Einstein Healthcare Network Ob/Gyn Residency Personal Statement Examples

Postgraduate PA School Residency and Fellowship Programs

As a new, or even experienced PA, it is normal to feel uncomfortable with the thought of jumping into a medical specialty.

Often we have had little more than 30 days of training in a particular field, and we are joining a team of specialists who expect us to perform at the level of seasoned doctor.

PA training is generalist in nature with the ability to pick and choose among rotations as a student that may help one gain more experience in a particular field of study prior to graduation.

If you have been practicing in a field for some time and want to change directions, it can be very intimidating.

We want to do right by our patients, providing them with the very best care in all situations. While on the job training is fine and dandy, depending on your practice you may receive a lot or very little hand holding. This can be a setup for occupational success, professional and personal growth or, on the flip side, failure!

To help PAs looking to successfully transition into careers of medical specialty postgraduate PA programs began popping up in the early 1970's. As the profession grows and more and more PAs are entering specialty practice, PA residency programs have adapted to fit our needs.

Over the past four decades the PA postgraduate training movement has slowly expanded, and in 2017 there are more than 84 postgraduate PA programs with 70 of those listed on the Association of Postgraduate PA Programs (APPAP) website.

All of these postgraduate training programs also referred to as residencies or fellowships, provide some form of advanced learning in various medical and surgical specialties.

PA Residency Program Accreditation

Unlike PA schools across the country which must undergo a rigorous accreditation process through the ARC-PA, PA residency programs do not require a formal accreditation to exist. Although I think this will change with time, here are the two accrediting bodies:

  • ARC-PA: There are currently only 8 accredited clinical residencies for PAs in the US, listed on ARC-PAs website here. Accreditation is voluntary through ARC-PA and does ensure a certain level of educational standards, but it is not required and offers no current benefit. Since 2014 The ARC-PA has placed the accreditation process for clinical postgraduate PA programs in abeyance while it studies a different type of process to recognize program educational quality.
  • Association of Postgraduate PA Programs (APPAP): At the American Academy of Physician Assistants Convention in Los Angeles in May 1988 a group of postgraduate PA programs met to formalize a national postgraduate PA program organization. Bylaws were written and approved by the eight founding programs and the Association of Postgraduate Physician Assistant Programs (APPAP) was formed to further specialty education for PAs. Programs are not required to be registered with APPAP and certain membership criteria must be met to be eligible. While there are benefits to being registered with APPAP, there are also very expensive membership fees that programs may not wish to spend their money on.

Do not be hesitant if the program you find interesting is not on APPA's or ARC-PA website. In 2017 this says very little about the quality of the postgraduate program.

The Pros and Cons of Physician Assistant Residency Programs

There are pros and cons to completing a residency program, but it is the decision of each individual PA to choose to participate, which greatly depends on the specialty.

PROS of PA Residency Programs

  • Residency programs allow the physician assistant to gain both clinical and didactic knowledge that would take years of on-the-job training to attain.  It provides a faster paced, formalized training program of supervised practice, which allows physician assistants to be utilized much faster than new graduates.
  • The PA can develop the judgment and technical abilities in a specialized practice area, thus increasing their confidence in their chosen specialties.
  • Many employers give preference to residency-trained physician assistants.
  • Residency programs can be a great way to transition to specialty practice for a mid-career PA looking for a new challenge.
  • It is also recognized that most employers are willing to pay more for a physician assistant who completed a residency program.

Emory University Critical Care Residency

PA Surgical Residency Personal Account

I attended the Norwalk/Yale Surgery residency 2 years ago. I thought the training was invaluable. The pay was less and the work was exhausting but I'm absolutely positive I am a much better surgical PA because of it. I went into CT surgery after and feel like I've always had a huge advantage in my field because of my training.

I think most of the negative attitude towards residency comes from PAs that didn't complete one or had very little exposure to any. Most of the people I know that attended residencies were happy they did. I know there's a fear that residency training limits you to one specialty but I think it does the opposite. If you end up switching specialties it shows employers that you have a passion to learn and were willing to put in a little harder work for better training. It doesn't hurt your lateral mobility at all. If two candidates want to switch from CT surgery to Derm, who is the stronger candidate, the one with 3 years of CT experience, or the one with 2 years CT and 12 months of intensive surgical training?

Sure, you can get a job that does an excellent job of training you up and allowing you to become a well-rounded, knowledgeable PA but some jobs just need you to crank out patients and know the right answer, not necessarily understanding why that's the right answer. Residency training just concentrates everything you have the potential to learn in your first 2-3 years into 12 long months.

I personally believe if more people did residencies it would strengthen our entire career field. We pride ourselves in being trained in the medical model and residencies are what really separate Physicians from APPs, so why not.

PA Cardiology Residency Personal Account

I am currently in a cardiology post graduate residency/fellowship at The Ohio State University. However, it is not accredited/not listed on the APPAP website. I decided to pursue this after graduation because I wanted more exposure in the different subspecialties of cardiology, something I don't think I could've received if I got a general cardiology position. Here are some +/- of my experience so far (~4 months in)

(+) -Exposure to many different sub-specialties: ep, hf, CT, vascular, transplant, adult congenital etc. Also get to spend time with palliative (mostly pts with hf), stress/echo lab, consults etc. -Decent pay (70k). I know I could get paid more but this amount was imo a good trade off. -Lots of learning opportunities. I can and am encouraged to attend grand rounds, conferences etc that are set up for md residents/fellows. We don't work excessive hours - unlike medical residents. My hours average from 36-40ish a week m-f. Throw in study time and obviously it goes up. -Good mix of inpatient/outpatient exposure. More so inpatient. -Program is very open to feedback/suggestions and are accommodating. For example, I wanted to spend some time in the stress lab to see vo2/stress/etc test and it was set up very soon after. I imagine the program to get better every year.

(-) -Taking a hit on salary. -Moving to a new st 2500 miles from home is/was an adjustment. -The cardiology fellowship for mid-levels is a new thing at Ohio St - so there are obviously things that can be improved such as some teams allowing us to just shadow, or some preceptors not knowing what the fellowship really entails. Each team I am part of is different from the next in terms of learning opportunity, etc. For the most part, many of the teams I am on I feel like I am part of a team and have preceptors who are genuinely interested in my education. Other times (which is rare) I feel like I'm just there to shadow.

