Program Director – “So what are you looking for in a residency program?” Interviewee – “Well let’s begin by discussing the lunch spread during Wednesday conference.” NOTE: do not say this during your actual interview.

Having completed about half my interviews at this point, I still struggle when program directors ask me this question. And not because I don’t know how to respond but because I don’t know what they expect. I, along with my MS4 peers, am on the cusp of the great divide in medical education as I begin to shed the “student” label and take the first steps to becoming the clinician that I have obsessively worked for since my white coat ceremony. With each passing interview I am becoming increasingly frightened and invigorated about the prospect of becoming an intern.

This question of what I am seeking in residency invariably catches me off guard. Why? Because I want what I imagine everyone else wants: that at the end of 3-4 years, I can confidently and competently take care of the critically ill, to obtain the technical mastery of life-saving procedures, and to have the scholastic and emotional aptitude to be the point of care clinician for patients in the ED. Isn’t that what EM residency programs are supposed to do?

There is a ton of background noise during interview season. Between your career advisor, your peers, other applicants you meet on the trail, the reputation of various institutions, and the internet superhighway, you will inevitably come to hear just about every imaginable pro and con to every residency program. Unfortunately (or perhaps fortunately), there are no US News & World Report rankings for residency. And then there are those who strive to give you the illusion that certain programs are definitively superior than others (we all know the third party players attempting to do this now). The company line in emergency medicine is that every program is a good program and I have no reason to believe otherwise.

So why does everything seem so complicated and ambiguous? It’s because our need to be happy wherever we match. We don’t want to make a good decision, we want to make the best decision. The fact of the matter is, you are not your career advisor, you are not your best friend from the west coast, you are not that weird kid who keeps showing up in surgical clogs to every pre-interview happy hour, and you are not that random online blogger (go away EMStud_AOA87). Until I was in the driver’s seat, sitting across from the program director in my fitted suit, I didn’t grasp how intimate and personal that decision is. Every program will train you to become an excellent clinician. It’s deciding what else matters to you: program size, location, patient population, support staff, culture, fellowships, international opportunities… and the list goes on and on.

So here are a few core ideas that seem to be generally accepted and are worth holding onto:

  1. What does the Program Director/Residency Leadership believe in?
    • These are the individuals that are in charge of your training and are essentially your bosses for the next 3-4 years. They represent the face of the program and have your interests directly in mind when making certain choices regarding graduate medical education. Do their priorities align with yours?
    • PD’s might not give you an explicit description of what they value the most in their program, but read between the lines and you can typically figure it out.
  2. Are these your type of residents?
    • When it’s 3a.m. in the morning and the Emergency Department is slammed with patients, will you get along with your co-residents? You are going to sink or swim with these people; they will pick you up when you’ve fallen down and will push you to succeed when are you are sure that you will fail. They are the people with whom you will experience the highest of highs and lowest of lows as a clinician in training. Ask almost any attending: the bonds forged during residency are unlike any other.
  3. What’s your end game?
    • Where do you want to end up after residency? – work in the community, in an academic setting, fellowship, etc.? Choosing a program is a critically important piece in our training, but residency eventually ends. It represents only a sliver of our clinical shelf life. Will your training at this residency get you to where you want to go?
  4. Listen to your gut.
    • Interview season is like speed dating. Both parties are trying to ascertain a great deal of information and gauge interest in an unrealistic amount of time. Unless you have rotated at a particular institution, it’s incredibly difficult to understand what it means to be a resident there. You will have to take a lot of information on faith. I always ask residents why they chose a particular program. I am consistently met with the following types of responses: “Something just felt right on interview day”…“I gelled really well with the program director and residents”…“I could just see myself succeeding at a place like this.” Listen to your instincts; they’ve gotten you this far.

Ultimately, there is no magic formula in finding the “right” program. The truth is, is that we all want different things and that’s okay. The interview journey is one that supposedly demands that we as applicants answer tough questions with grace and eloquence and frequently externalize our line of interrogation. But perhaps the most important questions one has to answer are one’s own.

So what are you looking for in a residency program?