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Handbook 2006
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Section 4: Graduate Medical Education
GRADUATE MEDICAL
EDUCATION a.k.a. “RESIDENCY”
The information contained in this section is not
a definitive “how to” guide for residency application.
Rather, these pages contain an overview of some of the activities
and institutions involved in graduate medical education, i.e.,
residency and fellowship training. The Keck School will provide
additional information about the residency application process
to students in their third and fourth years, and other commercial
and not-for-profit agencies are valuable information sources.
NATIONAL RESIDENT
MATCHING PROGRAM (NRMP)
Graduate Medical Training Programs ("residencies")
are approved by the Accreditation Council for Graduate Medical
Education (ACGME).
The First Post-Graduate Year Training
The ACGME has specified that all first post-graduate years
of training be sponsored by an accredited residency program,
and either:
#l Meet the requirements of training in the first year
of that residency, or
#2 Serve as a suitable antecedent to the residency training
which begins in the second year.
First post-graduate years in category #1 above are called
complete or categorical programs,
while those in category #2, are listed as either preliminary
or transitional in the Directory of Graduate
Medical Education Programs (Green Book) and the AMA-FREIDA
database program.
Complete Programs
Those in which the first post-graduate year is an integral
part of the total residency program are considered Complete
Programs. Such programs are designed for those students who
have decided to pursue that specialty. These programs should
not be considered antecedent to another specialty. Examples
include most residency programs in Family Medicine, Internal
Medicine, Pediatrics, and others.
Preliminary Programs
One year programs available primarily in Medicine and Surgery.
Preliminary medical programs are designed for those who are
interested in a medical specialty, but undecided as to which
one, or who have decided on a specialty whose residency starts
in the second year, and for which a year of medicine is an
appropriate preliminary, e.g., Neurology, Radiology, and Dermatology.
Similarly, Preliminary surgical programs are for those who
are interested in a surgical specialty, but undecided as to
which, and for those who have decided on a surgical specialty
which requires an antecedent year or years of surgical training,
e.g., Urology, Otolaryngology.
Transitional Programs are designed for the
student who:
- Is undecided as to specialty interest, or
- Plans to go into a specialty which requires such an
antecedent year, e.g., Pathology, Anesthesiology, and
Radiology, or
- Plans to enter the Military or Public Health Service
as a general duty officer after that year of training,
or
- Feels that such a year is needed to "round out"
his/her medical education.
Preliminary/Transitional programs also serve as a back-up
for those students who may be unable to secure a first post-graduate
year in the specialty of their choice. For such students,
the year can serve as a springboard for a second attempt at
acceptance into the residency of their choice.
SAN FRANCISCO MATCHING PROGRAM
The San Francisco Matching Program, or SF Match, functions
in a somewhat parallel fashion to the NRMP. The SF Match serves
most residency programs in the specialties of Neurological
Surgery, Ophthalmology, and Plastic Surgery. Typically, deadlines
for these programs are earlier than the NRMP, increasing the
importance of being prepared and applying early in the fourth
year of medical school. Further information about the SF Match
and programs it represents can be found at their website,
www.sfmatch.org.
AMERICAL UROLOGICAL ASSOCIATION (AUA) MATCH
Urologists have their own residency matching process, run
by the AUA. Information about this match is available from
their website, http://auanet.org/residents/resmatch.cfm
DIRECTORY OF GRADUATE MEDICAL EDUCATION PROGRAMS (GREEN
BOOK)
A directory published annually by the American Medical Association
(AMA) listing all approved post-graduate training programs.
Copies are available for student review at the Norris Medical
Library and the Office of Student Affairs (KAM l00-B). Students
wishing to purchase a copy should contact the American Medical
Association, Book and Pamphlet Fulfillment OP416790, P.O.
Box 10946, Chicago, IL 60610. The Green Book may also be purchased
through the Health Sciences Bookstore.
AMA-FREIDA (AMA's FELLOWSHIP AND RESIDENCY ELECTRONIC
INTERACTIVE DATABASE ACCESS SYSTEM)
An on-line searchable database designed to help students
find a graduate medical education program most suited to their
needs. The website is http://www.ama-assn.org/ama/pub/category/2997.html.
All ACGME accredited graduate medical education programs are
included in the database program, as well as Board-approved
combined specialty programs, such as internal medicine/pediatrics.
FREIDA includes basic information about each program and information
relating to the faculty, educational environment, work environment,
and compensation/benefits offered by each program, and users
can search for training programs by selecting specialties,
states, or training institutions.
