With application season officially underway and interviews slated to begin in a few months, I’m posting these recommendations I’ve provided some others on questions to ask programs and factors to consider when formulating rank lists. One should understand that on the interview trail, applicants are not the only ones trying to present a polished image of themselves – programs will be trying to do the same. The latter is why it becomes important to read between the lines and gather as much information as possible about a program during the interview. So long as your inquiries are posed in a professional and discreet 1-on-1 manner, you are doing your due diligence toward constructing a well-informed rank list.
The following are 6 factors I recommend inquiring about, listed in decreasing order of importance.
1. PGY3 or higher-level residents being fired or repeating years in the past 6 years. While you may see old SDN posts or hear stories of such instances, it would behoove you to find out how prevalent these practices are at programs in recent years. The reasons behind such cases should also be elucidated and it is up to each applicant to critically think about the legitimacy of claims; at times, such decisions that clearly have a profound impact on a trainee’s career and present a massive opportunity cost are made based on very subjective reasons and applicants should be aware of the kind of training environment they may be entering, and the risks associated therein.
2. Faculty and scope. This is arguably the biggest external factor that will influence your surgical abilities and shape the trajectory of your career. Program faculty largely determine the scope and culture of a program and while nearly every program will present itself as full scope, applicants should evaluate whether a program’s attendings perform neck dissections, microvascular reconstruction, primary craniofacial surgery, etc., and the frequency with which they do so.
A second important factor to consider is faculty turnover. While a certain level of turnover is inevitable, the departure of multiple attendings over the length of a trainee’s 4-to-6 year residency indicates issues with faculty retention and introduces instability that can be detrimental to one’s training. The adverse effects of this phenomenon will be magnified the fewer faculty there are from the onset and the smaller a service is. Applicants should assess the risk of this occurring during their tenure at programs by inquiring about the number of attendings who have left the program in the past 4 years.
Another useful metric for identifying faculty with a track record of commitment to resident education is the Faculty Educator Development Award (FEDA). Individuals who have won this award are generally exceptional educators who have pledged to remain in academia for a specified time with a documented plan about how they and their supporting institution will develop their academic skillset, much of which entails resident education. This may serve as a contrast to those faculty who entered academia not due to a passion for resident education, but rather for reasons such as a dissatisfaction with private practice, etc.
3. Inbreeding of residents. This factor is limited to programs at dental schools and certain non-categorical programs. While it may be more comfortable to favor applicants from one’s home institution, the dangers of this approach materialize as an absence of diversity within a program, creating issues ranging from a cliquish culture to a resistance to change. For these reasons, applicants should inquire into the resident composition at programs and determine whether the level of diversity meets their expectations. In my estimation, it’s reasonable to have a third of the residents within a program originating from the home dental school, however approaching 50% or more would make me question the reasons behind such a resident composition. As a matter of fact, there are programs that have a tendency of prematurely deciding who they will be accepting for a position behind closed doors even prior to conducting interviews. Yet, these very programs will continue to interview other unsuspecting applicants to maintain a guise of impartiality, unfortunately wasting these outside applicants’ time and money in many cases. With the increasing transition back to in-person interviews, I recommend carefully considering whether it’s worthwhile for one to allocate their resources toward interviewing at such programs if they have other interviews. I believe Drs. Miloro and Hussain from UIC as well as Fattahi from UF-Jacksonville have discussed the importance of resident and faculty diversity on different occasions for those who are interested.
4. OR caseload. Reps in the OR will profoundly impact your caliber as a surgeon. While it may seem nice to do daily bread and butter cases in clinic, one will quickly reach a point of diminishing returns doing so, and many of the skills entailed can be refined through moonlighting or upon graduation; this is evident by the increasing number of GPs competently performing bread and butter oral surgical procedures. Consequently, applicants should inquire about the volume and types of cases that were performed in the OR over the past year and how many ORs are running simultaneously by the service on average each day. Consistently running multiple cases simultaneously in different ORs indicates a well-respected service with adequate OR exposure. In today’s age of social media, programs are increasingly publicizing their work and it is prudent for applicants to avoid being misled into believing that a couple of busy weeks in the OR at a program represents the norm year-round.