In conclusion, the program here at OSU could use some more structure but overall I'm glad I applied and was accepted. After just four months in, I am confident I will have more experience/knowledge than if I just took a job. With that said, after one year I obviously have much to learn and will be that way for the rest of my career.

CONS of PA Residency Programs

  • PAs who jump into specialty without residencies claim you can get paid 2-3 x as much, work less, and learn just as much while getting your training on the job.
  • Even though employers are willing to pay more for a PA who completed a residency, the salary maxes out and becomes equal to those who did not do a residency program.
  • Residency requires more education thus increasing the duration of school and structuring the profession more like a physician. Tuition for a Physician Assistant Program is around $78,000 for didactic months and the clinical year. If a student has to take out a loan for $36,000 for two semesters, and, with seven total semesters, our total debt at the end of our physician assistant program is around $126,000. This does not include any interested accumulated. Adding on more expenses and loans for residency programs may put the PA graduate in more debt and leave one with more accumulated interest that is more difficult to pay off in a timely fashion.
  • A negative aspect of employers’ rewarding those who complete residency programs with a larger salary is that it could become mandatory for physician assistants to complete specialty residency training in order to compete for the positions since more applicants may apply for higher paying jobs than lower paying ones.
  • Residencies require more education, therefore delaying those practitioners from entering the clinical setting on a full-time basis. This delay limits the number and availability of physician assistants as mid-level practitioners, exacerbating the lack of health care providers to meet the increasing demands of the population for health care.

As you can see, this can turn into a contentious debate! What do you think, are fellowship programs here to stay?

PA program residency quick facts:

  • What about my loans? You can defer student loans during your residency and some programs offer loan repayment.
  • Do I get paid during my residency? Most residencies provide stipends of 40 - 75 k and require 40-80 hours per week up to 6 days per week.
  • How many hours will I be required to work? The average program length is 12 months but some programs are up to 24 months long.
  • How competitive is the process? 10-30 people interview at each program annually and accept on average 1-4 residents.

PA Residency Program offerings

Below, is an exhaustive list of US PA postgraduate residency and fellowship programs as of January 2017.

  • By far the most comprehensive PA residency program is hosted by the Carolinas Healthcare system which offers eight PA fellowships in Acute Care, Critical Care/Trauma, Family Medicine, Hospitalist, Internal Medicine, Pediatrics, Urgent Care and Urology!
  • The Mayo Clinic also offers a deep network of PA residency programs in Critical care/Trauma, Hospitalist, Hematology and Oncology, Internal Medicine, Otolaryngology and ENT.

I have added a brand new section for Postgraduate PA residency programs as part of the PA School finder website. You can now search by program and specialty via a geographical search console or use the new interactive perfect match tool.

PA Postgraduate Residency and Fellowship Programs by Specialty (Updated March 2017)

Use the search box to search by specialty or location. Click the header column to sort based on that criteria. Click on the web link to visit the postgraduate residency program website.

