A D.O. Student

1
A D.O. Students Guide to Residency

• Where Does It End?
• Draion M Burch, DO
• Council of Interns and Residents
• American Osteopathic Association

2
Disclaimer!

• The goal of this lecture is not to persuade any
  osteopathic medical student to pursue any
  particular specialty, residency program or
  D.O./M.D. postgraduate training. The purpose of
  this lecture is to help you make an informed
  decision. The information in this lecture is
  subject to change!

3
Outline

• 2nd year
• CV
• Portfolios
• Research
• Academic File

4
Outline

• 3rd year
• Unique Rotations
• Evaluations on Rotations
• Choosing a specialty
• 4th year
• Budgeting
• Scheduling and Applying for Elective Rotations
• Audition Rotations and Acting/Sub-Internships

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Outline

• 4th year (cont)
• Boards- (COMLEX Level 2/ USMLE Step 2)
• Tips for selecting a residency programs (AOA vs.
  ACGME)
• Preparing to Apply for Residency
• Electronic Residency Application Service (AOA vs.
  ACGME)
• Residency Interviewing Skills
• The Match and Scrambling Processes (AOA vs.
  ACGME)
• Requirements to Start Residency (AOA vs. ACGME)

6
Outline

• Post-doctoral
• Medical Licensing/Board Certification (AOA vs.
  ACGME)
• Osteopathic Approval of ACGME Postdoctoral
  Training Programs -Resolution 42

7

• 2nd year

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By the end of your 2nd year

• Update Curriculum Vitae
• Start Portfolio
• Conduct Research
• Student Researchers are more desirable to
  competitive residency programs!
• Review Academic File
• Make copies of items in your academic file for
  your portfolio!

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Curriculum Vitae Essentials

• Identification Information
• Education
• Work Experience
• Leadership
• Research
• Publications, Poster Competitions, Presentations
• Professional Experience

• Professional Affiliations
• Military
• Volunteer Activities
• Honors Awards
• Special Skills
• Hobbies Interests
• References

10
Portfolio Essentials

• Title Page with identification information,
  objective
• Table of Contents
• Curriculum Vitae
• Personal Statement
• Evaluations
• Clinical evaluation summary, recommendation
  letters, etc

• Honors
• Top 10 letters, Scholarship Awards,
  Certificates, etc
• Research
• Publications, Posters, Protocols, Papers not
  published, etc
• Lectures
• Public Relations
• Newspaper articles

11

• 3rd year

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Unique Rotations To Consider

• Research Rotation
• International Rotation
• International Research Rotation
• Do a research rotation at a residency program of
  interest!

13
Evaluations On Rotations

• During your clinical years, you will receive
  grades per rotations.
• Try to earn HONORS on all of your clinical
  rotations- especially in your specialty of
  choice.

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By the end of 3rd year

• Time to Choose a Specialty
• You should have narrowed down your choices of
  specialties to 1-2 .
• You can apply to more than one specialty via
  ERAS!
• If not, dont worryyet! The earlier you decide,
  the easier this process will be for you.
• Once you have decided on a particular specialty,
  apply for out rotations/electives in either this
  field or in one of its subspecialties.

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• 4th year

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Budgeting

• Expenses during 4th year include
• Boards USMLE Step 2 /or COMLEX Level 2
• COMLEX Level 2 Physical Examination/Clinical
  Skills Travel expenses to testing site
• Elective Rotations
• Application Fees, Travel expenses
• ERAS application
• The number of programs you are applying to
• The number of specialties you are applying to
• Transcripts (COMLEX/USMLE and Medical School)
• Interviews
• Travel expenses such as flights, hotels, rental
  cars, meals
• Costs can range from 100-5,000

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Elective Rotations

• Visit potential residency programs by applying to
  do elective rotations or acting internships
  (AI)/Sub-internships (Sub-I).
• Try to rotate in these residency programs between
  July-Dec. Try to interview while you are rotating
  there!
• Pursue a well-rounded medical educationthis is
  your last chance to truly see anything and
  everything before you begin your residency or
  internship.

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Elective Rotations

• Elective rotations are just what they say. You
  get to choose what you want to do.
• Complete rotations that will help you get a
  well-rounded education.
• Use this time to see various residency programs.
• If a program director is in a specific
  subspecialty, do an elective rotation in that
  subspecialty!

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Elective Rotations

• Check hospital websites for
• Intern and residency programs (Graduate Medical
  Education Links)
• Application requirements and deadlines for
  elective rotations
• Student (Extern) Rotation Application Form- may
  be an online application process.

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Elective Rotations

• Apply for elective rotations 3-6 months in
  advance.
• Hospitals will fill these rotations with their
  home medical school students before they place
  students from outside schools.
• However, if you apply early you will be on the
  top of the outside school pile.
• Some hospitals charge an application fee
• 20-250

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Elective Rotations

• Some hospitals do not provide housing, travel
  expenses, or meals.
• Apply to 2-3 rotations for the same month.
• You may be rejected from an elective rotation.
• Cancel a rotation if you have another scheduled
  that you plan on completing so other students can
  have the same opportunities as you.

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Elective Rotation Paperwork

• Hospital Student Application Form
• Immunization Records
• Letter of Good Standing
• Professional Liability Insurance Certificate
• Copy of Transcript
• Copy of USMLE Step 1/COMLEX Level 1
• CV or resume
• Criminal Background Check/Fingerprint Analysis
• Additional paperwork specific to the hospital may
  be required.

