Considerations for Your Residency Rank List for the Match

Choosing the right residency program is a significant decision, and there are many factors that go into determining how programs should be ranked. As you prepare for interviews and later plan your residency rank list, it’s important to think about what matters most to you and ask the right questions to get the information you need. In this post, we'll explore several key factors to consider during the residency application and interview process.

Class Size and Team Structure

Finding the Right Fit for You

Class size is one of the first things you’ll need to consider when evaluating residency programs. For some applicants, smaller class sizes with more individualized attention are a priority, while others prefer a larger group dynamic.

Personally, I enjoy having a class size of around eight residents. It allows for close connections with my co-residents while ensuring that I don’t feel lost in a crowd. Larger programs might have more residents, which can provide a different type of learning experience—one that may involve being more independent on rotations and potentially interacting less with your peers. It's important to determine what will make you feel supported and engaged.

Ask the Right Questions

Be sure to ask current residents about the class size and how much interaction they have with each other. Does the program foster a team environment, or is it more individualized? These questions will give you insight into the day-to-day dynamics of the program and help you decide which environment is best suited to your learning style.

Didactics: In-Person vs. Virtual

The Value of In-Person Interaction

Another key consideration is how didactics (lectures and other formal educational sessions) are delivered. Some residents prefer in-person sessions for the increased opportunities for interaction with faculty and peers. For instance, I’ve noticed that programs with in-person didactics tend to foster stronger connections between residents. Additionally, in-person learning allows for better discussion and collaboration.

On the other hand, some programs have virtual didactics, which may provide flexibility, but could also lead to a feeling of disconnection between residents. The lack of interaction with peers and faculty might make it harder to form relationships with your co-residents or get to know residents in other years.

Tailored Curriculum and Year-Specific Didactics

In some programs, the curriculum is tailored to the specific needs of each year of residency, with PGY-1s receiving different lectures than PGY-3s or PGY-4s. If you're someone who thrives in a structured, progressive learning environment, this may be an important factor to consider.

Teaching Opportunities and Academic Involvement

Engaging with Medical Students

If teaching is an important part of your career goals, be sure to ask specific questions about teaching opportunities. While many programs will answer “yes” to whether teaching is available, there is a great deal of variation in how often residents are given teaching roles. Ask about which rotations allow you to teach and whether you will be working with medical students or other residents.

Some programs provide more hands-on teaching experiences, such as working directly with third-year or fourth-year medical students. Others may focus more on other responsibilities, with fewer opportunities to lead educational sessions. The more specific your questions, the easier it will be to compare programs and understand how teaching will fit into your training.

Pay and Housing Considerations for Your Residency Rank List

Salary and Cost of Living

While salary is an important consideration, it’s usually standardized across many programs. However, cost of living varies dramatically depending on location. Urban programs may offer slightly higher salaries, but the cost of living—particularly for housing—can eat into that income. Conversely, programs in rural areas may offer lower salaries, but your income will likely go further in terms of housing costs.

When asking about salary, it’s more useful to inquire about housing. Specifically, ask residents about how far their salary goes in terms of rent or mortgage payments. Do most residents own homes, or are they renting apartments? This can provide valuable insight into what it’s like to live in the area on a resident's salary.

Urban vs. Rural Programs

Programs in urban areas may be more expensive to live in but might also offer greater networking and lifestyle opportunities. If you have a family or prefer a larger living space, a more rural program might be a better fit, despite potentially offering a lower salary. Consider your personal needs and priorities when evaluating this factor.

Call Schedules: Night Float vs. Traditional Call

Balancing Work-Life Demands

Call schedules can have a significant impact on your work-life balance during residency. Some programs use a night float system, which allows residents to work overnight for a set period, while others rely on traditional call schedules, where residents may need to be on call for longer periods and handle post-call duties the following day.

If possible, ask about how call is scheduled. Are residents given flexibility to swap shifts, or is the schedule determined by a chief resident or faculty member? Some programs may have resident-run call committees, which can provide greater control over scheduling.

Night Float vs. Call Rotations

Ask how the program structures its night float or traditional call rotations. Does the program allow for time off after a night shift, or will you need to return to work after a shift ends? This can have a significant impact on your overall well-being during residency.

The Impact of Program Location

Rural vs. Urban Exposure

If you're interested in gaining a well-rounded experience, consider programs that provide exposure to both rural and urban populations. Having a variety of patient demographics can help expand your skills and knowledge, especially if you plan to practice in diverse settings after residency.

Traveling Between Rotation Sites

Some programs require residents to travel between multiple rotation sites, which can be a consideration in terms of time management and transportation. Evaluate whether you are comfortable with the extra commute or if you'd prefer a program that consolidates rotations at one location.

Osteopathic Recognition and Training

Incorporating Osteopathic Philosophy

If you're a DO applicant, it's crucial to ask about the program's commitment to osteopathic philosophy. While some programs have formal osteopathic recognition, others may not integrate this philosophy into their training. Ask about the presence of DO faculty, the inclusion of osteopathic training, and whether the program supports DO residents’ needs.

It’s important to advocate for osteopathic principles in all your interviews. Make sure to ask about how osteopathic philosophy is implemented and whether the program truly embraces the holistic approach that defines the osteopathic profession.

Specialty-Specific Considerations

Psychiatry

For those interested in psychiatry, consider asking about specific rotations such as detox, rehab, neuromodulation (ECT, TMS, ketamine), and forensic psychiatry. Additionally, inquire about psychotherapy training, patient populations (involuntary vs. voluntary), and inpatient vs. outpatient experiences. The scope of training can vary greatly depending on the program.

Family Medicine

In family medicine, consider whether the program offers full-spectrum training or focuses on a particular niche. Some programs provide opportunities in integrative medicine, sports medicine, or women’s health. Additionally, inquire about OB experience and whether residents can participate in deliveries or assist with C-sections.

Conclusion: Asking the Right Questions

When ranking residency programs, it’s essential to ask the right questions to ensure that you find the best fit for your needs and preferences. From class size to call schedules, teaching opportunities to salary, each factor will play a role in your experience. Make sure to ask detailed questions during interviews and prioritize what’s most important to you in your residency training. By doing so, you'll be better equipped to make an informed decision and rank programs with confidence.