Name of ProgramSpecialtyLocationDurationClass Sizeweb
University of MissouriAcute CareColumbia, MO15 months2http://medicine.missouri.edu/acutepa/
Carolinas Healthcare System CenterAcute CareCharlotte, NC12 months28http://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Advanced Practitioner Acute Care residency at Mission HealthAcute CareAsheville NC6-12 months4 every 6 monthshttp://www.mission-health.org/index.php
Mercer-Piedmont HeartCardiologyAtlanta, GA12 months2http://www.piedmont.org/medical-professionals/join-the-team/mercer-piedmont-residency-program
St. Joseph Mercy HospitalCardiothoracicYpsilanti, MI12 months1http://www.stjoesannarbor.org/physicianassistantresidencyprogram
Dartmouth-Hitchcock Medical CenterCardiothoracicLebanon, NH12 months2http://med.dartmouth-hitchcock.org/heart_vascular/ctparesidency.html
Methodist DeBakey Heart and Vascular CenterCardiothoracicHouston, TX12 months2 to 3http://www.houstonmethodist.org/heart-vascular/for-healthcare-professionals/learning-opportunities/
Carolinas Healthcare System CenterCritical Care & TraumaCharlotte, NC12 months28http://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Intermountain Medical CenterCritical Care & TraumaMurray, UT12 months1https://intermountainhealthcare.org/careers/residencies-training/medical-resident-fellow-training/trauma-residency/
Einstein/Montefiore Division of Critical Care MedicineCritical Care & TraumaBronx, NY12 monthscontact programhttp://www.einstein.yu.edu/departments/medicine/divisions/critical-care/division.aspx?id=21583
Emory Critical CareCritical Care & TraumaAtlanta, GA12 months2http://whsc.emory.edu/home/education/critical_care/
Johns Hopkins HospitalCritical Care & TraumaBaltimore, MD12 months6http://www.hopkinsmedicine.org/surgery/education/pacc_residency/description.html
St. Joseph Mercy HospitalCritical Care & TraumaYpsilanti, MI12 months1http://www.stjoesannarbor.org/physicianassistantresidencyprogram
St. Luke's HospitalCritical Care & TraumaBethlehem, PA12 months4http://gme.slhn.org/fellowships/critical-care-emergency-medicine-advanced-practitioner-fellowship
Mayo Clinic ArizonaCritical Care & TraumaPhoenix, AZ12 months1http://www.mayo.edu/mshs/careers/physician-assistant/physician-assistant-fellowship-hospital-internal-medicine-arizona
WakeMed Health and HospitalsCritical Care & TraumaRaleigh, NC12 months3http://www.wakemed.org/careers-surgical-physician-assistant-residency-program
Winthrop University HospitalCritical Care & TraumaMineola, NY12 months1http://www.winthrop.org/pa-postgraduate-residency
Medical College of WisconsinDermatologyMilwaukee, WI12 monthscontact programhttp://dermatology.mcw.edu/education/physician-assistant-fellowship-program/
Albany Medical CenterEmergency MedicineAlbany, NY12 months5https://www.amc.edu/academic/GME/programs/ed_pa_fellowship/index.cfm
Albert Einstein Medical CenterEmergency MedicinePhiladelphia, PA18 months2 or 3http://www.einstein.edu/education/non-physician-programs/em-physician-assistant
Arrowhead Regional Medical CenterEmergency MedicineColton, CA14 months15http://armcemergency.org/
Baylor College of MedicineEmergency MedicineHouston, TX12 months4 to 6https://www.bcm.edu/departments/medicine/sections-divisions-centers/emergency-medicine/education/physician-assistant-fellowship
Brown Alpert Medical SchoolEmergency MedicineProvidence, RI12 monthscontact programhttps://www.brown.edu/academics/medical/about/departments/emergency-medicine/index.php?q=emped
Carilion ClinicEmergency MedicineRoanoke, VA12 months3https://www.carilionclinic.org/emergency-department/fellowship/np-pa
Eastern Virginia Medical SchoolEmergency MedicineNorfolk, VA12 months2 to 4https://www.evms.edu/education/centers_institutes_departments/emergency_medicine/fellowships/physicians_assistant_fellowship/
St. Luke's HospitalEmergency MedicineBethlehem, PA12 months4http://gme.slhn.org/Fellowships/Critical-Care-Emergency-Medicine-Advanced-Practitioner-Fellowship
Jane R. Perlman / NorthShore University Health SystemEmergency MedicineEvanston, IL12 months2http://www.northshore.org/academics/academic-programs/fellowship-programs/np-pa-emergency-medicine/
Johns Hopkins - Bayview HospitalEmergency MedicineBaltimore, MD18 months1 every 6 monthshttp://www.hopkinsmedicine.org/johns_hopkins_bayview/education_training/residency_programs/emergency_medicine_physician_assistant_residency_program/
Lakeland Regional HealthEmergency MedicineLakeland, FL12 months4https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwi1kJyEh7jRAhVFqVQKHbEKC58QFggfMAE&url=https%3A%2F%2Fwww.lakelandhealth.org%2Fgmemain%2Fresidencyprograms%2Femergency-medicine-residency&usg=AFQjCNE6m-nXMUTYPyXqxafA_rlbSNpdCQ&sig2=mDO2tjXsIu4huhfhI0kqeA
Marquette University - Aurora HealthEmergency MedicineMilwaukee, WI12 monthscontact programhttp://www.marquette.edu/physician-assistant/postgraduate.shtml
New York University (NYU)Emergency MedicineNew York, N.Y.10 months2https://med.nyu.edu/emergency/education/PA-Fellowship
University of MissouriEmergency MedicineColumbia, MO13 months2http://medicine.missouri.edu/emergencypa/home.html
New York Presbyterian-Weill Cornell Medical CenterEmergency MedicineNew York, NY12 months4http://www.weillcornellparesidency.org/
Regions HospitalEmergency MedicineSt. Paul, MN18 months2http://www.regionsem.org/pa-residency
Staten Island University HospitalEmergency MedicineStaten Island, NY24 months4http://www.statenislandem.com/pa-fellowship/
Team Health EMAPC FellowshipEmergency MedicineOklahoma City, OK12 months2 to 3 every 6 monthshttp://myemergencymedicinecareer.com/Residents/Residency-Programs.aspx
University of IowaEmergency MedicineIowa City, IA18 monthshttps://medicine.uiowa.edu/emergencymedicine/education/pa-residency-programs
University of New Mexico School of MedicineEmergency MedicineAlbuquerque, NM18 months2http://emed.unm.edu/education/prospective-applicants/physician-assistant-residency-in-emergency-medicine.html
UCSF FresnoEmergency MedicineFresno, CA18 months2http://www.fresno.ucsf.edu/em/pa/
The US Army/ Air Force-Baylor Emergency Medicine Physician Assistant (EMPA) Residency Must be Active Duty Army or Air Force, with a minimum of 4 years (Army) or 2 years (Air Force) active commissioned service as a Physician Assistant.Emergency MedicineJBSA Fort Sam Houston, TX18 monthshttps://www.bamc.amedd.army.mil/staff/education/allied-health/empa/
Yale New Haven HospitalEmergency MedicineNew Haven, CT18 months2https://medicine.yale.edu/emergencymed/residency/pa/
University of KentuckyEmergency MedicineLexington, KY12 months4http://wildcatem.com/app-residency/
Carolinas Healthcare SystemFamily MedicineCharlotte, NC12 months28 per cohort, variablehttp://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Carilion Clinic Urgent Care and Rural HealthFamily MedicineDaleville, VA12 months2https://www.carilionclinic.org/family-medicine/fellowship
