Post by jfletchermd on Apr 11, 2007 13:46:05 GMT -5
GENERAL:
• Take some time to figure out what exactly about the field of OB/GYN appeals to you and why you want to make a career out of it. There is no “right” or “wrong” answer here, just be honest with yourself. For me the major draw was being able to combine continuity of care across a patient’s lifespan with the opportunity for surgical intervention and the immediate results that come from it. Keep these things in mind throughout the application and interview process, as they’re a favorite topic for personal statements and interview questions!
• Realize that although it’s billed as a “primary care” field, OB/GYN is most definitely a surgical specialty, so if you can’t stand the idea of keeping surgeon’s hours, or if you don’t love (and I mean LOVE) the operating room, OB/GYN might not be the field for you.
• Along similar lines, there’s something of a push right now within the field to distance ourselves from the “primary care physician” moniker and to re-bill OB/GYNs as “surgeons first.” Although the degree to which this attitude is present varies wildly from program to program, it seems to be a common theme, so it might be more to your benefit if you focused your own attitudes/comments/etc. more on the surgical nature of the specialty.
• Whatever you do, don’t let naysayers get you down. Although it may seem like there’s always someone attempting to dissuade you by reminding you of the malpractice costs, the long hours, the legal pitfalls, gender discrimination, diminishing reimbursement, etc., keep in mind that there are plenty of OB/GYNs working in the field who love what they do and are happy doing it.
APPLICATION:
• Get an idea of where (geographically) you’d like to be, and the type of setting you’d like to complete your residency in. As with all other fields, there are community hospitals, university affiliated community programs, and university programs. If you’re not exactly sure what you’d like, do some research into what each type of program offers, and feel free to apply to each type.
• Apply to as many programs as you like, but the general consensus among my classmates was to apply to 15-25 programs with 3-5 being “fallbacks” that we felt pretty certain that we could get into and a similar number being “dream” programs.
• APPLPY EARLY!! I cannot stress this enough! This is becoming a hugely important factor as the field becomes more and more competitive.
• Many programs will have a minimum “cutoff” for Step I scores. At most places it was 200, but at some of the more competitive programs it could be 210 or even as high as 220. At some programs this is a “soft” cutoff (meaning that if you got 197 but had a good GPA and great letters you’d still get an interview) but at many places it was a “hard” cutoff, and I have a feeling that given how competitive the field has become, you’ll see a lot more of this practice in the future. If your Step I score wasn’t the greatest, and you’re still interested in some of the more competitive programs, my advice is to take Step 2 CK as early as possible during fourth year, and to do your best to improve your score as much as you can. In my experience, programs will be a lot more apt to overlook the fact that your Step 1 score was three points below their minimum if you jumped up thirty points on Step 2!
• Most places will require three or four recommendation letters, including one from the Department Chairperson. Try your hardest to have at least one from a well-known physician (Drs. Devoe, Layman, and MacFee are great ones to go with from MCG,) but bear in mind that it’s a lot more important to have a recommendation from someone who knows you personally than to have a big name toss out a page full of generic statements.
• If you can’t get four letters from OB/GYNs who know you well, attendings in other surgical specialties with whom you may have worked are also great resources for letters.
• I know it’s hard, but do your best to avoid clichés in your personal statement. Don’t talk about how cool it was the first time you delivered a baby, or how ever since you saw your dog have a litter of puppies you’ve been fascinated by the miracle of birth. Instead focus on why you chose OB/GYN over other specialties and what led you to this decision. Drs. Francis, Irwin, and Murphy are all great resources for critiquing personal statement drafts.
AWAY ROTATIONS:
• These are a great opportunity to get a chance to investigate one or two programs that you’re really interested in, but they’re not the “make it or break it” point on whether or not you will match the way that they can be in some other specialties.
• If you’re interested, I’d recommend doing away rotations during the early part of 4th year so that you can get a feel for a program before committing to an interview, and to have time to get recommendations from the physicians with whom you worked if you are interested in this program. The peak times for away rotations in our class were August-October.
• Some people also did away rotations in January/February after the interview furor had died down so that programs would “have them in mind” while creating a rank list.
• A lot of the info about away rotations is online. If not just give the site’s clerkship coordinator or director of undergraduate education a call. Even if they personally can’t help you they should be able to direct you to someone who can. Start looking early so you know what the application requirements and when deadlines are.
INTERVIEWS:
• Interviews for OB/GYN residencies start as early as late October/early November and typically run through the third week of January. December seems to be the busiest month, so consider taking that month off to dedicate to interviews.
