*Disclaimer: the Integrated IR residency is a brand-new entity. Few data currently exist to define its competitiveness.
USMLE Step Exams
The mean Step 1 score in 2016 of matched and unmatched DR applicants was 240 and 221, respectively. Many successful applicants have scores below and above 240 as denoted by the distribution below. Ultimately, these numbers may serve as cutoff values in getting one’s application through the initial screening process, however applicants are often reviewed holistically beyond the USMLE scores alone. A step 2 CK score is not required for applicants, but it may partially help compensate for a relatively low Step 1 score. The mean Step 2CK score in 2016 of matched and unmatched diagnostic radiology applicants was 247 and 229, respectively. Distribution of both Step 1 and 2CK scores for DR are provided below from “NRMP Charting the Outcomes 2016.”
The Integrated IR residency program is going to be competitive. Similar to other integrated residency program extracurricular involvement and faculty mentorship is of particular importance. Although students may pursue research or involvement in IR to develop a competitive residency application, the primary benefit is to get to know the specialty and the nature of developments in the field. Understanding the positive and negative attributes of a medical specialty is paramount in choosing whether it truly is one’s best career path. This investment of time is invaluable to help students decide if IR is right for them.
According to “Charting the Outcomes 2016,” the mean number of abstracts, presentations, and publications for matched and unmatched diagnostic radiology applicants was 4.9 and 2.7, respectively. Although the standard deviation is not provided by the report, the data is skewed with a long left tail; indicating a strong preference for five or more research publications or presentations. Even if a student is not particularly research-inclined, it is a worthwhile endeavor since it can help applicants learn more about IR. Of course, research publications run on a spectrum with regard to impact factor and quality. Higher quality work may have a more meaningful contribution on a residency application, but it will likely require a more intense time commitment. Students should engage in a preemptive discussion with principal investigators regarding their mutual expectations. Does the faculty expect only an abstract or poster, rather than a full-length, peer-reviewed article? Does this project require a time commitment that will cut into USMLE exam preparation?
Students interested in IR should spend time in the department and meet as many faculty as possible. This accomplishes several objectives. Perhaps most importantly, you gain firsthand exposure to the specialty and begin to develop relationships with potential researchers, mentors, and advocates for your candidacy. Ask the residents on service who might be best to start a research project with, or who does the most teaching during cases. Seeking out this kind of advice is extremely helpful in finding a mentor who has a history of publishing papers and also an interest in teaching medical students. On the topic of mentorship, consider focusing more on who you get along best with in the department rather than a “big name,” faculty with whom it might be impossible to schedule time to meet with. Down the road, letters of recommendation are most meaningful from a faculty who has known the applicant for a long period of time and has had significant experience with them. Thus, a letter from an Assistant Professor can theoretically surpass one from the Chair of the Department; it just depends on with whom the applicant had the most experience with.
Opportunities to work with IR physicians should be pursued as early on as possible. At most academic medical centers there is no shortage of IR attendings enthusiastic to take on an interested medical student. A good first step towards contact involves contacting the Dean of Students or Student Affairs that has regular connections with both medical students and clinical medicine. Ask him or her for recommendations about who to contact in the department for shadowing and proceed from there. Fortunately, SIR has developed an outstanding online IR faculty mentorship directory to help interested students around the country meet their local faculty. The link to this website is below:
Additional opportunities to become further involved in IR are abundant. Students can become members of the Society for Interventional Radiology (SIR), present research or cases at the annual conference, and even become a member of the SIR Medical Student Committee. Being a member of SIR also opens up many doors including scholarships, conference opportunities, and access to online journals.
Extracurricular activities besides those described above are certainly valuable but should not be as highly prioritized as research involvement. According to Charting the Outcomes 2016, the mean number of volunteer experiences for matched and unmatched radiology applicants was 5.7 and 5.8, respectively. Thus it appears, though important, volunteer experience is not the pièce de résistance for residency applications since it does not distinguish matched from unmatched applicants. However, if a student has a particular passion toward an activity she should feel free to pursue it assuming the other factors described above are adequately addressed. In fact, unique pastimes and extracurricular involvement can set you apart from other applicants who appear otherwise identical on paper. In full, community service and volunteering outside of radiology will help create a well-rounded application but are not the most critical aspects of the application.
