Residency Ready 275x275The School of Medicine prepares students for residency success.When it comes to snagging a coveted medical residency on Match Day, the competition is hot and getting hotter. That is because the number of residency applicants in the U.S. Match has long outpaced the number of available medical residency spots. In fact, the number of residency registrants reached an all-time high of 43,909 in 2018, for only 30,232 first-year post-graduate (PGY-1) positions.

Getting the preferred residency is just the beginning. New interns often find the first few weeks on the job nerve-racking as they begin treating patients on their own.

“Certainly all our students have required clinical rotations and clerkships for their specific disciplines, including internal medicine, pediatrics, surgery, neurology, psychiatry, and family medicine,” says Craig Hoesley, M.D., senior associate dean of medical education. “But still, we want to give the students specific skill sets that will help them succeed in every way in their residencies.”

To help students, the School of Medicine is using technology and expanding its existing residency preparation coursework. The goal is to boost students’ confidence before and long after Match Day.

Choosing Wisely

When it came time for 2017 School of Medicine graduate Riley Camp, M.D., to select residency programs to apply to, he had a dizzying number of factors to consider. The 28-year-old Hoover native is in his second year as a UAB anesthesiology resident, but he recalls spending hours online browsing different residency programs’ websites. He also consulted with his career adviser, Alethia Baldwin Sellers, M.D., associate professor in the UAB Department of Anesthesiology and Perioperative Medicine, and older residents to get their opinions about different programs.

“Personally, some factors I prioritized were the quality of the training program and the medical center, where the program was located, the different kinds of academic support staff, and the assistance provided,” says Camp. “And my wife and I wanted to stay in the Southeast.”

Most medical students choose a specialty by their third year, at which point they are encouraged to choose a career adviser in that field. In addition to serving as a career adviser and an assistant professor of general internal medicine, Winter Williams, M.D., co-directs the Internal Medicine Clerkship Program. Williams says he advises between 12-15 students every year. He starts by listening to the students, providing them with information about the reputations and rigor of various residency programs, and finding out what students hope for in terms of lifestyle.

“It goes beyond how good an institution is,” says Williams. “It’s important to get the best possible clinical training that you can, but it’s also important to be happy where you are and to find a good match that incorporates some of those things that are going to be very student-specific and can vary from person to person. It’s also really important to match up expectations with reality whenever you’re making a list.”

Williams says career advisers are instrumental in helping students determine where they are likely to match based on their step scores and class rankings. “We show them where people with similar scores and similar objective metrics have gone in the past five years,” says Williams. “I think it’s a helpful starting point for crafting a list.”

Once students have their lists, they start the application process. Today, students use the Electronic Residency Application Service, or ERAS, where they submit their applications, letters of recommendation, and other necessary documents online.

Once the application process began, Camp says Sellers helped him critique his personal statement and curriculum vitae. “She provided valuable advice about programs where I would be competitive and the number of programs I needed to apply to be successful in the Match,” he says. “Then, we met before rank lists were due in February of my fourth year, and she told me about the pros and cons of the programs I was interested in.”

In the end, Camp says he applied to 30 anesthesiology programs, received 25 offers for interviews, and went on 11 different interviews before selecting UAB.

Managing Jitters

After graduation, first-year residents often feel both excited and fearful. “Before my intern year, I was terrified,” says School of Medicine graduate Jennifer Anderson, M.D., a 26-year-old PGY-2 pediatrics resident at UAB. “I knew I had learned a lot the prior four years, but I also knew I had so much more to learn. I was mostly scared of making mistakes and hurting patients.”

UAB intmed mabrySeth Landefeld, M.D., center, walks with residents. Photo by Andrea Mabry. Associate Dean for Undergraduate Medical Education Kevin Leon, M.D., says anxiety and a lack of self-confidence are common among new residents. “They’re putting in orders on patients, and those orders are being followed through on, and they don’t have to have them co-signed by anyone,” says Leon. “It’s a lot of uncertainty, a lot of self-doubt, and a lot of overthinking things.”

To assist students before starting their internships, the School of Medicine offers a “Preparation for Residency” course in April for fourth-year students. Leon says he and Hoesley created the course more than a decade ago as a week-long special topics course where students could review some of the skills and standards they learned earlier in medical school. Over time, the course evolved into a two-week elective.

Today, the course includes medical simulations based on case studies. This provides students opportunities to practice teamwork and communication skills, and dealing with difficult patients. Students also practice common procedures like IV placement, airway management, handling crossover emergencies, and disclosing medical errors.

“If they didn’t have an opportunity to do a lot of lumbar punctures, for example, or they didn’t manage a lot of ventilators, or if their confidence just isn’t there, this is a way for them to revisit some of these things,” Hoesley says.

Starting in 2019, “Preparation for Residency” will become required, Leon says, and will include two different two-week courses. One two-week course will be for medical students going into procedural specialties such as surgery, anesthesiology, or obstetrics and gynecology. The first week of that course will cover topics applicable to all first-year residents. Depending on their interests, the students will be divided up into either a surgical boot camp or an obstetrics and gynecology boot camp in the second week.

The other course will be taught the following two weeks for the next half of students who will be going into the primary care medical specialties such as internal medicine, pediatrics, neurology, psychiatry, etc. The first week will cover topics applicable to everyone like cross-cover emergencies, pain management, nutritional support, hand-offs, and product utilization. During the second week, these students will be divided into an internal medicine boot camp and a pediatric boot camp based on their interests.

“One of the things UAB prides itself on is its clinical care, and our students are phenomenal in terms of their clinical skills,” Leon says. “I think now this course will make them much more confident, especially as they go out to other institutions.”

Despite her early nerves, Anderson says the class—which includes pediatric simulations and assessments and Pediatric Advanced Life Support (PALS) training—gave her an added level of comfort and confidence in her first few weeks on the job as a pediatric intern.

“Honestly,” says Anderson, “I found that just pretending to be a resident for a couple weeks, focusing on clinical care of patients and having a resident mindset, was one of the most important benefits of the course.”

By Gail Short