Episode 94: Learn what programs are looking for in an ERAS application.

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What draws people to psychiatry?

  •   Interest in serving patients with chronic, severe mental illness. Enjoying psychotic patients can be a big determinant.
  •   Fascination with neuroscience.
  •   Strong interpersonal skills. Ability to engage and successfully navigate almost any typeof person.
  •   Introspective types; ability to look within and then MODEL appropriate, mature behaviorto your patients.
  •   Lifestyle. You can’t beat it. Possibility of a cash-only practice with relatively little start-up costs; anytime, anywhere. More people chose psychiatry in 2013.1
  •   Longer appointment slots: 20-30 minutes vs. 10 minute follow-up visits.
  •   In psychiatry, priorities and staying centered in family is respected. 

What types of programs exist in Psychiatry?

(adapted from http://www.psychiatry.org/medical-students/subspecialties-in-psychiatry)

  1. Child and Adolescent Psychiatry
  2. Geriatric Psychiatry
  3. Addiction Psychiatry
  4. Forensic Psychiatry
  5. Psychosomatic Medicine
  6. Research – 2 years

Combined Programs

  •   Triple Board Residency (Psychiatry/Pediatrics/Child & Adolescent Psychiatry) – A five-year combined residency which integrates psychiatry, pediatrics and child and adolescent

    psychiatry.

  •   Psychiatry/Family Practice – five-year combined residency.
  •   Psychiatry/Internal Medicine – five-year combined residency.

  Psychiatry/Neurology – five-to-six year combined residency.

What medical school grades do competitive applicants have for psychiatry residencies?

A solid medical school performance is important. Therefore, passing all of your medical school classes the first time is huge, but I don’t have to tell you that. That said, it’s nice if you got a High Pass or Honors in your Psychiatry rotation but that’s not required. That grade isn’t often going to be a deciding factor by itself. So, my answer here is for the student to have an absence of failed classes rather than the presence of Honors grades.

What are the Step scores of competitive applicants?

Data adapted from http://www.nrmp.org/match-data/main-residency-match-data/.

Unscientific research into this question puts the number needed for USMLE Step 1 historically around 208. Don’t let that number “psych” you out. Different programs emphasize different things and an application is viewed in its entirety.

How important is research to remain competitive?

This depends on where you’re applying. Personally, I interviewed at Duke and UT Southwestern where it is very important. I’m training at Scott & White where it’s not emphasized but I’ve done 20 scholarly activities; far more than I could have accomplished at the other, busier programs.

If you have a publication, that stands out because of the amount of dedication required to follow through on it. Otherwise, a few volunteer assignments on someone else’s project isn’t that impressive. If you have no research experience at all, it may appear that you are unmotivated or cocky.

How to research, grades and Step scores interplay?

Again, the application will stand as a whole and should reflect who you are. If family is a priority and you haven’t done much “extra”, don’t worry about it. Find a way to mention them in your personal essay. In psychiatry, priorities and staying centered in family is respected.

Other ways you can shine in your residency application are mission trips, volunteering with the underserved, recommendations for Psychiatry program directors and AWAY rotations.

How important are away rotations?

Away rotations are KEY if you really want to train at that residency. It’s a 1-month interview! Similarly, residency is a 4-year interview for a staff job there.

You want to schedule all of your psychiatry rotations EARLY in the 4th year for letters of recommendation and so your performance can serve as an interview.

That said, away rotations in October-December would be ideal for interviewing. Often, programs will interview you while you are there so you don’t have to travel back there again later. If they don’t they’re not very nice.

Away rotations or at-home Psychiatry rotations (as in any other field) in August- September are best for getting letters of recommendations.

The only “type of letter” that matters is that it come from a psychiatrist. Program directors, chair, etc. are especially nice. Not everyone reads them, so title is important.

What are frequent turn-offs or missing components on an application?

Childhood stories are a bit overused in residency essays. Sometimes essays aren’t answering the core questions they’re supposed to. I’ve only seen 1 incomplete application. If a Step 2 score is missing initially, add it to your application ASAP and that gives you a reason to cordially contact the program director, or residents if you’ve already met them on interviews, to let them know that your Step 2 score has been added.

What can really make an applicant stand out in Psychiatry?

Isn’t that a medical student-type question? Competition has been fierce, long, and sustained. In some residencies, the competition will continue. In Psychiatry, the competition is over. Not because we don’t have exams, tough academic concepts, and a ton to memorize – but because we strive to know ourselves better, take competent care of our patients (not just prescribe something to address an item on a problem list) and be the beacon of hope to our patients that sometimes lose heart. If psychiatry residents feel constant pressure, threatened, and aren’t secure in who they are, it would be very difficult to provide stability to your patients.

Therefore, the number one piece of advice is: know yourself. Genuinely engage in a process of personal and professional development. Don’t just worry about USMLE scores, but reflect on what you’ve been sacrificing all these years. Imagine how our patients must feel that have often sacrificed, and lost, a lot. Read lots of books. Quit trying to do just the minimum in this area. Respect yourself and grow.

If you’ve done all of the things in the preceding paragraph to the best of your ability at the time, then don’t advertise it to the residency program. Let your maturity seep through on interview day. Leave us wanting more. Because we will…

References

1. Moran M. More Graduates Choose Psychiatry in 2013 Match. Psychiatr News 2013;48:1- 24.

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