine--University of New Mexico, for instance, has the most critical care-trained EM attendings of any emergency department in the country and has a very academic vibe. Many (but by no means all) of the departments that are strong in Medicine are less strong in Emergency. And those that are both well-reputed across many fields and are also strong in medicine can be paradoxically wary of MD/PhDs being more interested in a cushy, lightly clinical residency because they feel like that is how they are perceived as compared to some of the county programs. Many of the highly regarded county or not-traditionally-strong-in-other-fields EDs are extremely interested in research-focused residents; others are not. In short, leave all of your assumptions at the door, and ask around.

The perception of MD/PhDs in EM is also in transition. In 2008 the consensus in EM was, “Some people skydive; some people SCUBA dive; some people do research,” i.e. just another hobby. These days that has changed quite a lot, with Department Chair-level interest in recruiting MD/PhD residents.

Be aware that EM *requires* that you do an away sub-I, which can make returning from the PhD to clinics a bit fraught. The Penn EM folks’ advice combined with Helene’s magic will serve you in good stead here, but plan early, both to fit it all in before you apply and to to make sure you apply to the good away rotations on the day they open.

Finally, unique to EM, there are 3-year residencies and 4-year residencies, both qualifying you to do the same thing. In general, the 4-years are in more academic places (or on the West Coast, where they get their pick of applicants for various reasons and have little incentive to give up on the resident labor). You will have to decide individually whether 3 or 4 is the right choice for you. The 4’s generally (but not always) have more time to spend on research, but obviously there’s one more year where your research skills are atrophying and you can’t get attending-level resources with which to do research. The 3’s save you a year and some are very academic-friendly, but others are predominantly oriented towards training excellent community clinicians. The fewest compromises come in the Midwest and South, where there are many academic powerhouses that are 3-year programs. Again, apply broadly and with an open mind.

Neurology is a field that is extremely welcoming to MD/PhDs, and for those starting with neuroscience PhDs, it is not a challenge to connect previous research with career goals. That said, you should not exclude neurology as a choice for residency if your PhD was unrelated to neuroscience. Neuroscience can easily be approached from a background of cell and molecular biology, immunology, biochemistry and biophysics, or bioengineering. You should be prepared to address what got you excited about neurology and what your future career goals are. This can be accomplished by the personal statement or during the interview process. Most neurology programs offer some elective time that can be used for research, ranging from 3-9 months in the last year. In some programs this is more formalized than others. Many top programs have an R25 grant, which allows you to do 6 months of NIH-funded research in the last year of residency, followed by an additional 18 months as a fellow. The grant is transferrable between institutions. A current list of programs with the R25 can be found on the NINDS website. Additionally, a few programs are beginning to offer specific physician scientist tracks. These may or may not be formalized, so it is worth checking with programs to see if this is an option. Generally these tracks involve doing more neurology in the PGY1 year at the expense of internal medicine electives, which frees up more time for research at the end of the residency. There is currently no true "fast track" option (i.e. no way to shorten the time in residency by replacing it with time in fellowship.)

The number of MD/PhDs completing Neurosurgery residencies has been increasing over the past several years (1). There are several example academic neurosurgeons integrating a basic research program with their practice throughout the country. These individuals are very common in Functional Neurosurgery (DBS/Epilepsy) - e.g., Emad Eskandar (MGH), Eddie Chang (UCSF, not MD PhD), Timothy Lucas (Penn), Mark Richardson (Pitt) and Kareem Zaghloul (NIH). However, there are examples in other domains as well, e.g., Tumor - Henry Brem, Hopkins, and John Sampson, Duke.