Radiology residency interviews generally take place in December and January. Hence, sub-internships rotations early in the academic year are recommended. This ensures students get in months of DR and IR, with plenty of time before applications to get their grades and letters of recommendation collected. Letters of recommendation and grades should be submitted before September 15th, which is when residency programs download applications. Although the number of rotations is not well-defined, a panel of DR residents intending IR recommended that students complete one IR rotation and one DR rotation (3).
Away, or audition IR rotations can be quite useful for the residency applicant. Unlike a diagnostic rotation, the nature of IR allows students to get involved, scrub in, workup patients, and have an active role in the department. The away rotation should be done after the home institution IR rotation, and before November in order to allow plenty of time for interviews (3). Away rotations should only be done at programs the student has a high level of interest matching at.
An IR-intending applicant would be wise to apply for IR residency, ESIR, and DR programs that will receive approval for an IR residency. In essence, IR residency programs will need to fill their upper level positions. These positions will likely be filled through internal transfers from the diagnostic residency. Thus, an applicant can enter into a diagnostic training program, but end up in the IR residency without losing any time relative to a resident accepted into the IR residency straight out of medical school. If one is applying for both IR and DR programs, it will be crucial to understand how the specialties are alike and how they differ. An applicant will have a reduced chance of success matching into a DR program if they used the exact same application they assembled for IR.
Although they share similar training backgrounds IR physicians have preferences and personalities that differ from diagnosticians. IR is rooted on procedures and direct, longitudinal patient care. Thus, it is far more akin to a surgical specialty and appeals to more of a surgically-oriented individual compared to DR. Despite this dichotomy, it is crucial to acknowledge and appreciate the interdependence of IR and DR. When composing a personal statement or interviewing for programs, be prepared and well-versed to describe why you are interested in one of these specialties and not the other. However, you must be able to acknowledge and appreciate the importance and interdependence of IR and DR.
Essentially all IR and DR residency programs use the Electronic Residency Application Service (ERAS) and participate in the National Resident Matching Program (NRMP). The application opens in May and is not submitted to the selected programs until September 15th. ERAS essentially is a website where an applicant registers and then fills in their personal, academic and professional accomplishments, personal statement(s), and assign letters of recommendation to various programs. Note that an applicant might use different personal statements for internship and IR programs. Completed letters of recommendation can be assigned to various programs on ERAS. An applicant might want to send different letters to their internship versus their IR programs for example. Since the Dean’s letter ( a component of the application outside the student’s control) might not be submitted until October 1st, interview invitations might be delayed until later in the year.
In general a high-quality residency application follows a central theme in most of its parts. If you emphasize a quality which makes you unique (specific research projects, a prior career, or other non-traditional background), it should be mentioned appropriately in the personal statement, in the “experiences section,” of ERAS and during interviews as appropriate. For some, unique attributes can potentially allow applicants to gain a leg up when the residency admission committee is deciding between candidates.
In terms of how many programs one should apply for, that is difficult to quantify at this point given the novelty of the IR residency. Moreover, there are an immense array of factors that influence the number one should apply for (USMLE scores, medical school reputation, grades, evaluations, research involvement, couples matching., etc.). In general, the goal is to rank 10-15 programs. This means you must interview at 10-15 programs minimum; regarding how many programs to apply for. At a recent IR/DR resident panel, panelists cited about 30-50 residency programs as a general number. Though an applicant will be well-served to apply for a large number of programs, she will only need to attend interviews and rank about 10 programs to ensure a near 99th percentile chance of matching as depicted in the graph below. Note that these data do not refer to internship year and nor address those with special circumstances (applicants with red flags, international/foreign medical graduates, and those in the couples MATCH), whom will need to expand their application numbers accordingly.
Since most radiology programs are “advanced” training positions, applicants will also need to apply for an internship year. The number of internship programs to apply for also varies depending on the applicant’s competitiveness and which specialty(s) is applied for. Numbers cited by a recent IR/DR resident panel included 10 surgery preliminary programs or 40 Transitional year programs. The wide variation between these number is directly related to each specialty’s competitiveness. Note that it is possible to not match into a preliminary program and either need to scramble or, worse, defer residency by one year. Thus it is imperative to apply broadly and have safety programs in mind.
