A Prelude to Residency

by Andre Alcon, MD

The last several months have been a tremendous learning experience that has not only dramatically expanded my knowledge of plastic surgery, but has also shaped my aspirations and perspectives on the future. Nearly 75% of applicants match at a place they did a rotation, so there was a lot riding on these brief four-week rotations. I knew that having all of the right answers certainly wasn’t going to be enough. Surgery is a team sport, so programs are looking for competent surgeons who also play well with others and aren’t afraid to lay down a bunt and take one for the team.

Before my first rotation, I got a lot of good advice on how to make the most of my time. Those tips proved to be invaluable; however, sometimes I was so preoccupied with what I should and shouldn’t do that I forgot to just relax, have some confidence, and enjoy the rotation. Fortunately, as time went on, I became more comfortable in my role and began to let my guard down. I could think more clearly and had much calmer, more natural demeanor than before. I received much better feedback as a result and I had a lot more fun to say the least, not just in the operating room, but also in my interactions with patients, residents, and attendings. When so much is at stake, it is easy to panic and not trust yourself. We have endured a lot and there is a good reason why we have succeeded thus far; I just wish I had realized it earlier on.

Of course, we all want to go to the best training program, i.e. one that churns out competent surgeons that can handle just about anything that comes their way. Before my rotations, I had a vague sense of what constituted “the best program.” Was it reputable faculty, case loads, tradition, research activity, or some combination thereof? By the end of my rotations, I discovered that “the best program” is much more personal than I had imagined before. Sure, it should incorporate many, if not all of the components mentioned above. However, unlike college and medical school, there is a lot more variation when it comes to their strengths, weaknesses, structure, and culture. Thus, finding the “best program” is more about finding a combination that creates an environment where you can be happy and thrive, and not necessarily relying entirely on reputation like it was for college and medical school. When residents are happy, they not only perform better and take a more active role in their own learning, but they also cooperate better with other residents, attending physicians, and, most importantly, patients, just as I discovered myself over the summer.

Additionally, as we think about where we want to go for the next six to seven years, we also have to think about where our lives may be at the end of residency. Plastic surgery self-selects individuals that are extremely driven and up until now, most of us have made career decisions with little to consider other than our own success.  However, for many of us, our lives are going to change significantly over the next six to seven years as we transition from students to physicians, get married, or start families. We don’t know how our lives will change, which makes it nearly impossible to plan for, but as we tour the country on interviews and begin to think about our rank list, we should be asking ourselves some difficult questions. We should be honest about what we want from our lives, our career, and our families. Though we will continue our drive to the best surgeons we can be, we also have to recognize that what it takes to be the best can and likely will change over time.

I learned a lot from my rotations. I did the best that I could and hopefully it will be enough to earn an interview and, better yet, a residency position. Most importantly, though, sub-I’s gave me a preview of what the future might bring. I started my rotations with a lot of uncertainty, but when I finished, I realized that there is a lot more variety when it comes to residency than I had originally believed. Soon, we will have to decide which program provides us with the best opportunity to be the best surgeon we can be. This will be unique to each applicant, but as we think about our rank list, don’t forget to think about how our priorities can change.

Unfortunately, where we match is not entirely up to us, especially when we are applying to the most competitive residency field in the country. We still have control over our rank list, though. Some believe that they are a game of odds; however, after talking to program directors, faculty, and residents both junior and senior, it seems to me that the best approach is to rank at the top what you feel are the “best” programs and let the cards fall where they may. Our goal is to become a plastic surgeon and at the end of the day, most of us will take just about any spot we can get to achieve that goal. Don’t forget though, we do have some control and we can maximize our chances of matching where we want by being honest with ourselves about what it will take to succeed. Good luck.

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