The Complete Residency Program Switch Process Part I: Prerequisites, Misconceptions, and Initial Preparations

The Complete Residency Program Switch Process Part I: Prerequisites, Misconceptions, and Initial Preparations

Jan 23, 2023 Published by Kathrin O'Neill

In medical school, most students believe that residency training is a narrow tunnel with not much room to turn around – instilling the fear that doubts and indecisions are not necessarily a helpful thing for someone striving to be successful in their career. It is difficult to reestablish the fact that program switches are a thing, especially when the process is hidden in too much stigma and there is an evident lack of information to highlight the benefits or even the basic step-by-step procedure of how it is performed.

As a resident, you need to understand that you would be exposed to the specialty or program that you have matched in with more depth than ever before – and sometimes, that is not such a good thing when examined from a deeper perspective. Excessive exposure to the specialty or program that you believe is suitable for you could highlight the flaws you could never distinguish before. In addition to that, throughout your residency training, you may be exposed to other specialties or programs that offer far more benefits and are more aligned with your values, capabilities, and preferences – making it a lost opportunity if you never even bother to look back. Sure, the stigma has a certain truth to it in the sense that starting over could put you at a significant disadvantage, especially in trying to further your career in that specific field, but what good is success if you never feel fulfilled in doing what you once imagined your future self as?

We are blatantly trying to say that the path towards switching residency programs is certainly not an easy one, but it is also not as harsh as many individuals make it out to be. At the end of the day, the one thing that matters is that you are not keeping yourself locked in a program where you are not getting any satisfaction from doing what you once loved – an aspect that could not only affect you and your profession but the welfare of your patients as well. After all, medicine is a holistic practice that requires the utmost care and dedication from the physician for its benefits to be translated from being theoretical to something practical.

Understanding the Regular Residency Roadmap

To highlight the difference between how the regular residency program applications are performed in many US Universities, perhaps it is practical to look back and examine the step-by-step process as to how you went from discovering various specialties through medical school to reaching that long-awaited Match Day at long last.

The entire residency application roadmap consists of nine different stages that are just as daunting as the last. For starters, you must begin with your medical school education, wherein you will be exposed to various courses that will give you a rough idea of the specialties that are available in the medical profession. According to the Association of American Colleges, the following are the specialties that currently have the largest number of residency positions in ACGME-accredited (Accreditation Council for Graduate Medical Education) programs:

  • Internal Medicine
  • Family Medicine
  • Pediatrics
  • General Surgery
  • Anesthesiology
  • Emergency Medicine
  • Obstetrics and Gynecology
  • Psychiatry
  • Diagnostic Radiology
  • Orthopedic Surgery

Of course, there are various other specialties available in the medical profession that you could take up if the topics interest you or if you have a particular liking to the aspect of the field. Still, it would be best if you likewise remembered that the number of available positions for those could be slim – resulting in a particular disadvantage in having a successful match upon submitting your rank order.

Following the selection of a specialty in mind comes the sheer number of tests designed to test your basic knowledge and how efficient you are in applying this knowledge in a practical setting. These tests are also known as the United States Medical Licensing Examination Tests or USMLE Test, divided into two different portions that focus on two contrasting aspects.

The Step 1 USMLE Test comes first, and this is where your basic scientific knowledge is put to the test. The Step 1 Examination is set to assess whether you can recall and apply important scientific concepts and subsequently relate them to the practice of medicine, explain specific mechanisms, and use them accordingly depending on the indicated mode of therapy. It is pretty much a trivia game, for the lack of a better term, but it would ultimately rely on your test-taking skills and ability to comprehend the questions and what you have studied beforehand.

After the Step 1 Exam comes the Step 2 Clinical Knowledge Test, wherein your medical knowledge and how you integrate them in your practice and medical care provision are assessed. Throughout this 1-day examination period, you will be evaluated based on your attention to various clinical science principles, patient-centered skills, and ability to provide competent and safe care for your patients throughout the scenarios and situations provided initially.

When you finally finish the tedious exams and successfully achieve excellent scores throughout, you may now proceed to the application process of various residency programs. This procedure is less tedious than the last but is not necessarily easier in the strictest sense. From that point forward, you may now start to apply in various ACGME-accredited programs or opt for an early match to get the Matching process started earlier. Following that, you would then receive various interviews if you were successful. You would then submit a rank order list identifying the priority programs you want yourself to get into.

Then, after months of waiting, you would now arrive at the dreaded Match Day, wherein you would now be matched to a particular available residency program, preferably one that you have indicated in the rank order list that you have submitted.

Long is perhaps an understatement in describing just how lengthy this complete process is.