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Elective Rotations

• Most students will agree that you should try to
  schedule one or both of the following
• ICU rotation
• Acting/Sub-internship

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Elective Rotations

• Most students will agree that you should try to
  schedule one or both of the following
• ICU rotation
• Acting/Sub-internship

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Acting/Sub-internship

• You and another student are paired up for the
  month. The two of you equal one intern. You
  assume the responsibilities of an intern in terms
  of call, admissions, and discharges.
• Glimpse of intern year while still having someone
  looking over your shoulder.
• Chance to shine and show a particular program
  what you are capable of.
• Great way to get a good letter of recommendation,
  which carries more weight.

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Audition Rotations

• Remember rotations at hospitals you will be
  applying to for residency should be considered
  Audition rotations.
• Show the program why they should take you. Get
  your face seen and known. This way when they
  receive your application they will remember the
  impression you left.

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Boards

• By now, you have completed and passed USMLE
• Step I and/or COMLEX Level 1. Many students ask
• Do I need to take step 2/level 2 before I apply
  for residency?
• Do I need to take the USMLE to apply to an
  allopathic program?

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When to take USMLE Step 2/COMLEX Level 2?

• You should take the your second set of boards
• (including the PE) by the late summer/early fall!

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Do you need to take step 2/level 2 before
residency applications?

• Most residency programs would like to see step 2
  before they make their official rank order list.
• Therefore you should take the boards (including
  the PE) by the late summer/early fall.
• Some programs may not rank you until you have
  completed both parts of step 2 (CK and PE)!
• Make sure to check with the programs you are
  interested in as these requirements are
  program-dependent.

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Do you need to take the USMLE to apply to
an allopathic program?Do you need to take
the USMLE to apply to an allopathic
program?

• Answer yes no.
• No program can deny your application if you just
  submit your COMLEX scores however, they may
  choose to not consider you.
• This is program dependent. At some programs, your
  chances may be increased if you take the USMLE.
• Choosing to take only COMLEX depends on how
  competitive an applicant is and how competitive
  their specialty choice is!

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Reasons Not to Take the USMLE

• COMLEX is based on the COMS curriculum while
  USMLE is based on the LCGME curriculum.
• A D.O. must pass all 3 parts of the COMLEX only
  to be licensed as a D.O.
• If you fail any exam and the state licensing
  board inquires, you must report your results-
  which becomes part of your permanent record that
  your state licensing board keeps!
• You double the cost, preparation time, etc. by
  taking both exams.
• Some ACGME programs will accept candidates with
  COMLEX only.

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Board Preparation

• Common resources for Step 2/Level 2
• First Aid for Step 2
• Boards and Wards- great resource for rotations
• Crush for the Boards
• Usmleworld.com or Kaplan Question Bank
• OMT Review
• Savarese
• W. Crowe COMLEX Review
• http//www.md-do.org/NewOMMBoard20Review02-REV.ht
  m

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Miscellaneous Info about Boards

• You can take the USMLE Step 2, without taking
  USMLE Step 1.
• There is not a consensus if this is helpful,
  however, I would like to make you aware of this
  option.

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Residency
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Allopathic Positions you may apply to

• Categorical
• programs that begin in the PGY-1 year and provide
  the training required for board certification in
  medical specialties.
• Advanced
• programs that begin in the PGY-2 year after a
  year of prerequisite training.
• Preliminary
• one-year programs beginning in the PGY-1 year
  that provide prerequisite training for advanced
  programs.
• Physician
• programs that are reserved for physicians who
  have had prior graduate medical education.
  Physician programs are not available to senior
  U.S. medical students.

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Osteopathic Positions you may apply to

• OPTION 1 (OGME-1 Resident) Specialty Track
• The first postdoctoral year will be the first
  year of residency. This is the same as the
  current specialty track model. All trainees will
  receive residency credit for this 1st year of
  training. These positions will be known as OGME-1
  Resident.

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Osteopathic Positions you may apply to

• OPTION 2 (OGME-1 Preliminary) Special Emphasis
• The first postdoctoral year is not included in
  the residency, but is a specific preliminary
  entrance requirement into the specialty to
  produce an enhanced educational opportunity for
  that specialty. The trainee will have been
  accepted into the OGME-2 specialty while a senior
  in osteopathic medical school. These positions
  will be recorded by the AOA as Preliminary
  interns and be known as OGME-1 Preliminary.

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Osteopathic Positions you may apply to

• OPTION 3 (OGME- 1 Traditional) Traditional
• Rotating Internship
• This first postdoctoral year is not included in
  the residency, but is available in the format of
  a Traditional Rotating Internship. It may be
  utilized by any osteopathic graduate uncertain of
  residency plans or those who want a single year
  program. These positions will be recorded by the
  AOA as OGME-1 Traditional.

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Choosing a ResidencyFactors To Consider

• Location and proximity to family
• Didactics
• Volume (Surgeries, Deliveries, Procedures)
• Fellowship opportunity
• Program Reputation/Rankings
• Program atmosphere (residents/attendings/facility)
  
• Research opportunities
• Night float vs. overnight call
• Amount of scutwork
• Board pass rates
• Amount of autonomy

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Information about Residency Programs

• FREIDA Online Website
• http//www.ama-assn.org/ama/pub/category/2997.html
  
• DO Online Website Opportunities
• http//www.do-online.org
• Student Doctor Network Website
• http//www.studentdoctor.net/
• SCUTWORK Website
• http//www.scutwork.com
• Washington University SOM Website
• http//residency.wustl.edu/
• Great website with helpful information about
  residency
• MDsecrets
• http//mdsecrets.com
• List of unfilled allopathic residencies

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How do you know if a program is DO Friendly?

