Residency Selection Process: Description and Annotated Bibliography BY PHIL R. AARON, M.D., Resident
Department of Community Medicine
TAGALIE L. FRYE, Head, Public Services
Medical Center Library University of Kentucky Lexington, Kentucky
ABSTRACT
Specialty and residency training choices of medical students will affect the quality, mode, and geographic location of their future practice; the importance of such choices should not be underestimated. Medical school librarians have largely ignored the opportunity to interact with both medical students and medical school officials in providing sources needed to assist these career decisions, and for the most part students and administrators have ignored the opportunity to utilize the medical library in this process. This article presents an overview of the processes and procedures in which third- and fourth-year medical students are involved in selecting specialty and residency training, and provides a detailed description of the resources which the medical student should consult in order to make thoughtful, informed career decisions. The article urges medical school advisers and medical librarians to work as partners in providing information on specialty and residency selection to medical students.
ON MARCH 12, 1980, graduating medical students will receive the results of the computerized "match" that will dramatically affect their lives and their futures in medicine. They will then learn where they will pursue their residency training. The importance of this moment in the physician-in-training's career cannot be underestimated; it will affect his or her future medical specialty and the geographic location, quality, and mode of practice. For many medical students the match and the events surrounding it forever remain a mystery. The residency selection process can be confusing, complex, and, all too often, learned by word of
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mouth rather than through any organized procedure. It is incongruous that a decision of such importance is often approached by students without adequate data or preparation. It is just as incongruous that medical school librarians, alleged gatekeepers of information, have largely ignored their opportunity to demystify the match and assist the medical pilgrims through the maze-like obstacle course they face in selecting their specialty choice and residency program. This paper urges an expanded role for the medical librarian, one in which the librarian assures that the needed resources are available and critically reviews, evaluates, and disseminates the information-a role which librarians have historically left to the medical colleges themselves. We suggest, too, that deans of students and those medical school administrators involved in advising medical students about obtaining graduate medical education positions recognize and fully utilize medical school libraries in this process. The purpose of this article is to familiarize librarians with the processes and procedures in which third- and fourth-year medical students are involved in selecting specialty and residency programs; to provide an overview of the sources available to assist in these processes in an organized, instructive format which compares relative values; to recommend methods for an effective, feasible presentation of this information to medical students; and to identify specific areas in which the librarian and the medical school adviser can work as partners to assist the medical student. Bull. Med. Libr. Assoc. 67(4) October 1979
RESIDENCY SELECTION PROCESS
SELECTING A MEDICAL SPECIALTY That part of the process by which medical students select their future specialties should begin by Christmas break of the junior year at a fouryear medical school. For specialties such as orthopedics, dermatology, and ophthalmology, which have historically had many more applicants than positions, even earlier decisions and applications must be made. It is unrealistic to suggest that all students have their specialty choice finalized at this stage; most are only halfway through their first clinical clerkships.The clinical exposures and rotations will, however, allow the students to answer several questions. First, what have they learned about themselves? Was any particular specialty, any attending physician or house staff officer appealing as a role model? Did a particular rotation interest them in academic medicine or research as opposed to private practice? And what about lifestyle and location of practice? At some medical schools the dean's office will have administered personality tests, such as Myers-Briggs Type Indicators, and specialty preference tests; however, the major portion of each student's decision will probably be based upon information obtained after reviewing and evaluating himself and his life goals. At this stage it is very important to provide medical students with empirical data about medical specialties and the relative competitiveness of entrance into each, in order that they might make educated career choices. Weschler's Handbook of Medical Specialties is the one source which brings together biographical and personality characteristics of each medical specialist, specialist demographic data, and current and future manpower needs of each medical specialty. The AMA's Profile of Medical Practice is a good source for updating the statistical information, but it is not as comprehensive as the Weschler book. Current journal literature is also a good source of information on specific medical specialties. Students can obtain this information through Index Medicus, MEDLINE, or the monthly bibliographies which appear in the Journal of Medical Education, compiled from MEDLINE and arranged by subject. When specialty selection is a difficult decision, it is sometimes helpful for the medical student to attend a state, regional, or national meeting of the specialty being considered. Such attendance may also be helpful to students who have already chosen a particular specialty and desire to discuss various programs informally with physicians in that field. Bull. Med. Libr. Assoc. 67(4) October 1979
Listings of these meetings appear in JAMA bimonthly. REVIEWING RESIDENCY OPTIoNs In the past the first year of graduate medical education was termed an internship. Additional training beyond the internship was termed residency training. In 1975 all free-standing internships in which only one year of graduate medical education was offered, were eliminated. Today all graduate medical training programs must offer the opportunity for completing an entire residency training in a particular specialty. Thus, many specialties today refer to training year one as the first year of the residency. Residencies operate under one of the following three plans for the first program year: 1. Categorical first year. The training is largely limited to a single specialty, and the program is planned, sponsored, and supervised by one department. 2. Categorical* first year. The sponsorship of this program is the same as a regular categorical one, but the content of the program may include experiences in two or more fields; for example, it may be sponsored by internal medicine and provide experiences in internal medicine and pediatrics. 3. Flexible first year. This program is sponsored by two or more approved residencies and is jointly planned and supervised; for example, a program sponsored by internal medicine, surgery, and pediatrics. A medical student who has not made a firm commitment to a life-time specialty might, therefore, find it helpful to seek out programs that are either categorical* or flexible. Such programs afford the house staff physician additional time to consider and settle upon a medical specialty. As soon as students make their specialty preference choices (ideally by spring of the junior year), they should start reviewing the literature on the residency selection process itself. This should be done during the period of January through March of the junior year. There is little room for independence in this process; residency accreditation, residency selection, and participation in the National Residency Matching Program (NRMP)-the computerized match-are structured processes to which the medical student must conform. NRMP, for example, is so structured that failure to follow specific instructions or to meet specified deadlines results in disqualification from participation.