Here are some notes for the application:

• Some institutions place a much higher emphasis on recruiting MD/PhDs compared to other (e.g., Cornell, Pittsburgh, Stanford to name a few). You can look through the list of current residents at each program to identify more of these programs.
• Solid publications and F30 funding is attractive (as with everything else I guess).
• Your clinical performance on sub-is is extremely important. No matter how impressive your CV is, the first priority is for programs to identify good people who are reliable clinicians and team members
• You don't need to know how exactly you plan to integrate science and clinical work. It helps to have an idea, but keep an open mind

Feel free to contact Ashwin Ramayya if you have questions: ashwinramayya@gmail.com

1 Choi, B. D., DeLong, M. R., DeLong, D. M., Friedman, A. H., & Sampson, J. H. (2014). Impact of PhD training on scholarship in a neurosurgical career: Clinical article. Journal of neurosurgery, 120(3), 730-735.

General

Ophthalmology is a wonderful specialty that is increasingly popular with MD-PhD students because of the interesting science, the friendly people and the flexible nature of the specialty. Academic ophthalmologists can frequently combine research, clinical work and surgery, and can vary the amount time they spend on each of these over the years.

Early Match

It is an early match. Applications for residency should be submitted by August 1^st, interviews happen early, rank lists are due early and you find out where you match on January 15^th instead of the March 15^th Match Day. This means that you need to stay on top of deadlines and committee meetings during the PhD phase and meet early with Maggie to plan the transition from the PhD back to clinic. The ideal time to defend your thesis is in the summer (July or early August), with the latest being early fall, so that you have time to do all of the required clinical rotations prior to submitting your application.

1+3 Training

Training for Ophthalmology is 1 preliminary year followed by 3 years of ophthalmology. There are many options for the 1^st year: preliminary year in medicine, preliminary year in surgery, transitional year, or even pediatrics. Most people opt for preliminary medicine or a transitional year. The transitional year tends to have a greater number of electives than preliminary medicine and may include a month or two of surgery or peds or OB/Gyn depending on the hospital. The application for the preliminary year is a totally separate process from the application for ophthalmology. The prelim year can be done at a different institution and in a different city than the ophthalmology training. You will find out where you Match for prelim year on the March 15^th Match Day.