Michael E. DeBakey VA Medical Center - Houston, Texas - Physician Assistant Post-Graduate Residency in Geriatric MedicineGeriatricsHouston, TX12 monthscontact programhttp://www.houston.va.gov/Education/Physician_Assistant_Residency_Geriatric_Medicine/Physician_Assistant_Residency_Geriatric_Medicine.asp
Mayo Clinic ArizonaHematology & OncologyPhoenix, AZ12 months1http://www.mayo.edu/mshs/careers/physician-assistant/physician-assistant-fellowship-hospital-internal-medicine-arizona
MD Anderson Cancer Center - The University of TexasHematology & OncologyHouston, TX12 months2https://www.mdanderson.org/education-training/clinical-research-training/clinical-education-for-non-physicians/physician-assistant-program-in-oncology.html
Carolinas Healthcare SystemHospitalistCharlotte, NC12 months28 per cohort, variablehttp://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Mayo Clinic ArizonaHospitalistPhoenix, AZ12 months1http://www.mayo.edu/mshs/careers/physician-assistant/physician-assistant-fellowship-hospital-internal-medicine-arizona
Regions HospitalHospitalistSt. Paul, MN12 months1http://www.regionshospital.com/rh2/careers/physician-assistant-fellowship/index.html
Carolinas Healthcare SystemInternal MedicineCharlotte, NC12 months28 per cohort, variablehttp://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Children's Hospital of PhiladelphiaNeonatologyPhiladelphia, PA12 months2http://www.chop.edu/pages/neonatal-physician-assistant-residency-program
University of KentuckyNeonatologyLexington, KY12 months2 to 3https://pediatrics.med.uky.edu/pa-neonatology-residency
Arrowhead Regional Medical CenterOB-GYNColton, CA12 months6https://www.arrowheadmedcenter.org/resObyGen.aspx
Montefiore Medical CenterOB-GYNBronx, NY12 months2http://www.montefiore.org/obgyn-pa-residency
Arrowhead OrthopedicsOrthopedicsRedlands, CA12 months4 to 6https://www.arrowheadmedcenter.org/mpOrtho.aspx
Carilion ClinicOrthopedicsRoanoke, VA12 months2https://www.carilionclinic.org/orthopaedics/fellowship-acp
Illinois Bone and Joint InstituteOrthopedicsPark Ridge, IL12 months5 to 7http://www.ibji.com/education/professional-education
DMC Orthopaedics and Sports MedicineOrthopedicsWarren, MI12 months2http://www.dmcmedicalgroup.com/pa-orthopaedic-fellowship/
UCSF FresnoOrthopedicsFresno, CA13 months2http://www.fresno.ucsf.edu/orthosurgery/pa/
Riverside University Health SystemOrthopedicsMoreno Valley, CA12 monthscontact programhttp://rcrmc-ortho.org/home/index.php?option=com_content&view=article&id=115&Itemid=51
Navy PA Graduate Training: Orthopedics - Career military physician assistantsOrthopedicsPortsmouth, VA12 months2-4https://navypa.com/navy-pa-info/professional-development/orthopedics-fellowship
Mayo Clinic ArizonaOtolaryngologyPhoenix, AZ12 months2http://www.mayo.edu/mshs/careers/physician-assistant/physician-assistant-fellowship-otolaryngology-arizona
Carolinas Healthcare SystemPediatricsCharlotte, NC12 months28 per cohort, variablehttp://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Shasta Community Health CenterPrimary CareRedding, CA12 months2-3http://www.shastahealth.org/nppa-fellowship
North Florida-South Georgia Veterans Health System – University of Florida Physician Assistant Residency in Primary CarePrimary CareGainesville, FL12 monthscontact programhttp://pap.med.ufl.edu/about-us-2/post-graduate-programs/
The Emory Physician Assistant Program and The Veterans Atlanta Medical Center (VAMC)Primary CareAtlanta, GA12 monthscontact programhttps://med.emory.edu/pa/education/cme.html
Nationwide Children's Hospital Child and Adolescent Psychiatry PA ProgramPsychiatryColumbus, OH12 months2http://www.nationwidechildrens.org/psychiatry-pa
University of IowaPsychiatryIowa City, IA12 months2https://medicine.uiowa.edu/psychiatry/education/fellowship-programs
The Cherokee Mental Health Institute (CMHI)PsychiatryCherokee, IA12 monthscontact programhttp://psychiatricfellowship.com/program-details/
Bassett HealthcareSurgeryCooperstown, NY12 months2http://www.bassett.org/education/medical-education/residency-programs/surgical-postgraduate-physician-assistant-program/
Duke University Medical CenterSurgeryDurham, NC12 monthsvarieshttps://surgery.duke.edu/education-and-training/residency-programs/physician-assistant-surgical
Hartford HealthcareSurgeryHartford, CT12 months2 to 4https://hartfordhospital.org/health-professionals/education/residencies-fellowships/pa-surgical-critical-care-residency
Johns Hopkins HospitalSurgeryBaltimore, MD12 monthsup to 11http://www.hopkinsmedicine.org/surgery/education/pa_residency/
Montefiore Medical Center - Albert Einstein College of MedicineSurgeryBronx, NY14.5 months5http://www.montefiore.org/postgraduate-residency-physician-assistants-surgery
Norwalk Hospital/YaleSurgeryNorwalk, CT12 months12http://www.norwalkhospital.org/departments/residencies-and-fellowships/pa-surgical-residency
Texas Children's Hospital Pediatric SurgerySurgeryHouston, TX12 months6https://www.texaschildrens.org/health-professionals/fellowships-and-residencies/surgery-physician-assistant-fellowship
University of FloridaSurgeryGainesville, FL12 months4http://surgery.med.ufl.edu/education/pa-surgical-residency/program-information/
University of Pittsburgh Medical CenterSurgeryPittsburgh, PA12 months2http://www.upmc.com/healthcare-professionals/education/advance-practice-providers/education/advanced-practice-provider-surgical-residency-program/Pages/default.aspx
Carolinas Healthcare SystemUrgent CareCharlotte, NC12 months28http://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
Carilion Clinic Urgent Care and Rural HealthUrgent CareDaleville, VA12 monthscontact programhttps://www.carilionclinic.org/family-medicine/fellowship
Carolinas Healthcare SystemUrologyCharlotte, NC12 months28http://www.carolinashealthcare.org/center-for-advanced-practice-fellowship
UT Southwestern Medical CenterUrologyDallas, TX12 months1http://www.utsouthwestern.edu/education/medical-school/departments/urology/education-training/residency-program/pa-postgrad.html
Hepatology Physician Assistant FellowshipHepatologyAlexandria, VA12 monthscontact programhttp://www.aasld.org/foundation/awards-fellowship/nppa-clinical-hepatology-fellowship-program
Hispanic Serving Health Professions Schools (HSHPS) Graduate Fellowship Training ProgramOtherMultiple Locations12 monthscontact programhttp://www.hshps.org/programs
Public Health PA Fellowship, GA Epidemic Intelligence Service (EIS)Public HealthAtlanta, GA12 monthscontact programhttps://www.cdc.gov/eis/
Physician Assistant Abdominal Organ Transplant Fellowship (Arizona)Organ TransplantArizona12 monthscontact programhttp://www.mayo.edu/mshs/careers/physician-assistant/nurse-practitioner-or-physician-assistant-abdominal-organ-transplant-fellowship-arizona
The Ohio State UniversityOncologyColumbus, OH27 monthscontact programhttps://cancer.osu.edu/cancer-specialties/nursing/acute-care-oncology-fellowship-program