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Accreditation of residency programs is done by the Liaison Committee on Graduate Medical Education (LCGME), composed of representatives from the American Medical Association, the Association of American Medical Colleges (AAMC), the American Board of Medical Specialties, the Council on Medical Specialty Societies, the American Hospital Association, one person from the federal government, and one person from the general public. This committee has total power concerning whether specific programs are accredited; and in order to be licensed to practice medicine, a physician is required by most states to train in an accredited program. The LCGME Directory of Residency Training Programs lists all accredited programs. Applications to over 90% of these programs must be submitted through NRMP, which was established to provide some structure to the chaotic system interns and residents formerly used to apply for graduate medical training. Students need to review the instructions and information contained in the NRMP Directory to find out the procedures, deadlines, and general format of NRMP. This directory also lists the names and codes of each specific program; students will need this information if participating in the match. Most do choose to participate. While the term match sounds simple and forthright, it is really a rather complex, computerized process. A good explanation of this process appears in the Student's Guide of the American Medical Student Association (AMSA). A more complex explanation appears in the NRMP Directory. Medical students participating in the match complete their first NRMP papers in the spring of their junior year. At this time they sign a contract which binds them to participation according to the rules and regulations of NRMP. Students, therefore, should be familiar with residency selection procedures early in the process of selection and application. Students apply to and then interview for specific programs. In December or January they rank their preferences for these training positions. The medical students who want to begin this process with full awareness of where they are headed will probably want to consult sources other than the basic ones cited above. They can turn to current journal literature to get some feeling for the state of the art in particular specialties and for information on specific residency programs. They might also want to review the article which appears
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annually in the July issue of the Journal of Medical Education which details the results of the match of the prior spring. This information will not only give them some general idea of what to expect, but will also inform students of the relative competitiveness of particular specialties. APPLYING TO RESIDENCY PROGRAMS Presumably, by April of the junior year medical students will have made their specialty selection choices and reviewed the residency selection process. Next they must start getting together information which will be helpful in the application process. This includes: 1. A curriculum vitae or resume; 2. An autobiography containing a statement of future goals and interests inside and outside of medicine; and 3. Selection of individuals who can write letters of recommendation or assist the student.
A section in AMSA's Student's Guide contains excellent suggestions about this process. Standard sources dealing with such topics as job interviews might also be helpful to the student as an aid toward making a good presentation in the residency interview. Each student's application is sent out from the dean's office to the prospective training program, accompanied by a letter from the dean which outlines and summarizes the student's performance. A student at a school which has a summer vacation between the third and fourth years is advised to make an appointment before vacation with the department chairman or residency adviser of the specialty chosen to express an interest in the specialty and to request suggestions for house staff programs. This preliminary interview also affords an opportunity to meet with an individual who can be very helpful and instrumental in the student's eventual success in obtaining the desired house staff position. The next step is deciding where to apply. For students who anticipate applying to highly sought after programs, an early start is advisable. A good rule of thumb is to remember that house officers generally start their training on July 1 of each year. Any time after this date is usually acceptable to schedule interviewing. The NRMP Directory and the LCGME Directory are not available, however, until the fall of each year; October, therefore, is when most students will make on-site interviews. July might be too early, yet December Bull. Med. Libr. Assoc. 67(4) October 1979
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is most certainly too late. The key advice to the able to contract and negotiate with these programs medical student is to plan ahead and make realistic by telephone. It is most important that an interviewing timetables. unmatched student does not panic and take the first position offered, unless that position is one that the student really desires. EVALUATING A PROGRAM Since an important aspect of the students' deciOTHER PROGRAM OPTIONS sions will be their perceptions of a program based on an on-site visit or interview, many students While most medical students participate in appreciate guidelines on what to look for in a NRMP's match, those applying to federal governprogram. One good source of this information is ment or military programs use additional proceAMSA's Student's Guide, which provides ency- dures. The Army, Navy, Air Force, Public Health clopedic suggestions on different types of data to Service, and Bureau of Medical Services all collect about a program. Other sources available in provide options for residency training. Applicathe library should include the American Hospital tions to these programs must be made directly, Association Guide to the Health Care Field, the since these organizations do not participate in COTH Directory, and the COTH Survey of House NRMP. Their deadlines for applications are Staff Policy and Related Information. The generally earlier than those for NRMP. InformaLCGME's Directory should again be consulted for tion on these programs is available at local recruiting offices or directly from the programs, and program details. At this point it might be helpful for students to should be made available in medical school librarknow who, if anyone, from their medical school is ies. Military and federal graduate medical educacurrently in training at residency programs in tion offers many excellent and, often, unusual which they are interested. This information is opportunities. The Navy, for example, offers trainavailable from the medical school and can be kept ing in such areas as undersea medicine, aerospace in the library. Brochures of specific residency medicine, and cold weather medical research. programs are often public relations items, but are useful to medical students seeking information PRESENTATION OF INFORMATION about a specific training site and program. Other This survey of the decision processes involved in more traditional sources can also be provided: a the medical student's selection of medical specialty U.S. atlas, information about climate and recreational areas, and general geographic and demo- and residency programs has been only a brief overview. Countless other questions arise for which graphic data. the medical school librarian should be prepared. What source does one recommend for married MATCHING FOR A RESIDENCY PROGRAM medical students who want to find out how they By January of the senior year, the residency can apply for residencies in the same program or selection process is over for most medical students. city? What source lists the program directors of In January students complete a form giving their accredited programs, to whom the medical student top choices (one to ten) for a residency program. must address inquiries? Which sources should During this same time period each training students consult to know what salary they can program completes a similar form, listing its top expect as residents? It is hoped that the following choices for residency positions. The data go into a annotated bibliography will help librarians select computer, and student choices are matched against the best sources of data for specific information program choices. After the students have com- needs. Table 1 is an attempt to facilitate this pleted their rank order forms and submitted them process. Medical school librarians should review all the to NRMP, there is little left to do but wait to learn sources listed below to verify that they are included the results of the match. For those individuals who do not fare success- in their collection. Excellent opportunities exist for fully in the match, there are still options available. the medical librarian to participate as a partner At the time the match results are released, with medical school officials in acquainting medistudents who are unmatched receive an additional cal students with the resources and procedures brochure from NRMP. This booklet lists all the involved. Information sources can be kept in areas programs which had vacancies after the match. of the library designated for students pursuing Medical students not initially matched often are specialty or residency program selection. Video Bull. Med. Libr. Assoc. 67(4) October 1979
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programs, programmed texts, and after-hours lectures or seminars are other means for providing this information. Several years ago Hudnut stated that "very little has been written on the subject of advising medical students about internships" [1]. Today we find that this is not the case. But much of what has been written has not been collected and assembled in a usable form. Many medical students desire a cookbook with a timetable to help them attain successful residency selection results; the medical school librarian is, potentially, an ideal partner and facilitator who can be helpful to a medical school administration desirous of advising and assisting its students about graduate medical education. Developing a program to incorporate the medical school librarian and the medical library as resources will not mean that every student will obtain the particular residency desired; it will mean, however, that the information that should be utilized by medical students making career decisions is readily available, and, ultimately, that the process of specialty and residency selection will be better understood.
