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Congratulations! You have finished the hardest parts of medical school! You have successfully completed all of your pre-clinical exams, studied for and taken the daunting USMLE Step I and II exams, rotated through many of the clinical services in the hospital during your third-year clerkships, and have interviewed at a variety of residency programs. Before making your rank list and thinking about the next steps of your training, it is important to take a step back and recognize the phenomenal nature of what you have accomplished over the past few years.
Students often find making a rank list to be very challenging due to the overwhelming number of factors that they have to consider. Although there is no right way to make a rank list, here we present a framework for comparing programs so that you can make the decision that is best for you.
Clinical Volume and Opportunities
The Accreditation Council for Graduate Medical Education (ACGME) reviews all residency programs in the United States. This review process standardizes the clinical training between programs to ensure that graduates of the program will be able to practice medicine in their respective fields competently. With that said, the natural variation between residency programs will result in some programs providing better exposure to some clinical areas than others.
As a result, it is important to touch base with current residents and ask them about the strengths and weaknesses of their program. For example, some programs may have a much higher clinical volume than others, whereas others may offer clinical training opportunities that could enhance your training. Some programs might involve training at multiple hospitals, have built-in time for international or away rotations, or may spend time training with private practice physicians. Although these opportunities may be valuable to some residents, they may not be valuable to everyone. Therefore, it is important to match the training opportunities offered by residency programs with your career goals.
Track Record and Fellowship
When comparing residency programs, be sure to take time to look at the track record of the program to understand what graduates of the program go on to do after completing their training. For example, if you are highly interested in going into academic medicine after completing your residency training, it is worthwhile to see if graduates of the residency program have historically been able to secure jobs at academic institutions.
If you are interested in pursuing a particular fellowship, it will be important to check to see whether graduates of the residency program have successfully been able to match into the fellowship that you are interested in, especially if that subspecialty is particularly competitive (check out Doximity’s residency navigator to get an idea of fellowships pursued by graduates of the program). Take note of programs that offer fellowship training in the field that you are interested in, as that could indicate that training in that particular field is strong at the institution and that there are mentors at the institution who are very familiar with the process of applying for and securing fellowship positions in that particular specialty (search FREIDA to learn about fellowship availability at programs).
If research is important to you, then it is important to evaluate the academic opportunities available through the program. Make a note of the academic productivity of the residents during their residency training. This will help you to get a sense of whether or not residents in that program have enough time to work on research during their residency training and whether or not research is a priority for the program. Programs that protect time during residency training for research likely value research highly and are trying to make an effort to give residents an opportunity to be academically productive. Think about what type of research you are interested in, as programs might not be strong in all areas of research, from basic science to translational to clinical. Make sure you take a look at the types of research projects that the residents and faculty are involved with to see if those projects are interesting to you.
The People and Culture of the Program
Arguably, the most important factor to consider when selecting a program is whether or not you like the other residents and people in the program and fit with the culture of the program. Fit is very difficult to quantify and is highly subjective. Think back to the meet and greet and interview day and about whether or not you enjoyed spending time with the residents and faculty. It is important to get a sense of whether the residents are happy in the program and if they feel like their concerns about the program are heard by the program leadership. At the end of the day, determining whether or not you fit in with the people and culture of the program comes down to the gut feeling that you had on interview day as to whether or not you like the program. It is important to remember that you will be spending most of your time in the hospital with the people in the program, so it is crucial that you enjoy spending time with them.
Although you will be spending most of your time in the hospital during residency, it is important to at least consider if you like the area in which the program is located. It could be very beneficial to go to a residency program that is near your family and friends so that you will have a strong social support system outside of the hospital throughout your training. Think about whether or not you would enjoy living in the area. For example, if you enjoy living in big cities, going to a residency program in a city with an abundance of things to do outside the hospital would be a big plus. If you enjoy living in small cities, then the higher living costs, traffic, and noise in larger cities may be off-putting (use Niche to get basic information about cities).
Closing Advice for Your Rank List
Ultimately, making your rank list is a highly personal decision and will depend entirely on your own personal preferences. It is important to remember that programs should be ranked in the order of your own preference and should not be based on other people’s opinions of where you should go or what the best program is. You should not base your rank list on whether or not you think a program will rank you highly. You can learn more about how the matching algorithm works before submitting your rank list here. Ultimately, you will only have so much control over where you train. It is important to remember that residency training is what you make of it, and you can create opportunities that are absent. It is important for you to believe that the program that you match in to will be the right one for you, regardless of where you ended up falling on your rank list. Regardless of where you match, you will finally be able to officially start practicing medicine.
We wish you the best of luck as you craft and finalize your rank list this season!