Applying and Interviewing for Ophthalmology

1. Meet with Dr. Sankar at Scheie and let him know that you will be applying in Ophthalmology. He has a wealth of information and has many years of experience guiding Penn med students through the application process. He will meet with you several times during the process and will check in on you frequently by email or phone. He will advise you on how many programs to apply to and which ones, will give you feedback on your personal statement and application, and will even do a mock interview with you.
2. Get letters of recommendation early. Don’t wait for electives to ask for letters. On some electives you will not have a chance to spend much time with attendings, so if you had a good experience on a core rotation (such as Surgery or Peds), ask for a letter of recommendation. It’s better to have a back-up letter rather than scramble for one as the application deadline approaches. For Ophthalmology you will need 3 letters – generally one from your PI, one from an Ophtho rotation, one more from another clinical rotation. For the prelim year application you may need a fourth letter.
3. Take the Ophthalmology (OP300) elective and either Neuro-Ophthalmology (ITD340) or Peds Ophthalmology (OP301). You do not need to take both Neuro and Peds, just one. It may be hard to get a letter of recommendation from OP300 because you work with so many faculty members, so your Ophtho letter will probably be from Peds Ophtho or Neuro-Ophtho. Away electives are generally discouraged.
4. Apply through SFMatch at sfmatch.org. You can register starting on June 1^st. You should submit your application by August 1^st. The application will require some basic information, a personal statement, your college transcript, med school transcript, Step 1 scores and 3 letters of recommendation. You will need to pick up these materials from Suite 100 and physically mail them to SFMatch (make sure to do delivery confirmation). SFMatch can take several weeks to process your materials, upload them, and forward them to programs, so make sure to get everything in as early as possible.
5. Take Step 2CS and Step 2CK early. You will take Penn’s version of Step 2CS, called CSI, in March or April. Step 2CS is almost identical to CSI in format, but is easier than CSI. One suggestion is to use CSI as your practice and schedule Step 2CS for one or two weeks after CSI. Step 2CS is pass/fail. Register early, as the spots fill up quickly, months in advance. It’s nice to have this test out of the way so that you don’t have to think about it again. Step 2CK scheduling is a bit trickier. Jomo and Helene generally recommend taking Step 2CK after interviews, but Dr. Sankar recommends taking it before. If you decide to take it early, a good time to take it is right after you have submitted your applications, but before interviews have started (September-ish). Your CK scores will arrive after your applications have been submitted. The scores are not automatically reported to programs and I have not heard of any Ophthalmology programs requesting score reports before ranking you. Most people study using First Aid or Crush Step 2 and a Question Bank. It is nice to get this test out of the way before beginning interviews because you will be miserable if you try studying during interviews or need to re-schedule the test multiple times because of an interview conflict. Also, taking it before interviews you have the advantage of being fresh off the core and elective rotations, and you will remember more about general medicine than you will after a few months of interviewing. Most people study less for Step 2 than Step 1 but score within a few points of their Step 1 score.
6. Make a calendar and print out a copy of it to have at all times for quick reference. Most Ophthalmology programs only have 2-3 interview dates, especially the top programs. The interview dates for many programs will be on the same day, so you will need to make quick decisions as to which interviews you will attend. Most programs interview on approximately the same dates each year. When you register for SFMatch some of the programs will have their interview dates posted, but not all. You can find the interview dates for the other programs on their residency websites, or you can make an educated guess by looking at the previous few years of interview dates on Student Doctor Network. (For example, a certain program will interview on the Wed, Thurs and Fri of the first week of December each year). Put all the interview dates of your top choice programs on the calendar and know which dates are your first, second and third choices, that way you will be prepared when the invites arrive.
7. Make sure you have a smart phone with email. Interview invitations will come via email or phone call. Some programs will call and ask you whether you can interview on a specific date, others will send out all 3 or so available dates and then assign dates to applicants based on a first-come first-served basis. Program interview dates can fill up in a matter of minutes, so you have to be quick.
8. Interviews. Ophtho interviews begin in mid-late October and last until mid-December. Generally interviews are all day at most programs with a dinner the night before or after the interview. Most programs have multiple (up to 8 or 9) 1-faculty-to-1-student interviews or 2-faculty–to-1-student interviews. A few programs have 3 or 4 small panel interviews (4 or 5 faculty members with one student), and one or two programs have a large panel interview (one interview of 15+ faculty to one student). In general, most interviews are very friendly and good-natured with very general questions, mostly to learn more about you as a person and a little more about your research. Many will ask you about the interests and hobbies listed on your application. There are occasional quirky questions (what are you going to be for Halloween? what superpower would you like to have?), but most are in good spirit.
9. Have fun. Ophthalmology is a small field, only ~450 students Match per year, and if you are interviewing at the more academic programs that MD-PhD students tend to interview at, chances are that you will see the same 30-40 people over and over again. You will have many new friends by the time the interview season is over.

Applying and Interviewing for the Prelim Year

1. Apply through ERAS (same application that everyone else does for regular match). You can register July 1^st and start working on your application in September. The whole application is electronic. You do not need to write a brand new personal statement for ERAS – it’s fine to use a modified version of your Ophthalmology personal statement.
2. Prelim vs Transitional. You don’t have to know which one you prefer before applying – you can apply for both and interview for both and then see which one you prefer. You can also rank both prelim year and transitional year programs at the same time.
3. Where to apply. There are many good prelim and transitional year programs in the Philly area. Most people apply in Philly and several other cities that they’d enjoy spending a year in or would like to match in for Ophthalmology.
4. When to schedule prelim interviews. You will begin to receive prelim interviews at the same time as the Ophtho interviews. Try to push the prelim interviews for late December, January or February, this way they won’t interfere with the Ophtho interviews and you will have a clearer picture of where you will be going for Ophtho by the time you start prelim interviews. You will find out where you match for Ophtho more than a month before the prelim year rank list is due.