about medical practice, with exhaustive statison aspects of each specialty, including numbers of physicians, numbers of specialists, average weeks of practice by specialty, average fees, numbers of office visits, expenses, and incomes. It is the best primary source for such data, but other sources which compile and summarize this information might be more easily used. 3. Journal of the American Medical Association (JAMA). Chicago, v. 1- , 1883- . Weekly. Of particular interest to medical students during the time of residency selection is the "Annual report on graduate medical education," which appears in JAMA as the Education Number, the final issue in December. This report includes statistics relevant to numbers of house staff positions offered, filled and not filled, and the number of foreign medical students in American graduate medical education programs. It also includes information on new developments in medical education and a special section on graduate medical education of black Americans, women, and osteopaths. Medical students who ANNOTATED BIBLIOGRAPHY wish to attend meetings of specific specialty associations should consult the JAMA referSpecialty Selection ence directory entitled "Organizations of 1. AMERICAN MEDICAL ASSOCIATION. CENTER medical interest," which appears in the third FOR HEALTH SERVICES RESEARCH AND DEVELissue of JAMA in February, April, June, OPMENT. Physician Distribution and Medical August, October, and December. This gives Licensure in the United States. Chicago, 1975. the name and address of specialty organizaAnnual. tions and, usually, the date and location of the Provides current information on the geoannual meeting of each. graphic distribution of physicians in the 4. Medical Student. New York, Patient Care United States and discusses historical trends. Publication. Bimonthly. The statistics included are detailed from Distributed by Pfizer Pharmaceuticals to all county through national levels, including data medical students without charge, this publicaon population, number of hospitals, per capita tion often has articles relevant to physician incomes, and number of physicians by type of specialty selection. One special issue, "Guide practice (for example, group). This is the most to Career Planning," has been prepared and is complete and authoritative source for raw available. Articles are brief but informative statistics, but other sources, such as Weschand contain useful capsulized statistical data ler's Handbook of Medical Specialties, are compiled from AMA and specialty organizamore convenient to use because they provide tion statistics. summaries of the data by specialty. 5. WECHSLER, HENRY. Handbook of Medical 2. AMERICAN MEDICAL ASSOCIATION. CENTER Specialties. New York, Human Sciences, 1976. FOR HEALTH SERVICES RESEARCH AND DEVELA readable and comprehensive compilation of OPMENT. Profile of Medical Practice. 6th ed. information on medical specialties, this handChicago, 1977. Annual. book covers factors pertinent to career deciThis work, commonly known as the "Red sions for medical students and house officers. Book," is based on data collected largely It includes data and analyses by specialty on through physicians surveyed by the AMA. It medical specialty certification requirements, includes short essays on issues of interest average incomes and practice expenses, and
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projected manpower needs, among other things. One particularly interesting chapter, "The specialist: who is he and how is he viewed by others," discusses personality types for each medical specialty based on previously published surveys and research. While common sense might bring one to discount the stereotype of a particular specialty, the information provided in this handbook can be very helpful. It can be useful, for example, to know that a radiologist sees more patients per week than most other specialists, or that an internist tends to work more hours per week. The Handbook is a good means for developing some realistic expectations about one's future career.
Basic information contained in this source includes hospital addresses, names of administrators, hospital controls, types of services offered, census, expenses, and numbers of personnel. Information relevant to residencies includes medical school affiliation, numbers and types of residencies, and average resident stipends by region. Hospitals are listed by state and city, with all data regarding hospitals listed in an adjacent chart. A listing of other accredited education programs (such as those for hospital pharmacy residents and operating room technicians) is provided in this format. This composite listing is an improvement over the separate listings of such programs in the AHA Guide. The potential resident is here able to determine the full scope of an institution's involvement in medical education.
Residency Selection 6. BRIGGS, WILLIAM E.; TAYLOR, JULIET K.; AND DANNIS, CAROL M. Internship and Residency 8. COUNCIL OF TEACHING HOSPITALS. COTH Announcements for 1979. Columbus, Ohio, Survey of House Staff Policy and Related Information- 1977. Washington, D.C., AssoMajor Hospital Atlas, 1978. Annual. ciation of American Medical Colleges, 1977. For almost thirty years this annual publicaProvides a comparative analysis of data gathtion has been available without charge to ered from members of the Council of Teachmedical students and medical colleges, providing Hospitals regarding salaries and fringe ing information on residency programs that benefits for residents in accredited programs. pay to be included. It should not be confused Data are not provided for individual instituwith the LCGME Directory of Residency tions, but are presented as averages by region Training Programs, which lists all accredited and type of hospital. Administrators of resiresidency programs, or the NRMP Directory, dency programs can view their programs in a which lists all accredited programs participatnational regional perspective, and potential ing in the match. This directory is often a house staff officers can observe an overall reprint of the brochures which a program has picture upon which to base expectations for prepared for advertisement, and much of the specific programs. information is biased and out-of-date. It is of The data included are very specific. Statisvery little assistance at best; many of the tics are provided, for example, on percentages programs listed are ones that historically have of programs which pay for house staff officers' not filled their openings for house staff. malpractice insurance, medical and dental 7. COUNCIL OF TEACHING HOSPITALS. COTH insurance, parking fees, and so on. Also Directory. Washington, D.C., Association of covered are such subjects as numbers of weeks American Medical Colleges, 1977. of vacation, percentages of chief residents who While much of the information contained in receive additional stipends, and sources of the COTH Directory is also included in other salaries and fringe benefits. Also useful are a sources, it is still a useful source for medical detailed statistical analysis of the salaries and libraries involved with institutions of medical benefits in sixteen major American cities and education. This source gives information simia report on minority groups as house staff lar to that contained in the AHA Guide to the officers. Health Care Field; however, it contains information only on hospitals that are members of 9. American Hospital Association Guide to the Health Care Field. Chicago, 1978. Annual. the Council of Teaching Hospitals of the The basic source for information on health AAMC. Membership in this group is limited care institutions. Specific information on to not-for-profit hospitals that have at least hospitals provided in this annual publication four ongoing, approved residency programs. Bull. Med. Libr. Assoc. 67(4) October 1979
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It discusses "The essentials of accredited residencies," requirements which must be met before a residency program is accredited helpful in evaluating a house officer training program. It also contains specialty certification requirements. The lists of approved residencies are divided into two categories: (1) "Accredited residencies" gives residency training programs by specialty or subspecialty, the program director's name, and data about the program, including census, admissions, outpatient visits of the hospital, and number of residency positions available for the upcoming year. (2) The "Consolidated list of hospitals" gives more information on the hospitals sponsoring each training program, including mailing address, medical school affiliation, hospital governance, number of beds, percentage of patient deaths, positions offered, and NRMP code. An appendix contains reviews of requirements for medical licensure by state, with names and addresses of licensing bodies. The Directory is provided without charge through accredited U.S. schools of medicine to all incoming fourth-year medical students or is available for purchase from AMA. 12. NRMP Directory. Evanston, Ill., National Resident Matching Program, 1978. Annual. The essential handbook for every medical student who plans to participate in the matching program. Provided in this source are a list of hospitals and programs participating in the upcoming match, the number of spaces available by program, and the program codes which must be used by students in compiling their rank order lists. Incoming fourth-year students, however, should not neglect to read the first forty pages of this directory, containing the history and function of the match, as MEDICAL GRADUATE 11. LIAISON COMMITTEE ON well as the mechanics of the matching EDUCATION (LCGME). 78/79 Directory of program. Residency Training Programs. Chicago, AmeriAmong other specific information provided can Medical Association, 1978. Annual. is a summary report of results of last year's First published over sixty years ago, this match, a sample institutional agreement, directory lists all graduate medical education NRMP commitments and procedures for programs officially accredited by LCGME. is reporting violations, and an explanation of it Book," "Green the as known Popularly program categories. These textual pages also often used by medical students merely to get provide answers to such specific questions as: the names and addresses of residency program How do married medical students participate imporother of wealth a directors. It contains so that they are matched in the same program tant information, however, including general or geographic area? How does the match work information on foreign medical graduates, procedurally? What are the deadlines that NRMP. and program accreditation processes,
includes names and addresses of hospitals by geographic area and data on specific hospitals as to number of beds, admissions, census, occupancy, newborn data, expenses, number of personnel, and institutional membership affiliations. This source also lists regional, national, and international agencies, state licensing boards, and accredited health education programs. Its use to the potential house staff officer is for the information it provides on those hospitals which sponsor residency programs. 10. Journal of Medical Education (JME). Washington, D.C., Association of American Medical Colleges. v. 1- , 1925- . Monthly. Provides information on all aspects of graduate and undergraduate medical education. Of particular interest to medical students preparing to make the transition to house officers is the report which appears annually in the July issue giving data on and analysis of how graduating fourth-year medical students fared in obtaining first-year residency positions in the latest match. Of continuing interest are the articles on specific programs, current issues, and problems particular to medical education. The Bibliography featured in each issue is a good means for locating information on medical education which has been recently published in other journals. Datalogue, also appearing each month, is a statistical report which focuses on subjects relevant to medical education. As a major source for state-of-the-art information, this journal should be read regularly during all years of medical training, especially prior to career decision making and planning. After a specialty choice has been made, one might desire to review articles on that specialty.
