I had
a difficult time deciding. When I first entered medical school,
I thought I would do primary care because that's all I really knew
about. As I entered my 3rd year, I thought a lot about emergency
medicine. I thought it sounded exciting being the 1st to make a
diagnosis. I also thought I would like shift work and the flexibility.
However, during my emergency medicine sub-internship, I disliked
the pace of constantly seeing one patient after another and I didn't
like the night shifts. Overall, it was just not right for me. I
started to look into alternative fields and on the web I read about
occupational medicine and environmental health. I did a rotation
with the residency director at UCLA and I really enjoyed it. There
is a lot of diversity in terms of how you want to direct your career.
How
did you prepare yourself for application to your chosen specialty?
For
this field, it's not very competitive. Basically, I did a rotation
in it and also worked on a small research project. Through both
of these, I was able to get to know the residency director. I also
read a textbook about the field. Generally, the residencies would
prefer if you have completed another residency 1st such as internal
medicine or family practice. But right now I think there are enough
open spots that you can get in with just a preliminary year. In
terms of applying for a preliminary year, it's important to do
well on your 3rd year medicine clerkship, since you must have a
chairman's letter. Programs want to make sure that you'll be a
good intern for a year.
Who
wrote your letters of recommendation for your application?
You
can only apply a year in advance to occupational medicine and environmental
health, so I won't be applying until August. However for the preliminary
medicine year, I got a letter from the UCLA internal medicine chairman,
another from my Doctoring 3 preceptor, and another from an emergency
medicine attending. You're required to have 3 and one has to be
from the internal medicine chairman. I think for the other letters
you should think about where you want to go. For example, I thought
I wanted to go to the Olive View-Sepulveda program, and my preceptor
worked there, so I got a letter from him. But overall, get letters
from someone who knows you and can write you a strong letter. The
field that they're in is not that important to most preliminary
programs.
Which
programs did you apply to and why?
I applied
to 18 programs which is a lot. I did this because I was pretty
sure I wanted to leave California for a year. I wanted to go somewhere
in the west, so I applied to Virginia Mason in Seattle, St. Vincent's
in Portland, University of Utah in Salt Lake City, St. Joseph's
in Colorado, Good Samaritan and St. Joseph's in Phoenix, Stanford
and Santa Clara Valley in Northern CA, as well as Olive View-Sepulveda,
West LA VA, Cedars-Sinai, Santa Barbara Cottage, UCSD, Mercy, and
White Memorial in Southern CA. I applied mostly to community programs
over academic programs because they are generally less rigorous.
What
kinds of questions did programs tend to ask you?
They
all want to know what you're going into and why. They want to know
what you want out of a preliminary year and how you chose their
program. If you are coming from California and you are at a program
in a different state, it is really important to stress that you
really want to come there (if you really are interested in their
program). Most programs seem to have a hard time believing medical
students will leave California. Other questions I was asked: what
was your favorite rotation and why, what was the most difficult
situation encountered during a rotation, where I saw myself in
10 years, what are your strengths and weaknesses. Most of the interviews
had very few questions. Mostly they want you to ask them questions.
What
would you have done differently in applying?
I would
not have applied to any academic programs, because they usually
are more rigorous. I don't think my resume was strong enough anyway,
because I didn't get interviews from some of them. I like the more
laid-back style that community programs tend to have.
What
was the most difficult part of the application process?
It was
really difficult to know what programs to apply to because I didn't
know a lot about them. My advisor only knew about the Southern
California programs, and other people in the SAO as well seemed
to only have limited information. So applying to out of state programs
was based on visiting their web site and guessing. I usually looked
to see how many spots were available and I also e-mailed the programs
to see if what kind of candidates they would accept. For example,
the University of New Mexico would only take people going into
specialties at their hospital. I also looked at the call schedules
and average number of hours worked per week. But you really have
to visit the program and talk to the residents to see what they're
like. However, most of the programs are generally the same. You'll
have 7-8 months of wards, 1-2 months of ICU, I month of ER, 2 months
of electives, and I month of vacation. One difference is that some
programs will have preliminary interns do a ½ day per week of clinic
and some won't. Salaries are pretty much the same.
What
should I look for on my interview and tour day?
I would
ask about the call schedule and talk to a preliminary intern. They
were the best source of information and you can usually tell how
satisfied they are. They all take you on a tour of the facilities.
Have someone show you the computer system to see how user-friendly
it is. Call rooms were not that important to me, since I'm only
there for a year. You can also look for subtleties such as if the
program makes an effort to let you meet different residents, if
the interview day is well-organized, if the staff is friendly,
etc. To me this things reflect how happy people are there and how
busy they are.
What
questions should I ask of residents, faculty, and program directors?
a) What
do you look for in a preliminary candidate?
b) What is the patient population?
c) What electives are available?
d) How are preliminary interns treated compared to categorical interns?
e) How are the ancillary services?
f) Who are the attendings? How are you taught?
How
did you form your rank list?
For
me (and I think for most preliminary candidates), location and
difficulty of the program were the 2 most important criteria. It's
only one year, and most of the programs are generally the same
in terms of the schedule over the year. I had to decide if I wanted
to stay in California or not. Once I decided I wanted to leave,
I chose based on the 2 criteria above. I think you should just
rank the programs you like the best and not worry too much about
what the program's national rank is or other things like that.
I think you just end up confusing yourself.
What
other advice can you give seniors applying in your specialty?
Remember
that categorical and preliminary spots at the same program can
be very different in terms of how difficult they are to get. For
example, one program may fall in the middle of the pack for internal
medicine, but it may have an easy intern year, so it will be very
popular for preliminary candidates. I think you should think about
what type of program you want to be at (academic, community, VA)
and then just decide what are the basic criteria that would make
you happy for one year. Also, it's easy to get burnt out towards
the end of the interview trail, but try not to blow off interviews.
For me, the last program that I visited was the one I liked best.
I was sick of interviewing and almost didn't go but I'm glad I
did.