• You (likely) will be offered more interviews than you can reasonably get to. Turn down interview requests that you know that you will not be able to make it to, but be sure to provide them with an e-mail or call so that they can offer the slot(s) to someone else.
• Everyone seems to have a different opinion regarding this, but I personally scheduled one or two interviews with programs I wasn’t terribly interested in at the very beginning of my interview trail. This allowed me to learn about what was expected at an interview and get some idea of the type of questions I’d be asked. I scheduled the bulk of my interviews between Thanksgiving and Christmas, including those at the programs I was most interested in. After the New Year, everyone (yourself included) will be a little worn out from the interview process, so while you may have to squeeze one or two of your top choice programs in after the break, be prepared to cancel some January interviews as the time (and the money) get tighter and tighter.
• The interviews themselves range from very formal Q&A sessions with several faculty members at a time to more informal “get-to-know-you” type conversations. The questions asked ranged from the practical (“Why Ob/Gyn…why our program…) to the esoteric (“who is your hero…define October…) I did have a couple of interviewers ask me questions about anatomy and pathology, and even had one interviewer ask me to tie a one-handed knot during the session, but these were definitely the exceptions to the rule.
• Likewise, the experience of the interview day also varies greatly. At some places you’ll sit in on Grand Rounds or a case conference, while at others more emphasis is given on the tour of the facilities and personal interaction with the residents. On average, though, you’ll be in the actual interview from around 7:00 AM to just after lunchtime and will complete 3-6 “interview sessions” with individual faculty and residents.
• Be prepared to ask some question of your own! Programs like it when you show interest in how they do things versus how other programs may do it.
• Try your best to attend the pre-interview dinner the night before the interview day if at all possible. This will give you a chance to interact with the residents (and at some places, the faculty) on a more individual basis and see if they’re the kind of people you want to work with.
• Try to send a thank you letter or thank-you cards to all of the places that you’ve interviewed.
PROGRAM AFFILIATION
• As I said before, there are community programs, university-affiliated community programs, and university (academic) programs.
• In general, the idea that “if you want to do a fellowship, you should go to a University program” can hold true, albeit to a small degree. There are plenty of great community and uni/com residencies with active research programs that are putting residents into fellowships left and right. Likewise there are plenty of university programs (including some very big name programs) that haven’t put out a fellow in years. My advice would be to go somewhere where you think you’ll get the best training and have ample opportunity for research, regardless of the program’s affiliation.
• In my experience, the main difference I saw between community and academic programs was numbers. The community program graduates usually had higher surgery and delivery numbers than those at academic programs, primarily because residents at these programs worked one-on-one with private physicians as well as their own full-time faculty. While academic program residents in general had lower numbers, they almost always had exposure to more unusual cases (i.e. their numbers were lower because they weren’t doing as many “bread-and-butter” cases,) and many times had more opportunities for research.
• Bear in mind, too, that a religious affiliation may impact your training in a very unique way when it comes to the field of OB/GYN. Hospitals with a religious affiliation most often do not offer training in or exposure to pregnancy termination, and (depending on the nature of the hospital’s religious affiliation) may not offer provision for contraceptive services. Each program has different ways of dealing with these issues – some may offer off-site rotations in contraception/family planning, some may have an outlying surgery center or private office at which these services are available, some may simply not offer these experiences at all. In my opinion, I wouldn’t let a hospital’s religious affiliation affect my decision to apply somewhere, as there are several OUTSTANDING programs that are religiously affiliated (Saint Louis University and Saint Vincent Health System – Indianapolis being two that come to mind immediately) but how these programs balance their limitations with resident educational objectives is definitely something to ask about on interview day and consider during your final decision.
GENDER ISSUES:
• This is a very delicate issue for all persons involved, with convictions running very deep on both sides of the issue. I will say, however, that although the great majority of applicants for OB/GYN residency are female, there has been a growing demand for variety in physician gender at all levels of practice. This, combined with the growing popularity of the specialty itself, has led to a steadily increasing number of male applicants over the past three years.
• If you’re a male who’s interested in OB/GYN, do NOT let the perception that “it’s a woman’s field” dissuade you.
• Of the programs I interviewed at, about 70% were predominantly female, about 30% were approximately 50-50 male/female, and one program was actually predominantly male.
• The three male members of the Class of 2007 who applied for residency in OB/GYN were all successful in obtaining spots in outstanding programs.
FELLOWSHIPS:
• ABOG approved fellowships are available in Maternal-Fetal Medicine, Reproductive Endocrinology and Infertility, Gynecologic Oncology, and Urogynecology/Pelvic Reconstructive Surgery. All are three years in length.
