This article written by Cary Amiel G. Villanueva (UPCM Class 2017) was originally published via UP Medics.
For many medical students, the career plan includes specializing in one of the several fields of medicine. (TheFilipinoDoctor.com lists at least 60 different specialties.) UP Medics recently spoke with chief residents from two departments at the Philippine General Hospital (PGH) on getting into a residency.
“Getting a residency in the specialty you desire, at the institution you crave, is a COMPETITION.”
(Dr. Kenneth V. Iserson, Getting into a Residency: A Guide for Medical Students)
Each year about 100 MD’s apply for internal medicine residency in PGH. The Department of Medicine admits only 21 IM and 5 dermatology residents each batch. Meanwhile, the Department of Pediatrics received 48 aspirants last year from which only 21 proceeded to become residents. However, only 19 will be accepted for the next batch due to changes in salary allocations.
Dr. Michael San Juan (UPCM Class 2009), who served as chief resident of internal medicine last year, admits that getting into residency at the national university hospital is indeed competition. The number of graduates the UP College of Medicine produces annually surpasses “the available slots for first year residency in PGH (although not all graduates will go to residency),” he commented.
And so, what does it take to land a spot in residency? For pediatrics, applicants are screened based on the overall pre-residency rating, their academic background, an interview with consultants, a case management presentation, an examination and finally their clinical performance. “You have to perform well,” says Dr. Monette Faner (UPCM Class 2010), the incumbent chief resident of pediatrics. “Sometimes it’s (in) the case management where most have low grades.” The largest part of the criteria however comes from performance during pre-residency.
Similarly, good academic performance is invaluable when applying for IM residency. “But remember that this is not the sole criteria. Leadership, research and performance in the pre-residency period are also given significant weights in the deliberation,” Dr. San Juan said. A group of consultants also interview the applicants, and the final decision is left to the Executive and Training Committees of the department.
The former IM chief resident gives this advice to medical students: “It is of utmost importance that they study well from first year medical school until internship. The foundation of being a good clinician is a good understanding of medicine as a science.” With these, the high-minded medical student would be proactive in preparing early on. But what about all the information we load into our hippocampi that seem to refuse transcending into long-term memory? “Don’t worry,” reassures Dr. Faner. “During your clinical years in LU V to LU VII, you will have the chance to get back to your books and read up again. But now when you’re faced with a real patient, it usually helps you to remember more and to get used to managing them and applying those knowledge.”
Of course medical school is not all about academics. “Leadership trainings and organizations can help a medical student improve their communication skills, ability to work in a team and perform administrative functions,” comments Dr. San Juan. But while the participation in extracurricular activities and organizations may give the consultants an impression of being well-rounded, they are not prerequisites for residency in both departments.
For those who desire to go into residency amidst other alternatives (including but not limited to public health, primary care and the academe), choosing a field of expertise is both challenging and complex. In his book, Dr. Iserson lists the following steps: self-assessment, tentative specialty choice, information gathering, commitment, relief and stability, anxiety, and decision point. Dr. San Juan shares that he started “ruling out” specialties since his first year in med school. On the other hand, Dr. Faner has always looked up to her pediatrician who until now serves as her inspiration.
Once you’ve decided, received your degree as medicinae doctor and passed the board exam, it’s time to file your application! In PGH, one has to complete an application form and comply with the other requirements of the Office of the Deputy Director for Health Operations. These will include your ranking in medical school, transcript of records, physician licensure examination results, and character references among others. They will then be forwarded to the departments you’ve indicated. For both medicine and pediatrics, applicants will have to take a qualifying exam after which some will be selected to undergo pre-residency and be interviewed by department consultants. About 50-60 are admitted to internal medicine pre-residency where they will rotate at the various service areas of the department – wards, outpatient clinics and pay floors – performing tasks done by IM residents. Consultants and residents will evaluate their performance. In pediatrics, pre-residents rotate one week each in Ward 9, Ward 11, and the outpatient department and emergency room. The pre-residency rating is given by the current residents.
What happens if you get the misfortune of not being accepted? Don’t lose heart! It’s possible to try again. “It does happen that an applicant gets accepted during their second or third attempts,” says Dr. San Juan. Maybe it’s just that your fellow applicants have very impressive credentials. “But there are also other good institutions,” adds Dr. Faner. “And besides, they probably have the same consultants also. It’s just that PGH has the advantage (such) that you have the actual patients.”
Admittedly, five years of medicine proper is no walk in the park. “I think you just have to learn to love what you’re doing,” says Dr. Faner. She warns not to be afraid to ask questions and look for the answers ourselves for it helps us in learning. The pediatrics chief resident also emphasizes that working together is essential. “You have to help each other – kahit hindi n’yo friends ‘yan, you have to help each other so that you’ll finish medical school.”
Asked what fueled him in medical school, Sir Mike responds, “Love for the work and love for the professional vocation.” Dr. San Juan encourages medical students to “understand the science and to acquire the art of medicine” treating medical school “not just something that we have to “get through”.”
For some, discernment about residency or what to pursue graduation is not a far off decision. As for me, it is still a long journey; I’d rather strive to do my present work well and leave the anxiety for later.