5. Teaching paradigm. Evaluate the who, what, and how of teaching within a program. Inquire about how involved each attending is with teaching in the OR, morning rounds, and via lectures, journal clubs, etc. While a resident-led culture may seem nice to an extent, it can indicate the absence of adequate attending oversight and commitment to teaching residents. A good gauge of attending involvement is the presence of attending rounds; two well-respected programs I’m aware of proudly conduct these daily. Applicants may also request to see a list of topics for the most recent journal clubs, etc. and find out how involved attendings are with facilitating these meetings to ensure knowledge translation occurs accurately. Applicants should also examine the frequency of extracurricular learning opportunities such as sim labs (eg. to practice microvascular techniques), cadaveric dissections (outside of preclinical med school years), SORG workshops, participation at academic conferences beyond annual AAOMS meetings, etc.
6. Medical school activities. At MD-integrated programs, evaluate whether there are expectations superimposed by the residency atop what may be an already demanding medical school curriculum. You may encounter programs that prohibit moonlighting, yet at the same time expect you to informally drop-in periodically to help run the service. This was a point of concern for myself and other applicants at a program while I was on the interview trail. There is another program I’m aware of where a resident was unhappy about intrusions by the program into their non-moonlighting activities during med school.
On a similar note, inquire as to how many of a program’s residents moonlight for renumeration, especially during med school years. While the USMLE takes precedence, moonlighting is extremely beneficial to furthering one’s oral surgical and patient management abilities. I know of several residents who primarily honed their implant and dentoalveolar skills through moonlighting such that they were able to devote more of their on-service time to furthering their skills in the OR. An obvious additional benefit of moonlighting is the renumeration one may put toward loan repayment, etc.
After keeping in touch with friends at other programs, it seems like some ”red flag” issues are more pervasive across multiple programs than I originally thought, but these were the 6 most important factors in decreasing order of importance in my mind on making one’s ranking process as objective as possible if you are competitive enough to land multiple interviews. While externing may provide a glimpse of how you’d vibe with different personalities and cultures, many times you just won’t be there long enough to get a deeper understanding of the program‘s internal dynamics (eg. conflict between residents, etc.) since most places try to present a polished image much like during interviews. As such, it’s prudent to define objective criteria that one should adhere to in order to avoid making subjective and emotional decisions during a ranking process that has such profound implications on one’s future.
The following are 6 factors I recommend inquiring about, listed in decreasing order of importance.
1. PGY3 or higher-level residents being fired or repeating years in the past 6 years. While you may see old SDN posts or hear stories of such instances, it would behoove you to find out how prevalent these practices are at programs in recent years. The reasons behind such cases should also be elucidated and it is up to each applicant to critically think about the legitimacy of claims; at times, such decisions that clearly have a profound impact on a trainee’s career and present a massive opportunity cost are made based on very subjective reasons and applicants should be aware of the kind of training environment they may be entering, and the risks associated therein.
2. Faculty and scope. This is arguably the biggest external factor that will influence your surgical abilities and shape the trajectory of your career. Program faculty largely determine the scope and culture of a program and while nearly every program will present itself as full scope, applicants should evaluate whether a program’s attendings perform neck dissections, microvascular reconstruction, primary craniofacial surgery, etc., and the frequency with which they do so.
A second important factor to consider is faculty turnover. While a certain level of turnover is inevitable, the departure of multiple attendings over the length of a trainee’s 4-to-6 year residency indicates issues with faculty retention and introduces instability that can be detrimental to one’s training. The adverse effects of this phenomenon will be magnified the fewer faculty there are from the onset and the smaller a service is. Applicants should assess the risk of this occurring during their tenure at programs by inquiring about the number of attendings who have left the program in the past 4 years.
Another useful metric for identifying faculty with a track record of commitment to resident education is the Faculty Educator Development Award (FEDA). Individuals who have won this award are generally exceptional educators who have pledged to remain in academia for a specified time with a documented plan about how they and their supporting institution will develop their academic skillset, much of which entails resident education. This may serve as a contrast to those faculty who entered academia not due to a passion for resident education, but rather for reasons such as a dissatisfaction with private practice, etc.