Other Info Relevant to Ophtho Residency

1. Board Scores. Yes it is true that average board scores are high for medical students matching in ophthalmology, and that they seem to increase every year. The 2013 average for students that matched was 239. However, scores are not everything, so don’t shy away from the field because of scores alone. Your research and letters of recommendation are very important.
2. How many programs? It depends, and you will decide this with Dr. Sankar. MD/PhD students tend to apply to fewer programs than MD-alone students because there are 20 or so programs that have strong research, the rest are much more clinical. MD/PhD students may apply to 20-30 programs, while MD-alone students at Penn may apply to 40-50. Students from other medical schools may apply to as many as 70.
3. Electives/SubI. Most med students applying for Ophthalmology do a Medicine SubI. Electives can vary, but some electives that people have found useful are Endocrinology, Rheumatology, Neurology, ENT, Dermatology, Anesthesia and Neuro-radiology.
4. Research During Residency or Fast Track. There is no research track or fast track for Ophthalmology. Some programs have a month in the second or third year set aside for research, but many do not. Many programs require that you have at least one publication of some kind during your three years, but generally residents do not spend much time on research because there is so much hands-on learning to be done in the clinic and the operating room during these three years.
5. Beyond Residency - Fellowships. Most people wishing to stay in academics do a fellowship. There are many fellowship options in ophthalmology and they are generally 1-2 years in length. Some fellowships are more surgical, while others are more clinical or research oriented. Current fellowships include Medical Retina, Surgical Retina, Cornea, Pediatrics, Glaucoma, Uveitis/Immunology, Ocular Oncology, Oculoplastics, Neuro-Ophthalmology, Pathology and Genetics.

Radiation oncology has become an increasingly competitive field over the past 10 years. See the career night booklet for general career advice -- it is quite good and useful. I will highlight some salient aspects that I would add here to that general advice. .

Making your decision to apply

Ideally you should have locked down that you are interested in this field before coming back from your PhD because of the nature of needing to do away clinical rotations. Though some faculty at Penn have not necessarily advised away rotation as being “absolutely needed” during the interview season this year at competitive institutions, I did not meet a single individual who did not do at least one away rotation. The average is almost always 2. During your PhD years or pre-clinical years, try to get some shadowing/clinical time in. This was very helpful to me in making my decision but ultimately it was still my Penn rad onc rotation that was the most important. It can be important also to explore med onc and surg onc, even if you don’t think you will be interested. Acting internships in surgery and medicine, or a 300 level rotation on the med/surg oncology can be especially helpful, not only in terms of getting those good clinical grades but also helping you to evaluate and make your decision. You will inevitably be asked during the interview trial -- why rad onc? Why NOT surg onc? Why NOT med onc?

Recommendations about preparation

If you are particularly interested in a specific geographic area (Especially if you are applying from the Northeast and you are interested in the West Coast but not from the West Coast or have strong family ties, you are well-advised to do an away rotation there. Even if it is not at the top institution of your choice, showing that you are willing and capable of living there for some period of time is important. One of the most important aspects of an away (perhaps more so that trying to make it into an audition) is to get a good letter. In fact, I think JoMo makes a great point about the fact that away rotations in general have a high risk and low return, but in the case of rad onc getting a letter from a BIG name is a BIG deal. I can assure you that multiple times along the interview trial, the name of the letter writing for my letters came up. It is impressive to have a good, candid, and heartfelt letters and 100X better if it comes from a giant in the field.

Note that you do not necessarily need to do a medicine Sub-I but if you are interested in staying at Penn, then you are well-advised to do a medicine Sub-I in advance of the MSPE. For most programs, clinical grades are important but not nearly as important as Step 1 Scores. It is quite clear that many programs will consider this as a first step in filtering candidates and a 240+ is probably advised if you want to get an interview at a top 20 program. Clinical grades are important but not critical that you get Honors in all courses. A mix of HP/H are ok, just try to get H in either Peds, IM or Surgery as these are viewed as most important.