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students must meet? What is the relative competitiveness of programs by specialty? What standard must a program meet in order to be accredited? A thorough reading of this directory should be a high priority for any third- or fourth-year medical student. It is provided without charge by accredited schools of medicine to all third-year medical students or is available for purchase from NRMP. 13. RAFF, MARTIN, J.; AARON, PHIL R.; AND RAY, C. ELLIOT. A Student's Guide to the Appraisal and Selection of House Staff Training Programs. Chantilly, Va., American Medical Student Association (AMSA) Communications Network, 1974. For the past four years AMSA has been distributing this book to meet the basic need for information on the application and interview process and for guidelines for evaluating a residency program. This pocket-size book is concise and yet comprehensive. It includes clear, detailed information on the steps the medical student needs to take prior to interviews (writing a vitae and what it should include) and what should go into a letter of recommendation. It tells how to arrange an interview and what to expect during one. Once students have arranged interviews, they will want to review the section on how to evaluate a training program. Tips on things to look for, as well as a list of suggested questions, are provided. While the greatest strength of this source is its information on applying to and evaluating programs, it has other useful information, including a description of NRMP, a discussion of how hospitals select residents, and options for residency programs. This book will not take long to read, but its downto-earth information and style will help when it is time to apply to, inverview at, and select a residency program. This volume needs to be revised and updated. 14. NRMP Results: Number of Candidates Sought and Number Matchedfor Each Participating Hospital and Unfilled Programs by Specialty. Evanston, Ill., National Residency Matching Program, 1978. Annual. Distributed annually to medical schools with their students' match results. It lists all residency programs participating that year and gives the number of residencies sought and the number of positions filled. More importantly, however, it also lists the number and location Bull. Med. Libr. Assoc. 67(4) October 1979
of programs that did not fill all their vacancies. It is needed by those medical students who did not match and must, therefore, seek a residency position after the match. 15. Alumni Bulletins. At graduation, or soon thereafter, most medical schools publish a listing of the graduating class and where the members will go for residency training. It can'be helpful for a student to look through the last several years of this publication to see if a previous student from his medical school has gone to a residency program in which he is interested. Such a personal resource can be extremely helpful in finding out information that might not be apparent on paper or in the interview process itself. 16. Program Brochures. Medical schools and libraries receive many brochures each year from various institutions describing medical education programs. Often their purpose is to present the program in the best possible perspective in order to attract applicants. They should, therefore, be considered in this light. Year in and year out the best source of information about the strengths or weaknesses of a house officers' training program comes from house officers already in that program. A student will learn more from talking with these individuals during an on-site visit than from reading what the program brochures portray.
Sources of Information on Alternative Options 17. Reduced Residencies. Some medical students would rather complete their residency training on a part-time basis, known as a "reduced residency." While options for shared residencies are now listed in the NRMP Directory, there is only one source available which lists all options for reduced residency training: Institutions Offering Reduced-Schedule Training, 1977, available for $2.50 plus $.50 postage and handling from:
Harvard Reduced-Schedule Residency Project Attn: Eileen Shapiro 25 Shattuck St. Boston, Mass. 02115
Military Residencies. Even though military resident training programs do not participate in the NRMP match, they are listed in the LCGME Directory. Many students applying to military programs also choose to participate in NRMP, since acceptance into military residency programs is highly competitive. These students sign the NRMP contract in the spring, making separate
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application to the branch of the military service in which they are interested. Since announcements regarding acceptance to military training programs are made in the fall, those students who were not accepted have the option of securing a residency through NRMP. Students accepting military residencies withdraw from NRMP. Specific information regarding military graduate medical training programs and application to them is available from any local recruiting office or can be obtained from the following: U.S. Air Force Recruiting Service Medical Recruiting Division Randolph Air Force Base, Tex. 78148 Commander U.S. Army Medical Department Personnel Support Agency Attn: ABPE-PDO 1900 Half St., N.W. Washington, D.C. 20324
Commanding Officer Naval Health Sciences Education and Training Command Bureau of Medicine and Surgery Department of the Navy 23d and E Sts., N.W. Washington, D.C. 20372
Organizations That Can Provide Additional Information The following organizations provide various types of information or publications relevant to career decisions for medical students;
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American Medical Student Association (AMSA) 14650 Lee Rd. Chantilly, Va. 22020
AMSA publishes The New Physician, which contains articles on career decision making, and distributes A Student's Guide to the Appraisal and Selection of House Staff Training Programs. Organization of Student Representatives of the Association of American Medical Colleges 1 Dupont Circle Washington, D.C. 20036 Physicians National Housestaff Association 1625 L St., N.W. Washington, D.C. 20036 Student Business Section and Resident Physician Section of the American Medical Association 535 N. Dearborn St. Chicago, Ill. 60610 Student National Medical Association 1720 Massachusetts Ave., N.W. Washington, D.C. 20006
REFERENCE 1. HUDNUT, H. B. Advising medical students about internships. JAMA 213: 1165, 1970.
Received February 21, 1979; accepted May 14, 1979.
