Trinity School of Medicine News Blog

Strategy and Residency Match: What You Need to Know

Last week, we published data that gave insight into this year's match for Trinity and its graduates. As a follow up, we're going to break down some of the complexities at play in the match itself, and give guidance to medical students, present and future, on how, and where, Trinity students go that extra mile and succeed.

Results of the 2016 NMRP program director surveyFirst, What Is the Match? In a word, it's complicated. The match is a national (Canada and the US each have their own at nearly, but not quite, the same time) search held each year where teaching hospitals across the country hire doctors out of medical schools. So in many ways, it's a job interview. At the same time, it's also the next step of a physician's training: it's where they develop the knowledge and skills associated with their specialty (every doctor is a specialist in some regard, even if their specialty is general practice), and that takes years of additional study, guidance, and on-the-job learning. The difference is at this point, they are licensed doctors and they're drawing a salary as they learn, rather than paying tuition.

The match is a high pressure time in a future doctor's life. It's as if they're trying to get into medical school all over again, while at the same time, trying to get that first job after graduating. The scale and complexity of the process means it happens once a year, all at once, and if a medical student does not "match" (they select a program, that program selects them), then they must typically wait a year before trying again. 

So, How do People Match? There are two answers, here.

First, technically speaking, their school (and the ECFMG in the case of IMGs) certifies their eligibility to match, they enter into the program, and, after a lot of research and decision making, select their possible future teachers/employers. At the same time, the residency directors are combing through the applicants that select them, and start a selection process of their own.

The more complicated answer is how those directors make that choice and how Trinity prepares students to be chosen. This will be the focus of the rest of today's post, breaking down the data the match programs provide, and connecting that data-driven strategy to examples of specific Trinity graduates. 

USMLE Step-1
Now, as we've pointed out in the past, per the NRMP, the top criteria used by program directors to determine their list of interview invitations has been, and continues to be, USMLE Step-1 scores. It's also worth noting, as it often comes up when students are considering an international school, graduating from a prestigious US school isn't even in the top 20 of residency directors' criteria for selection

Regarding that top criteria of Step-1 scores, this is why Trinity so heavily integrates preparation for the board exams into our curriculum: it directly correlates with securing a residency match. See below.

MCAT is not the predictor Step 1

The above graphic is an excellent example of why Trinity looks deep into an applicant's background and doesn't eliminate candidates based on MCAT score alone. They just don't track evenly with Step-1 scores.

Residency specialty (again, the area of focus a physician will develop, e.g. thoracic surgery or internal medicine), and Step-1 scores correlate on a predictable curve. This is often a method of aptitude measurement, but it is also, just like most other elements of selection in medicine, a result of a constellation of factors. The more competitive a specialty is, the higher the Step scores required for consideration. Using our examples, thoracic surgery and internal medicine, there are a wide variety of variables that make thoracic surgery more competitive than internal medicine; income potential, years of training required, the need for a specialty (a population needs more internal medicine specialists than it needs thoracic surgeons), even perceived prestige, can influence how competitive a specialty is at match time. As a result, the higher paying, rarefied need for thoracic surgeons makes it a more competitive residency to secure, even if you discount the Step exams as aptitude indicators.

USMLE Step 1 Scores (US IMG and Trinity)
At the same time, Step scores are a major factor in securing a match at all because they're the only quantifiable means of evaluating all candidates by the same standard. Moreover, earlier we gave an example of something that's perceived to be a factor (an applicant's medical school) that really isn't. This leaves the question lingering, though: what are the factors a student should evaluate and strategize around? 

A
s the top chart indicates, much like with the MCAT, even with Step-1's high correlation, there are many factors worth considering: selecting specialty, selecting programs, even electives taken in the final years of medical school, that can influence the outcome. Put another way: medical students are gifted and hard-working in their studies. In those areas, and other traditional barometers of success, students are often at the top of their game and, as such, at a point where it takes a dramatic effort to minimally move the needle on progress.

While self-improvement and focus are integral elements of success, so is a recognition of when an individual is playing a game of diminishing returns. But where do you put that energy? We're going to dive into what we advise Trinity students and what they've learned themselves, and show you how Trinity School of Medicine sets its students up for success.

Strategy and the Match: What does the data tell us?
Residency is a major step for physician. It feels like a big deal because it is a big deal, make no mistake. However, it's not as simple as point (select your career path), shoot (go after it 100%), and hope for the best. It is, just like going to medical school, a step towards a new beginning and, in no real way, an "end point." 