Personal Preparations

Considering the hurdles that you may have cleared throughout the process of getting into a residency program, it might take you a few months or so of deep thinking before you finally come to terms with switching your residency programs. As such, it might be essential for you to start the preparation process with some sort of personal and emotional conditioning that would go a long way in ensuring that you are holistically prepared before you even begin the draining process of looking for a new residency program to get into.

If you would like a detailed guide on how you could ensure that your program switch makes sense, you could check out this guide to learn more about the questions you could ask yourself before you devote yourself entirely to this swap.

Understanding Your Motives

Before you even consult your program director about the possible options that you could have in switching between residency programs, you may want to ask yourself beforehand what drives you in choosing this path, among many others, considering the stigma that surrounds the entire endeavor in the first place. You see, certain impulsive decisions could lead to excellent results and favorable long-term outcomes but switching residency programs is such a huge step that it could even cause repercussions to your personal and financial life. You need to understand that the process you are about to take is a tedious and difficult one – and one that you would have to primarily take alone to boot. As such, perhaps it might be wise to take a few hours beforehand to think about just how committed you are to the entire endeavor, considering that backing out of this one might not be an option that is favorable now nor soon.

Knowing Whether You Want to Change Programs or Specialty

When deciding whether you would like to change programs, two general options are available to you in the simplest sense: whether you would simply like to change programs but would work under the same specialty still, or you would like to change your specialty entirely to take on a whole other field altogether.

The difference might not be as massive as you might perceive at first. Still, the effects of choosing either one could be reflected even in its long-term results and outcomes – making it essential that you weigh the benefits and advantages of each option before you make the ultimate choice.

To give you a rough perspective, choosing to simply switch residency programs because of, let us say, a toxic environment or an unfulfilling learning setup would only require minimal changes to the required knowledge level, breadth of experience, and general familiarity with the way that the program works (except for cases where the program director imposes different rules and methods of training than your previous training program). On the one hand, if you choose to switch to another program under a whole other specialty entirely, this would automatically imply that you would have to catch up with the experience and knowledge necessary to perform efficiently and adapt quickly to the environment of that particular field. Considering how your specialty has been developed ever since you were in medical school, it is a given that switching specialties could make you struggle along the way, albeit none of it is a guarantee, especially when you know how to prepare for the worst that is yet to come. Either way, the bottom line is that while switching between programs could be an easier option, running the risk of being unfulfilled still is imminent, especially if you took on an impulsive streak when you decided to switch programs. On the one hand, while switching specialties could be terrifying and extremely difficult to boot, learning how to navigate throughout this new field is a skill that you could always learn later on – making it a feasible option nonetheless for those who would like to follow their passion instead of focusing on what is practical.

Are You Open to Moving Locations?

Well, it is not necessarily a must when switching residency programs but considering that you are going to be applying for programs on your own and separately from the usual matching process (if you opted out of choosing the Match option), looking for available residency programs within the same institutions, or even within the same city or region, could be difficult, to say the least.

As such, if you are contemplating whether you would like to push through with your switch, you would have likewise to figure out whether you are capable enough to handle massive changes in your lifestyle that may be caused by the scarcity of available residency programs nearby. Of course, moving places could be the cause for your switch, but that is another topic entirely that we would no longer elaborate on.

Looking Ahead

Whether you are deciding about what you should add to your grocery list or deciding whether it is worth it to switch residency programs halfway through your current training, it is essential that you look at the situation from a long-term perspective wherein you are considering your long-term goals, aspirations, and capabilities to adapt to the changes later.

When you transition between residency programs, you will be met by various hurdles in your professional and personal life that would almost seem cruel in the sense that there is not much room to even think or contemplate about it midway. As such, before you even utter the words to your program director, you must always look at yourself in the mirror and ask, “Am I capable enough to make this change?” You need to ask yourself whether the decision of switching programs would fit snuggly with our long-term goals, considering that trying to back out of it later might not be much of an option anymore.

Never settle with any impulsive plans, as indecision can be a tricky monster to spar with. Always look at the situation with a clear head and always look forward even if the boat is rocking you back. It is never wrong to have the guts to brave the storm, but you should only tread on if you know that an island awaits you at the end of this wave.

Myths About Switching Programs

Considering the fear that many medical students had in switching residency programs halfway through their training, it is easy to confuse the myths and incorrect preconceptions about the process from the facts and actual procedures that this entire endeavor entails.

When examined from a broader perspective, the two primary negative connotations that many people have about this procedure are the surrounding general stigma about the negativity of switching programs and the lack of information about how the process is performed.