Bull. Med. Libr. Assoc. 67(4) October 1979
Department of Community Medicine
TAGALIE L. FRYE, Head, Public Services
Medical Center Library University of Kentucky Lexington, Kentucky
ABSTRACT
Specialty and residency training choices of medical students will affect the quality, mode, and geographic location of their future practice; the importance of such choices should not be underestimated. Medical school librarians have largely ignored the opportunity to interact with both medical students and medical school officials in providing sources needed to assist these career decisions, and for the most part students and administrators have ignored the opportunity to utilize the medical library in this process. This article presents an overview of the processes and procedures in which third- and fourth-year medical students are involved in selecting specialty and residency training, and provides a detailed description of the resources which the medical student should consult in order to make thoughtful, informed career decisions. The article urges medical school advisers and medical librarians to work as partners in providing information on specialty and residency selection to medical students.
ON MARCH 12, 1980, graduating medical students will receive the results of the computerized "match" that will dramatically affect their lives and their futures in medicine. They will then learn where they will pursue their residency training. The importance of this moment in the physician-in-training's career cannot be underestimated; it will affect his or her future medical specialty and the geographic location, quality, and mode of practice. For many medical students the match and the events surrounding it forever remain a mystery. The residency selection process can be confusing, complex, and, all too often, learned by word of
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mouth rather than through any organized procedure. It is incongruous that a decision of such importance is often approached by students without adequate data or preparation. It is just as incongruous that medical school librarians, alleged gatekeepers of information, have largely ignored their opportunity to demystify the match and assist the medical pilgrims through the maze-like obstacle course they face in selecting their specialty choice and residency program. This paper urges an expanded role for the medical librarian, one in which the librarian assures that the needed resources are available and critically reviews, evaluates, and disseminates the information-a role which librarians have historically left to the medical colleges themselves. We suggest, too, that deans of students and those medical school administrators involved in advising medical students about obtaining graduate medical education positions recognize and fully utilize medical school libraries in this process. The purpose of this article is to familiarize librarians with the processes and procedures in which third- and fourth-year medical students are involved in selecting specialty and residency programs; to provide an overview of the sources available to assist in these processes in an organized, instructive format which compares relative values; to recommend methods for an effective, feasible presentation of this information to medical students; and to identify specific areas in which the librarian and the medical school adviser can work as partners to assist the medical student. Bull. Med. Libr. Assoc. 67(4) October 1979
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SELECTING A MEDICAL SPECIALTY That part of the process by which medical students select their future specialties should begin by Christmas break of the junior year at a fouryear medical school. For specialties such as orthopedics, dermatology, and ophthalmology, which have historically had many more applicants than positions, even earlier decisions and applications must be made. It is unrealistic to suggest that all students have their specialty choice finalized at this stage; most are only halfway through their first clinical clerkships.The clinical exposures and rotations will, however, allow the students to answer several questions. First, what have they learned about themselves? Was any particular specialty, any attending physician or house staff officer appealing as a role model? Did a particular rotation interest them in academic medicine or research as opposed to private practice? And what about lifestyle and location of practice? At some medical schools the dean's office will have administered personality tests, such as Myers-Briggs Type Indicators, and specialty preference tests; however, the major portion of each student's decision will probably be based upon information obtained after reviewing and evaluating himself and his life goals. At this stage it is very important to provide medical students with empirical data about medical specialties and the relative competitiveness of entrance into each, in order that they might make educated career choices. Weschler's Handbook of Medical Specialties is the one source which brings together biographical and personality characteristics of each medical specialist, specialist demographic data, and current and future manpower needs of each medical specialty. The AMA's Profile of Medical Practice is a good source for updating the statistical information, but it is not as comprehensive as the Weschler book. Current journal literature is also a good source of information on specific medical specialties. Students can obtain this information through Index Medicus, MEDLINE, or the monthly bibliographies which appear in the Journal of Medical Education, compiled from MEDLINE and arranged by subject. When specialty selection is a difficult decision, it is sometimes helpful for the medical student to attend a state, regional, or national meeting of the specialty being considered. Such attendance may also be helpful to students who have already chosen a particular specialty and desire to discuss various programs informally with physicians in that field. Bull. Med. Libr. Assoc. 67(4) October 1979
Listings of these meetings appear in JAMA bimonthly. REVIEWING RESIDENCY OPTIoNs In the past the first year of graduate medical education was termed an internship. Additional training beyond the internship was termed residency training. In 1975 all free-standing internships in which only one year of graduate medical education was offered, were eliminated. Today all graduate medical training programs must offer the opportunity for completing an entire residency training in a particular specialty. Thus, many specialties today refer to training year one as the first year of the residency. Residencies operate under one of the following three plans for the first program year: 1. Categorical first year. The training is largely limited to a single specialty, and the program is planned, sponsored, and supervised by one department. 2. Categorical* first year. The sponsorship of this program is the same as a regular categorical one, but the content of the program may include experiences in two or more fields; for example, it may be sponsored by internal medicine and provide experiences in internal medicine and pediatrics. 3. Flexible first year. This program is sponsored by two or more approved residencies and is jointly planned and supervised; for example, a program sponsored by internal medicine, surgery, and pediatrics. A medical student who has not made a firm commitment to a life-time specialty might, therefore, find it helpful to seek out programs that are either categorical* or flexible. Such programs afford the house staff physician additional time to consider and settle upon a medical specialty. As soon as students make their specialty preference choices (ideally by spring of the junior year), they should start reviewing the literature on the residency selection process itself. This should be done during the period of January through March of the junior year. There is little room for independence in this process; residency accreditation, residency selection, and participation in the National Residency Matching Program (NRMP)-the computerized match-are structured processes to which the medical student must conform. NRMP, for example, is so structured that failure to follow specific instructions or to meet specified deadlines results in disqualification from participation.
