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Choosing a residency as an M.D.-Ph.D.

So you’re finally finishing your M.D.-Ph.D. Congratulations! You’ve dissected cadavers, devoted hours to sitting in the library studying for exams, and spent many more on your feet seeing patients. You’ve completed many experiments (and failed many more), learned a thing or two about PowerPoint and data analysis, and successfully defended your Ph.D. thesis. You even managed the harrowing transition from research life (late nights in the laboratory) to third-year medical student on clinical rotations (early mornings in the hospital).

Now what?

When I started my final year of medical school, I knew that I wanted to be a physician-scientist, splitting my time between the clinic and the laboratory, bridging basic science research and patient care. It was not clear, however, what particular considerations I should take into account while looking for a residency training program to help me get there. There were ample resources to help the majority of my graduating medical school classmates—M.D.s who wanted careers in clinical medicine—determine what to look for as they moved on to their residencies, but for me, the process was somewhat enigmatic. I did not even know whether it was possible to do basic research during residency.

After working through a lot of uncertainty, I’m now an incredibly happy second-year pediatrics resident in a program where 12 months over the course of my 3 years will be dedicated to research. The workload is heavy—as it is for all residency training programs—but I’m so thrilled to have found a program that balances and supports both my clinical and research interests. Here are some of the lessons I learned in the process of finding the residency program that was right for me.

Identify your priorities. When I first started thinking about residency programs, I was overwhelmed by the number of factors to consider. There was physical location, research emphasis, expertise in certain specialties, program size, and more; I didn’t know how to weigh these different elements. What I came to realize, though, was that no one could tell me what my priorities should be; I had to decide for myself.

I have plenty of friends who picked residency programs based on location, family members, significant others, or other personal ties. Others chose programs based on a specific mentor that they really wanted to work with. Still others prioritized program size, cost of living, work load, or ability to do outdoor activities year round. All of these considerations are valid, but you have to figure out for yourself what is most important to you. Once you have some idea of what your priorities are, you will be in good shape to start thinking about which programs might best fulfill them.

Pick a specialty. Deciding what specialty you want to pursue is a key first step to further home in on residency programs that might be good options. The choice can sometimes be difficult, however, and even counterintuitive. When I started my M.D.-Ph.D., for example, I thought I wanted to specialize in adult neurology. I completed my Ph.D. in neuroscience, studying the cellular and molecular mechanisms of synapse maintenance in fruit flies, and as I re-entered medical school, I envisioned a future career treating patients with Alzheimer’s disease while studying synapse biology in the lab—the perfect combination.

But these carefully laid plans hit a bump when, about 6 months after finishing my Ph.D. and returning to medical school, I found myself completely enamored with pediatrics. At first, I panicked. I was violating my master plan! With some time, though, I opted to go with the flow and explore this interest further. By the time I was applying for residency programs, my love of pediatric medicine had been confirmed.

So, when I had to decide what I wanted to specialize in for my medical career, I faced a conundrum. Should I stick with my initial plan to focus on adult neurology or follow my burgeoning excitement about pediatrics?

At first, I made the mistake of feeling that my Ph.D. had to dictate what specialty I went into, and I felt locked into adult neurology. But as I thought about it more and wrestled with my true desire to pursue pediatrics, I realized that my Ph.D. was less about the topic that I studied, and more about learning critical skills that can be applied in multiple contexts. The capacity to ask thoughtful, clinically relevant questions in an experimental laboratory setting is just as relevant for pediatrics as for neurology. So, I chose to go with pediatrics, and I’m so glad I did. I’m excited to apply my skills to patients and clinical questions I deeply care about, now and into the future, even as those questions continue to change and evolve.

Remember that research matters. I knew that I wanted to do research while furthering my clinical education, but most residency programs do not focus on this aspect of the training they offer. Therefore, I had to do a little work to figure out which ones would allow me to do so. Several mentors proved to be essential, suggesting residency programs they knew to be particularly research-friendly. With their help and some research of my own, I found that there are several pediatrics residency programs that demonstrate—through funding opportunities, strong mentorship, and protected research time—a true commitment to training pediatrician-scientists. These were the ones I pursued. 

Make sure to find out each program's research track record. Does the program value research? What kind of opportunities are there for research pathways, such as the Accelerated Research Pathway in pediatrics, which can be particularly appealing for M.D.-Ph.D.s given the already long training time? Do they have residents who have fast-tracked into fellowship? Some residency programs have an M.D.-Ph.D. interview day or offer the chance to meet with potential research mentors; absolutely take advantage of these opportunities if you can. 

Make the most of your interviews. Take each interview as an opportunity to learn as much as you can about that particular program—and have an open mind. You may find that a training program that was not at the top of your list is now your first choice. Or you may discover that a program that looks great on paper is not the best fit for you after all.

In addition to the technical details of the program, the personal side of things is incredibly important. For me, the residents that I met on interviews made the largest impression on me, in both good and bad ways. At one program, the residents were incredibly enthusiastic. They not only clearly loved their work, but also seemed to get along with each other very well, which suggested to me that, if I joined that program, I would enjoy going to work every day and be surrounded by fantastic colleagues.

The people you meet can also become valuable advisers, even if their programs are not the right fit for you. I was fortunate enough to interview with a fantastic, honest faculty mentor who ultimately offered me some incredible career advice, even though his home institution was not my top pick. In addition to his invaluable guidance, he taught me that mentors can arise from unexpected circumstances, as long as you’re open to it. 

And don't forget to enjoy the interview process. Take a little time out to explore the places you visit. Stop by a coffee shop, walk around, take public transportation, and see for yourself what it would be like to live there. The training that you will receive as a resident is obviously crucial, but what you do outside of work will also be an important part of your experience.

Finally, interviews can be quite draining, both physically and mentally, and it can be challenging to recall exactly how you felt while visiting a particular program a few weeks—or even just a few days—after the fact. So, on the advice of one of my mentors, after every interview I would sit down before going to sleep to write down all my thoughts about the day’s program: my gut reactions and the things that I liked and didn't like. I also noted some arguably more objective factors—including program size, location, availability and feasibility of research during residency, and the names of specific research mentors I could potentially work with, which I hoped would help me easily compare programs down the line. In fact, as I was putting together my final list of programs, I returned to these notes to help me make my decisions.

Decide for yourself. After the interview process, I felt overwhelmed and spent a lot of time asking every single person in my life for their advice. What I realize now is that you can ask for all the advice in the world, but no one else can make the decision for you. At the end of the day, return to your priorities to decide which program will be best for you. If you ground yourself in these values, you ultimately can’t go wrong.

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