• Look at the programs websites and see what their
  specific requirements are- also look to see if
  there are any DOs in the program.
• Some programs require passage of USMLE Step 1 to
  apply for their residency program!
• If they list resident contact information (email
  address), contact the residents especially if
  there are DOs.
• Dont hesitate to contact the program directors
  or program coordinators if you have any
  questions!

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What if I choose not to do an Osteopathic
Internship?

• There are five states (PA, OK, FL, WV, and MI)
  which require completion of an osteopathic
  internship in order to be licensed to practice in
  that state.
• Without this internship or osteopathic approval
  you are unable to participate in a residency,
  fellowship, or practice in these five states.

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Documents Needed for ERAS Application

• Regardless of whether you are going to pursue
  osteopathic or allopathic postgraduate training
  there are specific documents you must have.
• You will need
• 3-4 good letters of recommendation
• (1 from your specialty choice)
• Updated CV
• Personal statement
• Deans Letter
• USMLE/COMLEX Transcripts
• Medical School Transcripts
• Photo

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Letters of Recommendation

• You will need at least 3-4 good letters of
  recommendation.
• Dont get them all in one specialty. Programs
  want to see that you are a well-rounded candidate
  (not only did you do well in Pediatrics, but also
  Surgery and Psychiatry)
• Get an early start- ask for letters during your
  3rd year!
• Dont wait until a few weeks before you plan on
  applying on ERAS.
• Consider completing an acting internship for a
  final letter of recommendation.

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Letters of Recommendation (LOR)

• Each LOR will be accompanied by an ERAS
  coversheet, which includes your information, the
  physicians information, and your option to waive
  your right to see the LOR
• You may want to waive your right on the cover
  sheet. This will allow the physician to give you
  a fair and unbiased evaluation.

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Packet for Preceptors to help them write your LOR

• Curriculum Vitae
• Personal Statement
• Their evaluation of you during your rotation
• Thank you letter
• ERAS coversheet
• Small envelope- stamped, addressed to your
  address in case preceptor wants to mail you a
  copy
• Large envelope- stamped, addressed to Student
  Affairs for ERAS application

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Personal Statement (PS)

• Dont underestimate the importance of your
  personal statement!
• Dont procrastinate!
• Start writing it as soon as you choose a
  specialty.
• Have several individuals review your PS-your
  advisors, residents in your specialty, the
  residency program director at your medical
  school!

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Websites to help you write your Personal
Statement

• http//u101.com/articles/med-school/residency-pers
  onal-statem.shtml
• http//www.rushu.rush.edu/studentlife/career/medps
  tate.html
• http//www.ama-assn.org/ama/pub/category/6700.html
  
• http//www.residencyandfellowship.com/page3.html

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Medical School Transcripts

• Request copy of transcripts for yourself and for
  Student Affairs (for ERAS).

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COMLEX /or USMLE Transcripts

• On MyERAS, you must release your COMLEX
  transcripts!
• On the other hand, you do not have to release
  your USMLE transcripts!
• May be changing for future classes. Make sure you
  look into this if you took the USMLE.

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Deans Letter

• Now known as the Medical Student Performance
  Evaluation (MSPE)
• Your Deans letter is a formal institutional
  reflection of your academic background and
  achievements.
• It is NOT a personal letter of recommendation.
• Your medical schools student affairs uses your
  Personal Academic File along with your
  Curriculum Vitae to write your Deans Letter.

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What does your Deans Letter contain?

• Confirmation of good academic standing
• Anticipated Date for D.O. degree
• Your undergrad/grad degree
• Degree, year, where conferred
• Undergraduate Activities Descriptions
• Volunteer work, research activities, clubs,
  honors, teaching, etc.

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What does your Deans Letter contain?

• Explanation/Description of curriculum
• Grading system
• Academic achievements
• Activities Descriptions
• Volunteer work, research, clubs, tutoring,
  professional associations, honors, awards,
  fellowships

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What does your Deans Letter contain?

• Facilitator Comments
• Board Exam Completion (percentile included if in
  top 30)
• Rotations to date, including
• Positive comments from each rotation
• Final assessment marginal to honors
• Closing paragraph to summarize and recommend

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Request a copy of your Deans Letter

• Request a copy in early Fall of Senior Year

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Photo

• Use a picture of you in your business attire- it
  looks more professional. Remember- you are
  interviewing for a job!

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ERAS
https//services.aamc.org/eras/myeras2009/
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What is ERAS?

• ERAS is a service that transmits residency,
  fellowship and osteopathic internship
  applications, letters of recommendations, MSPEs,
  medical school transcripts, USMLE transcripts,
  COMLEX transcripts, and other supporting
  credentials from you and your designated Dean's
  Office to program directors using the Internet.

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4 Components of ERAS

• MyERAS Website
• This is where you complete your application and
  personal statement, select programs to apply to,
  and assign documents to be received by those
  programs.
• Deans Office Workstation (Student Affairs)
• This is ERAS software used by staff at your
  designated Dean's Office. From this software they
  create the ERAS Token that applicants use to
  access MyERAS. They also use this system to scan
  and attach supporting documents to your
  application, such as photograph, medical school
  transcript, MSPE, and letters of recommendation.

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4 Components of ERAS

• Program Directors Workstation (Hospital Graduate
  Medical Education Office)
• This is ERAS software used by program staff to
  receive, sort, review, evaluate, and rank
  applications.
• ERAS Post office
• This is a central bank of computers which
  transfers the applications. You can monitor the
  activity of your files in the ERAS Post Office on
  the Applicant Data Tracking System (ADTS).