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Accreditation of residency programs is done by the Liaison Committee on Graduate Medical Education (LCGME), composed of representatives from the American Medical Association, the Association of American Medical Colleges (AAMC), the American Board of Medical Specialties, the Council on Medical Specialty Societies, the American Hospital Association, one person from the federal government, and one person from the general public. This committee has total power concerning whether specific programs are accredited; and in order to be licensed to practice medicine, a physician is required by most states to train in an accredited program. The LCGME Directory of Residency Training Programs lists all accredited programs. Applications to over 90% of these programs must be submitted through NRMP, which was established to provide some structure to the chaotic system interns and residents formerly used to apply for graduate medical training. Students need to review the instructions and information contained in the NRMP Directory to find out the procedures, deadlines, and general format of NRMP. This directory also lists the names and codes of each specific program; students will need this information if participating in the match. Most do choose to participate. While the term match sounds simple and forthright, it is really a rather complex, computerized process. A good explanation of this process appears in the Student's Guide of the American Medical Student Association (AMSA). A more complex explanation appears in the NRMP Directory. Medical students participating in the match complete their first NRMP papers in the spring of their junior year. At this time they sign a contract which binds them to participation according to the rules and regulations of NRMP. Students, therefore, should be familiar with residency selection procedures early in the process of selection and application. Students apply to and then interview for specific programs. In December or January they rank their preferences for these training positions. The medical students who want to begin this process with full awareness of where they are headed will probably want to consult sources other than the basic ones cited above. They can turn to current journal literature to get some feeling for the state of the art in particular specialties and for information on specific residency programs. They might also want to review the article which appears
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annually in the July issue of the Journal of Medical Education which details the results of the match of the prior spring. This information will not only give them some general idea of what to expect, but will also inform students of the relative competitiveness of particular specialties. APPLYING TO RESIDENCY PROGRAMS Presumably, by April of the junior year medical students will have made their specialty selection choices and reviewed the residency selection process. Next they must start getting together information which will be helpful in the application process. This includes: 1. A curriculum vitae or resume; 2. An autobiography containing a statement of future goals and interests inside and outside of medicine; and 3. Selection of individuals who can write letters of recommendation or assist the student.
A section in AMSA's Student's Guide contains excellent suggestions about this process. Standard sources dealing with such topics as job interviews might also be helpful to the student as an aid toward making a good presentation in the residency interview. Each student's application is sent out from the dean's office to the prospective training program, accompanied by a letter from the dean which outlines and summarizes the student's performance. A student at a school which has a summer vacation between the third and fourth years is advised to make an appointment before vacation with the department chairman or residency adviser of the specialty chosen to express an interest in the specialty and to request suggestions for house staff programs. This preliminary interview also affords an opportunity to meet with an individual who can be very helpful and instrumental in the student's eventual success in obtaining the desired house staff position. The next step is deciding where to apply. For students who anticipate applying to highly sought after programs, an early start is advisable. A good rule of thumb is to remember that house officers generally start their training on July 1 of each year. Any time after this date is usually acceptable to schedule interviewing. The NRMP Directory and the LCGME Directory are not available, however, until the fall of each year; October, therefore, is when most students will make on-site interviews. July might be too early, yet December Bull. Med. Libr. Assoc. 67(4) October 1979
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is most certainly too late. The key advice to the able to contract and negotiate with these programs medical student is to plan ahead and make realistic by telephone. It is most important that an interviewing timetables. unmatched student does not panic and take the first position offered, unless that position is one that the student really desires. EVALUATING A PROGRAM Since an important aspect of the students' deciOTHER PROGRAM OPTIONS sions will be their perceptions of a program based on an on-site visit or interview, many students While most medical students participate in appreciate guidelines on what to look for in a NRMP's match, those applying to federal governprogram. One good source of this information is ment or military programs use additional proceAMSA's Student's Guide, which provides ency- dures. The Army, Navy, Air Force, Public Health clopedic suggestions on different types of data to Service, and Bureau of Medical Services all collect about a program. Other sources available in provide options for residency training. Applicathe library should include the American Hospital tions to these programs must be made directly, Association Guide to the Health Care Field, the since these organizations do not participate in COTH Directory, and the COTH Survey of House NRMP. Their deadlines for applications are Staff Policy and Related Information. The generally earlier than those for NRMP. InformaLCGME's Directory should again be consulted for tion on these programs is available at local recruiting offices or directly from the programs, and program details. At this point it might be helpful for students to should be made available in medical school librarknow who, if anyone, from their medical school is ies. Military and federal graduate medical educacurrently in training at residency programs in tion offers many excellent and, often, unusual which they are interested. This information is opportunities. The Navy, for example, offers trainavailable from the medical school and can be kept ing in such areas as undersea medicine, aerospace in the library. Brochures of specific residency medicine, and cold weather medical research. programs are often public relations items, but are useful to medical students seeking information PRESENTATION OF INFORMATION about a specific training site and program. Other This survey of the decision processes involved in more traditional sources can also be provided: a the medical student's selection of medical specialty U.S. atlas, information about climate and recreational areas, and general geographic and demo- and residency programs has been only a brief overview. Countless other questions arise for which graphic data. the medical school librarian should be prepared. What source does one recommend for married MATCHING FOR A RESIDENCY PROGRAM medical students who want to find out how they By January of the senior year, the residency can apply for residencies in the same program or selection process is over for most medical students. city? What source lists the program directors of In January students complete a form giving their accredited programs, to whom the medical student top choices (one to ten) for a residency program. must address inquiries? Which sources should During this same time period each training students consult to know what salary they can program completes a similar form, listing its top expect as residents? It is hoped that the following choices for residency positions. The data go into a annotated bibliography will help librarians select computer, and student choices are matched against the best sources of data for specific information program choices. After the students have com- needs. Table 1 is an attempt to facilitate this pleted their rank order forms and submitted them process. Medical school librarians should review all the to NRMP, there is little left to do but wait to learn sources listed below to verify that they are included the results of the match. For those individuals who do not fare success- in their collection. Excellent opportunities exist for fully in the match, there are still options available. the medical librarian to participate as a partner At the time the match results are released, with medical school officials in acquainting medistudents who are unmatched receive an additional cal students with the resources and procedures brochure from NRMP. This booklet lists all the involved. Information sources can be kept in areas programs which had vacancies after the match. of the library designated for students pursuing Medical students not initially matched often are specialty or residency program selection. Video Bull. Med. Libr. Assoc. 67(4) October 1979
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programs, programmed texts, and after-hours lectures or seminars are other means for providing this information. Several years ago Hudnut stated that "very little has been written on the subject of advising medical students about internships" [1]. Today we find that this is not the case. But much of what has been written has not been collected and assembled in a usable form. Many medical students desire a cookbook with a timetable to help them attain successful residency selection results; the medical school librarian is, potentially, an ideal partner and facilitator who can be helpful to a medical school administration desirous of advising and assisting its students about graduate medical education. Developing a program to incorporate the medical school librarian and the medical library as resources will not mean that every student will obtain the particular residency desired; it will mean, however, that the information that should be utilized by medical students making career decisions is readily available, and, ultimately, that the process of specialty and residency selection will be better understood.