Regarding research in Rad Onc, it is not necessary to have publications IN rad onc. I did not at the time of application but I did give talks in rad onc research and have multiple manuscripts in preparation. However, I was hardly asked about these during the interview trail. In fact, the questions much more oriented around my PhD work as they tend to gravitate towards your area of expertise. Note that Rad Onc is a very research intensive field and 95% of non-PhD candidates will have done some research in the field and 50% or so will have published in the RED Journal or field specific journals by the time of AMCAS submission at top institutions.

Make sure, no matter what, that you get a mentor at Penn who can vouch for you and write you a strong letter. Get their candid advice, especially if you can get an early appointment with Dr. Neha Vapiwala as she will be extremely helpful for you because she has had a lot of experience in mentorship students applying into the field. There are many many excellent mentors at Penn and honestly, nearly all the faculty are extremely supportive. It is honestly one of the best departments in the country in terms of finding a mentor. 

Applying, interviewing and such

Try not to get your heart set on one specific school or geographic area. This is a very very competitive field and made all the more so by the fact that each program has only at most 4-8 spots and the vast majority have only 1-2 per year. Apply broadly. Did I say broadly? Most people on the interview trail applied to an average of 50-60 programs. Even the most competitive applicants apply to at least 30 or so. Historical advice is that continuously ranking (ie interviewing) at 12 or more programs is a safe number to guarantee that you will match.

Interviews are much much more intense than prelim medicine or TY program interviews. Some programs can be two days. Many programs require that you meet with 6-10 people over the course of the day (most competitive programs are at the order of 10-12 meetings). Usually a dinner prior to the interview day is offered but it is not requisite that you go. In fact, I gave up on trying to attend because of the logistics of trying to schedule these rad onc interviews as well as prelim/TY year interviews.

At research-intensive schools you may be given the opportunity to meet with people in your research field or be asked to talk specifically about your particular research interests. Be prepared to define your research goals and defend your work. I have been asked strange things like whether protons are appropriate or rather “defend the use of protons in this case”, as the use of protons is rather controversial, so prepared that you may get a third degree at some institutions given Penn’s strong position as a proton institution. At other institutions, I have been asked to outline my research career vision in 10 years, etc. Otherwise you will get the same bread and butter kinds of questions you already expect: 1) why rad onc 2) why this school 3) what are your strengths/weaknesses etc etc.

A note about scheduling. During the ERAS season, once you get an invite to interview, respond NOW. Now being <1 hour. If you take a whole day to respond, chances are you will not get the spot on the day you want and sometimes in the case of at least a few institutions you may not get a spot at all, since they invite more people than there are spots for! Because you are applying broadly for rad onc, it can be helpful to have some geographic or other limitation for the prelim/TY year program. Otherwise you may end up like me trying to juggle between whether to accept conflicting rad onc vs prelim year interviews. You can see the IM/Prelim year section for advice about this but do not underestimate how competitive the golden one-year spots can be, whether it is because you are trying to go to California (highly prized for location) or a cushy TY program. In some cases, prelim programs on the West Coast or cushy TY programs get >2000 applications per year. In other words, it can be MORE competitive to get into this than your rad onc program!

Research during residency

6 months of research are required during residency, the vast majority of top 10-20 programs at academic institutions will give 9-12 months of protected research time (note it’s not 100% protected as you may still be required to take call or see ½ day a week of clinic during that time, depending on the program). There is a special pathway for research focused candidates called the “Holman pathway”, sponsored officially by the ABR. However this is not supported by a number of programs and is viewed as somewhat controversially, with regard to whether or not it really improves the likelihood candidates will go on to an academic research-intensive career. There have been some discussions between department chairs at various institutions as to whether the 1.5 year (with holman you get a little more time, essentially 15-21 months depending on the institution) is truly enough, as clearly it’s dramatically short of the 3-5 years expected for most post-docs in the biological sciences. Some programs have added one year fellowships, which could then be used to exclusively conduct research and pay residents an instructor level salary during that time, in which patient care responsibility is <10-20% and usually in the treatment site of interest. There are also many possibilities of training in one place followed with fellowship/post doc in another which seems to have been a very popular path in the past for physician scientists.

Feel free to contact Yun Rose Li, if you have questions.