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How does ERAS work?

• Applicants receive an electronic Token from their
  assigned Dean's office, and use it to access the
  MyERAS Web site.
• Applicants complete their ERAS application,
  select programs, assign supporting documents, and
  transmit their application to programs.
• Schools receive notification of completed
  application, and start transmitting supporting
  documents transcripts, letters of
  recommendation, photos, MSPEs.

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How does ERAS work?

• Examining boards receive and process requests for
  score reports.
• Programs contact the ERAS Post Office on a daily
  basis to download application materials

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ERAS Timeline

• Mid June- Download ERAS Applicant Manual will be
  available for PDF download by chapters or in its
  entirety on the Web site.
• Late June- Schools may begin to generate and
  distribute MyERAS tokens to applicants.

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ERAS Timeline

• July 1st- MyERAS website opens to applicants to
  begin work on applications.
• July 15- Osteopathic applicants may begin
  selecting and applying to Osteopathic Internship
  programs ONLY. Osteopathic Internship programs
  can begin contacting the ERAS Post Office to
  download application files.

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ERAS Timeline

• September 1st- Applicants may begin applying to
  ACGME accredited programs. ACGME accredited
  programs may begin contacting the ERAS Post
  Office to download application files.
• November 1st- MSPEs (aka Deans Letters) are
  released.
• December- Military Match

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ERAS Timeline

• January- Urology Match
• February- Osteopathic Match
• March- NRMP Match results will be available.
• May 31st- ERAS Post Office will close to prepare
  for the next season.

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Application Process Guideline

• Step 1Research/Contact programs of interest to
  find out their requirements and deadlines.
• Step 2Request your token from your designated
  Dean's Office and download your applicant manual.
  
• Step 3Register on MyERAS.

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Application Process Guideline

• Step 4Register for your Match.
• Step 5Obtain documents and send them to the
  designated Dean's Office to be scanned and
  uploaded.
• Step 6Create your Profile and MyERAS
  Application.

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Application Process Guideline

• Step 7Create personal statements, create a list
  of recommendation writers, and authorize
  transmission of your USMLE and/or COMLEX
  transcripts.
• Step 8Search/Select programs of interest.
• Step 9Assign documents to programs.

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Application Process Guideline

• Step 10Certify and submit your MyERAS
  application then apply and pay for programs.
• Step 11Check the status of your applications.
• Step 12Adding programs/Updating assignments and
  keep your Profile current.

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Using MyERAS- Overview

• Account
• Profile
• Checklist
• Messages
• Password
• Application
• Home
• Page One - General Info
• Page Two - Education
• Page Three - Medical Education
• Page Four - Previous Residency/Fellowship

• Page Five - Experience
• Page Six - Publications
• Page Seven - Exams
• Page Eight - Licensure Info
• Page Nine - State Medical
• Licenses
• Page Ten - Race
• Page Eleven - Ethnicity
• Page Twelve - Misc Info

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Using MyERAS- Overview

• Documents
• USMLE Transcript
• COMLEX Transcript
• Personal Statements
• Letters of Recommendation

• Programs
• Search Allopathic Programs
• Search Osteopathic Programs (Visible to
  Osteopathic Applicants only)
• Programs Selected
• Programs Applied To
• Preview Invoice
• Apply to Programs
• Invoice History
• Assignments Report

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ERAS Application Fees

• Number of Programs Per Specialty AAMC Fees
• Up to 10 60
• 11-20 8 each
• 21-30 15 each
• 31 or more 25 each

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ERAS Application Fees

• Example 1 An applicant applies to 30 emergency
  medicine programs, AAMC fees are 290. (60 (10
  x 8) (10 x 15)).
• Example 2 An applicant applies to 20 OB/GYN
  programs, and 10 family practice programs. The
  fees are 200. (140 for OBGYN and 60 for family
  residency programs).

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ERAS Application Fees

• Example 3 An applicant applies to 23 internal
  medicine programs, and 7 radiology programs. The
  fees are 245 (185 for internal medicine
  programs and 60 for radiology programs).
• Example 4 An applicant applies to 12 internal
  medicine programs, 10 emergency medicine, and 8
  family practice programs. AAMC fees are 196 (76
  for internal medicine programs, 60 for emergency
  medicine programs, and 60 also for family
  practice).

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ERAS Application Fees

• Example 5 A military applicant applies to 5
  military family practice programs, 3 military
  internal medicine programs, 2 military surgery
  programs, and 7 civilian pediatrics programs. The
  fees are 120 (60 for the 10 programs
  consolidated under the military and 60 for the 7
  civilian programs).

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ERAS Application Fees

• Special Instructions for Osteopathic
  GraduatesAlthough the ERAS 2008 fee structure
  is the same for osteopathic and allopathic
  programs, it is administered differently. For
  osteopathic internships, the fee is applied based
  on the total number of programs applied to,
  regardless of the specialties to which the
  applicant applies. Applicants applying to
  allopathic programs are assessed based on the
  total number of programs applied to within a
  specialty.

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Miscellaneous Fees

• US (Allopathic and Osteopathic) and Canadian
  ApplicantsThe National Board of Medical
  Examiners (NBME) charges a flat 50 fee to US and
  Canadian applicants who request transmission of
  USMLE and/or NBME to programs, regardless of the
  number of transcripts requested. The NBME fee is
  included on your invoice and collected by the
  AAMC.