As a supplement/alternative to FREIDA, the directory of programs
participating in the NRMP Matching Program, including addresses
and telephone numbers as well as additional information regarding
residency training, is available on the web at www.nrmp.org
for students who are registered with the NRMP to participate
in the Match. Note that the NRMP site will not include programs
participating in the San Francisco Match.
SELECTION OF A SPECIALTY
Selection of the appropriate first post-graduate year of
training begins with a decision regarding the specialty choice.
A prudent decision should take into consideration the personality
type, goals, lifestyle, what activities bring satisfaction,
and how these expectations fit the practice of the proposed
specialty.
The student should also give consideration to practical matters,
such as the competitiveness of appointment to the training
program, the future supply and demand for physicians in the
specialty, the geographic distribution of specialists, and
any restrictions which might be applicable, such as physical
limitations, family and financial obligations, and geographic
mobility.
Only the student can make this decision, and the wisdom of
the choice is an individual responsibility. To assist students
in their deliberations, the School offers clinical advisors,
and advising programs. School programs also draw on the Association
of American Medical Colleges’ Careers In Medicine program;
information is available at www.aamc.org/students/cim/start.htm.
SELECTION OF A POST-GRADUATE YEAR PROGRAM
Selection of the proper training program (hospital) is largely
a matter of gathering information from all available sources:
- AMA-FREIDA database computer program
- The student's adviser
- The program director (through mail and internet communication)
- Faculty and specialists in the field
- House officers in the particular discipline at USC affiliated
hospitals
- Alumni who may have been in the program
- Spending elective time at the hospital(s) of interest
Finally, a personal visit may be arranged, preferably before
submitting a final application to the program. For some students,
this can be accomplished by an elective clerkship in the program
of interest. This is often an invaluable way for the student
to gain in-depth knowledge of the program, and to demonstrate
their value as a potential resident.
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APPLICATION TO A POST-GRADUATE YEAR PROGRAM
The application process should begin early in the summer
of the senior year. Although the NRMP encourages participating
programs to use the Electronic Residency Application Service
(ERAS) and most do, some programs may have their own forms.
Program directors may require a variety of materials from
applicants, including
- Medical School Performance Evaluation (MSPE, formerly
Dean's Letter, required by all programs)
- Transcripts
- USMLE Scores - optional (must be requested)
- A personal statement and/or curriculum vitae
- Letters of recommendation (generally three, and often
from designated persons
- Photo
Virtually all competitive programs require an interview.
The student will be invited by programs for interviews. The
student should complete his/her application and research the
program before the interview, bearing in mind that the program
(hospital) will select the students that they will
rank during the match process.
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ELECTRONIC RESIDENCY APPLICATION SERVICE - (ERAS)
ERAS will be used by most residency programs. A list of participating
programs is available on the World Wide Web, at www.aamc.org/eras.
All students applying to the listed programs must participate
in ERAS. If you are applying in another field in addition
to the listed specialties, you must use ERAS for the programs
listed above and contact the non-ERAS participating program
to find out its application requirements, facilities, and
deadlines. Common sources of information regarding non-ERAS
participating programs are the AMA Green Book, or the AMA-FREIDA
Web site at http://www.ama-assn.org/ama/pub/category/2997.html
Quick ERAS Overview
ERAS uses the WWW to communicate with applicants, the Office
of Student Affairs, and ERAS participating programs.
Medical Students use MyERAS via the WWW
to select programs, request the USMLE transcript, and create/assign
documents. All applications are stored at the ERAS PostOffice.
This permits students to manage their application from virtually
any computer with a web connection.
The Office of Student Affairs uses the Dean's Office Workstation,
DWS, to upload Medical School Performance
Evaluations (MSPE), transcripts, letters of recommendation,
and photos to the ERAS system. Residency programs use the
Program Director's Workstation, PDWS, to
download applications from their electronic mailboxes located
at the ERASPO. In addition, the residency programs use the
PDWS software to sort, review, and print applications
Important Information to Remember
MyEras is available to applicants in July. The Office of
Student Affairs provides you with a "Token" (a special
code to register and access MyERAS on line). Students need
to register promptly with MyERAS, as the office of Student
Affairs cannot upload information if the applicant has not
registered. At all times, the applicant is responsible
to contact the residency programs and to ensure that all deadlines
and requirements are met. It is also vital that the
contact information you submit to ERAS is updated throughout
the application season, since residency programs use this
information to invite your for interviews, alert you to missing
documents, etc. Students need to visit the ERAS Web site regularly
for the most recent news at Web site address, www.aamc.org/eras.
