“Match Week” in March of every year is like a medical/osteopathic school lottery. Thousands of students hope to get accepted into a residency and if they don’t, they use this week to apply again or “scramble” into open spots that might not have been filled.
Many of these applicants have fantastic CV’s or resumes, but might not have matched because they applied to programs who were highly competitive, or chose a specialty that did not have enough spots (too much demand and not enough supply).
So many other students may find themselves in the Spring without an internship or residency, feeling lost and scared about what the future may bring. If you’re one of them, realize you have options. Here are your next steps….
Keep searching for new and open spots!!!
Sites such as the NRMP and Resident Swap post the latest spots that open. Residency spots can be open post-match for any of the following reasons:
Some programs still have spots that did not fill
Some students may have extenuating circumstances that caused them to abandon a position they received during match
Some are new programs who just received accreditation
Check for openings daily!!!!
Boost your resume
While you are searching and waiting for new spots to become available you can spend the time you have doing the following:
Edit and improve your personal statement, MSPE characteristics, CV, etc.
Do research – many projects can be accomplished in a short amount of time and very meaningful
Do community service – again there are multiple meaningful projects that can be done that don’t require huge time commitments
If you had low board scores, consider retaking one of them
Consider taking Step III or Level III of your boards
Many residencies might not have chosen you because they thought you would score low on the boards. If you need to reapply next year and already have a “Pass” for your third set of boards, that issue becomes a non-issue and you become a highly competitive applicant. This may not be an option for all students, but is worth looking into.
In short, you are not alone. Hundreds of students don’t match and multiple programs fail to fill each year. And as new residencies are born each year, their timeline on accreditation or opening may differ from the rest allowing you the opportunity to apply and secure a spot in April, May and June. Don’t give up hope! You graduated medical/osteopathic school. Now let’s get you a job!!!
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.
The CDC reported this week that teen suicide rose 58% over the years 2007-2017 in the age group 10-24. Although many experts blame social media and teen drug use, one theory may need to be considered: nicotine withdrawal from vaping.
Millions of middle school and high school students admit to vaping…and many more are assumed who don’t admit to it when surveyed. So we have an underestimation of how many adolescents take regular hits of their electronic cigarette, exposing them to the powerful, addictive nicotine. One pod, placed in an electronic cigarette to be vaped, contains as much nicotine as a pack of cigarettes. Hence if a pod is smoked at school, and when the child is home goes hours without, they may “come down” off the nicotine high that they had hours earlier.
In 2002 Picciotto et al discussed how nicotine can affect mood swings, anxiety and depression, where in some cases it can act as an antidepressant but when one withdrawals from it can have increased and anxiety and depression.
The teenage mind and psyche is still developing during this time and a chemical dependency could muddy the mental health waters.
There’s no doubt social media and the misconception teens have that their lives are not as glorious as those who they view online is contributing to lack of confidence, poor self-esteem and depression. But the decision to commit suicide may also be chemically induced, or a withdrawal of one and should be investigated.
Vaping Linked to Heart Disease and Cancer
A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.
Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day. They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml. That dose would be commonly consumed by many humans who vape.
They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.
Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.
In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:
Formaldehyde (human carcinogen)
Acetaldehyde (carcinogen related to alcohol drinking)
Acrolein (highly irritating and toxic)
Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
Metals (possible carcinogens and toxins)
Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.
A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children). E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).
The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.
More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.
Last week, experts warned that many chemicals in vaping liquid may change to toxic substances (once heated) that can irritate the lungs.
Last year one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.
Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:
We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).
Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”
These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure. Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.
Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.
The start of the school year may be the most exciting time of the year (well maybe just for parents…) However going back to school can bring on a slew of health issues, so let’s look at how we can prevent them.
The most basic and easiest thing we can teach our children is to wash their hands whenever they touch something dirty, use the restroom or before they eat. True we need to be exposed to germs to increase our immunity, but some of these germs aren’t friendly and bring on colds, flu, rashes and intestinal bugs when we’re not expecting it.