By the Numbers - What do the studies say?

According to this PAEA study:

PA postgraduate residency education provides an important educational vehicle for training graduate PAs in specialty care. A substantial proportion of residents proceed directly from entry-level to postgraduate training. Residents report satisfaction with their programs generally and specifically in terms of knowledge and skills acquired. More information comparing the differences between academic and internship models of residency education is needed as is consideration of greater standardization in program record-keeping and support for research into the longitudinal outcomes associated with postgraduate education.

According to this PAEA study:

Although most students (89.3%) were aware of residency training programs, results indicated that few (7%) had definite plans to attend. Two-thirds of students stated that they received no information on residency training programs at school (journal ads were the most popular information source). Student perceptions of residency training programs were mixed. Their opinions varied according to their program level (p<0.03) and intended region of future practice (p<0.007). Additional significant variables related to student perceptions included student graduation date, age, and gender. However, these factors were not as significant as geographic region of intended practice and degree level.

Discussion: Although only one-third of students reported receiving material or information related to residency training programs from their faculty, two-thirds of faculty respondents stated that they provide students with residency information. Of those providing information, only 32.5% of faculty stated that they actually encourage their students to attend postgraduate training. Like their students, faculty members had mixed positive and negative perceptions of residency training programs

Final Thoughts

Personally, I have mixed feelings about residency programs for PAs.

I see the benefits for PAs, supervising physicians and patients. But, I fear that residency programs may become a requirement rather than an option.

This will lead to increase cost and time in school which is one of the key differentiators of the PA and MD profession.

Advice for fourth year medical students beginning the dermatology residency application process: Perspectives from interns who matched
Ali Alikhan MD1, Raja K Sivamani MD2, Misha M Mutizwa MD3, Lesley M Felsten MD1
Dermatology Online Journal 15 (10): 3
1. MacNeal Hospital, Berwyn, Illinois. alialikhan1@yahoo.com
2. Santa Clara Valley Medical Center, San Jose, California
3. Albert Einstein Medical Center, Philadelphia, Pennsylvania


Introduction

Getting a dermatology residency positionis a difficult hurdle. This article is targeted to fourth year medical students beginning the application process to dermatology residency programs. We discuss the application itself, the interview process, and the ranking process. We also discuss avenues to take if one does not match into dermatology but remains interested in the field. We summarize the perspectives of four recent medical school graduates, now interns, who matched into dermatology in the 2008-2009 cycle. It is important to remember that this is simply one pooled set of suggestions, and that decisions should ultimately be made by the student.


Discussion

Applying

Applying in dermatology can be an anxiety-provoking process, given the limited number of positions and abundance of well-qualified candidates [1]. The Electronic Residency Application Service (ERAS) application requires several parts: a detailed listing of activities (extracurricular, research, publications, time off, memberships, leadership, hobbies), a personal statement, letters of recommendation, academic transcripts, United States Medical Licensing Exam (USMLE) Step scores, and Dean's Letter.

It is difficult to address the question of how many programs to which one should apply – there is no penalty for applying to all programs except for expense. It is generally suggested that applications be submitted to at least fifty programs given the limited number of positions available. When deciding how many programs to apply to, balance the strength of your application (grades, scores, research, leadership), location desirability, family/spouse issues, and cost. However, given how strong dermatology applicants are, never be too confident. You will likely find yourself applying to many more programs than your friends who are applying in different specialties, even if you are a much academically stronger medical student than they are. Conventional wisdom is that the "average" (by dermatology standards) applicant should apply to as many programs as is financially feasible. This being said, one can save hundreds of dollars through a simple review of the past several years' match lists on the dermatology forum of the Student Doctor Network website (or through individual departmental websites). Discussion with past dermatology applicants who are familiar with the trends of particular institutions is also helpful. There are certain programs that typically take either medical students from that particular institution or region or individuals who have completed research fellowships at the institution. Applying to these programs may not be an efficient use of time and money.

The issue of where to apply is one worth discussing with your mentors, your program director, and other faculty members. In any case, it is better to err on the side of too many rather than too few applications. Though more interviews typically come from regional programs, this is not always the case. One author received almost all of his interviews in states other than his own and most of his interviews were not even in his region. Keep in mind that the programs you find desirable, be it for location, reputation, or another factor, will likely be highly sought after by your colleagues as well. Applying to some smaller, less centrally located programs may improve your chances of receiving an interview, simply because there will be less competition. Try to submit your application as close to September 1st as possible, but it may be important to delay slightly if this means that newly submitted papers can be included. Within dermatology departments, applications are not usually reviewed until October, November, or even December. Be aware that some programs require application submission before the typical November 1st deadline. For example, the earliest application deadline during the 2008-2009 application cycle was in early October. This information is almost always available on individual programs' websites.

Hopefully, over the past four years you have been keeping track of organization memberships, activities, research, and academic or leadership positions. All of these will be essential in completing the application. Additionally, the time spent per week or month and a brief (but clear) description of specific responsibilities will be important. Some judgment as to what to list is also important. Include activities that were meaningful and required a significant amount of involvement and time are important to include. Remember, anything on the application is fair game as an interview question. List activities about which you are passionate and can describe acurately. Avoid listing only things that are medically relevant – any hobbies or activities that demonstrate what kind of person you are should be included. Several of the authors participated in non-medical activities, ranging from environmental conservation to traditional Indian music. These kinds of things set you apart and make you unique. Always remember to be honest about everything you list – if you are not, it may come back to haunt you. This is particularly true for listing research publications; faculty at a particular program can call journals to inquire about the validity of a submission listed on an application [2].

The personal statement is another important component of the application. It is your chance to describe yourself outside of your grades, test scores, and CV. Although a phenomenal personal statement will probably not be the sole determinant in obtaining an interview, a poor personal statement may exclude you from interviews. Thus, a conservative approach, which still speaks to your interests and passions, is called for. It is important to discuss what attracted you to dermatology, what you hope to accomplish as a dermatologist, and why you will be an asset to a program. However, remember that every other applicant will be addressing these same issues. Your personal statement should address these issues briefly, but leave the reader with a unique and positive impression of your character.