Students can also access the Web-based Applicant Document
Tracking System, or ADTS, designed by ERAS
to allow applicants to track the status of application materials.
Its Web site address is www.aamc.org/eras.
Only one ERAS application per applicant is allowed, and only
4 letters of recommendation and 1 personal statement can be
assigned to any one program at a time; however, an individual
student may have different personal statements and more than
4 letters on file wit MyERAS, tailoring the selection of statement
and letters to a particular program/specialty. It is important
to remember that after certification, some items cannot
be changed in the application; therefore, you are cautioned
to carefully read the ERAS Applicant Manual before you begin.
The ERAS processing fee will vary according to the number
of programs selected.
INFORMATION TO BE INCLUDED IN STUDENT CURRICULUM
VITAE
Please refer to the Careers in Medicine Student Manual,
from the AAMC, for curriculum vitae information and format.
Go to www.aamc.org/students/cim/start.htm
for information on Careers in Medicine.
REQUESTING MSPE PACKET FOR POSTGRADUATE EDUCATION
According to the guidelines established by the AAMC, official
Medical Student Performance Evaluations may not be released
by any school to any student, program or hospital prior to
November 1st.
The AAMC has reported that there is no advantage to having
transcripts sent out prior to November 1st. If the applicant
requests transcripts prior to November 1st, we will comply;
however, we will not resubmit transcripts at a later date.
Once the official Medical School Performance Evaluation (MSPE)
packet has been sent on behalf of any student, the Office
of Student Affairs will not re-send any additional material
with the following exceptions: (a) the overall MSPE summary
adjective changes; (b) the student has achieved some significant
honor (i.e., AOA, Dean's Scholar); or (c) the student has
encountered any situation which could delay graduation.
Requests for MSPE packets from non-ERAS applicants must be
submitted in writing available in the Office of Student Affairs,
KAM 100-BB.
LETTERS OF RECOMMENDATION
Personal letters of recommendation are required to complete
the application to postgraduate programs. Recognizing this,
the student should make a positive effort to get to know the
faculty and staff who supervise his/her clerkship experiences.
The hospital/program will generally indicate how many letters
it wishes, and from whom they should be requested. Although
each hospital/program's requirements are different, the average
number of letters required is three. Where a program has specified
a desire number of letters and/or types of authors, students
should follow the stated specifications. The student should
assume that at least one letter should come from a USC faculty
member in the department which represents the specialty to
which the student is applying. Students are responsible for
downloading and printing the Instructions to Letter writers
from the MyERAS website.
Students may approach a potential author as the clerkship
progresses and ask if he/she would be willing to write a letter
of recommendation when the appropriate time draws near. Students
should indicate that they will later set up an appointment
and bring copies of evaluations to date through medical school,
thus having a chance to talk with the author before the letter
is prepared. All major departments will occasionally request
an appointment, and if so, will always request the student
bring a copy of the file to date. Some authors also request
a curriculum vitae, so students may anticipate this when making
requests.
All letters of recommendation submitted for residency application
are considered confidential to the student ERAS file. Students
will not be allowed to review letters received in the Office
of Student Affairs. All documents submitted to the Student
Affairs office for residency application will be used for
this purpose only until NRMP Match Day in March. Subsequently,
residency application files, which include letters of recommendation,
will be destroyed after Match Day and before the commencement
ceremony in May of the same year.
APPLICATION FOLLOW-UP
Students are encouraged to monitor their application process.
If applying through MyERAS, follow-up of the application can
be tracked through the AAMC ERAS website, www.aamc.org/eras.
If the application is paper, follow-up would be through communication
to the hospital/programs regarding the completeness of the
application. We suggest you call your first five choices (they
can verify your status immediately); the delay is greater
if your inquiry is by letter. Send self-addressed, stamped
postcards to the remainder of hospitals/programs, asking them
to verify that your application is complete, or to check off
which items are missing. You can pre-print the postcard with
the elements of your application – each LOR author,
application, transcript, etc. – to make the secretary’s
life simpler, and to increase your likelihood of receiving
a reply. Most places will keep you informed, but remember
they are overloaded with applications.
INTERVIEWS
It is strongly suggested that you allow vacation time sometime
during the November/December/January period of your senior
year to schedule interviews and travel regarding postgraduate
training.