3. Inbreeding of residents. This factor is limited to programs at dental schools and certain non-categorical programs. While it may be more comfortable to favor applicants from one’s home institution, the dangers of this approach materialize as an absence of diversity within a program, creating issues ranging from a cliquish culture to a resistance to change. For these reasons, applicants should inquire into the resident composition at programs and determine whether the level of diversity meets their expectations. In my estimation, it’s reasonable to have a third of the residents within a program originating from the home dental school, however approaching 50% or more would make me question the reasons behind such a resident composition. As a matter of fact, there are programs that have a tendency of prematurely deciding who they will be accepting for a position behind closed doors even prior to conducting interviews. Yet, these very programs will continue to interview other unsuspecting applicants to maintain a guise of impartiality, unfortunately wasting these outside applicants’ time and money in many cases. With the increasing transition back to in-person interviews, I recommend carefully considering whether it’s worthwhile for one to allocate their resources toward interviewing at such programs if they have other interviews. I believe Drs. Miloro and Hussain from UIC as well as Fattahi from UF-Jacksonville have discussed the importance of resident and faculty diversity on different occasions for those who are interested.
4. OR caseload. Reps in the OR will profoundly impact your caliber as a surgeon. While it may seem nice to do daily bread and butter cases in clinic, one will quickly reach a point of diminishing returns doing so, and many of the skills entailed can be refined through moonlighting or upon graduation; this is evident by the increasing number of GPs competently performing bread and butter oral surgical procedures. Consequently, applicants should inquire about the volume and types of cases that were performed in the OR over the past year and how many ORs are running simultaneously by the service on average each day. Consistently running multiple cases simultaneously in different ORs indicates a well-respected service with adequate OR exposure. In today’s age of social media, programs are increasingly publicizing their work and it is prudent for applicants to avoid being misled into believing that a couple of busy weeks in the OR at a program represents the norm year-round.
5. Teaching paradigm. Evaluate the who, what, and how of teaching within a program. Inquire about how involved each attending is with teaching in the OR, morning rounds, and via lectures, journal clubs, etc. While a resident-led culture may seem nice to an extent, it can indicate the absence of adequate attending oversight and commitment to teaching residents. A good gauge of attending involvement is the presence of attending rounds; two well-respected programs I’m aware of proudly conduct these daily. Applicants may also request to see a list of topics for the most recent journal clubs, etc. and find out how involved attendings are with facilitating these meetings to ensure knowledge translation occurs accurately. Applicants should also examine the frequency of extracurricular learning opportunities such as sim labs (eg. to practice microvascular techniques), cadaveric dissections (outside of preclinical med school years), SORG workshops, participation at academic conferences beyond annual AAOMS meetings, etc.
6. Medical school activities. At MD-integrated programs, evaluate whether there are expectations superimposed by the residency atop what may be an already demanding medical school curriculum. You may encounter programs that prohibit moonlighting, yet at the same time expect you to informally drop-in periodically to help run the service. This was a point of concern for myself and other applicants at a program while I was on the interview trail. There is another program I’m aware of where a resident was unhappy about intrusions by the program into their non-moonlighting activities during med school.
On a similar note, inquire as to how many of a program’s residents moonlight for renumeration, especially during med school years. While the USMLE takes precedence, moonlighting is extremely beneficial to furthering one’s oral surgical and patient management abilities. I know of several residents who primarily honed their implant and dentoalveolar skills through moonlighting such that they were able to devote more of their on-service time to furthering their skills in the OR. An obvious additional benefit of moonlighting is the renumeration one may put toward loan repayment, etc.
After keeping in touch with friends at other programs, it seems like some ”red flag” issues are more pervasive across multiple programs than I originally thought, but these were the 6 most important factors in decreasing order of importance in my mind on making one’s ranking process as objective as possible if you are competitive enough to land multiple interviews. While externing may provide a glimpse of how you’d vibe with different personalities and cultures, many times you just won’t be there long enough to get a deeper understanding of the program‘s internal dynamics (eg. conflict between residents, etc.) since most places try to present a polished image much like during interviews. As such, it’s prudent to define objective criteria that one should adhere to in order to avoid making subjective and emotional decisions during a ranking process that has such profound implications on one’s future.