Avoid clichés to the effect of "I am a visual person" or "I like that in dermatology you can be an internist, a surgeon, and a pathologist all in one!" Although there is certainly some truth to these points, they are likely to be true for virtually all applicants and thus will do little to make your application seem interesting [3]. It is important to keep your personal statement less than one page – with hundreds of these to read, multiple pages can turn a reviewer off. A different personal statement can be sent to each program. Therefore, it would be reasonable to use a few lines of the personal statement to highlight any specific interests in you have in a program (e.g., a particular mentor or research arena) or links you have to the particular geographical region where a program is situated. After creating a first draft and editing extensively, have several people look at it including your program director, chairman, other dermatologists and physicians, friends, family members, and classmates.. Essay editing services are available online for unconfident writers. Clearly indicate your motivation and your objectives.

Like a personal statement, letters of recommendation can also offer a personal glimpse of an applicant, beyond activities, grades, and scores. Strong letters from non-dermatologist physicians may also be helpful. Supporting letters from specialists in medicine, pediatrics, and surgery may be helpful if they are excellent. Several dermatology programs ask for a non-dermatologist letter (they prefer supervising physicians from an inpatient rotation). Furthermore, preliminary and transitional year programs almost always want such a letter (or two).

As far as dermatology letters go, the most valuable letters are from the people who know you best and who spent the most time with you. Dermatologists with whom you conducted research or worked with extensively over the years, especially mentors, can write letters that are very detailed and powerful. After this, your program director and chairperson (if your school has a dermatology program) are important. Finally, other dermatology faculty at your institution or at away institutions should be considered. Only four letters are acceptable in the ERAS application. Simply having a letter with the name of a well-recognized dermatologist is not as important as a letter from someone who can vouch for your abilities, discuss your interpersonal communication, and demonstrate that they know you personally. If this person is also well-recognized in academic dermatology, that is ideal. When it comes to asking for the letter of recommendation, try to do this in person. Make sure to ask the writer if he/she would feel comfortable writing a strong letter of recommendation; an average or standard letter will not be helpful. This gives the potential letter writer the option to say "no," saving the letter writer time energy and the applicant from having a lukewarm letter, which can be detrimental.

Sending out an email to request a meeting is an appropriate way to do this and it will ensure protected time dedicated to discussing your letter. Be prepared to provide your letter writers with a copy of your personal statement and your CV; this will help them fill in important details they may not know. Remember to give letter writers at least one to two months notice – they are busy people, and need advanced notice.

When deciding which letters to send to which programs, several factors may be of import. These include: 1.how well a particular letter writer knows you 2.the connections that a letter writer may have at a particular program 3. the emphasis of particular programs- clinical versus research. The dean's office at one author's home institution had access to viewing the letters of recommendation as they were uploaded to ERAS and was able to provide guidance about which letters were strongest. Not all medical schools will do this for their students, but it may be worth your time to ask.

Finally, the Dean's letter is considered by some to be critical in the interview offering process. Many programs will not begin looking at applications until the Dean's letter arrives (typically November 1st). Although the major content of this letter is not in your control, most universities allow their students to participate in its production. When a first draft is sent to you, read it carefully. Make sure that it represents your character and what is important to you. If you feel that something is not discussed or discussed incorrectly, notify the writer as soon as possible. This letter should accurately portray you and your accomplishments during medical school. It is important that it contains evidence to support any subjective statements that are made.

Ultimately seek advice from those who have guided you and those involved in medical education (e.g., your program director or chairperson) when compiling your application. Ask them where to apply and what activities to include; have them read your personal statement and ask them which letters to send to which programs. Experience is key. For instance, your program director may tell you to apply to a particular program in another state (which you may not have done otherwise) because that program has a strong track record of interviewing and admitting candidates from your school.


The use of Online Forums

By now, most readers are probably aware of the existence of several online discussion forums targeted primarily at dermatology applicants. Decide early on whether you want to make use of these forums during interview season. These sites can provide invaluable information and services to applicants (e.g., a listing of when various programs make interview offers or send out rejections, a listing of applicants interested in trading interview dates, and so forth). These forums are also useful in that they allow for exchange between current applicants, residents, and faculty members. Some applicants find these types of sites overly stressful and choose to avoid them. Anyone who does choose to use these sources should be aware that some of the information provided by anonymous posters is, unfortunately, designed to mislead. Everything you read on any of these forums should be taken with a grain of salt. One should particularly avoid reading too much into posts regarding applicant statistics (e.g., board scores, AOA status, number of publications). These are often used to intimidate other prospective applicants.


Interviewing

Many of you have not interviewed for any position since applying to medical school and this can be a strange and sometimes nerve-wracking experience. Fortunately, anxiety decreases after the first few interviews when you begin to feel more comfortable with yourself and with your answers.

Getting interviews for dermatology residency positions is challenging and many programs may only offer one or two interview dates. This becomes a dilemma if your interview invitations are from programs with overlapping interview days. Scheduling interviews for dermatology is a test of speed because they are scheduled on a first come-first serve basis for the dates. Apart from the few programs that personally call or send snail mail offers, most programs will send mass email interview offers. Because of this, you may find yourself in the predicament of having to schedule two interviews for the same date. Consider investing in a mobile phone with email capabilities, so that you are able to check throughout the day. While this may seem excessive, be aware that the majority of your fellow applicants will be doing this. In one author's experience, particular interview dates have filled within an hour of when an email was sent out. Also, it is wise to schedule as many interviews as possible in December because the majority of interviews occur in January when scheduling conflicts are most likely to arise. Weekend dates, when available, are also good options; the vast majority of interview dates will be during weekdays.

Should there be a conflict between interview dates, one option is to ask the coordinator at either school to put you on a waiting list for another preferred date. Remember to be polite and considerate to the interview coordinator because they may have some influence about your application (usually only if there is a negative experience). Being perceived as pushy or needy or simply annoying to the interview coordinator could well be the kiss of death for any chance of acceptance at that program.