If a child skips breakfast or eats primarily sugar and carbohydrates, they not only face immune system weaknesses but also poor attention, concentration and ability to do well in school. Make sure your kids eat a good breakfast with protein and Vitamin C-packed fruits before heading for the school bus.
If the kids were accustomed to staying up late and now have to wake up at 5:30 in the morning, they might spend much of their school day nodding off. Insufficient sleep has been linked to obesity as well as poor immunity so get them on a regular schedule of a bedtime that will allow 8-10 hours of sleep a night.
Chances are your child grew an inch this summer, so shoes and clothing may be a little tight. Use the finger tip rule for pants and shoes to make sure there is room to grow. And avoid accessories that your kids can chew on, swallow or can lose as they will concentrate more on the lost earring than what the teacher is saying.
Talk to them, often
Back to school can bring on anxiety in many children and make sure you have open conversations to allow them to share their fears. Bullies make themselves apparent the first few days of school, and your child may be getting wet willies, wedgies or their lunch stolen right under the teacher’s nose.
Be aware of what’s going around the school
If joining the PTA doesn’t appeal to you, at least make buddies with parents of children in your kid’s class as they will be the first to notify you if lice, pink eye or sore throat is making the rounds before a school may.
Discuss stranger safety with your children
If you child walks to or from school or a bus stop, educate them on how to avoid strangers and what to do if approached by one. Consider driving your child if you think they are at risk.
Teachers face health risks
In 2006, a study published in BMC Public Health, found teachers to suffer more from ENT (ear, nose and throat) ailments, dermatitis, bladder infections, bronchitis, conjunctivitis and varicose veins than those who work in other professions. Teachers are on the front lines when it comes to cough and cold season as they come into contact with hundreds of children a day, many of whom are contagious prior to knowing they are symptomatic. Once the fever shows itself, parents may keep the child home but the student already exposed others earlier in the day.
Standing on one’s feet for extended hours does a number on the peripheral vascular system, manifesting in leg swelling and at times, varicose veins. And when breaks are infrequent, bladder infections brew since one can’t visit the bathroom when they need.
Long work hours during the week prevent many educators from seeing a health care provider and many health plans don’t have providers who work on the weekends. Teachers can very easily put their own health care needs on the back burner during a long school year.
Taking care of school business is paramount during the school year but parents, teachers and kids need to still put health and safety.
For those medical students applying for residency, the student needs to provide a short list of “noteworthy characteristics” that are not listed elsewhere in their application.
The Association of American Colleges (AAMC) explains what the “noteworthy characteristics” are:
This section includes information intended to help a residency program selection committee review applicants holistically to achieve a residency class that brings a diverse set of background experiences, characteristics and perspectives.
• Provide a maximum of three characteristics highlighting the most salient noteworthy
characteristics of the student.
• This section should be presented as a bulleted list. Each characteristic should be described in 2 sentences or less. Information about any significant challenges or hardships encountered by the student during medical school may be included.
• Lengthy biographical descriptions are not recommended due to the time required for review and because these details can be found in other sections of the applicant’s portfolio (e.g., ERAS application, personal statement, letters of recommendation, interviews).
• The identification of the noteworthy characteristics can be done by each student in consultation with a designated mentor or advisor, or by the MSPE author.
So in essence, they are no more than 3 short entries highlighting a unique quality and why you possess that quality. Even though they say a “maximum of 3” do not just write one. I would suggest writing three. By the time the program director reads these three short sentences, they have a better picture of you as an individual.
Topics that you can draw your characteristics from include:
Raising a family while going to school
Creating a charitable/community event
Passion, hobby, talent
Personal or family challenge
Why you chose your research project
Honors and Awards
Leadership positions that you held and what you impressive task you completed
These are usually written in third person.
Examples of these may be:
As an avid traveler (or having completed a mission), Mary is fluent in Spanish, which has helped her communicate with many of her patients during training who were Spanish-speaking only.
