It is that time of year again. Time for jingle bells, ugly holiday sweaters, cheesy lifetime holiday movie marathons, egg nog, mistletoe, and, oh yes, the beginning of residency season. As someone who went through this process a few years back, and who has seen this process from both sides, I definitely have some thoughts to help ease your way if you are applying for a residency (or planning on applying for one in the near future).
At the start:
- Cast your net as far as possible. Everyone knows that residencies are competitive, but sometimes fear of the unknown can hold us back and keep us from achieving our potential. If you are able to cast your net further afield from the place where you currently go to pharmacy school (this is not always possible in cases of family, children, or spouses), you may markedly improve your chances of landing a residency--particularly if you live in a large metropolitan area with lots of nearby pharmacy schools. This is the time to get out there and really see the world, and that residency out-of-state or in that rural area may be just the inspiration for taking your practice skills to a new level. Maybe there is a city or state you always wanted to experience? Or a place you visited once that you would like to see again? Don’t be afraid to consider all your options.
Insiders tip: There are lots of great residencies which are not located in or near huge cities, and many students overlook these residencies because they do not want to leave their state. Be brave. If you are young and can travel, consider a program that might be in a place you have never been but might still want to go.
- Cast your net thoughtfully. Applying to a program because you think it is so far out in Timbuktu that nobody is going to go there is obviously a bad idea. You should still apply to programs that appeal to you--places you can see yourself and would be excited to be. Likewise consider how many times you will cast---5 places? 20 places? If you get invited to interview at all 20 places, are you going to be able to go to all those interviews without wanting to poke your eyes out? Conversely, if you only apply to a handful of places and you only get one or two interviews, are you going to be okay with that decision? You need to decide at the outset how important residency is to you and what you are willing to give up BEFORE the Match and Scramble even happen. If you want a residency more than the convenience of actually being able to select where you are going ahead of time, you should thoughtfully apply to programs with this end goal in mind.
Insiders tip: Many students are very specific about what they want from a residency program at the outset and then end up settling on programs that are very different than the ones they originally set out to pursue (whether they Match or Scramble). Fear not. Believe that you will end up where you are meant to be. Your residency experience will largely be shaped by what you, yourself, bring to it. A year goes by very quickly.
- Cast your net wide. While it is good to target programs that have specialties (e.g. trauma, pediatrics, cardiology, infectious disease) in areas in which you know you are interested, don’t be so quick to rule out a potential program just because it may not have all the potential rotations you are looking for. Some programs will let residents have experiences at other hospital systems nearby which they cannot provide (if they have close relationships with those institutions). So, don’t lose heart completely if you end up somewhere that doesn’t specialize in everything that interests you.
Insiders tip: My residency program didn’t have a rotation in emergency medicine, but they graciously worked with me to help set up a rotation in the ER at a neighboring health system which offered this rotation. This is how I got my current job as an ER pharmacist. Be optimistic. You may still get that dream rotation you always wanted. Not all programs can offer this flexibility, but some will, particularly if they know you have passion for a certain area of pharmacy practice.
During the application process:
- Line up your references early. Help out your references by arming them with the information they need to write your references early on—at a minimum you should give them your CV at least two weeks ahead of time as well as a list of the places to which you are applying. As a preceptor, I also like to see a some kind of cover letter/statement of intent, so I can tailor my recommendation for student based on what I feel he/she is looking for from a given residency program. The more information you can give your references about what you want to get out of a residency program, the more personalized (read: stronger!) your recommendations will be. As someone who also reviews residency applications, your recommendations can make or break you, so choose your references carefully. References who are poor communicators, who are unfamiliar with the residency application process, and/or who do not paint the candidate in the best light can be the kiss of death on applications. So devote some time and care in this area to get the best outcome possible.
Insiders tip: Your references ideally should be people who know you best. These should be either people who can speak to your clinical skills or your skills on the job (or during rotations). If you choose a professor, it should be someone who can speak to the trajectory of your learning and growth as a professional over time (not someone who has only known you for a semester). Be proactive. Try and cultivate these relationships early in your pharmacy career (before December!) if possible.
- Make the most of Midyear. Midyear is expensive, and the Residency Showcase is a bit of a zoo. Mix in a few thousand people elbow to elbow, the stress of competing in a contest where the outcome is uncertain, anxiety about the unforeseen future, and it can all feel a little bit like “The Hunger Games,” the pharmacy version. You need to prepare yourself to be a Tribute (I mean, a candidate!), so make sure you study up on the Game beforehand. Make the most of the experience Katniss Everdeen-style by doing your homework and learning about the programs in which you are interested BEFORE showing up at their respective booths. Study the Showcase map, learn where you need to go, and make sure you use your time and resources wisely.
Insiders tip: If you take the time to stop at a booth during the Residency Showcase, make sure you leave your business card and/or resume as a tangible reminder that you were there (unless a program specifically tells you not to). Be smart. At the end of the day, if you don’t leave some kind of calling card, there is no record that we even talked to you (to help us jog our memories when we are discussing candidates).
- Give Midyear the snub. Midyear isn’t your only option to network for residencies—particularly if you are planning a residency within your current state. Networking at statewide conferences is a much better option for getting your name and face in front of the programs in which you are interested years (!) BEFORE your crucial Midyear window even happens. Take advantage of statewide affiliate residency showcases (if offered) or statewide affiliate functions, and you will have a much better chance of being remembered by the health-systems in which you are interested whether you decide to go to Midyear or not. So take a deep breath, take some of the pressure off yourself, and remember that Midyear doesn’t have to the “be all-end all” for landing the residency of your dreams.