An alternative option would be to find another interviewee at that school who will be willing to switch dates. This can be done by posting your request anonymously on online dermatology forums, specifically the dermatology forum on the Student Doctor Network webpage. In the chance that you are unable to switch either of the conflicting interviews, one must be cancelled. Do this as soon as you know you will not be able to attend an interview because this may permit another applicant to interview.

The majority of programs conduct pre-interview dinners where applicants are able to converse with residents and, rarely, faculty. Make every attempt to attend these dinners if you are able; this is the best chance to get a feel for a particular program and its residents. It may also be an important component of the applicant evaluation process at that program. Oftentimes faculty at the formal interview will ask about the dinner and being able to talk about your experience shows you are serious about their program. Whereas you may be aware that you are being informally evaluated at these dinners, be yourself. Keep this in mind when interacting with residents and, just as importantly, other applicants. In general, individuals who are outgoing without being overbearing or obnoxious do the best in these situations. If you are a wallflower, make an effort to be more outgoing without seeming disingenuous. Similarly, if you are an extrovert, avoid dominating conversations. There are certainly topics that should be avoided during pre-interview dinners. It is fine to compare your experiences at other institutions with other applicants and residents, but avoid saying anything overly negative about individuals or programs. It is also wise to avoid discussing the number of interviews you have received (as well as grades and scores) or asking residents questions that may be perceived as being too intrusive.

The interview day will be different at each program. Know where and when to be somewhere; showing up late would be poor form. Interviews may last as few as ten or up to forty-five minutes. Most interviewers will opt for a casual conversational approach. Others may have a pre-set list of questions and will conduct a more formal session. Make sure you have thoroughly reviewed your application, including your personal statement, CV, and extracurricular activities. It is particularly important to be intimately familiar with the details of each research pursuit included on your application. Remember, anything listed is fair game for discussion. Also, think about anything that may have changed in your application since submitted; there may be an opportunity to discuss a new publication, research project, or leadership position. Anticipate some potential questions and think about how to answer them. Why do you want to be a dermatologist? Why did you apply to our program? What is the last book you have read? Tell me something about you that is not on your application? This may sound elementary, but answering questions clearly and thoughtfully is important. If you have not thought through such simple questions recently, you may find yourself tongue tied or rambling during the interview. Also, be aware that some interviewers will ask you bizarre questions or very technical questions about dermatology. Be aware that these types of questions are generally designed to assess your stress response – take a few seconds to think about your responses and remember to smile. A great resource for basic interviewing skills and answers to common interview questions is Iserson's Guide to Residencies.

Many interviewees are unsure of the etiquette surrounding thank you notes after interviews. Some of the authors routinely wrote thank you notes, but others did not write any. As a general rule, thank you notes are unlikely to affect your position on a rank list. If you feel uncomfortable not sending a thank you note, by all means you should do it. However, be aware that some programs instruct not to send thank you notes to their faculty. If so, follow these instructions. Be aware that at some programs interviews will be with more than ten faculty members. There are certainly candidates who sent thank you notes to every interviewer they encountered on the trail, but a reasonable approach with larger programs is to send thank you notes only to the interviewers with whom you had the most meaningful conversations. Alternatively, some candidates only sent thank you notes to the program director and/or chairperson.


Ranking

Once interviews are over, applicants are faced with the task of creating a rank order list. Some authors created a list of pros and cons for each program; others sorted their lists simply by gestalt. Some chose to rank based on the perceived prestige of the program. Whereas there is no right or wrong way to make a rank list, conventional wisdom is to trust your gut. Rank list ordering is facilitated by asking the right questions of residents during the interview day or at the pre-interview dinner. It is advisable to compile notes about each particular program immediately after the interview day; it will be difficult to remember some important details when it comes time to compare and contrast programs several weeks later. Remember that the match will always work in the applicant's best interest. Whether or not a program ranks you highly on their list should not affect how you rank them.

Once you have finalized your rank list, the final thing that should be done is to let your #1 choice know that they are your #1 choice. According to the NRMP rank list rules, the dermatology program or the candidate may voluntarily divulge their interest in the other as long as they do not solicit the other party's interest. Therefore, it is well within the rules to let a program know that you are very interested in them. Make such communication brief and concise. Making a particular program aware that you have ranked it first will not necessarily improve your chances of matching there, but in general it can do no harm; programs want residents who are enthusiastic about them.

Dermatology is a small field and many of the academic dermatologists know each other. If you have built up a strong or close relationship with a particular mentor, it may be reasonable to have that mentor place a call to the program(s) you like best. This should be done carefully, if at all, and only to places you are serious about after the interview. A special case in which you may have your mentor place this call before the interview is if you are declined an interview from an institution in which you were exceedingly interested. In this case, your mentor may make the difference in helping garner a precious interview.

With regards to ranking preliminary programs, the NRMP allows you to make two distinctions on your rank order. There is a primary rank order and a secondary rank order. The primary rank order is the main list where the NRMP match algorithm will start in trying to match you into programs. You can place any program, be it a dermatology program, a preliminary program, or a transitional program on this list. The secondary rank order is for ranking your intern year programs. This can be a combination of preliminary and transitional year programs. You can make a separate secondary list for each program on the primary list. Secondary lists are required only for programs that require you to find your own internship, such as an advanced dermatology program. The NRMP website will not allow you to attach a secondary list to programs that already have the internship included.

One point of confusion that arises is the difference between a "preliminary year" and a "transitional year." Both are one-year internships. Preliminary years have more focus on a certain field, such as medicine, surgery, or pediatrics. A transitional year is a "rotating internship" where the experiences tend to be more varied and time will be spent in surgery, internal medicine, pediatrics, and ob-gyn. There is also more specialty elective time. It is advisable to place a reputable preliminary medicine year on your primary rank order list as a backup should you fail to match in dermatology. Most clinical fellowships require an internship and dermatology residency programs tend to prefer candidates who have completed an internship in internal medicine because they are viewed as being more rigorous than other types of internships. It can certainly be argued that there is great value in a transitional year for individuals interested in dermatology; in these there is the opportunigy to spend months on subspecialty rotations that are more relevant to dermatology (e.g., rheumatology, infectious disease, plastic surgery). Indeed, all four authors are currently completing transitional year internships. However, avoid ranking transitional programs as a backup if you go unmatched; these internships tend to be looked down upon by faculty at many programs. Be aware that you will be asked what you plan on doing for your internship during interviews; be prepared to answer this question.