Having come to the United States as a small boy, Ti learned English and the American culture at a young age, making new friends and excelling in his school work.
John served as Events Coordinator for the ACOFP and organized a water and sunscreen passout to homeless people at risk of dehydration, heat illness and skin cancer last summer.
Ryan is an avid pianist and has performed at multiple venues including local adult day care centers and charity galas.
Having seen her grandmother battle lung cancer, Jaime worked with other students to put up tobacco hotline numbers on university campuses.
After Breana had a scare with an abnormal skin lesion, that fortunately was not skin cancer, she devoted additional patient education on how to screen for skin cancer with many of her patient interactions as a student.
Lisa participated in multiple marathons, including the Boston Marathon, completing all of them.
Mark lost over 50 lbs when he discovered a plant-based diet, and now educates patients on how inclusion of vegetables is paramount to a healthy diet.
Scott’s academic strength was exemplified by making the Dean’s List during both years of Basic Science, and choosing to tutor other younger students when he moved on to his clinical years.
Maya actively practices yoga and many times has held yoga and meditation workshops for students after school.
So as you see you can be as creative as you wish, and don’t be afraid to “brag.” This is your time to toot your horn and make yourself stand out! You are applying for the job of your life….prove to them you are exactly what they need for their residency program.
Thousands of medical students are hitting the final stretch of their medical school education and beginning to embark on one of the most critical times of their career…choosing a residency and applying for a position.
Despite one’s academic prowess, however, the interview could make or break an applicant.
Therefore, let’s get you ready for the biggest job interview of your life.
Know your audience
Every residency program is different. And each one has defining elements. So don’t make the assumption that all hospitals, doctors, staff and teaching programs are the same.
Do your research before your interview, and know inside and out what makes them tick.
The services they offer that other institutions don’t
The type of community they serve
Current research studies
What are they known to have excelled at or trail-blazed
It might even help to read up on the program director and see what he/she published.
Why?? Because the first question they ask you is:
Why did you choose our residency?
Know the specialty you’re applying for
This may seem like a no-brainer but many students will, when nerves take over, cite misconceptions or negative stereotypes of the field their entering.
For example one may cite during a surgical residency interview that they “Prefer cutting over figuring out what the patient has.”
Or during a family medicine interview say, “I don’t like working in the hospital,” or “I would rather be a Jack-Of-All-Trades, than specializing in one subject.”
These answers could make the interviewer cringe. So the following examples may be better statements:
Surgery – “I enjoy working with both my mind and my hands when it comes to the vast amounts of pathology one sees as a surgeon.”
Family Medicine – “I enjoy working with the family as a unit and am excited to have the capability to treat those of all ages.”
Internal Medicine – “I’m fascinated by the complexity of cases seen in internal medicine and how the history and physical exams skills we learned in medical school can be just as accurate as the most powerful imaging study used when determining what is wrong with a patient.”
Pediatrics – “Children make me laugh and smile and to be able to do that every work day is a rarity in many professions and specialties.”
Remember it’s an interview
Dr. Thomas Hunt, Program Director, Valley Health System Family Medicine Residency Program, states:
Generally programs are looking for a good fit – fit to the specialty, culture, community, and mission of the program. Each program will weigh elements of your application differently, taking into account your transcripts, scores, letter of recommendation, etc. looking for candidates that best adhere to their “Ideal” resident.
That being said, the best advice I can give to students interviewing for residencies this season is to relax, be yourself, and remember that you are interviewing the program as much as they are interviewing you. Watch how the faculty, staff, and residents interact with one another and ask yourself “How do I see myself fitting into this program over the next 3 to 5 years? Is this what I am looking for? Will I be happy and thrive in this environment?”
So remember…. it’s an interview. The reason why you are sitting before them is because they liked what they saw on paper but now they need to see how you act, speak, and compose yourself in person. So the same rules apply.