Regarding the stigma surrounding the process, it is evident that there is a negative connotation attached to the entire process even before the risks and disadvantages of the switch are laid out. However, according to the reports collated from various physicians who chose to follow their interests instead of going with the flow of the profession, there was little to no negativity that they have experienced throughout the entire transition. Their colleagues were supportive, their program directors helped them straighten out their documents and requirements, and the other professionals in their new environment were very accepting and collaborative despite knowing that they lacked experience because of their completely different previous programs. As such, if you are still having doubts about whether choosing to switch is right for you, perhaps what you should ask yourself instead is whether you want that switch in the first place? After all, there is no need to worry about how you will be perceived in the professional setting, and there really is no need to agonize about whether you would be able to catch up or not. What matters is what you want, and that is what you should ultimately listen to.

On the one hand, when it comes to the amount of available online information, it is arguable that the stigma about its procedure has overshadowed the necessary details about how this process is performed. However, considering the recent developments in how the medical profession is practiced, this misconception is no longer valid. In fact, many universities and institutions post detailed steps regarding their transfer process to guide prospective residents in their transition.

General Timeline of a Program Switch

Considering that each program varies depending on what specialty they work under and how strict their requirements are, it is difficult to provide a specific timeline for how long it would take for you to undergo the transition in general.

With multiple factors coming into play when you decide to look for a new program to apply in such as availability of spots, acceptance criteria, timing, processing of documents, and such, the rough estimate of its timeline could go from around two months to even up to a year in total – and this is yet a theoretical value that could still be longer depending on the availability of slots and openings in various institutions during that year.

To give you a little perspective, upon deciding to apply, you must contact the Post-Graduation Medical Education (PGME) Office first of your prospective university to thoroughly understand the requirements for the transfer. Following that, you would have to collect recommendation letters, certain pertinent documents, and In-Training Evaluation Reports (ITER) to complete your application kit way before your application is even processed. Some programs could even request elective courses to strengthen your foundation, and you might likewise go through an interview with the program director before you could get into your chosen program. Overall, the process is just as tedious as the regular residency application process, but you should note that what makes you different is that you already have connections within the medical community. Try calling program directors for available spots, calling friends to recommend specific programs, and utilize your contacts to hasten your transition process.

Preliminary Preparations Before Confirming with Your Program Director

To ensure that you are knowledgeable about the necessities of your transfer, try to take note of the program you are trying to enter, the requirements of the entire endeavor, and the particular requirements that you might need help in when trying to process them. Considering that your program director serves as your “advisor” in this entire ordeal, you could rest easy that they are there to help you along the way.

References Used:

American Medical Association. (2018). Want to switch residency programs? 5 things you should know. Retrieved from https://www.ama-assn.org/residents-students/residency/want-switch-residency-programs-5-things-you-should-know

Association of American Medical Colleges. (n.d.). Roadmap to Residency: Understanding the Process of Getting into Residency. Retrieved July 2021 from https://hms.harvard.edu/sites/default/files/assets/Education/Off_of_Student_Affairs/AAMC_Roadmap_to_Residency.pdf

Association of American Medical Colleges. (n.d.). Your Journey from Premed Through Residency. Retrieved July 2021 from https://students-residents.aamc.org/

KevinMD. (2019). How to transfer residency programs. Retrieved July 2021 from https://www.kevinmd.com/blog/2019/01/how-to-transfer-residency-programs.html

McGill. (n.d.). Transfers and Changes of Program. Retrieved July 2021 from https://www.mcgill.ca/pgme/current-trainees/while-training/transfers-changes-program

PARO. (n.d.). Program Transfer Guide. Retrieved July 2021 from https://myparo.ca/program-transfer-guide/

The Student Doctor Network. (2010). Switching Specialties. Retrieved July 2021 from https://www.studentdoctor.net/2010/03/07/switching-specialties/

The Student Doctor Network. (2014). How to Approach a Residency Swap. Retrieved July 2021 from https://forums.studentdoctor.net/threads/how-to-approach-a-residency-swap.1071744/

The Student Doctor Network. (2015). My Experience Switching Residencies. Retrieved July 2021 from https://forums.studentdoctor.net/threads/my-experience-switching-residencies.1127164/

United States Medical Licensing Examination. (n.d.). Step 1. Retrieved from https://www.usmle.org/step-1/

United States Medical Licensing Examination. (n.d.). Step 2 CK (Clinical Knowledge). Retrieved from https://www.usmle.org/step-2-ck/

University of Toronto. (n.d.). Transfer of Residency Programs from program to program or school to school. Retrieved July 2021 from https://www.dfcm.utoronto.ca/transfer-residency-programs-program-program-or-school-school

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