Obstetrics and gynecology has always been considered a competitive specialty in medicine. Although grades and board scores continue to be paramount in residency application, I believe that it is a field where people actually value personality and diversity.

As a 3^rd year, I toiled over my 4^th year schedule thinking that it was the be-all and end-all of everything. Please take a deep breath, and remember that you have completed your 3^rd year and what’s done, is essentially, done.

If you are not pleased with your 3^rd year grades, schedule all the important electives prior to the dean’s letter. The important elective includes a medicine sub-I because certain programs (i.e. Yale) require a letter of recommendation from the Medicine Department. Completing your sub-I prior to the application deadline affords you an opportunity to reflect either improvement or consistency in excellence. Another important elective is the ob/gyn sub-I where you will be further familiarized with the fundamental basics of obstetrics and gynecology.

Sub internships aside, I also recommend these following electives: emergency medicine, a well-managed rotation with excellent exposure to gynecological diseases, and maternal-fetal medicine, for its coverage of core obstetrics. Any medicine elective would be equally good. I believe the worth of a surgical rotation is highly debatable and individual-dependent.

To add to my stress of beginning 4^th year, I embarked on what I now perceived as a futile quest to set up my away rotations. I made a series of mistakes, and I sincerely hope that you will not be as clueless as I was.

I had heard from people that away rotation is a chance for you to shine, for you to flaunt your incredible clinical skills and fecund knowledge of medicine. All this is true; however, there are little intricacies that nobody told me which I had to learn the hard way. First of all, choose the away elective wisely. Do hard-core ob/gyn such as one month elective on L&D, MFM or a sub-I because this is a great way for you to expose yourself to various attendings (but not too many) and residents. You will get a more accurate assessment of the institution. I made the mistake of enrolling in ambulatory gynecology at Northwestern where I got zero resident exposure and only really worked with one attending.

Now that we have gone through what you should do, let’s talk about where you should do it. Location is very important because of housing, expenses, airfares and other unforeseeable events. The more desirable a city is (i.e. New York or Chicago), the harder it is to find housing. It is also important to keep in mind your chance of getting into that program, and this brings us to why do you want to do an away rotation.

Dr. Stubblefield recommends away electives in ob/gyn because it offers an excellent opportunity to learn from other institutions. Good reasons for doing an away rotation are for the learning experience (I am completely serious! Not pulling your chain, at all.), and to see how you would fit in a program. Most of all, enjoy yourself. The one bad reason is hoping to get into that program without an accurate assessment of your credentials and, inevitably, placing a lot of pressure on yourself while you are there. I did it for this bad reason when I was at Northwestern and Mount Sinai, and I was miserable!

The bottom line is that if you are qualified candidate, you will get an interview regardless. Attendings here have told the students that programs will automatically grant you an interview if you did a rotation at their institution. I know that BU ob/gyn is like that; however, this is not the current day norm.

From multiple 4^th years, the unanimous sentiment about away rotations is that in general, they do not help. Do away electives for fun: set it up at a highly prestigious institution and just learn. In short, this experience is reserved purely for you!

If you are strongly interested in a particular residency program, then definitely apply to do a rotation there before interviewing begins (interviewing begins November-December for most programs and continues through January). This allows the house staff and faculty the opportunity to get to know you and gives you an advantage over others when applications start rolling in. Most programs have a significant input from residents as to who will be chosen for residency, and the rotation offers the chance to let the residents get to know you more than is possible in a single day interview. This may also give you the added benefit of a letter of recommendation from an attending at an away rotation, which is another point that residency directors notice. Any of the electives offered at BU would be great to do, too. Try to schedule these earlier in the year if possible; again, this gives a faculty member a chance to get to know you and offers the possibility for a great letter of recommendation. However, your fourth year need not be inundated with OB/GYN electives. Take electives that interest you or may be beneficial for the beginning of residency. Now that all OB/GYN residency programs are required to provide six months of primary care training, interns and residents need to know more than just obstetrics and gynecology. You might want to consider medicine subspecialties such as cardiology, GI, endocrinology, ID, etc., but you don't have to limit yourself to these electives. Besides, this is one of the last opportunities you will have to do something fun that you won't get the chance to do once residency begins.

As for letters of recommendation, most programs expect one of the letters to be from the department chair or residency program director. In the case of BU, Dr. Stubblefield fills both of these positions. Let Dr. Stubblefield know early that you are interested in OB/GYN and ask for his input during the application process. He is extremely supportive of students and puts you as a priority. He is more than happy to advise students and write letters for students, and the better he knows you, the more personal that letter can be. Other letters of recommendation may come from other OB/GYN faculty who know you and your abilities (most programs want a second letter to be from another OB/GYN faculty member), the director of one of your rotations (e.g., your sub-I, third year medicine or surgery rotation), or any other physician that you feel comfortable asking. When asked for letters of recommendation, most writers will request a copy of your CV and personal statement. Although you don't need to prepare a CV for your official application, it would be a good idea to prepare one for those who have agreed to write you a letter.

