Tips for the transition from the fourth year of medical school to a successful Match and residency

Transitions can be scary, especially when you’re in medical school. It is often very helpful to hear the wise words of the DOs and students who have already been through these changes. In this Q&A, residents Omari Baines-Waiz, DO, and Hannah Boehler, DO, MS, PGY-2 at CoxHealth Family Medicine Residency – Springfield, share what factors they focused on in their rank lists, what they knew before they Matched and how to prepare for residency.

What advice would you give to a fourth-year medical student who is about to create their rank order list?

Dr. Barnes-Waiz: Before you begin forming your rank list, first figure out what your priorities are—research, big city, being close to family, free food, etc. I would suggest looking back at notes you have on each program and even discussing with your family and friends what they remember about your initial reaction to the program after your interview. Can you see yourself in that city? Can you see yourself connecting with the people in that program? You will likely run into the challenge of having to rank multiple programs that you feel all deserve the same spot. How will you decide which program will be ranked higher or lower than the others? While challenging, it’s not impossible.

Also consider what you’re looking for in a program—unique opportunities, good benefits, respect for mental wellness, etc. Which program best aligns with what you’re looking for? You may have some programs that have most but not all of the things you want or need.

Remember, you don’t have to rank all the programs you interviewed with. There may have been a program you were interested in when you initially applied, but then after the interview, you didn’t feel a connection. Ask yourself if you would rather not rank that program and potentially go unmatched.

Many people get caught up in wanting to rank “brand-name” programs high on their list purely because of the name. If you feel this way, truly reflect on how you felt during and after the interview. Base your decision on your needs and not what you think others will think of you. Also, don’t rank based on how you think the program will rank you.

Lastly, don’t feel pressured to figure out the rank list in one sitting. You may need time away to think and process.

Dr. Boehler: When making your rank list, I recommend making a card for each program, then start lining them up. I personally wrote pros/cons/random facts on the back of each one. As you look over them, think back to when you interviewed with each program. How did you feel? Most importantly, in my opinion, how did you feel amongst the residents? It’s okay to take a little time with this. One of the best pieces of advice I received regarding making my list was, “If you don’t want to go somewhere, don’t rank them.”

What factors were important to you in creating your rank list?

Dr. Barnes-Waiz: As I previously mentioned, your priorities should lead your ranking strategy. For me, location, my wife’s input, involvement in DEI and unique clinical opportunities were my priorities. Remember, you will be at this program for three-plus years and might even potentially stay for fellowship or your first job as an attending.

Dr. Boehler: The most important factor to me was going to a program that felt like home, as well as a place where I felt I would get the most experience. There were very few programs to which I applied that did not provide adequate education in all fields, but some programs provided more opportunities than others and therefore got bumped higher on my list. The most important thing to me was the community. You’re going to spend a lot of time with these people, so how you interact with them matters much more than the food in the doctors’ lounge.

Looking back on your journey, what is something you wish you knew before the Match process?

Dr. Barnes-Waiz: Throughout my fourth year of medical school, I was told numerous times to “trust the process” and “go with your gut.” Honestly, I didn’t believe these things until after I had gone through Match, but it was good advice, which I now extend to you. The process generates a lot of anxiety and uncertainty, but just know that whatever decision you make will be the best one for you.

Some people may feel if they don’t get their number one choice “it’s the end of the world” and somehow they have failed themselves. In reality, you have not failed, you have succeeded in becoming a doctor. Understand that regardless of where you match, you will manage to make things work.

Dr. Boehler: I wish I knew just how quickly everything happens. We all seem to have this idea that after Match Day everything calms down and the stress is over, and you have a second to breathe. However, I received a phone call from my program within two hours of Match to welcome me and give me info on next steps. The next week I was looking for housing. A month later I moved. Then I graduated. By June 15, I was an employed physician. On July 1st I was treating patients, and it still hasn’t slowed down, in the best way!