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Miscellaneous Fees

• US Osteopathic ApplicantsOsteopathic applicants
  may request an unlimited number of COMLEX
  transcripts to be sent via ERAS for 50.
  Applicants who request USMLE transcripts via ERAS
  also pay a 50 fee to the NBME for an unlimited
  number of electronic transcripts. Transcript fees
  are included on your invoice and are collected by
  AAMC.

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Payment Method

• You may use your VISA or MasterCard to pay for
  your ERAS fees online. This is the safest and
  fastest way to process your application.
• You also have the option to pay your ERAS fees by
  selecting the check/money order option, printing
  out the invoice in the payment module, and
  sending your fees by check (U.S. currency only)
  to the address on the invoice. Your
  application(s) may be withdrawn if payment isn't
  received within two weeks.
• All fees are payable in U.S. funds on U.S. banks
  ONLY.

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Payment Method

• If your check is returned for insufficient funds,
  you submit partial payment, or there is a problem
  with your credit card payment, ERAS will endeavor
  to collect fees owed and your application may be
  withdrawn.
• If ERAS withdraws your application due to
  nonpayment, your application will be withdrawn
  from each program to which you applied.

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ERAS Use During the M.D. Scrambling Process

• From 12 noon on the third Tuesday in March, until
  12 noon on the third Thursday in March each year,
  there is a "Scramble" period. This is before the
  NRMP Match Day results are revealed.
• During this period, applicants who did not match
  to a position attempt to fill remaining
  positions. ERAS is available to applicants to
  apply to a maximum of thirty (30) programs free
  of charge who meet the following criteria
• The applicant must have participated in ERAS
  during the regular season. This means you must
  have applied to (and paid for) at least one
  program.
• The applicant's account must be paid in full no
  less than two weeks prior to the Scramble period.
  

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Additional Scramble Information

• FindAResident is a company created by the AAMC to
  help applicants find open residency positions.
• http//www.aamc.org/students/findaresident
• It is an effective resource if you wish to
• Change specialties
• Change location
• Switch residency or fellowship programs

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Osteopathic Match Application

• The osteopathic match occurs through the National
  Matching Services (NMS).
• You will sign up in Sept. for this match after
  you are provided a pin number from your medical
  school.
• The initial fee is 60 to sign up for this match!
  
• http//www.natmatch.com/aoairp/
• Always Register for the OSTEOPATHIC Match!

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Allopathic Match Application

• The allopathic match occurs through the National
  Residency Matching Program (NRMP).
• You will sign up on Sept. 1 for this match after
  you receive your AAMC number.
• The initial fee is 45 to sign up for this match!
• http//www.nrmp.org/

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Interview Schedules

• Interviews at osteopathic programs typically
  occur from Sept.-Dec.
• Interviews at allopathic programs typically occur
  from Nov.-Jan.
• Make sure to schedule rotations and vacation time
  accordingly.

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Interviewing Skills

• Before you interview, try to go through a mock
  interview with a faculty member.
• Review the list of potential questions to ask
  during your interview.

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Other Interviewing Tips

• Schedule rotations appropriately for interview
  season.
• Choose rotations which have lighter schedules.
• Cluster interviews-if within the same city
• i.e. CCF/Metro/UH

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Other Interviewing Tips

• Interact with the residents during the interview
  day.
• They are the best source for information. Keep in
  mind some residency programs allow their
  residents to serve on the committee so act
  appropriately with the residents.
• Schedule interviews, even if its not at the top
  of your list.
• A program can feel different in person. Dont
  base your decision on their website or literature
  provided.

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After Interviews

• You should send a Thank You note in a timely
  manner.
• This can be in the form of an email, phone call
  to the program director, or a hand written thank
  you note.

94
After Interviews

• You can choose whomever you like to thank, but
  most applicants thank their interviewers and the
  program director.
• Make sure to get business cards from all of your
  interviewers. After each interview write down
  some highlights from the interview that you can
  mention in your thank you note. This will help
  you stand out and will not look like a generic
  thank you.

95
Letter of Intent
96
Letter of Intent

• After you have finished interviewing some suggest
  that you write a letter of intent to your top one
  to three choices.
• State why you want to be there are what this
  residency program offers that makes you want to
  train there.

97
Letter of Intent

• Do not lie and say to all three programs that you
  are ranking them 1, just say highly ranked to
  2 3
• This is a great way to keep in contact with a
  program
• Residency programs typically rank applicants in
  late Jan/ early Feb.
• Some programs rank applicants immediately after
  you interview!

98
After Interviews

• After you have completed the interview season,
  you are now challenged to create a Rank Order
  List (ROL)
• When creating a rank list remember to rank the
  programs that you want to go to in the order YOU
  want them and not based on your chance of
  matching there.

99
Rank Order List (ROL)

• The Rank Order List (ROL) is your preferred
  rankings for the residency you are pursuing.
• For the D.O. match, your ROL is created on the
  AOA Intern/Resident Registration Program website
• www.natmatch.com/aoairp/
• For the M.D. match, your ROL is created on the
  NRMP website
• www.nrmp.org/

100
ROL

• You can rank as many or as little programs as you
  like. The rankings are free for programs 1-30,
  after which you will be charged a fee for
  additional rankings.
• Applicants will have a greater chance of matching
  if they rank more programs.
• You can only rank programs you interviewed at.