OB/GYN residencies are applied for through the computerized ERAS application system. The diskette and instructions will be made available to you through the Office of Student Affairs during the summer.

Choose your programs wisely. OB/GYN is extremely competitive and applying to at least forty programs is not unreasonable to ensure an adequate number of interviews. Also, most programs only have three or four interview days that more often than not overlap with other program interview days - thus, even though you may be granted an adequate number of interviews (approximately 10-15), you may not be able to go to all of them. Being offered more than twenty interviews ensures that you will be able to make ten to fifteen of them.

Even if you are an extremely competitive applicant you need to apply to some "safety" programs. Alternately, do not sell yourself short if you think your grades or board scores aren't that hot, programs look for other unique qualities and they want their applicants to "fit in" with the residents already there. For example, if you are more research oriented, some programs value that very highly, whereas to others it does not matter so much. It is expensive to apply through ERAS, especially after 30 programs. However, it is a small drop in the bucket compared to the amount you pay for medical school and a small price to pay to ensure the appropriate number of interviews and a GOOD MATCH!

Keep in mind that most programs want ONLY the information contained on the ERAS diskette and will not accept any additional paperwork through the mail or in person at interviews. The only exception to this is the application photo. Sometimes the photos do not transmit well, and programs will request an additional one when you arrive for the interview, so it's a good idea to keep a copy of your photo with you. A good suggestion for the application is to list all Honors/High Pass coursework (i.e., beginning with first year) in the Honors and Awards section of the application as well as your shelf test score from your third year OB/GYN rotation if it is notable (some programs request shelf test scores regardless of performance). This will help buff your application, although many programs will not consider an application until an official transcript has been received. You will receive confirmations via e-mail when programs start downloading your application information. Nevertheless, be sure to call the programs that you are really interested in after receiving e-mail confirmations to ensure that all of your information to date has indeed been received -- the ERAS system is great, but it is not foolproof as of yet.

As for timing of the application, September or early October is a good time to shoot for. Despite getting your diskette submitted and into the ERAS system very early, many programs may not download information until late September or October (my disk was submitted in August, but no program downloaded my information until the last week of September). Furthermore, many do not offer interviews until the Dean's letter is received, so an extremely early application has little advantage. On the other hand, some programs may fill all interview slots before the application deadline, so it does not pay to wait until the last minute. The bottom line is that while OB/GYN is a competitive specialty, it is not impossible to acquire a residency position. When interviewing begins, you will see a wide variety of applicants. Don't sell yourself short, and be confident in what you have to offer.

It is always difficult to assess how competitive the programs are and how you measure against them. The best source of this information is from people who have recently gone through this process. Below is my attempt to provide an objective briefing, gathered from my own experience and talking to people in the field or about to enter the field, on some programs as categorized by regions.

Pro: Program is solid with good surgical and clinical volumes. Reputation of its undergrad helps to shine upon the overall respectability of its graduate and postgraduate education.

Con: In the middle of nowhere…Lebanon, NH.

Con: Residents are notoriously bitter and bitchy. This past year marked the exodus of some heavy weights from this department to Columbia. People, in general, express uncertainty both about the direction of the program and the hospital.

Interview day starts with presentations by the various section chiefs. Applicants have three ½ -hour meetings with faculty and one with a resident. Each applicant this year also met briefly with the acting chair. The program coordinator likes to be buttered up. After a tour, lunch is at a local Chinese restaurant.

It’s the Brigham…

As far as the interview: Lots of faculty and residents turn out for the informal mingle session over refreshments before the start of the interviews and are eager to talk with the applicants. Despite the big name, both residents and faculty are down to earth. With only four interview days, there are lots of applicants. There are three ½-hour interviews, including two with two faculty and one with a resident. Each applicant also meets informally with Dr. Barbieri, the chair, who seems to know all of the applicants’ backgrounds. You will likely talk about "leadership in women’s health" and "emotional intelligence" as a quality that makes for a good leader. Promoting future leaders is big.

Pro: The training, I am sure, is a solid one…although it is somewhat always in the shadows of the Brigham.

Con: If you make it to the interviews, perhaps you would be turned off by all the pomp and circumstance. First of all, they interview close to 100 applicants and insist on ranking only 10-15. The Harvard name constantly rolls off their tongues and they are eager to tell you helpful maxims such as "we are Harvard and we do everything right."