Letters of recommendation are another crucial element of the application. In terms of choosing letter writers, radiology programs tend to prefer writers who have meaningful, longitudinal experience working with the student. In this specialty, Chief or Chair letters carry little weight unless the condition described above is met. Essentially, a letter of strong content is more beneficial than a hollow letter from a heavy-hitting faculty. It is easy for application reviewers to see the difference between the letter from someone who truly knows and connects with the students, versus one that is generic and effectively meaningless. There is no defined criteria as of this writing, but in general an applicant should strive for 3-4 letters; one or two from IR faculty, one from DR, and at least one from another specialty attending, preferably surgery.(4) Certain programs may have stringent rules for number and type of letter. Be sure to check the requirements of each individual residency program online before beginning the application process.
Interviewing for residency may appear to be a logistical and financial hassle, but it can really be the most enjoyable component of the application process. All of an applicant’s efforts for the past four (or more) years have culminated in invitations for interview. At this point, programs are interested in the applicant and will try to sell her on the program in order to match their top ranked candidates and fill their residency class. Interviewing applicants should not feel as stressed at this point; they have what it takes to get into a program and now it is the program’s turn to impress the applicant at the interview.
On the day of the interview it is important to be yourself and exude qualities that show you are someone the interviewer would want to work with over the years of residency training. It is high-yield to prepare for interviews and the questions you almost certainly will be asked. Of which, these include:
“Why don’t you tell me more about yourself?”
“Why are you interested in this specialty?”
“What have you done to show your interest in this specialty?”
“What are some things you like and things you dislike about this specialty?” “Why not another procedure-oriented field like surgery?”
“What interest do you have in our particular program?”
The internship, or preliminary year is an outstanding opportunity to develop significant clinical competency in preparation for IR. This year will lay an essential foundation for the upcoming years and taking care of patients admitted to the IR service. The learning that takes place over this year is unprecedented and incredibly rewarding. Regardless of which type of internship one enters into, the one can be assured it will enable growth towards becoming an outstanding, well-rounded clinician and IR physician.
As of this writing, preliminary years can be completed in any specialty. These include internal medicine, surgery, transition year, OB-GYN, or pediatrics (2). For IR, a recent panel of IR residents and program directors emphasized the importance of a surgery internship. IR involves a great deal of periprocedural patient care; knowledge of which is optimally attained in a surgery year. One of the overarching objectives of the preliminary year is to learn how to take care of patients and understand the process of clinical decision making. IR is a primary hospital service with admitting privileges. IR physicians will be responsible for the day-to-day care of their patients and thus clinical knowledge is requisite. Not all surgical programs are the same however. There is a tendency for preliminary surgery interns (those who are not intending to become surgeons) to have less time in the OR and fewer learning opportunities from attending physicians while at more traditional academic centers. This is in contrast to the environment of a community hospital where preliminary interns are treated just like categorical interns (those in a full general surgery residency) and get abundant procedure and OR time. This is intended to be a thought-provoking commentary regarding which programs are best suited for IR candidates, it is certainly not a hard-and-fast rule since there are of course exceptions to this generalization. (2)
- King, Eric, MD. “Advice for the Competitive Applicant.” Telephone interview. Aug. 2016
- Chen, Jim Y. et al. Competitiveness of the Match for Interventional Radiology and Neuroradiology Fellowships. Journal of the American College of Radiology. Volume 11 , Issue 11 , 1069 – 1073
- New IR Residency and IR/DR Certificate: Future Direction of the Specialty. (2016). Retrieved August, 2016, from http://www.sirweb.org/clinical/IR_DR_cert.shtml3
- SIR. 2016 IR Residency Training Committee Webinar Series for Medical Students – Part 1: Gearing Up for Applications. August 8 2016
- SIR. Parag Patel, Saher Sabri, Paul Rochon, and Minajuddin Khaja. August 29 2016. IR Residency Applications – Program Directors’ Perspective.
- Jo, Alexandra, MD. “IR Residency Options.” E-mail interview. Aug. 2015
- Charting the Outcomes of the MATCH: NRMP. (2016). Retrieved September, 2016, from
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