• Non-accredited fellowships are available in Advanced Laparoscopic Surgery, Family Planning (contraception and pregnancy termination), Pediatric and Adolescent Gynecology, and Menopausal/Geriatric Medicine. Most of these fellowships are 1-2 years in length.
• Fellowships across the board are becoming more competitive, but in general Maternal-Fetal is the least competitive of the accredited fellowships (highest number of slots), while REI is the most competitive.
• My advice for those of you interested in fellowships is to find a program that will offer you a good training base in general OB/GYN, allow you to become involved in research early-on, and to tailor your clinical and research experiences according to your interest.
FOLLOW-UP:
• If after interviewing you are really interested in a particular program, do all that you can to let them know. E-mail your interviewers, talk to the residents you met, arrange a phone call or conversation with the program director. Also, be sure to ask about “second looks” – many programs will invite you back to tour the facilities, meet with residents, and (maybe) even spend a night on L&D or in the ED. Many times the program will even pay for your lodging and/or set you up with a resident who’ll take care of you during this second visit.
• Approximately the last week of January, e-mail the program directors at your top three choices and let them know that they’re at the top of your list.
• I know that it sounds stupid now, but rank EVERY program you’d rather be at than go unmatched. If you absolutely hated or have a lot of concerns about a program, it’s fine to leave it off your rank list, but bear in mind that the shorter your list, the higher your chances of having to scramble for a slot. (And this year there were only 4 categorical and 2 preliminary slots available to scramble into in the entire nation!) I can’t speak for others, but personally, I applied to 26 programs, was offered interviews at 22, took 17, and ranked 14 programs.
• If you’re at an absolute stalemate between two or three programs, and can’t decide where to rank highest, ask yourself where you’d most like to live. Location isn’t just a factor for real estate agents.
• Never be afraid to ask for advice. The attendings at MCG are great resources with many connections to top-notch institutions. Talk to other people who are interviewing in the field as well (but take what they say with a grain of salt!) and get their feedback on interview experiences.
• Relax and enjoy your fourth year!
Wow, that was a lot more than I intended to say when I first started out, but I hope that it’s all of some help to you. If there’s anything else that you have questions about or if you just want to talk about applying for OB/Gyn or get my opinions on the places I applied/interviewed, feel free to e-mail me at fletcher_james_c@yahoo.com
- James
• Take some time to figure out what exactly about the field of OB/GYN appeals to you and why you want to make a career out of it. There is no “right” or “wrong” answer here, just be honest with yourself. For me the major draw was being able to combine continuity of care across a patient’s lifespan with the opportunity for surgical intervention and the immediate results that come from it. Keep these things in mind throughout the application and interview process, as they’re a favorite topic for personal statements and interview questions!
• Realize that although it’s billed as a “primary care” field, OB/GYN is most definitely a surgical specialty, so if you can’t stand the idea of keeping surgeon’s hours, or if you don’t love (and I mean LOVE) the operating room, OB/GYN might not be the field for you.
• Along similar lines, there’s something of a push right now within the field to distance ourselves from the “primary care physician” moniker and to re-bill OB/GYNs as “surgeons first.” Although the degree to which this attitude is present varies wildly from program to program, it seems to be a common theme, so it might be more to your benefit if you focused your own attitudes/comments/etc. more on the surgical nature of the specialty.
• Whatever you do, don’t let naysayers get you down. Although it may seem like there’s always someone attempting to dissuade you by reminding you of the malpractice costs, the long hours, the legal pitfalls, gender discrimination, diminishing reimbursement, etc., keep in mind that there are plenty of OB/GYNs working in the field who love what they do and are happy doing it.
APPLICATION:
• Get an idea of where (geographically) you’d like to be, and the type of setting you’d like to complete your residency in. As with all other fields, there are community hospitals, university affiliated community programs, and university programs. If you’re not exactly sure what you’d like, do some research into what each type of program offers, and feel free to apply to each type.
• Apply to as many programs as you like, but the general consensus among my classmates was to apply to 15-25 programs with 3-5 being “fallbacks” that we felt pretty certain that we could get into and a similar number being “dream” programs.
• APPLPY EARLY!! I cannot stress this enough! This is becoming a hugely important factor as the field becomes more and more competitive.