It's crucial to employ the same sort of strategic thinking that's involved in selecting a medical school. In fact, it's even more important. Beyond there being residency programs of varying prestige and competition, residency candidates will find that same accessibility curve in residencies themselves. Dermatology had 26 matches this year, whereas internal medicine alone had well over 7,000. In fact, of the 31,000 matches, a full third were family and internal medicine, and only half of those were filled by US allopathic (MD) seniors. 

So, what does this mean for Trinity students graduating and heading into the match? It means know themselves, trusting their experience, following their dreams, but also following the data.

charting outcomes in the match for international medical graduatesThis report has crucial guidance (and some surprises) for US and Canadian medical students seeking to match in the United States. For starters, US IMGs (US citizens that graduate from international medical schools) that matched to residencies found significantly greater success when they had longer lists in their preferred specialty, and longer lists in general.

While research experience is considered a factor in general and can certainly lend itself to the interview (leading to competent discussion on relevant areas), US and non-US IMGs (non-US citizens that graduate from non-US medical schools) had statistically significant differences in research experience (while the average amount was the same, 15% fewer non-US IMGs had reportable experience) and this ultimately bore out to not be a factor in the selection itself. The takeaway here being take part in research for your personal learning and your interests, but once you've reached the median quantitatively, it ceases to be a differentiator. 

Similarly, with the exception of a few specialties, overall work experience was less of a factor, whereas volunteer experience, a pillar of the Trinity School of Medicine campus culture, was a major factor.

Strategy and the Match: what does experience tell us?
Earlier, we mentioned considering multiple specialties, rather than just focusing on one as part of a "long tail" list strategy when going into the match. Residency is just the next step and not the end, nor is it a pigeonhole, especially not with residencies like internal and family medicine that have a much greater public health need, and therefore greater opportunity for success for applicants.  
Median number of contiguous ranks of international medical graduates
Three of our most recent alumni spotlights were either family or internal medicine, and all three have gone on to sub-specialize in competitive fields via fellowships. Dr. Clinton Ezekiel is heading into pulmonary critical care, Dr. Adrian Garcia has sub-specialized in internal medicine-pediatrics.

Trinity grad Dr. Amy Hernandez spent much of her life preparing herself for a career in sports medicine, only to find her calling in psychiatry later on: while the science of sports medicine appealed to her, the patient interactions of psych ultimately fit more with the type of patient contact outside of a lab that she sought. 

Similarly, Canadian graduate Dr. Thomas Oliver initially matched into medical genetics in Manitoba. While the work was stimulating, he transitioned and found himself practicing family medicine back in his home of British Columbia, a notoriously competitive province for IMGs to match.

Finally, regarding the point about research earlier, Dr. Christopher Saling directly connected securing his residency to his enthusiastic approach to finding opportunities for research and pursuing them, so there are, of course, exceptions to every rule. 

Parting Thoughts
Much like Olympic athletes, physicians spend most of their life training with serious focus on achievement and the next challenge as it relates to their long term goal. If there's something medical students can takeaway from their counterparts in world class athletics, it's the understanding of diminishing returns and marginal gains.

At Trinity, we try to convey that it comes from not just understanding the specifics outlined above, covering areas where students could redirect their focus (while still consistently performing at their sustainable best), it comes from also recognizing where twice as much effort will result in only  marginal progression on a given metric of success. It also comes from developing the wisdom to know when it's time to push for that marginal progression, or where to direct that double-sized effort to another area to shape yourself, ultimately, into a significantly more attractive candidate for residency directors. 

When we talk about the Trinity advantage, we usually talk about our admissions process, our small class sizes, our Step-1 prep, our single-city clinical rotations, and our culture of support. And that's all accurate, but it's also important to look at the bigger picture that informs those choices we've made as a school: All of those elements culminate in a daily example of that wisdom to know it's not just about working hard, it's about working smart. It's about being informed and thoughtful in how effort is applied to succeed. We strive to impart to our students not just how to become exceptional physicians, but how to know, without cynicism or fear, what will make a difference and what won't, and how to do the most good where it counts.

If that sounds like you, if that spoke to you, it's time to apply. We're waiting to hear from you, so the question remains: What are you waiting for?

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Topics: international medical schools Accredited caribbean medical school residency match Graduates of Trinity School of Medicine

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