If you are scheduled for a clerkship during the interview
period, you must have prior permission from your clerkship
preceptor (get it in writing for your protection) if you plan
to miss time from your rotation due to interviews. Students
may miss no more than 3 days during a required clerkship,
Selective or Elective. If you anticipate that you will miss
more than 3 days for interviews , you will have to reschedule
the rotation for a later date. We have seen unsatisfactory
grades, incompletes and negative comments arise because of
this lack of courtesy, which could have been avoided. Some
preceptors may require you to make up any missed time; find
out what is expected of you if you miss time off their service.
PLAN AHEAD!
A letter to your interviewer after the interview is also
suggested. It need not be long, but simply an acknowledgment
of your appreciation (also a way to refresh their memory and
keep you in mind). This should be done with at least your
top five choices, but all programs, if possible.
APPLYING FOR A FIRST POST-GRADUATE YEAR APPOINTMENT
THE MATCH
Almost all appointments to GY-1 (Graduate Year 1) programs
are made through the National Resident Matching Program (NRMP)
which matches, by computer, the student to a program to which
he/she has applied (see description of the SF Match and AUA
Match for exceptions). The Matching Program guarantees placement
for GY-1 only, although complete programs typically retain
their students for subsequent training if their performance
in the first year is satisfactory. Virtually all accredited
programs participate in the match, and are not allowed to
offer positions to non-participating students until after
the match; therefore, it behooves all students to participate.
Even students who may be given consideration outside the match
(Armed Forces students and those completing graduation requirements
between January and March, for example), are advised to participate
to preserve their options.
Registration to participate in the match requires a fee
(subject to change), and the completion of an Agreement Form,
available on the NRMP website, www.nrmp.org
in August of the senior year.
Note: A number of specialties conduct special
matching programs separate from the NRMP program. These include
Neurological Surgery, and Ophthalmology. Information about
applying to these special residency programs can be found
on their websites. The San Francisco Matching Programs website
http://www.sfmatch.org,
is for Neurological Surgery, and Ophthalmology. Students interested
in these specialties must prepare applications for GY-1 and
GY-2 programs simultaneously. The deadlines and results of
these special matches are generally 4-6 weeks prior to the
NRMP program.
Urology match is through the AUA Residency Matching Program
for Urology, website is http://www.auanet.org.
Urology application is through ERAS.
THE RANK ORDER LIST INPUT AND
CONFIRMATION (ROLIC) SYSTEM
You will submit your Rank Order List to the NRMP via the
Internet, using the Registration, Ranking and Results (R3)
system on the NRMP website. NRMP will assign you a password
that will be used with your Applicant Code to enter your Rank
Order List.
If you are participating in the couples' match, you will
enter your partner’s Applicant Code (not his/her password).
Your partner will follow the same procedure; this allows you
to enter paired programs via the RRR system.
Remember, you should not list programs which you really
do NOT want, as a "match" is a contractual obligation.
You will receive complete information about these arrangements
in January of your senior year.
The Match results are announced in March each year, typically
in the third week (the exact date is announced annually).
UNMATCHED STUDENTS
The Office of Student Affairs assists in the placement of
unmatched students. Placement of unmatched students occurs
rapidly after match results are announced, and choices for
placement are extremely limited. As it is not possible to
predict whether a student will remain unmatched, it is wise
for all students to plan to be in the vicinity of the school
at the time match results are announced. International travel
during Match Week is strongly discouraged.
LICENSURE REQUIREMENTS AND THE POST-GRADUATE YEAR
Most states, including California, require at least one year
of post-graduate training in an approved hospital for licensure;
many require two or more years for licensure. The training
content of the year, as well as what is an "approved"
hospital, may be specified by the licensing agency. Although
most ACGME-approved programs offered by NRMP will meet licensure
requirements, the student should check to be sure that the
program(s) to which he/she is applying will meet the requirements
of the state in which he/she plans to practice.
LICENSURE
The Federation of State Medical Boards (FSMB) and the National
Board of Medical Examiners (NBME) have established a single,
uniform examination for medical licensure in the United States.
The United States Medical Licensing Examination (USMLE) provides
a common evaluation system against which to measure knowledge
and cognitive competence of applicants for medical licensure.
Currently, a California license to practice medicine may
be obtained by any of the following:
- Passing all steps of the USMLE (this is the route chosen
by most of our students).
To be certified by the NBME, you must pass Steps 1, 2, and
3.
- Reciprocity with a license obtained in another state.
Application for licensure may be filed at any time after
graduation, but licenses are released by the State of California
only after the completion of the GY-1 year, or first year
of post-graduate training. The licensing agency in California
is the Medical Board of California, Division of Licensing,
1426 Howe Avenue, Sacramento, CA 95825.
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