• Many programs will have a minimum “cutoff” for Step I scores. At most places it was 200, but at some of the more competitive programs it could be 210 or even as high as 220. At some programs this is a “soft” cutoff (meaning that if you got 197 but had a good GPA and great letters you’d still get an interview) but at many places it was a “hard” cutoff, and I have a feeling that given how competitive the field has become, you’ll see a lot more of this practice in the future. If your Step I score wasn’t the greatest, and you’re still interested in some of the more competitive programs, my advice is to take Step 2 CK as early as possible during fourth year, and to do your best to improve your score as much as you can. In my experience, programs will be a lot more apt to overlook the fact that your Step 1 score was three points below their minimum if you jumped up thirty points on Step 2!
• Most places will require three or four recommendation letters, including one from the Department Chairperson. Try your hardest to have at least one from a well-known physician (Drs. Devoe, Layman, and MacFee are great ones to go with from MCG,) but bear in mind that it’s a lot more important to have a recommendation from someone who knows you personally than to have a big name toss out a page full of generic statements.
• If you can’t get four letters from OB/GYNs who know you well, attendings in other surgical specialties with whom you may have worked are also great resources for letters.
• I know it’s hard, but do your best to avoid clichés in your personal statement. Don’t talk about how cool it was the first time you delivered a baby, or how ever since you saw your dog have a litter of puppies you’ve been fascinated by the miracle of birth. Instead focus on why you chose OB/GYN over other specialties and what led you to this decision. Drs. Francis, Irwin, and Murphy are all great resources for critiquing personal statement drafts.
AWAY ROTATIONS:
• These are a great opportunity to get a chance to investigate one or two programs that you’re really interested in, but they’re not the “make it or break it” point on whether or not you will match the way that they can be in some other specialties.
• If you’re interested, I’d recommend doing away rotations during the early part of 4th year so that you can get a feel for a program before committing to an interview, and to have time to get recommendations from the physicians with whom you worked if you are interested in this program. The peak times for away rotations in our class were August-October.
• Some people also did away rotations in January/February after the interview furor had died down so that programs would “have them in mind” while creating a rank list.
• A lot of the info about away rotations is online. If not just give the site’s clerkship coordinator or director of undergraduate education a call. Even if they personally can’t help you they should be able to direct you to someone who can. Start looking early so you know what the application requirements and when deadlines are.
INTERVIEWS:
• Interviews for OB/GYN residencies start as early as late October/early November and typically run through the third week of January. December seems to be the busiest month, so consider taking that month off to dedicate to interviews.
• You (likely) will be offered more interviews than you can reasonably get to. Turn down interview requests that you know that you will not be able to make it to, but be sure to provide them with an e-mail or call so that they can offer the slot(s) to someone else.
• Everyone seems to have a different opinion regarding this, but I personally scheduled one or two interviews with programs I wasn’t terribly interested in at the very beginning of my interview trail. This allowed me to learn about what was expected at an interview and get some idea of the type of questions I’d be asked. I scheduled the bulk of my interviews between Thanksgiving and Christmas, including those at the programs I was most interested in. After the New Year, everyone (yourself included) will be a little worn out from the interview process, so while you may have to squeeze one or two of your top choice programs in after the break, be prepared to cancel some January interviews as the time (and the money) get tighter and tighter.
• The interviews themselves range from very formal Q&A sessions with several faculty members at a time to more informal “get-to-know-you” type conversations. The questions asked ranged from the practical (“Why Ob/Gyn…why our program…) to the esoteric (“who is your hero…define October…) I did have a couple of interviewers ask me questions about anatomy and pathology, and even had one interviewer ask me to tie a one-handed knot during the session, but these were definitely the exceptions to the rule.
• Likewise, the experience of the interview day also varies greatly. At some places you’ll sit in on Grand Rounds or a case conference, while at others more emphasis is given on the tour of the facilities and personal interaction with the residents. On average, though, you’ll be in the actual interview from around 7:00 AM to just after lunchtime and will complete 3-6 “interview sessions” with individual faculty and residents.
• Be prepared to ask some question of your own! Programs like it when you show interest in how they do things versus how other programs may do it.
• Try your best to attend the pre-interview dinner the night before the interview day if at all possible. This will give you a chance to interact with the residents (and at some places, the faculty) on a more individual basis and see if they’re the kind of people you want to work with.
• Try to send a thank you letter or thank-you cards to all of the places that you’ve interviewed.
PROGRAM AFFILIATION
• As I said before, there are community programs, university-affiliated community programs, and university (academic) programs.
• In general, the idea that “if you want to do a fellowship, you should go to a University program” can hold true, albeit to a small degree. There are plenty of great community and uni/com residencies with active research programs that are putting residents into fellowships left and right. Likewise there are plenty of university programs (including some very big name programs) that haven’t put out a fellow in years. My advice would be to go somewhere where you think you’ll get the best training and have ample opportunity for research, regardless of the program’s affiliation.