Something else that I wish someone would have told me (not that I’d have listened) is that no matter where you end up, there is a reason for you to be there.

What advice do you have for new interns about to start residency?

Dr. Barnes-Waiz: My first piece of advice for beginning the transition to residency is take the time between Matching and June to relax. Reflect on how much work you’ve put into not only the process of Matching, but also the whole journey to becoming a doctor. It’s been a long road, but you’ve made it, and you deserve to enjoy any free time you have. Sure, you will need to start looking for housing in your new city, but other than that you should focus on celebrating yourself and your accomplishments.

Many people feel pressured to study because they want to be “prepared” prior to July 1. Remember that the purpose of residency is to learn on the job. This is the time to ask questions, make mistakes and build your confidence. It’s easy to get overwhelmed with everything you have to get done day-to-day while working, but try to set goals for yourself each month (or each rotation).

Make sure you have a good support system at home and start to create one during orientation. Like medical school, you will have ups and downs, and need people who will listen to you vent and encourage you to see another day at the hospital. Seek help and guidance from upper-levels and don’t forget about nurses and techs who can help you too!

Transitioning from medical school to residency is also a financial adjustment. Prior to your first paycheck, you will have some big expenses—moving, deposit on housing, first month’s rent, graduation, travel, fingerprinting, etc.—so hopefully you have saved some of your money for these things. You’re now going to make real money (yay!) and you will need to create a budget. Now that you will be out of school, you will also have to start paying your loans back. There are companies like Student Loan Professor and GradFin who help students with PSLF and repayment options.

One very important component to this transition is self-care. I recommend establishing care with a primary care provider (and other specialties that you may need), so that when you’re busy and something happens you aren’t scrambling to find a doctor to address your needs. Don’t forget about your hobbies either (or new ones you want to pick up). Try to find things in your new community that fit your needs.

Dr. Boehler: You’ve definitely heard that residency is hard, but in my experience, it is hard for so many reasons that you would not expect and cannot predict. My best advice is to go with the flow!

• Be willing to learn new ways of doing things. Recognize that things change daily.
• Night shifts are tough but can be so much fun.
• Make friends where you can. Nurses can be your greatest ally.
• If you speak a foreign language, brush up on it. You will inevitably have a patient who does not speak English, and the way their eyes brighten when you can speak their language rather than going through an iPad translator is incredible.
• Prepare your loved ones for what’s coming, even though they still won’t get it.
• Give yourself grace. The learning curve for intern year is steep. But it’s fun being halfway through the year and realizing just how far you’ve come.
• When it gets hard, focus on the small joys. Don’t let them pass you by or get buried by all the other stuff.
• Don’t be afraid to jump in and do things, but still know your limits. It’s OK to say you’re in over your head and need some help.

What is something about intern year you wish you knew before you started?

Dr. Barnes-Waiz: Similar to what I mentioned before, I thought I would need to know so much before July 1^st. What I realized was, being an intern isn’t all about knowing treatments and differential diagnoses, it’s also about learning and understanding your hospital system—how to navigate the hospital, knowing the supports for patients in the community, understanding some pieces of insurance, learning the electronic medical record (EMR) and more. The scope of intern year is similar in some ways to medical school. You must apply information you’ve learned in addition to starting your role as a physician. Best of luck to you in the Match and beyond, and don’t forget to enjoy your moment.

Dr. Boehler: I wish I’d known how much my patients would affect me and how much I would care about them. Of course, we all care about our patients; that’s why we’re in this business. But I didn’t know that I would fall asleep thinking about a case from the day, making a mental list of what more I could do to help. I didn’t know that I would watch our inpatient service list to see if any of my clinic patients had been admitted. I wish I’d known how exciting it would be to get to deliver a baby for the patient I met in my first week of residency.

Related reading:

Making the move from the second to third year of medical school

Overcoming obstacles as a medical student: A journey of resilience