101
Match Algorithm
At first look it may seem like a foreign
language, but with careful observation the match
really gives the applicant the advantage.
Not the real match algorithm!
102
The Match Algorithm

• The match favors the applicant!
• Here are the websites explaining the algorithms
• M.D.
• http//www.nrmp.org/res_match/about_res/algorithms
  .html
• D.O.
• http//www.natmatch.com/aoairp/ (click on match
  process)

103
Match Algorithm Example

• If your number one ranks you highly (ex. if they
  have 12 spots and you are within the top 12) you
  will match at your number one.
• However, what happens if you are number 16 and
  the first 12 applicants all have this hospital
  ranked as their number one. Then you dont match
  there and you continue to your number 2.

104
Match Algorithm Example

• If your number 2 has you listed highly (again if
  there are 12 spots, and you are listed within the
  top 12) you will match.
• Note Even if the 12 spots are filled by other
  candidates you can bump off the last candidate
  if you are ranked higher.

105
The Match Algorithm

• This is why you should always rank your list
  based on where YOU want to go.
• You can find another example involving several
  theoretical applicants at
• http//www.nrmp.org/res_match/about_res/algorithms
  .html

106
Osteopathic Match Timeline

• JUNE
• Beginning in June, students can download the
  Agreement form for participation in the AOA
  Intern/Resident Registration Program (the
  "Match") from this web site. To register for the
  Match, each student must return a signed
  Agreement to National Matching Services Inc.
  accompanied by the appropriate registration fee.
• JULY - JANUARY
• Students must apply to programs independently of
  the Match (via ERAS). Programs receive
  applications and interview students independently
  of the Match. Application deadlines for programs
  vary, therefore students should check with
  programs regarding their deadline dates.

107
Osteopathic Match Timeline

• AUGUST - SEPTEMBER
• Each institution offering osteopathic internship
  positions beginning in 2007 must provide to
  National Matching Services Inc. information on
  the program(s) being offered by the institution
  in the Match.
• OCTOBER
• Recommended date by which students should return
  their Agreements and registration fees to
  National Matching Services Inc.

108
Osteopathic Match Timeline

• Early NOVEMBER
• By this date, a Listing of Programs participating
  in the Match will be available on this web site.
• Late NOVEMBER
• By this date, instructions for submitting Rank
  Order Lists and obtaining Match results will be
  provided to registered students and programs.

109
Osteopathic Match Timeline

• Late JANUARY
• Final date for submission of student and program
  Rank Order Lists. No Rank Order Lists or
  Agreements can be accepted after this date.
• Mid FEBRUARY
• Results of the Match are released to all
  participants in the Match (students and
  institutions), as well as to the colleges of
  osteopathic medicine.

110
Osteopathic Match Timeline

• Institutions must complete an institutional
  contract for each matched student, and send it
  within 10 working days after receipt of the Match
  results to the student for signature. Each
  matched student must sign and return the contract
  to the institution within 30 days after receiving
  the contract from the institution.

111
Allopathic Match Timeline

• Mid August
• Applicant registration begins at 1200 noon
  eastern time.
• September 1
• Institution / program registration begins at
  1200 noon eastern time.
• December 1
• Applicant registration deadline (Note Applicants
  may register after this deadline by paying an
  additional late registration fee of 50.00 when
  registering after 1159 PM eastern time.)

112
Allopathic Match Timeline

• Mid January
• Rank order list entry begins. Applicants and
  programs may start entering their rank order
  lists at 1200 noon eastern time.
• Late January
• Quota change deadline. Programs must submit final
  information on quotas and withdrawals by 1159 PM
  eastern time.
• Late February
• Late registration deadline.

113
Allopathic Match Timeline

• Late February
• Rank order list certification deadline.
  Applicants and programs must certify their rank
  order lists by 900 PM eastern time. CERTIFIED
  applicant and program rank order lists and any
  other information pertinent to the Match must be
  entered in the R3 System by this date and time.
• Early March (3rd Monday in March)
• Applicant matched and unmatched information
  posted to the Web site at 1200 noon eastern
  time.

114
Allopathic Match Timeline

• Early March (3rd Monday in March)
• Filled and unfilled results for individual
  programs posted to the Web site at 1130 am
  eastern time.
• Early March (3rd Tuesday in March)
• Locations of all unfilled positions are released
  at 1200 noon eastern time. Unmatched applicants
  may begin contacting unfilled programs at 1200
  noon eastern time.
• Mid March (3rd Thursday in March)
• Match Day! Match results for applicants are
  posted to Web site at 100 pm eastern time.

115
Allopathic Match Timeline

• Mid March
• Hospitals send letters of appointment to matched
  applicants after this date.
• Note Any contact between programs and unmatched
  applicants (or their designees) prior to 1200
  noon eastern time Tuesday, March 13, 2007, is a
  violation of the Match Participation Agreement.
  Contact between programs and matched applicants
  prior to the general announcement of 2007 Match
  results at 100 pm eastern time Thursday, March
  15, 2007, also is a violation of the Match
  Participation Agreement.

116
Can you participate in both matches?

• YES. As a D.O. applicant you can choose to apply
  to both the D.O. and M.D. match, the D.O match,
  or the M.D. match. The D.O. match occurs before
  the M.D. match.
• If you apply for both matches and you match into
  an osteopathic residency program you will
  automatically be withdrawn from the match. This
  match is a binding contract. Therefore you cannot
  break it to try to match in the M.D. match.
• If you dont match at a D.O. spot, and you
  applied to both matches, you will then be entered
  in the M.D. match.