• In my experience, the main difference I saw between community and academic programs was numbers. The community program graduates usually had higher surgery and delivery numbers than those at academic programs, primarily because residents at these programs worked one-on-one with private physicians as well as their own full-time faculty. While academic program residents in general had lower numbers, they almost always had exposure to more unusual cases (i.e. their numbers were lower because they weren’t doing as many “bread-and-butter” cases,) and many times had more opportunities for research.
• Bear in mind, too, that a religious affiliation may impact your training in a very unique way when it comes to the field of OB/GYN. Hospitals with a religious affiliation most often do not offer training in or exposure to pregnancy termination, and (depending on the nature of the hospital’s religious affiliation) may not offer provision for contraceptive services. Each program has different ways of dealing with these issues – some may offer off-site rotations in contraception/family planning, some may have an outlying surgery center or private office at which these services are available, some may simply not offer these experiences at all. In my opinion, I wouldn’t let a hospital’s religious affiliation affect my decision to apply somewhere, as there are several OUTSTANDING programs that are religiously affiliated (Saint Louis University and Saint Vincent Health System – Indianapolis being two that come to mind immediately) but how these programs balance their limitations with resident educational objectives is definitely something to ask about on interview day and consider during your final decision.
GENDER ISSUES:
• This is a very delicate issue for all persons involved, with convictions running very deep on both sides of the issue. I will say, however, that although the great majority of applicants for OB/GYN residency are female, there has been a growing demand for variety in physician gender at all levels of practice. This, combined with the growing popularity of the specialty itself, has led to a steadily increasing number of male applicants over the past three years.
• If you’re a male who’s interested in OB/GYN, do NOT let the perception that “it’s a woman’s field” dissuade you.
• Of the programs I interviewed at, about 70% were predominantly female, about 30% were approximately 50-50 male/female, and one program was actually predominantly male.
• The three male members of the Class of 2007 who applied for residency in OB/GYN were all successful in obtaining spots in outstanding programs.
FELLOWSHIPS:
• ABOG approved fellowships are available in Maternal-Fetal Medicine, Reproductive Endocrinology and Infertility, Gynecologic Oncology, and Urogynecology/Pelvic Reconstructive Surgery. All are three years in length.
• Non-accredited fellowships are available in Advanced Laparoscopic Surgery, Family Planning (contraception and pregnancy termination), Pediatric and Adolescent Gynecology, and Menopausal/Geriatric Medicine. Most of these fellowships are 1-2 years in length.
• Fellowships across the board are becoming more competitive, but in general Maternal-Fetal is the least competitive of the accredited fellowships (highest number of slots), while REI is the most competitive.
• My advice for those of you interested in fellowships is to find a program that will offer you a good training base in general OB/GYN, allow you to become involved in research early-on, and to tailor your clinical and research experiences according to your interest.
FOLLOW-UP:
• If after interviewing you are really interested in a particular program, do all that you can to let them know. E-mail your interviewers, talk to the residents you met, arrange a phone call or conversation with the program director. Also, be sure to ask about “second looks” – many programs will invite you back to tour the facilities, meet with residents, and (maybe) even spend a night on L&D or in the ED. Many times the program will even pay for your lodging and/or set you up with a resident who’ll take care of you during this second visit.
• Approximately the last week of January, e-mail the program directors at your top three choices and let them know that they’re at the top of your list.
• I know that it sounds stupid now, but rank EVERY program you’d rather be at than go unmatched. If you absolutely hated or have a lot of concerns about a program, it’s fine to leave it off your rank list, but bear in mind that the shorter your list, the higher your chances of having to scramble for a slot. (And this year there were only 4 categorical and 2 preliminary slots available to scramble into in the entire nation!) I can’t speak for others, but personally, I applied to 26 programs, was offered interviews at 22, took 17, and ranked 14 programs.
• If you’re at an absolute stalemate between two or three programs, and can’t decide where to rank highest, ask yourself where you’d most like to live. Location isn’t just a factor for real estate agents.
• Never be afraid to ask for advice. The attendings at MCG are great resources with many connections to top-notch institutions. Talk to other people who are interviewing in the field as well (but take what they say with a grain of salt!) and get their feedback on interview experiences.
• Relax and enjoy your fourth year!
Wow, that was a lot more than I intended to say when I first started out, but I hope that it’s all of some help to you. If there’s anything else that you have questions about or if you just want to talk about applying for OB/Gyn or get my opinions on the places I applied/interviewed, feel free to e-mail me at fletcher_james_c@yahoo.com
- James