about medical practice, with exhaustive statison aspects of each specialty, including numbers of physicians, numbers of specialists, average weeks of practice by specialty, average fees, numbers of office visits, expenses, and incomes. It is the best primary source for such data, but other sources which compile and summarize this information might be more easily used. 3. Journal of the American Medical Association (JAMA). Chicago, v. 1- , 1883- . Weekly. Of particular interest to medical students during the time of residency selection is the "Annual report on graduate medical education," which appears in JAMA as the Education Number, the final issue in December. This report includes statistics relevant to numbers of house staff positions offered, filled and not filled, and the number of foreign medical students in American graduate medical education programs. It also includes information on new developments in medical education and a special section on graduate medical education of black Americans, women, and osteopaths. Medical students who ANNOTATED BIBLIOGRAPHY wish to attend meetings of specific specialty associations should consult the JAMA referSpecialty Selection ence directory entitled "Organizations of 1. AMERICAN MEDICAL ASSOCIATION. CENTER medical interest," which appears in the third FOR HEALTH SERVICES RESEARCH AND DEVELissue of JAMA in February, April, June, OPMENT. Physician Distribution and Medical August, October, and December. This gives Licensure in the United States. Chicago, 1975. the name and address of specialty organizaAnnual. tions and, usually, the date and location of the Provides current information on the geoannual meeting of each. graphic distribution of physicians in the 4. Medical Student. New York, Patient Care United States and discusses historical trends. Publication. Bimonthly. The statistics included are detailed from Distributed by Pfizer Pharmaceuticals to all county through national levels, including data medical students without charge, this publicaon population, number of hospitals, per capita tion often has articles relevant to physician incomes, and number of physicians by type of specialty selection. One special issue, "Guide practice (for example, group). This is the most to Career Planning," has been prepared and is complete and authoritative source for raw available. Articles are brief but informative statistics, but other sources, such as Weschand contain useful capsulized statistical data ler's Handbook of Medical Specialties, are compiled from AMA and specialty organizamore convenient to use because they provide tion statistics. summaries of the data by specialty. 5. WECHSLER, HENRY. Handbook of Medical 2. AMERICAN MEDICAL ASSOCIATION. CENTER Specialties. New York, Human Sciences, 1976. FOR HEALTH SERVICES RESEARCH AND DEVELA readable and comprehensive compilation of OPMENT. Profile of Medical Practice. 6th ed. information on medical specialties, this handChicago, 1977. Annual. book covers factors pertinent to career deciThis work, commonly known as the "Red sions for medical students and house officers. Book," is based on data collected largely It includes data and analyses by specialty on through physicians surveyed by the AMA. It medical specialty certification requirements, includes short essays on issues of interest average incomes and practice expenses, and
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projected manpower needs, among other things. One particularly interesting chapter, "The specialist: who is he and how is he viewed by others," discusses personality types for each medical specialty based on previously published surveys and research. While common sense might bring one to discount the stereotype of a particular specialty, the information provided in this handbook can be very helpful. It can be useful, for example, to know that a radiologist sees more patients per week than most other specialists, or that an internist tends to work more hours per week. The Handbook is a good means for developing some realistic expectations about one's future career.
Basic information contained in this source includes hospital addresses, names of administrators, hospital controls, types of services offered, census, expenses, and numbers of personnel. Information relevant to residencies includes medical school affiliation, numbers and types of residencies, and average resident stipends by region. Hospitals are listed by state and city, with all data regarding hospitals listed in an adjacent chart. A listing of other accredited education programs (such as those for hospital pharmacy residents and operating room technicians) is provided in this format. This composite listing is an improvement over the separate listings of such programs in the AHA Guide. The potential resident is here able to determine the full scope of an institution's involvement in medical education.
Residency Selection 6. BRIGGS, WILLIAM E.; TAYLOR, JULIET K.; AND DANNIS, CAROL M. Internship and Residency 8. COUNCIL OF TEACHING HOSPITALS. COTH Announcements for 1979. Columbus, Ohio, Survey of House Staff Policy and Related Information- 1977. Washington, D.C., AssoMajor Hospital Atlas, 1978. Annual. ciation of American Medical Colleges, 1977. For almost thirty years this annual publicaProvides a comparative analysis of data gathtion has been available without charge to ered from members of the Council of Teachmedical students and medical colleges, providing Hospitals regarding salaries and fringe ing information on residency programs that benefits for residents in accredited programs. pay to be included. It should not be confused Data are not provided for individual instituwith the LCGME Directory of Residency tions, but are presented as averages by region Training Programs, which lists all accredited and type of hospital. Administrators of resiresidency programs, or the NRMP Directory, dency programs can view their programs in a which lists all accredited programs participatnational regional perspective, and potential ing in the match. This directory is often a house staff officers can observe an overall reprint of the brochures which a program has picture upon which to base expectations for prepared for advertisement, and much of the specific programs. information is biased and out-of-date. It is of The data included are very specific. Statisvery little assistance at best; many of the tics are provided, for example, on percentages programs listed are ones that historically have of programs which pay for house staff officers' not filled their openings for house staff. malpractice insurance, medical and dental 7. COUNCIL OF TEACHING HOSPITALS. COTH insurance, parking fees, and so on. Also Directory. Washington, D.C., Association of covered are such subjects as numbers of weeks American Medical Colleges, 1977. of vacation, percentages of chief residents who While much of the information contained in receive additional stipends, and sources of the COTH Directory is also included in other salaries and fringe benefits. Also useful are a sources, it is still a useful source for medical detailed statistical analysis of the salaries and libraries involved with institutions of medical benefits in sixteen major American cities and education. This source gives information simia report on minority groups as house staff lar to that contained in the AHA Guide to the officers. Health Care Field; however, it contains information only on hospitals that are members of 9. American Hospital Association Guide to the Health Care Field. Chicago, 1978. Annual. the Council of Teaching Hospitals of the The basic source for information on health AAMC. Membership in this group is limited care institutions. Specific information on to not-for-profit hospitals that have at least hospitals provided in this annual publication four ongoing, approved residency programs. Bull. Med. Libr. Assoc. 67(4) October 1979
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It discusses "The essentials of accredited residencies," requirements which must be met before a residency program is accredited helpful in evaluating a house officer training program. It also contains specialty certification requirements. The lists of approved residencies are divided into two categories: (1) "Accredited residencies" gives residency training programs by specialty or subspecialty, the program director's name, and data about the program, including census, admissions, outpatient visits of the hospital, and number of residency positions available for the upcoming year. (2) The "Consolidated list of hospitals" gives more information on the hospitals sponsoring each training program, including mailing address, medical school affiliation, hospital governance, number of beds, percentage of patient deaths, positions offered, and NRMP code. An appendix contains reviews of requirements for medical licensure by state, with names and addresses of licensing bodies. The Directory is provided without charge through accredited U.S. schools of medicine to all incoming fourth-year medical students or is available for purchase from AMA. 12. NRMP Directory. Evanston, Ill., National Resident Matching Program, 1978. Annual. The essential handbook for every medical student who plans to participate in the matching program. Provided in this source are a list of hospitals and programs participating in the upcoming match, the number of spaces available by program, and the program codes which must be used by students in compiling their rank order lists. Incoming fourth-year students, however, should not neglect to read the first forty pages of this directory, containing the history and function of the match, as MEDICAL GRADUATE 11. LIAISON COMMITTEE ON well as the mechanics of the matching EDUCATION (LCGME). 78/79 Directory of program. Residency Training Programs. Chicago, AmeriAmong other specific information provided can Medical Association, 1978. Annual. is a summary report of results of last year's First published over sixty years ago, this match, a sample institutional agreement, directory lists all graduate medical education NRMP commitments and procedures for programs officially accredited by LCGME. is reporting violations, and an explanation of it Book," "Green the as known Popularly program categories. These textual pages also often used by medical students merely to get provide answers to such specific questions as: the names and addresses of residency program How do married medical students participate imporother of wealth a directors. It contains so that they are matched in the same program tant information, however, including general or geographic area? How does the match work information on foreign medical graduates, procedurally? What are the deadlines that NRMP. and program accreditation processes,
includes names and addresses of hospitals by geographic area and data on specific hospitals as to number of beds, admissions, census, occupancy, newborn data, expenses, number of personnel, and institutional membership affiliations. This source also lists regional, national, and international agencies, state licensing boards, and accredited health education programs. Its use to the potential house staff officer is for the information it provides on those hospitals which sponsor residency programs. 10. Journal of Medical Education (JME). Washington, D.C., Association of American Medical Colleges. v. 1- , 1925- . Monthly. Provides information on all aspects of graduate and undergraduate medical education. Of particular interest to medical students preparing to make the transition to house officers is the report which appears annually in the July issue giving data on and analysis of how graduating fourth-year medical students fared in obtaining first-year residency positions in the latest match. Of continuing interest are the articles on specific programs, current issues, and problems particular to medical education. The Bibliography featured in each issue is a good means for locating information on medical education which has been recently published in other journals. Datalogue, also appearing each month, is a statistical report which focuses on subjects relevant to medical education. As a major source for state-of-the-art information, this journal should be read regularly during all years of medical training, especially prior to career decision making and planning. After a specialty choice has been made, one might desire to review articles on that specialty.