117
Can you participate in both matches?

• You can match to a D.O. intern year and then
  match into an M.D. program if that program
  requires a prelim year (i.e. anesthesia, PMR,
  path). You will apply to the M.D. match for a
  PGY-2 spot.
• If you choose to pursue just the allopathic match
  you should withdraw from the D.O. match on
  natmatch.com. There is an option for withdrawal
  that states you will be competing in the M.D.
  match.

118
Can you participate in both matches?

• There is one exception in regards to residency
  requirements. If you want to pursue an allopathic
  residency in ophthalmology, you MUST do an
  allopathic transitional year.
• The Ophthalmologic board does not recognize an
  AOA internship year and therefore you will not be
  granted board certification because you failed to
  complete the necessary requirements.

119
Pre-Match Contractions?

• Prematches are residency position offers outside
  of the match.
• Prematches are available to D.O.s and FMGs
  applying to the allopathic match.
• As a D.O., you can accept a prematch from an
  allopathic residency program. However, if you
  pursue this route, make sure you have a signed
  contract. Do not skip the match based on a
  verbal agreement.

120
Pre-Match Contracts?

• Also you may want to have an attorney look over
  the contract for any loopholes.
• If you accept a prematch, you must withdraw from
  the match.
• Prematches occur before Jan. 31, which is the
  last day programs have until they have to notify
  the NRMP of the number of seats (quota) available
  for the match

121
What if you dont match

• If for some reason you do not match you can
  always scramble.
• The scramble is a brief period of time that is
  set aside for those applicants who did not match.
  The Scramble gives applicants an opportunity to
  contact unfilled programs and possibly secure a
  position.
• Both matches (D.O. and M.D.) have post-match
  scrambles for applicants who did not match into a
  perspective residency program.

122
Osteopathic Scramble

• Students who fail to match initially are provided
  with information on programs with available
  positions for them to contact.
• Likewise, programs with available positions are
  provided with information regarding unmatched
  students to contact. Thus, opportunities to
  obtain a position may still exist after the
  Match.
• Unmatched students may receive emails from
  programs that did not fill.
• If you have to scramble, go back to your medical
  school in order for them
• to help you!

123
Allopathic Scramble

• Unmatched applicants who submitted a certified
  rank order list will be given access to the
  Dynamic List of Unfilled Programs at 1200 p.m.
  EST on Tuesday of Match Week. Applicants may not
  contact unfilled programs prior to 1200 p.m. EST
  that Tuesday. The list is updated by the NRMP
  every hour to reflect the number of remaining
  unfilled positions.

124
Allopathic Scramble

• If you have already applied to a program, but
  that program still has unfilled positions, you
  may contact the program and inform them that you
  wish to be considered a Scramble applicant. That
  program will not count towards your thirty (30)
  Scramble programs on MyERAS. Also, during
  Scramble, you may NOT apply to more than thirty
  (30) programs using MyERAS, even if you wish to
  pay for them.

125
Allopathic Scramble

• During this period, applicants who did not match
  to a position attempt to fill remaining
  positions. ERAS is available for applicants to
  apply to a maximum of thirty (30) programs free
  of charge who meet the following criteria
• The applicant must have participated in ERAS
  during the regular season. This means you must
  have applied to (and paid for) at least one
  program.
• The applicant's account must be paid in full no
  less than two weeks prior to the Scramble period.

126
Requirements to Start Residency

• Each residency has its own requirements. There
  are also state requirements that must be
  completed for a training license.
• When applying through ERAS, check with your
  residency program for the necessary requirements
  prior to the start of residency.

127
Licensing vs. Board Certification

• ?

(A.T. Stills original medical license)
128
Licensing/Board Certification

• Do not get these two terms confused.
• Your license is state dependent.
• Your certification is based on your residency
  training.

129
Licensing

• You will be licensed by the state you are
  training in.
• At the beginning of your residency you will be
  issued a training license
• By the end of your residency you will apply for a
  full practicing license.

130
Licensing

• When thinking about licensure there is one
  special caveat all osteopathic students need to
  consider.
• There are 5 states that require an osteopathic
  internship or its equivalent for licensure
  purposes. (PA, MI, WV, OK, FL)
• Without this internship year, you can NOT train
  or practice because you will be denied a license
  from the associated state osteopathic
  association.
• There are options, which we will get to later.

131
Certification

• Your certification is based on your residency
  training.
• If you pursue osteopathic training you will be
  boarded by an affiliated osteopathic board
• (i.e. IM will be boarded by the American Board
  of Osteopathic Internists ABOI)
• If you pursue allopathic training you will be
  boarded by an affiliated allopathic board
• (i.e. IM will be boarded by the American Board of
  Internal Medicine ABIM)
• States have no regulation over your certification

132
Certification

• Should you choose to train in an allopathic
  residency program or practice in those 5 states
  and you are unable to complete an osteopathic
  internship year, you can seek to get approval of
  your first year of residency.

133
Importance of AOA Certification

• You can't be a COM Dean, Program Director, or DME
  without AOA certification!

134
Resolution 42

• If you decide to pursue an allopathic residency
  program there is a path you can pursue to get AOA
  approval of your intern year.

135
What is this Resolution?

• Some students who pursue allopathic training will
  mention Resolution 42.
• This is a resolution created by the American
  Osteopathic Association to help osteopathic
  physicians remain connected to the AOA.
• These resolutions require certain criteria to be
  met during the intern year.

136
History of these Resolutions

• These resolutions began because the number of
  graduates of colleges of osteopathic medicine
  out-numbered the available osteopathic residency
  positions.
• In 1986 Resolution 65 was developed. The AOA
  allowed graduates from the classes of 87-89 AOA
  approval of their first year of training as long
  as they participated in the AOA match, but did
  not match and then pursued ACGME training.
• In 1996 the AOA replaced Resolution 65 with
  Resolution 22.