In case you do not match

If you do not match into dermatology, it is not the end of the world. In fact, many dermatologists and dermatology residents did not match on their first try. Begin looking into alternatives around the time of submitting your ERAS application.

Before you submit the application, think long and hard about what you want for your future. If becoming a dermatologist is the only thing that will make you happy in life, then put yourself out there and feel confident in your decision. However, many of you may have other interests outside of dermatology. If there is another field in medicine that interests you, it is worth your time to consider dually applying to both dermatology and another field. Although this is not an easy task to do (it requires a separate personal statement, separate letters of recommendation, and potentially twice as many days to interview), it can be and has been done before. If you decide to double apply, keep this information to yourself as much as possible. Do not apply to two different programs in the same institution. Program directors for either specialty may not take you seriously if they know you are not 100 percent committed to their field. However, it is your right to do this if you so choose. It may be comforting to know that if you do not match into dermatology, you may still match into something else you enjoy.

If however, becoming a dermatologist is the only reason you live and breathe, begin to consider alternative options should you not match into dermatology. Several possibilities exist: 1) Complete an internship in medicine, pediatrics, or surgery and then reapply during the next application cycle. 2) Conduct a year of research and apply again during the next cycle (be aware this option is more appropriate for those with basic science interests; most clinical research fellowships require prior completion of an internship). 3) Complete an internship followed by a pre-dermatology residency fellowship and apply again in two or three cycles (depending on the length of the fellowship). Such fellowships, improve the chances that one will match during his/her next go-around [4], oftentimes at the institution where he/she is participating in the fellowship. However, be aware that these fellowships do not typically "guarantee" a residency slot. Hard work, perseverance, productivity, and above all, interpersonal skills are essential during these fellowships. Be on the lookout for fellowship opportunities on the dermatology page on the Student Doctor forums, the message boards at derminterest.org, and the websites of individual dermatology programs. These fellowships are typically competitive so it is advisable to contact fellowship coordinators early and have your mentors and faculty send letters, emails, and/or make phone calls in your support. Try and pick programs with a good track record of matching their fellows into dermatology residencies. The best way to find out which programs fall into this category is through word of mouth – ask past applicants and faculty members at your institution. The time to contact these fellowship sites would be right after the match results are posted.

For those who want to start an internship and then apply again in the next cycle, ask yourself "what will be different this time?" In other words, evaluate how the application has changed since the unsuccessful match? Perhaps you were able to submit several papers, present a poster, give an oral presentation, or win a major award. Realistically evaluate the changes and consider whether or not a year of research (e.g., such as pre-dermatology fellowship described above) could help more. Remember, each time you apply, your chances of successfully matching decrease.

Finally, you may decide if you do not match that you would like to conduct a year or two of research and reapply for dermatology in the next cycle or in two cycles (delaying graduation in other words). The first step is to make sure your school is approves this. The second step is to find a suitable research mentor and suitable project ideas. Remember that productivity in such a year is crucial to a successful retry of the match process. Select a mentor who is well-published and whose students have a strong track record of matching into dermatology residencies. For more information on mentor selection, see our first article [5]. If you think you'd rather not begin a transitional or preliminary medicine year if you do not match into dermatology, remember to make your intern year contingent upon matching into dermatology on the NRMP website. Otherwise (e.g., if you rank intern programs below dermatology programs on your primary list), you may match into a preliminary medicine or transitional year program without matching into a dermatology program. Remember the NRMP is a contractually binding agreement and it is not acceptable to say "no" to a program after you have matched there.

If you decide that you would not like to apply for dermatology again, or have applied several times unsuccessfully, but still love studying cutaneous disease, do not worry. Many family practitioners and general practitioners also practice a great deal of dermatology. During and after a family medicine and internal medicine residency, there are opportunities to work with dermatologists to learn, in greater detail, about diagnosis and treatment of skin disease (including procedures) [6].


Conclusion

There are clearly many factors to consider when applying to, interviewing at, and ultimately ranking programs. Careful consideration of the issues discussed above is crucial to a successful outcome. Nevertheless, in many cases, even the most qualified applicants fail to match on their first try. With persistence and dedication, a successful match is certainly attainable. The key is to plan early, be organized, stay positive, and discuss any concerns or issues with mentors, residents, and faculty members at your institution and institutions where you have rotated. Although it is important to take the application process seriously and to stay focused, try to enjoy yourself and the company of your future colleagues!

Acknowledgments: We thank Dr. Steven R. Feldman and Dr. Andrew Lee for their valuable editing, suggestions, and ideas.

References

1. Wu JJ, Tyring SK. The academic strength of current dermatology residency applicants. Dermatol Online J. 2003 Aug;9(3):22. [PubMed]

2. Boyd AS, Hook M, King LE, Jr. An evaluation of the accuracy of residency applicants' curricula vitae: are the claims of publications erroneous? J Amer Acad Dermatol. 1996 Oct;35(4):606-8. [PubMed]

3. Heymann WR. Advice to the dermatology residency applicant. Arch Dermatol. 2000 Jan;136(1):123-4. [PubMed]

4. Wasong SJ, Miller JJ, Zaenglein AL. Does a predermatology fellowship increase the chance to match in dermatology? J Amer Acad Dermatol. 2008 Sep;59(3):535-6. [PubMed]

5. Alikhan A, Sivamani RK, Mutizwa MM, Aldabagh B. Advice for Medical Students Interested in Dermatology: Perspectives from Students Who Matched. Dermatol Online J. 2009;15(7):4.

6. Kosari P, Alikhan A, Yentzer BA, Lynch PJ. The Role of Family Practitioners in Skin Care. Skin & Aging. 2009;9(4):48-51.

© 2009 Dermatology Online Journal

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