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Preliminary Residency Program Advice: How to Apply and Rank Programs

It’s residency application season! I remember how stressful this is, as I just went through the process last year, and wish the best of luck to everyone! If you’re applying to derm, anesthesia, radiology, or PM&R, you have to apply to and rank preliminary/transitional year programs as an extra challenge on top of the overall process. As a PGY1 going into derm currently in my prelim year, I wanted to share my advice for applying to and ranking preliminary years.

A woman wearing a light purple scrub top and a white coat reading "Andrea Rustad, MD; Resident Physician" as well as a red pin that says "she/her/hers", standing in front of a white wall and smiling. She has dark blonde hair and blue eyes and has a small red hair clip on the left side.

Here are the top 5 factors to consider in my opinion! I discuss these in this video here as well!

1. Location: There are two major ways to think about this - would you rather adventurously go somewhere new for just a year where you've been interested in living, or return somewhere where you have a connection, but knowing you will likely need to move two times on either end of this year? Or would you rather minimize moving and the associated logistical challenges and stress, and stay in your current city or move near a potential advanced program?

Also, consider how the location impacts the cost of living, need for a car, activities available for fun and wellbeing outside of work, and the diversity of the patient population you will care for and learn from.

2. Schedule/workload: you’ll be busy no matter what in residency, especially your first year, but program schedules/workload ranges a lot. Some programs have 24-hr call shifts while others have more manageable rotating call schedules. The requirement of ICU vs nights vs general surgery varies significantly between programs, so it’s important to figure out which of these you prefer (or perhaps, prefer to avoid). Patient volume and acuity can be very different as well between community hospitals and large academic centers. Try to find out patient caps for interns, work start and end times, etc. Also be sure to note the vacation policy!

3. Electives: consider both the total number of elective blocks and the elective options. Some programs offer only 1 while others have up to 6! You may not get to choose all your electives, or always get your top choices, so that is something worth asking about. Look for options that interest you and are relevant for your future specialty. For example, I looked for rheum, allergy, and infectious disease as electives relevant to dermatology.

4. Another key is culture, which is hard to get a good sense of until interviews. You want to feel supported and surrounded by good people. I found it helpful to talk 1:1 with a resident who had done or is currently in the program, ideally someone in your future specialty, to hear their unfiltered experience and ask specific questions.

5. Logistical things like salary are of course important to note and consider as well, although they really don't vary much between programs and the variation is generally proportional to the cost of living in the respective location. However, stipends and housing options can vary. Many, but not all, programs cover the cost of Step 3 and/or test prep materials, which is really helpful and important to note! A few programs also provide low-cost housing, which is great if you’re moving somewhere for only 1 year, but this is not very common overall.

I could talk much more about this, but these are the factors I found most helpful to consider and compare, I so I hope this helps you! Good luck with applications and interviews, and let me know if you have any questions!


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