137
History of these Resolutions

• Resolution 22 allowed AOA approval of the first
  year of ACGME training if there were special
  circumstances and if the applicant completed the
  rotational requirements of an osteopathic
  internship.
• In 1998, Resolution 19 replaced Resolution 22.

138
History of these resolutions

• Resolution 19 did not require an osteopathic
  curricular component for approval.
• In March of 1999, the AOA suspended Resolution
  19.
• In July of 2000, the AOA passed Resolution 42.
• Resolution 42 was designed to clarify the meaning
  of special circumstances. It also required a
  commitment to osteopathic principles and practice
  and it allowed current and past trainees a route
  for AOA approval.

139
Resolution 42

• Resolution 42 is the latest idea created by the
  AOA for approval of the first year of ACGME
  training.
• Resolution 42 "Approval of ACGME Training as an
  AOA-Approved Internship" is a policy to grant AOA
  internship approval for appropriate ACGME
  training.

140
Resolution 42

• Like previous training approval policies, the new
  "Approval of ACGME Training as an AOA-Approved
  Internship" policy maintains a consistent theme.
  That is, to be eligible for AOA internship
  approval of ACGME training the osteopathic
  physician must complete all six of the
  traditional rotating internships core rotations
  
• 2 months internal medicine, 1 month emergency
  medicine, 1 month family practice, and two
  additional core rotations (internal medicine,
  surgery, OB/GYN, pediatrics, family practice, or
  emergency medicine) so that a total of 6 months
  in these core rotations are completed.

141
Resolution 42

• Unlike previous policies, the new "Approval of
  ACGME Training as an AOA-Approved Internship"
  policy responds to the needs of current and past
  trainees who have completed their first year of
  training in an ACGME-accredited program.
• Like the superceded Resolution 19, special
  circumstances must be present to request approval
  of ACGME training as equivalent to an AOA
  internship, as indicated in Resolution 42.

142
Changes in Resolution 42

• Special circumstances has been Eliminated!

143
Results of Resolution 42

• Not everyone that applies for Resolution 42 is
  approved.
• As of November of 2005, a total of 937 applicants
  have applied under Resolution 42.
• 557 (men), 380 (women)
• 544 applicants received approval (58)

144
Resolution 42

• For more information regarding Resolution 42, you
  can call the AOA Division of Postdoctoral
  Training at
• [phone], extension 8276.
• Bulger, J. Approval of ACGME Training as an
  AOA-Approved Internship History and Review of
  Current Data. JAOA. Vol. 106 (No. 12). Dec.
  2006. 708-713.
• You can also check out the AOA website
• https//www.do-online.org/index.cfm?PageID
  sir_postdocabtres42

145
So what does this mean?

• Resolution 42 will allow approval of an
  allopathic intern year to be counted as an
  AOA-approved internship year.
• This will allow students to pursue training or
  practice opportunities in the states (PA, Fl, WV,
  Ok, MI) requiring the osteopathic internship.

146
Additional Requirements for Resolution 42 Approval

• The trainee must be a member in good standing of
  the AOA.
• Trainees are responsible for negotiating
  rotational changes with their programs.
• A trainee may attend an AOA annual meeting, state
  osteopathic annual meeting, specialty college
  annual meeting or prepare and conduct an
  osteopathic clinical presentation to satisfy the
  educational activity requirement.
• All osteopathic clinical presentations are
  reviewed and subject to approval or disapproval
  by a representative of the Program and Trainee
  Review Committee.

147
Miscellaneous Info
148
Can an Osteopathic Trained Resident obtain an
Allopathic Fellowship?

• YES!

149

• Can an osteopathic physician who has ACGME Board
  Certification bill for treating patients with
  OMT?
• YES!

150
What to do with this information?

• Although it may seem overwhelming now, keep this
  PowerPoint presentation tucked away in a safe
  place until you are beginning your 4th year,
  which is when I hope it becomes a very valuable
  document.

151
Disclaimer!

• The goal of this lecture is not to persuade any
  osteopathic medical student to pursue any
  particular specialty, residency program or
  D.O./M.D. postgraduate training. The purpose of
  this lecture is to help you make an informed
  decision. The information in this lecture is
  subject to change!

152
For more information

• www.do-online.org
• Here you can find the list of D.O. residency
  programs go to For Students then Opportunities
• http//www.ama-assn.org/ama/pub/category/2997.html
  
• Freida online listing of M.D. residency programs
  
• go to Residency/Fellowship Training Program
  Search
• http//www.mdsecrets.com

153
For more information

• www.scutwork.com
• A peer review of residency programs
• www.studentdoctor.net
• A students/resident online forum
• Iserson, K. Getting into a Residency A guide
  for medical students
• Desai, S. The Residency Match 101 Biggest
  Mistakes and How to Avoid Them

154
QUESTIONS?
155
Contact Information

• Draion M Burch, DO
• Region III Trustee
• Council of Interns and Residents
• Vice Chair Intern-Resident Committee
• Michigan Osteopathic Association
• Resident Representative Board of Trustees
• American College of Osteopathic Obstetricians
  and Gynecologists
• Dept of Obstetrics and Gynecology
• Statewide Campus System
• Michigan State University College of Osteopathic
  Medicine
• St John Health System Osteopathic Division
• Macomb-Oakland Hospital, Macomb Center
• dr.draionmburch_at_gmail.com