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students must meet? What is the relative competitiveness of programs by specialty? What standard must a program meet in order to be accredited? A thorough reading of this directory should be a high priority for any third- or fourth-year medical student. It is provided without charge by accredited schools of medicine to all third-year medical students or is available for purchase from NRMP. 13. RAFF, MARTIN, J.; AARON, PHIL R.; AND RAY, C. ELLIOT. A Student's Guide to the Appraisal and Selection of House Staff Training Programs. Chantilly, Va., American Medical Student Association (AMSA) Communications Network, 1974. For the past four years AMSA has been distributing this book to meet the basic need for information on the application and interview process and for guidelines for evaluating a residency program. This pocket-size book is concise and yet comprehensive. It includes clear, detailed information on the steps the medical student needs to take prior to interviews (writing a vitae and what it should include) and what should go into a letter of recommendation. It tells how to arrange an interview and what to expect during one. Once students have arranged interviews, they will want to review the section on how to evaluate a training program. Tips on things to look for, as well as a list of suggested questions, are provided. While the greatest strength of this source is its information on applying to and evaluating programs, it has other useful information, including a description of NRMP, a discussion of how hospitals select residents, and options for residency programs. This book will not take long to read, but its downto-earth information and style will help when it is time to apply to, inverview at, and select a residency program. This volume needs to be revised and updated. 14. NRMP Results: Number of Candidates Sought and Number Matchedfor Each Participating Hospital and Unfilled Programs by Specialty. Evanston, Ill., National Residency Matching Program, 1978. Annual. Distributed annually to medical schools with their students' match results. It lists all residency programs participating that year and gives the number of residencies sought and the number of positions filled. More importantly, however, it also lists the number and location Bull. Med. Libr. Assoc. 67(4) October 1979
of programs that did not fill all their vacancies. It is needed by those medical students who did not match and must, therefore, seek a residency position after the match. 15. Alumni Bulletins. At graduation, or soon thereafter, most medical schools publish a listing of the graduating class and where the members will go for residency training. It can'be helpful for a student to look through the last several years of this publication to see if a previous student from his medical school has gone to a residency program in which he is interested. Such a personal resource can be extremely helpful in finding out information that might not be apparent on paper or in the interview process itself. 16. Program Brochures. Medical schools and libraries receive many brochures each year from various institutions describing medical education programs. Often their purpose is to present the program in the best possible perspective in order to attract applicants. They should, therefore, be considered in this light. Year in and year out the best source of information about the strengths or weaknesses of a house officers' training program comes from house officers already in that program. A student will learn more from talking with these individuals during an on-site visit than from reading what the program brochures portray.
Sources of Information on Alternative Options 17. Reduced Residencies. Some medical students would rather complete their residency training on a part-time basis, known as a "reduced residency." While options for shared residencies are now listed in the NRMP Directory, there is only one source available which lists all options for reduced residency training: Institutions Offering Reduced-Schedule Training, 1977, available for $2.50 plus $.50 postage and handling from:
Harvard Reduced-Schedule Residency Project Attn: Eileen Shapiro 25 Shattuck St. Boston, Mass. 02115
Military Residencies. Even though military resident training programs do not participate in the NRMP match, they are listed in the LCGME Directory. Many students applying to military programs also choose to participate in NRMP, since acceptance into military residency programs is highly competitive. These students sign the NRMP contract in the spring, making separate
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application to the branch of the military service in which they are interested. Since announcements regarding acceptance to military training programs are made in the fall, those students who were not accepted have the option of securing a residency through NRMP. Students accepting military residencies withdraw from NRMP. Specific information regarding military graduate medical training programs and application to them is available from any local recruiting office or can be obtained from the following: U.S. Air Force Recruiting Service Medical Recruiting Division Randolph Air Force Base, Tex. 78148 Commander U.S. Army Medical Department Personnel Support Agency Attn: ABPE-PDO 1900 Half St., N.W. Washington, D.C. 20324
Commanding Officer Naval Health Sciences Education and Training Command Bureau of Medicine and Surgery Department of the Navy 23d and E Sts., N.W. Washington, D.C. 20372
Organizations That Can Provide Additional Information The following organizations provide various types of information or publications relevant to career decisions for medical students;
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American Medical Student Association (AMSA) 14650 Lee Rd. Chantilly, Va. 22020
AMSA publishes The New Physician, which contains articles on career decision making, and distributes A Student's Guide to the Appraisal and Selection of House Staff Training Programs. Organization of Student Representatives of the Association of American Medical Colleges 1 Dupont Circle Washington, D.C. 20036 Physicians National Housestaff Association 1625 L St., N.W. Washington, D.C. 20036 Student Business Section and Resident Physician Section of the American Medical Association 535 N. Dearborn St. Chicago, Ill. 60610 Student National Medical Association 1720 Massachusetts Ave., N.W. Washington, D.C. 20006
REFERENCE 1. HUDNUT, H. B. Advising medical students about internships. JAMA 213: 1165, 1970.
Received February 21, 1979; accepted May 14, 1979.
Bull. Med. Libr. Assoc. 67(4) October 1979