Thank them before and after the interview, using a handshake when appropriate
Dress professionally, but comfortably so you appear comfortable and professional
Avoid slang and overly wordy responses
Keep giggles to a minimum, even if they make a funny joke
Be gracious to everyone with whom you come into contact with that day from the security guard to the program director to the parking attendant
If a question seems random, and you don’t know the answer, respond with, “That’s a good question, let me give some thought into my answer before I respond,” to provide you with some pause to collect your thoughts.
Why should they pick you?
Each program is being inundated with applications and your competition is fierce. However, don’t let that over-intimidate you. The fact that you clutched an interview means you are already ahead of the pack. Now you need to convince them they made the right choice in choosing to interview you.
Remark how appreciative you are in them giving you the opportunity to interview for such a highly coveted position.
Highlight your strengths and how they can be of benefit to their residency
If you are multilingual, don’t hold your tongue, let them know!
If you did an audition rotation there and worked well with the residency team (less transitioning needed) remind them of how well you all worked together
If your academics and board scores are strong, gently remind them you are a strong test taker (it can enhance their Step/Level 3 test score average)
Some may straight up ask what three things make you valuable for their residency program, so be prepared to answer this and other questions (see below.)
Discuss how you want to become apart of the community in which the residency resides and help continue their good work.
Many programs want to train those who will stay instate and provide much-needed care to their residents. If you do plan on living in the state in which you train, make sure you let them know!
Will they try to trip you up?
The short answer….No. Program directors don’t have time to waste by choosing applicants and then scaring them off or tricking them into performing badly.
However, they are going to want to get to know you. Residents and their attendings are committed to working with each other anywhere from 3-5 years and your future boss wants to know you can make the cut and work well with others. Don’t be afraid to show some personality but remember to be brief and continue to allow them control of the interview.
Smile…you’re on CAMERA
Many interviews are now being conducted online, virtually. This can pose advantageous for some, disadvantageous for others.
Many of us rely on “distractors” during interviewing by using body language, hand gestures, or even our application/CV that lies between the applicant and interviewer.
Video interviews change that and can put all the focus on one’s face. So here are pointers to help you prepare for your “virtual interview”.
Test the lighting and your screen before the interview, making sure you view yourself as they will see you.
Make sure the light source is shining on you to avoid shadows.
Choose an area for your interview that appears professional and clean.
If you have a pet do not allow them into your interview area (cats love to hog the camera)
Try to wear clothing with solid colors rather than patterns. Choose ties/accessories that are professional looking (avoid the outlandish).
Avoid heavy makeup as camera lighting can add more shadows making one’s light makeup appear excessive.
If you have facial hair, remember to trim and shoot for a clean look. If shaving, do so a few hours prior to the interview to avoid fresh nicks/bleeding. Neck stubble may appear more prominent on video so consider a clean shave in those areas.
Try elevating the camera/laptop with books, boxes to have a slight angle. Looking up at the camera for some offers a more slender, cleaner look than looking down. However, as discussed earlier, test your image first before going live.
Practice a mock interview and review your video. Watch for lip biting, facial grimaces and saying “Uh” multiple times. Although it’s hard to watch ourselves on tape we learn a lot about what other people can see and this will give you an opportunity to improve your skills.
Finally…..wear pants! Even if you think the camera will only video waist up, it’s not worth the risk.
So what are some sample questions?
You might be asked any of the following:
Why did you choose our residency?
What made you choose this specialty?
How would you define our specialty?
What do you like about our institution?
What do you dislike about our program?
What sub-specialty are you interested in?
Where do you want to live once you graduate?
Do you work well with others?
Give me an example of when you had a conflict with a coworker and how did it get resolved.
What are your strengths?
What are your weaknesses?
Tell me about your research.
Tell me about your volunteer work.
Tell me about your community service.
Have you had any leadership roles?
Briefly touch upon some of your academic challenges.
What do you do for fun?
What are your hobbies?
How do you relieve stress?
Do you have family and friends who support your career choice?
Do you read books, and what book are you currently reading?
