Friday, March 16, 2012
The Match sets medical students in search of themselves
Medical students quickly become familiar with residency match ("the Match"). Almost every attending and resident physician has interesting stories about his or her experience. Older students share endless advice regarding the Match, and many institutions and professional societies shine spotlights on the process each year. On a larger level, the Match receives regular attention across numerous Internet forums and occasionally in the mainstream press.
These factors have helped tether the Match in student consciousness. But behind the massive collection of coverage, opinion, anecdotal stories (and lore), we students sometimes miss what a unique way it is to find our first jobs as physicians.
On one level, considering residency programs requires uncommon diligence. After synthesizing enormous amounts of advice from mentors and peers, we must carefully construct our applications over several weeks and then invest considerable time, energy and resources visiting a number of programs. Subsequently, we spend the better part of four months methodically studying features from each, a process that proves as demanding as it is essential. While grueling, it reflects the arguably unprecedented academic importance of our choices and their implications for our careers.
On another level, the Match is also unlike any other process most of us have ever experienced. At every other transition point in our educations, from high school to college, and then to medical school, we were largely in control. We applied to as many schools as desired, interviewed as circumstances allowed, and received exceptions when needed. We heard back from all schools definitively, giving us concrete acceptances, rejections, or waitlist statuses to use in our decision making. We could take full inventory of our options and arrive at choices that felt like ours.
With residency, the process is distinctly more opaque. Some programs respond more quickly to our applications than others, if at all, and ultimately, we only receive feedback from one. We must process our goals using potential scenarios and consider our preferences without any assurance of acceptance.
What makes the Match unique, however, is how this uncertainty can blend with personal reflection to create powerful self-understanding. While we sometimes visit programs that are exactly as we imagined, it is not uncommon to be over- and underwhelmed by many. While we might set up complex rubrics and systems for ranking programs, decisions often boil down to what is known in the medical community as "gut feelings." While certain features pique others' interests, they might not pique ours.
As obvious as these observations might seem, they point to crucial lessons: that to find true matches, we must understand ourselves as we try to understand programs. To emerge clear-minded from a potentially opaque process, we must diligently take inventory of our values and remain resolute in them.
In my case, that required regular exercises of courage and honesty. To my surprise, several programs did not fit my career goals despite excellent reputations and resources, while others complemented those goals but did not resonate with me. Some programs disappointed in certain domains but exceeded my expectations in others. Ultimately, I did not want to reflexively follow popular opinion or make far-reaching choices based on brief, subjective feelings.
To avoid that, and to filter through the complex array of academic and personal factors, I had to dedicate considerable time to ensure that while I could not control the outcome, I would handle the process well. The task frequently required enough honest introspection to ask myself difficult questions about my motivations, as well as the personal courage to trust my final judgment more than rankings and other opinions. That sustained disciplined proved harder than expected, a sentiment many of my peers around the country seemed to share.
Amid the important but often overwhelming attention given to the Match, this opportunity for self-understanding is crucial. As applicants, we do need evidence-based approaches to critically assess our options and soberly understand the academic rigor of each. We do benefit from early curriculum vitae preparation and knowledge about scores, attire, etiquette, and commonly asked interview questions. Anecdotal advice from mentors and older students can be appropriately tailored to our individual backgrounds. But the importance of self-knowledge, and the way it helps us create rank lists that are true to ourselves, seems too often lost in the frenzied preparation.
So despite the Match process's many attendant challenges, my parting charge to my peers is to pursue self-knowledge diligently. For some, it may mean drafting personal statements early to understand their degrees of confidence and understanding in their specialty choices. For others, it may mean deeper consideration of how research interests or advanced degrees fit with clinical medicine. Those still undecided may benefit from asking trusted advisors and loved ones about their observations. And for most, it will be essential to ask themselves what matters most to them and what they are willing to compromise.
Regardless of detail, the benefits of this pursuit are tangible: more thoughtful personal statements, clearer ways of communicating our interests on interviews, more penetrating analysis of various programs, and greater contentment that we have done everything possible to pursue the very best match for ourselves.
Ultimately, that is crucial. Behind the massive collection of opinion and information, the Match is not just a unique way to find our first jobs as physicians. It is also a unique, powerful way to find out more about ourselves and the people we are becoming.
Joshua Liao is an ACP Medical Student Member and a current fourth-year medical student at Baylor College of Medicine in Houston who will begin his internal medicine residency this July. His professional goals include care redesign and the promotion of patient safety across care settings.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
Controversies in Hospital
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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David Katz, MD
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Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
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Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.
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Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).
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Other blogs of note:
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.
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The Public Library of Science's open access materials include a blog.
One of the most popular anonymous blogs written by an emergency room physician.