Pro: The department is committed to serving the indigent population of the city. Under Dr. Stubblefield, the program is also dedicated to providing all services, and this also includes providing abortions.

Residents are unionized, which means that you get the best benefits in the city!

Con: Surgical and delivery volumes are not too impressive.

Pro: The U.Mass medical center is an up and coming institution with great potentials. The hospital is ever expanding, and the program is considered to be a solid one as well with great representation of all subspecialties of ob/gyn.

Con: Perhaps location, although I can certainly think of worse places to be than Worcester.

Pro: The residents are extremely happy there. People who did an away rotation there really loved the program and described it as nurturing. It is an incredibly convivial environment where one could foster optimal learning experiences. The rumor is that they try to have an equal male/female ratio.

 

Some unflattering things have been said about this program; rumors have been augmented by the recent departure of its whole gynecologic oncology department. Applicants are concerned about where the program is headed.

They are all very strong and super competitive. The New York programs like to keep their own, however. It is debatable which one is the best; all three are excellent.

Con: Bitchy residents who are mean and gossip-y, although there are a few exceptions. The most expensive hospital in Manhattan!

A community/university based program that is strong and competitive. People who interviewed there ranked it highly largely because the chairman is tremendously enthusiastic and optimistic about the future of his program.

 

This program is terrific for multiple reasons. First of all, the obstetrical experience is incredible because all the high-risk pregnancies are delivered at this hospital that has one of the only two perinatal surgical facilities in the country. The gynecologic surgery is also solid. Residents are a very friendly and nice group of people. Faculty is young and approachable. Hospital is located in the middle of U.Penn’s idyllic campus.

 

Pro: This program is really a gem! This department is headed by Copeland, a giant in the field of gynecologic oncology (previous chairman was Gabbe). It has a good representation of all subspecialties. The surgical and clinical volumes are equally impressive. With the guidance of Dr. Copeland, the program has consistently placed their residents in competitive fellowships, especially gynecologic oncology. One resident from this year is going for an onc fellowship at MD Anderson!

Con: Ohio

Pro: The program has some academic heavyweights. Sciarra, the chairman, is extremely well respected and has authored a big tome-y textbook. Lurain, head of gynecologic oncology, is another person who commands respect. Teaching is always evidence-based, and there is a lot of that going on there.

Con: Uro-gynecology is not well represented for an academic institution of this stature. Over-whelmingly high group of private patients, although the residents argue that they take care of these people nonetheless.

Pro: Wonderful program all around. It has comprehensive representation of all subspecialties of ob/gyn. It is by far, the tertiary center in the city of Chicago. Residents, consist of a fairly diverse racial group, work hard but seem to get along just fine. It is one of the few institutions where the medical center is located in the same neighborhood as the undergraduate campus, and this undergraduate campus is impressively beautiful.

Con: It is located in Hyde Park. Cabbies would refuse to either take you there or pick you up there.

Residents looked fatigued and haggard on the interview days, and they are not too enthusiastic about the program. The program consists of off and away sites in and around the city of Chicago, such that in spite of the large number of residents, the call is still brutal.

Pro: The word is that a lot of chair-persons in the South trained at Baylor, and invariably, this institution carries a lot of weight in the South, Southwest and beyond. As a part of the Texas Medical Center, the largest medical center in the world, Baylor offers a phenomenal residency experience. It has great surgical and clinical numbers with a diverse exposure in treating both the indigent and affluent. Residents rotate through Ben Taub, a county hospital not unlike City Hospital at BU and also Methodist Hospital, a gloriously designed and maintained hospital.

Con: Most people from the East Coast have reservations about Houston. Do keep in mind that Houston is the 4^th largest city in the States and it stands as the headquarters for multiple national-companies such as Shell and Compaq.

Pro: This community based program is another gem! I fortuitously applied to this program due to my own confusion of the two "Baylors" and found that this community-based program has much to offer. The hospital is impressively maintained: the ancillary staff is incredible (UT-Southwestern people think this hospital is "cushy."). The medical center offers multiple amenities, one of which is a grand workout facility/gym where you may catch the local Dallas Cowboys or the Mavericks working out. This program certainly does not lack hardcore academics: it offers a phenomenal surgical experience; in fact, it may be the only program that trains its residents in laparoscopic CO2 laser surgeries.

Con: The program has little experience placing its residents into the more competitive fellowships such as gynecologic oncology.

 

     In recent years, the field of OB/GYN has become increasingly popular and therefore more competitive for residency applicants. As with all residencies, the more impressive your grades, board scores, and extracurricular activities, the stronger your application. By no means does this require you to be AOA or have extensive research experience to be selected for a residency position in OB/GYN. Many programs look for a well-rounded individual, so tailor the application to reflect this. Highlight your strengths, no matter where they are.