Insiders tip: Programs will NOT hold it against you if you don’t go to Midyear. Several of my classmates skipped Midyear altogether and still got wonderful residencies (through networking at the local level). Be savvy. Get involved with your statewide affiliate early in your pharmacy career and get to know the pharmacists who work for the health-systems in the state in which you are interested in practicing. You will make meaningful connections this way that will carry you far beyond a residency.
- Stand out from the crowd. It is very difficult for students to stand out on a CV, as most students applying for residencies have had similar experiences and training. Where most students miss the golden opportunity to really distinguish themselves is the cover letter/statement of intent. Cover letters SHOULD be interesting, but they are usually ho-hum reads. Unlike your CV (which outlines what you have done), your cover letter/statement of intent should tell me who you ACTUALLY are. It is the place where you can imbue your application with your own distinct personality and enumerate your reasons for doing a residency in the first place. While CVs are important, don’t forget to take advantage of the cover letter as an opportunity to stand apart from the rest. Tell me something heartfelt, funny, or sad about your experiences in pharmacy or patient care--whatever you include should give me some sense of who you are and what makes you tick.
Insiders tip: Cover letters don’t have to be a snore. Be yourself. Make me laugh or cry, but make me feel something, and I promise I will remember you.
The final stretch
- Interviewing Part 1: Make the best first impression possible. You know what they say, “You never get a second chance to make a first impression.” Put your best foot forward and dress as professionally as possible for your interviews. I think it is fine to show a little bit of personality in your wardrobe, but be judicious with how you do it (and how much!). A cool tie for men or a pretty scarf or necklace for women is always appropriate. Rule of thumb: If you suspect something (e.g. shoes, color palette, piercings) is “too out there,” it probably is. Use your best judgment. Overall, things should be clean, pressed, and fit you well. You don’t want to be uncomfortable all day, so try and keep comfort in mind in your wardrobe selection, too. It IS possible to look nice and still be comfortable. Try and strike the right balance that works for you.
Insiders tip: You are always on display during your interviews--at lunch, during the tour of the facility, meeting the residents. Be aware of your surroundings at all times. Programs all look for how well you interact with the other candidates as well as assessing your level of interest by how you carry yourself when your guard is down.
- Interviewing Part 2: Be prepared to shine. Don’t forget to bring your enthusiasm and personality with you to interviews (whether it is your only interview or your umpteenth interview) and your reasons for why that program speaks to you. You should be prepared to articulate those reasons in depth as well as answer any questions you may get asked about your CV. Remember, anything on your CV is fair game, so be prepared to talk about those research projects and presentations in detail. However, the part of the interview which makes the candidates the most nervous is always the clinical skills portion. This might take the form of a case you must present, a problem you might have to solve, and/or clinical questions asked in rapid-fire succession, all of which will vary from program to program. Your pharmacy training (e.g. your rotations and didactic lectures) should have prepared you adequately to do well with this phase of the interview, so you really can’t formally prepare for this (which is why it is stressful!). Including a clinical portion within the interview allows programs to assess your baseline clinical knowledge and also see how well you react under pressure/stress.
Insiders tip: The biggest mistake I see candidates make is they get flustered and cannot recover their composure when they are asked something they either don’t know or aren’t sure of. Be unflappable but honest. If you don’t know, it is okay to admit this. Don’t make things up out of desperation. Resist the urge to ramble or clam up if you are uncomfortable. Talk me through what you would do to find the answer. In many cases saying, “I don’t know, but I believe I could find the answer by doing [x,y,and z],” is as good as getting the question 100% right out of the gate.
- Trust that you will end up where you are meant to be. Although more and more health-systems are offering residencies or expanding their residency programs, demand for residencies still far exceeds supply. But you shouldn’t let all the gloom and doom discourage you from going after your dreams and what you want to do, no matter what the odds may be. Expect the best, but recognize that the process isn’t perfect. There are great candidates who do not Match every year. If you DO get a residency, whew! You are on your way! If you don’t get a residency this time around, you can choose to Scramble or work for a year and perhaps reapply. There is no shame in either path. If doing a residency is what you want to do, please don’t give up on doing one, even if it might fall in a different place on your timeline than you expected. If you do elect to reapply in a subsequent year, you have the advantage of experience in a sea of uninitiated newbies. You will know what to expect and likely will have some practice experience under your belt. Use the time in between residency cycles for rebuilding and networking to improve your chances the next go-round. There are few things more impressive than a candidate who is willing to put themselves through the residency process a second time because they know exactly why they want to do a residency and are willing to give up job security and a pharmacist’s salary in order to get there.
Insiders tip: Know that there is life both inside and outside a residency. Don’t be discouraged if things don’t quite line up as expected. Many of my classmates got inpatient positions without residencies right out of pharmacy school (which is STILL possible, especially in less urban areas). In the current job environment, if you can get such a position, it actually may be a smarter strategy than doing a residency. If you are an eager learner, it is possible to learn the same skills on the job that you would learn in a residency. It might take a little more time, but in the end some of the smartest clinical pharmacists I know didn’t do residencies at all. And they turned out just fine.
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