Describe a challenging patient case you’ve come across.
How would you approach a colleague who is abusing narcotics?
Where do you see yourself in 5-10 years?
Do you have any questions for me?
For the final question, refrain from asking the interviewer questions that are easily answered on their website or catalog. Use the opportunity to show off your interests whether it’s regarding what research, community partnership, or teaching opportunities exist. You can also ask them what they like about the program, why they chose to teach there, and what they would like to see in terms of evolution and progress.
After the interview
You will thank them and shake their hand but when you return home send a thank you note for their time. Don’t stress over how your interview went. Most likely you performed better than you thought. Moreover expect your skills to improve with each interview. Some suggest to leave your favorite picks to the end until you gained more practice, however, some may argue to not allow the interviewer to get “applicant fatigue” such that by the time they meet you they have made their choice.
Practice with classmates or faculty if you need and remember to prepare.
Finally, realize that you have interacted with hundreds if not thousands of individuals in your lifetime whether they were students, patients or faculty and are very skilled at what you do. If not you wouldn’t be about to graduate medical school. You got this!! Crush it!
Student debt has been rising and the average undergraduate doesn’t feel confident they will pay off their loans before middle age.
Lots of factors contribute to the increased debt a student faces. Some of these include:
Higher tuition costs
Increased time requirements to obtain a degree (5 year program vs 4 year)
Fewer students work while taking classes
More competition after graduation
Higher cost of living precludes early repayment of loans
And it is projected to rise. The Congressional Budget Office each year projects the total amount of new federal student loans the office believes they will issue with this year projected to be nearly $1.5 trillion.
Andrew Coates, candidate for University Regent in Southern Nevada, states, “One way that colleges can help students keep their debt under control is by locking-in tuition rates. This means that tuition will not be increased while a student pursues their degree. By locking-in tuition, students will know exactly how much they will pay each year in college, which will help them budget accordingly.”
Andrew Coates, Candidate for University Regent, Southern Nevada
So how can students curb their debt?
Choose an affordable college
According to US News data, the average cost of tuition and fees for the 2018–2019 school year was $35,676 at private colleges, $9,716 for state residents at public colleges and $21,629 for out-of-state students at state school, with many universities easily exceeding these numbers. So students may want to consider getting early credits completed at community colleges and then finishing their degree at a university. Additionally, many will need to decide if its worth picking an out-of-state college for a degree that provides the same job market edge as an in-state school.
Research available loans, grants and scholarships
Many students don’t apply for grants, loans and scholarships because of time constraints, misconceptions such as they don’t fit a demographic, or “will be credit history required?”, and lack of optimism that they will even qualify.
Mark Kantrowitz, publisher and vice president of saveforcollege.com states, “More than 2 million students did not get a Federal Pell Grant even though they were eligible because they did not file the FAFSA.” FAFSA (link attached) is a free application for federal student aid assisting students who want to apply for a loan, grant or work study.
Scholarships are ideal in that they do not need to be paid back. Many can be found at scholarships.com.
Learn to budget
Many students get a culture shock living on their own when they spend as if Mom or Dad is still footing the bill. If eating out nightly, shopping online, or using excess data does not fit into the amount your trying to live on each month, budget expenses early on and stick to it.
Avoid the credit card trap
When we try to build our credit as a young adult, we may apply for a credit card that advertises to college students with no monthly fee and “rewards.” However, the interest rates can be up to 25%. If you do use the credit card don’t borrow more than you can pay off each month, always shooting for a zero balance.
Keep your living costs down
Rent, transportation, utilities, meals, entertainment, internet and phone service, add up and can be more costly than tuition. Share expenses with roommates or family members to lessen your loan debt.
Cook and prepare meals for the coming days, use school wifi, carpool to class, purchase less beer, and use the university gym to save money.
But most importantly, don’t stress about the debt. Your efforts should be concentrated on your schooling and getting a degree is one of the best ways to combat your debt later in life.
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.
She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada