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Benjamin Miller, MD, FAAP interview

Daniel Schumacher, MD, MEd, FAAP Peds Connect Response

Terry Kind, MD, MPH, FAAP article

James Perrin, MD, FAAP interview

Lee Ford-Jones, MD interview

Lisa Chamberlain, MD, MPH, FAAP interview

Marsha Raulerson, MD, FAAP interview

Sean Palfrey, MD, FAAP interview

Ted Sectish, MD, FAAP interview

2014 National Conference & Exhibition Residency Panel excerpt

Benjamin Miller, MD, FAAP Interview

Dr. Benjamin Miller
Assistant Professor of Pediatrics, The Paul C. Gaffney Diagnostic Specialty Service
Associate Program Director, Pediatric Residency
Children's Hospital of Pittsburgh of UPMC

What are some common questions that students ask during their interviews?
“What is your program looking for in an applicant?”
“What would you say is unique about the residents who graduate from your program compared to other similar programs?”
“How do residents receive feedback—formally or informally—in your program?”
“What is the greatest strength (or weakness/area for improvement) of your program?”
“Why did you choose to come here?”

Does it hurt my chances of getting into a program if I am not able to make it to the pre-interview dinner?
I highly doubt it.  The pre-interview dinner is a time to get to know residents in that program.  As a member of program leadership in our program, I can say that we never pay any attention to whether someone came to the pre-interview dinner.  It is meant as a service for the applicant to get to know the “personality” of a residency program and ask questions of the current residents.
That said, treat it like part of the interview day: be your best self.  We have definitely taken applicants off our rank list because of egregious behavior witnessed by our residents at the pre-interview dinner.

Do I have to hand write my thank you cards or can I just e-mail everyone I interviewed with?  Also, how quickly do I need to send my thank you cards out?
In this era of ubiquitous electronic communication, I don’t think it matters which mode of communication you choose.  I would make sure it’s personalized, though, with at least the individual interviewer’s name in the opening address.  I also don’t think it’s an absolute must to write at all, but I would encourage it as professional courtesy.  I think writing within a week is very reasonable.  If that is not feasible due to travelling or other constraints, then write as close to a week as possible.

Is it important that I e-mail the programs that I am most interested in in January to let them know?
I honestly don’t think this is important.  I also don’t see how it could hurt you if you choose to do so.  Programs are supposed to rank candidates based on their individual merits and ability to fit/mesh with the existing program.  We do not move residents up or down our rank list based on whether we received any notification about how much they liked us or how highly they will rank us, but it does give us the “warm fuzzies” when we hear it.  It also increases excitement when we see those names end up on our Match List in March, because we know those residents are as excited to be here as we are to have them.

What resources are available at your institution for completing scholarly activities, ie, time and/or resources allocated for these experiences as well as mentor availability?
This will obviously vary by institution. We have many enthusiastic faculty members who mentor residents in their scholarly projects, which can range from case reports to in depth translational research projects.  Residents often use elective time in the second and third year to help ocmplete these projects.

Does residency training occur all at one site or involve rotating within different settings?
This will also vary by training program.  The vast majority of training in our program occurs at our main Children's Hospital, with the excpetion of our NICU rotations, which occur at the Women's hospital included in our larger hospital system.  This is a good questoin to ask when looking into a program; it is very common for residents to have several sites to use throughout their training.

What attributes are you looking for in your incoming intern class?
Also going to vary by training program.  We like students with a strong record of academic achievement and demonstration of other special skills, like committment to community activities, research, education, etc.  We also make a conscious effort to recruit and match a diverse group of residents from a variety of cultural, ethnic, religious, socio-ecomonic, and experiential backgrounds.

How does the administration within your residency program seek recommendations for change from trainees? How are such suggestions implemented in the program?
We have several venues to address this.  We have monthly Residency Council meetings with members of each residency class (elected by peers) to solicit feedback.  We meet with each class quarterly during a lunch hour to solicit feedback. We also hold annual meetings with each class in a "retreat" setting to gather feedback about the program.

Peds Connect Response

DR. Dan Schumacher

Cincinnati Children’s Hospital Medical Center

​What are some unique experiences/research/advocacy/global health opportunities you've seen in pediatric residency ERAS applications (MS4s) that impressed you? In other words, do you have any recommendations for an MS1/2 looking for something to do with his/her summer off?
I think the most important thing is to do something that aligns with your passions/interests in medicine if that is possible. For people with strong interests in research, this is the perfect focus for them. For people with a passion for global health, a global health experience might really strengthen their application. For people with a passion for the underserved, advocacy work might be a great way to make a difference and demonstrate their commitment. The most important thing is that the activities are meaningful (i.e., you really put some time and effort into something that you did) and provide a strong demonstration of your passions. It is much more memorable to have applicants whose activities really give a good picture of what is important to them and what they care the most about than those who were involved in a sampling of things in a less invested way.

What are common mistakes/red flags applicants make in their personal statements?
I think there are two most common mistakes that people make that rise to the top for me. First, some people spend too much time talking about why they want to go into pediatrics. We know that you want to go into pediatrics and that you have a passion for children because you are applying to pediatrics. What are some of the other reasons that you want to go into pediatrics? It might be good to focus on these. Second, people often do not spend enough time really letting us know who they are and what drives them. The personal statement is a huge opportunity to leave a lasting impression before we even have the chance to meet you in person. What are you passionate about? What really drives you? If you have some ideas, what do you see yourself doing after training? Answering these questions with a focus on how they will relate to why you will be an exceptional resident and pediatrician is important, but the personal statement is also a great opportunity for us to get to know a little more about your personality as well. This is important for helping to determine if you might be a good fit for the people at the program you are applying to.

What qualities/attributes make up the perfect pediatric clerkship MS3 or sub-I? What specific things make them stand out during a clinical service rotation?
I have worked with a number of medical students across a wide range of personalities, styles, and clinical abilities. Across all of these factors, the most important variables that stand out to me are: 1) a genuine care for their patients, and 2) a genuine care for their team. Genuine care for the patient can be shown in a number of ways, including staying late to help with something going on with a patient, taking extra time to make sure something a patient needs is received, and making a point to build a therapeutic alliance/connection with patients and families. If the parents know the name of the medical student and their role, that is a huge compliment! Genuine care for the team can also be demonstrated in a number of ways, including offering to help other team members out if you have your work done, and staying late when things are busy to help get the work done. Both of these things have examples that may involve staying late or coming early to be sure that excellent patient care is achieved. This can be a great way to demonstrate that you place your patients' needs in front of your own, which is one of the hallmarks of an outstanding resident and pediatrician.

Research for Residency? ​ 

Terry Kind, MD, MPH 
Assistant Dean for Clinical Education
Associate Professor of Pediatrics
George Washington University 
Children's National Health System
@Kind4Kids and since this is about research, you can find me on PubMed here or ResearchGate here  

Why is research seen as a favorable activity amongst residency programs?  What qualities related to one's research activities are considered impressive to residency programs?

…said many medical student advisees in my office many times over the past decade or so that I've been involved in answering these sorts of questions.  In addition to providing my take on things, it's only fitting to provide an evidence-based response to this question about research!   

First, is it favorable? Findings from a survey of residency program directors published in Academic Medicine (Green, 2009) described that published research and research experience in medical school were in the top 14 important things, but they were ranked 13th and 14th.  Favorable to have research experience? Yes. Most important or essential?  No.  Does research experience differ significantly among those who match in their specialties of choice and those who don't?  No, according to the NRMP.   But being involved in research is still a good thing, for a variety of reasons, and it may be an important discriminator when applicants for are similar in other ways.  

So, why is it a good thing to gain research experience? Research draws upon important skills relevant to healthcare, including both team and independent work, critical thinking and analytic skills, formulating questions based on literature review, hypothesis generation and testing, quantitative and qualitative analyses, and staying true to the data.  By participating in research, students see and experience how to handle setbacks and unexpected findings.  Responsible conduct of research and maintaining the public trust includes upholding ethical standards, confidentiality, integrity, and the like.   

Through research, we share and disseminate ideas and findings that are subject to peer review and confirmation.  We address the "so what" questions.   And, residency programs might see in a medical student researcher a future superstar who will make groundbreaking advances in the field.  

How can a student find pediatricians who do research? How should they be approached? 

First, think about what you are interested in.  Scan table of contents from journals in your field of interest.  Peruse the websites at your own institution –not only the medical school and pediatric department, but the hospital and research divisions and any lists of resident, fellow, and faculty research projects, and you can get an idea of what type of research are being conducted and with whom you might be able to link up.  Your school may have a research track, or the residency program or hospital may have research centers with listing of ongoing (or completed) projects.  Your medical school library may have annual lists of faculty publications.

Contact your career/academic advisor or an attending from your pediatric clerkship and ask what research they or their close colleagues are involved in.  The pediatric clerkship director, residency program director, vice chair of education, and/or department chair may have a body of research, or know others who can bring a medical student on to their research teams.  Some may already have grant funding, but others may be looking for interested, enthusiastic, and "free" medical student assistance with data collection or literature review or coding or analysis.  If you become part of the team, you would discuss your inclusion in any abstracts, posters, or publications that arise from research to which you contribute.   ​

When you approach a faculty member, have some goals in mind (I want to learn more about grant proposals, or IRB submissions, or enrolling patients, or data analysis, etc) and have some idea of what that faculty member works on and what you are interested in.  Be open to listening, and ask if there is some aspect of a project that you could learn about and contribute to.  It is not that someone will necessarily hand you a project, you might create a chance to build something anew, posing a research question of your own, with necessary mentorship.  And always do a literature search before getting too far along!  Know what skill sets you have that could be helpful, and be prepared to do any IRB and HIPAA training that is required for the responsible conduct of research.  And a word on contacting these busy people, if you reach out and don't hear back, it's okay to follow up a second time or with a phone call.  And if you do set up a meeting, make sure to show up (on time), or respectfully reschedule should something come up to prevent you from making the meeting. 

Final tip:  If you are involved in research as a medical student, then make sure you can speak about it clearly and with interest on your residency interviews… know what you worked on!  

Interview with Dr. James Perrin, AAP President-Elect (December 2013)

How do you see medical students fitting into the national goals of the AAP during your presidency?

J.P.: Students go into medicine and especially pediatrics with most of the same goals that motivate all of us – a commitment to improve the lives of children and families in the multitude of ways that physicians can influence health. Students bring new ideas and fresh approaches to many of the issues facing American families- poverty, early childhood experiences, gun violence control, prevention, adolescent growth and development, among them. We look to medical students to help us find the best ways to address these complex questions.

What is one area you could see medical students actively participating in and instituting change?

J.P.: There are many – but I hope medical students can collaborate with all of us in finding solutions to the persistent problem of poverty in America and its effects on child health.

Do you have any specific goals for medical students for your presidency?

J.P.: To increase medical student involvement in state chapter work and key national committees.

Thinking back to your time in medical school and residency, what was one of the more rewarding experiences you had in regard to children and families and how has this affected your career goals?

J.P.: I had many great experiences in medical school and residency. As a medical student, one of the best was the "Family Clinic," where first year students were paired with a pregnant woman and followed her and her family through pregnancy and delivery and then served as the child's pediatrician – under the guidance of great teachers like Ben Spock and John Ken​nell. And during residency – actually between PL-1 and PL-2 years - I spent a couple of years in Washington, working on programs to improve rural health programs and their families. The experience taught me much about how the government works and what young physicians can do to bring about change.

What is your favorite part of working with medical students through advocacy, research, etc.?

J.P.: Students ask great questions – they challenge us to think well about the issues we're working on together and to explain clinical care, policy, and many other topics ​​better.

Do you have any overall words of wisdom for medical students interested in pediatrics?

J.P.: Pediatrics is a great career – it offers an incredible array of opportunities to make a difference in the lives of children and families, exciting subspecialty​​ work, advances in research, highly rewarding primary care, advocacy, and a great group of colleagues.

Interview with Toronto Hospital for Sick Children Social Pediatrics Elective Director: Dr. Lee Ford-Jones (June, 2011)​

Q: What inspired you to create the Social Pediatrics elective and training?

Ford-Jones: Our Chief of Pediatrics here at The Hospital for Sick Children, Toronto, internationally renowned Diabetes Clinician and Researcher, Dr. Denis Daneman, was finding very substantial numbers of his patients were  not getting their Diabetes under control due to their social  context – the micro and macro environment. He wanted to see an educational program for medical students and residents on the disadvantaged child to begin to address this, both from the disease management and health promotion and prevention perspectives. After nearly 30 years of working in infectious diseases, I could recognize an epidemic when I saw one, and jumped at the chance when offered the opportunity to develop the program. Infectious diseases have always had a strong equity foundation, e.g. control and prevention of infections is only as good as the weakest link, and everyone has a role to play. As important is the new neuroscience of experience-based brain development which has caught up with the social epidemiology. We now have very powerful evidence that what goes on in a child's social context has a profound effect on gene function – epigenetics has been described as the operating system with the genes being the hardware and experiences the software. Brains, and thus hearts, are built – we can build good ones or bad ones by the relationships we offer to all.

Q: What are some issues facing social pediatrics today?

Ford-Jones: We have hit the wall in the care of many children and youth as their social context community resources (including food, healthy sleeping accommodation and safe housing) may be inadequate, limiting the ability of families to comply with our medical treatments. These social determinants of health have got to be addressed – the first two mental health questions for our patients are "how did you sleep last night" and "have you eaten today?" The work situation of the parents and​​ their associated mental health, neighborhood safety, quality of the schools, income disparity and racism – all of the social determinants of health - have got to be addressed. Education is of paramount importance. Future prison cell needs are being calculated on the basis of Grade 3 Literacy scores. School achievement is not a bad measure of health outcome – everything has to be in balance academic success. It is putting in place, in a highly participatory way with the communities, the needed multidisciplinary population-based initiatives, and especially scaling up from the evidence-based "pilot" studies. These include early years and pregnancy support as well as on through the life trajectory through school-based supports and into adolescence. The mortality rate for 15-24 year old males is now 2-3 times that of 1-4 year old males in rich, middle and poor income countries! Addressing all of these issues will take greater awareness and commitment, and ultimately translating this interest into tangible political investments.

Q: What are some ways pediatricians today and pediatricians-in-training can incorporate aspects of social pediatrics in their everyday practice?

Ford-Jones: Ideally start by doing home visits, complete with public transportation and its realities (and limits). Awareness of what the food, housing and day to day safety concerns are for the family – so you understand what families are up against. Raising the profile of these issues can invigorate multidisciplinary endeavors with the community, and advocacy with our professional organizati​​ons. Only sustained unprecedented activism by people like you and me is going to change this. We must mobilize every inspired and inspiring person. The "Participatory Principle" is terribly important. The disadvantaged must have their views represented at the table ideally in person – there are outstanding community leaders who can represent their constituencies well and tell us what they need.

Q: How do you think the Social Pediatrics Elective Program will progress in the future, and what other aspects do you anticipate will be included in the program?

Ford-Jones: I hope we have a system which enhances the Life Trajectory – i.e. Life Course Developmental Health– through pregnancy and the early years and into schools. We need to improve the child welfare and protection system and mental health services with professional pediatric funding models, so that our pediatric trainees can develop even stronger career paths to serve in multidisciplinary capacities. We are physicians and scientists – we must make sure each professional is pla​​ying their best position and what can be well done by others is done by others. We must build capacity, collaborating with many able partners and professionals from the health care and community sectors – it is not just about we MDs alone. We cannot be afraid. We have got to level the playing field for all, and in doing so, improve the health and its determinants for our children.

Advocacy Training in Pediatrics: An Interview with Dr. Lisa Chamberlain (December 2013)

What does advocacy mean to you?

L.C.: I think there are different levels to it. Individual level advocacy is writing letters to parents, to landlords, working with individual families. At the community le​​vel, it's working with schools, working with non-profit organizations, police departments, Head Start. Legislative advocacy is educating policy makers, such as members of school boards, city councils, and state houses, about evidence-based solutions for kids. I think training in advocacy is essential if we hope to reduce child health disparities, and we need to work at all those levels.

Was your decision to go into pediatrics influenced by its emphasis on advocacy as a field?

L.C.: No, I decided on pediatrics before I thought about advocacy. Initially thought about pediatric heme/onc as a specialty. I fell in love with pediatrics and I really loved hem/onc, but then during residency I was drawn towards general pediatrics more and more as I becam​​e interested in helping the underserved.

You've been involved in developing an advocacy curriculum at the medical student and resident level at Stanford. How did your interest in teaching advocacy throughout medical education develop? When did you decide to study this academically?

L.C.: I come from a family of teachers – my mom, my aunt, and my grandmother were all teachers so I think at some level teaching is just a part of my DNA. A pivotal point for me was going to UC Berkeley and obtaining my MPH, which I did after residency. This opened my eyes to the fact that during my residency there was precious little education about health disparities or how to reduce them through advocacy. I returned to do a General Pediatrics Academic Fellowship focused on building​​ a medical education curriculum around these topics.

At the medical student level, you've developed and studied the population health curriculum at the Stanford School of Medicine from 2003 to 2007 that includes a requirement for first-year medical students to engage in community based population health projects [1]. What specific skills do medical students gain by having advocacy training as a component of their curriculum?

L.C. They learn how to look at and analyze the roots of health disparities, and they learn how to act on those disparities at the community and policy levels. I think it's important to address advocacy training in medical education because medical students go into all specialties. A​​ll types of doctors need education on health disparities and advocacy whether they become OB/Gyns or surgeons, etc. not just pediatricians. I like working at the medical student level because it challenges me to think about adult health disparities, and it is exciting to address future leaders across all fields of medicine.

At the resident level, you've developed and studied the Child Advocacy Curriculum in which residents from three pediatric training programs (Stanford, UCSF, University of Miami) participated in standardized workshops and the development of individual advocacy projects in 2002 [2]. What did you learn about the evolution of advocacy at the medical student level as compared to the resident level?

L.C.It's really very different. The residents have more clinical experience. They are much more empowered and build on their experiences. Medical students in their pre-clinical years lack this. Residents are able to draw from their passions because they are taking care of people. The other t​​hing that's fundamentally different is that I have more time with residents over the course of three years. This is not so say I don't enjoy working with med students – they are so idealistic and energetic. They constantly amaze me. Med students and residents are very different and it is fun to watch them grow and change over the years based on their training.

At the state and institution level, you developed the Collaborative in 2007, a group of 13 pediatric residency programs in California that participated in improving advocacy training from 2008 – 2010 [3]. What did you learn from that experience trying to broaden the scope at which advocacy is taught?

LC: Well, I learned what amazing things are going on at these different programs. All residencies have similar requirements for accreditation, and I learned a ton from colleagues. We have experienced a wide range of challenges (developing advocacy training), and I think we are a lot stronger when we are united sharing curricula and sharing ideas. We're also stronger in Sacramento, providing a more coherent voice for kids' issues. I learned how important it was for us, at the state level, to h​​ave unifying voices specifically for children and families. I really enjoy working with the Collaborative. It's one of my favorite parts of what I do. 

In the future, does the Collaborative have the ability to operate at a national level?

LC: Yes, the idea of the Collaborative at the national level i​​s possible. We have ongoing statewide collaborations that are formed or now underway in New Jersey, New York, Missouri, Texas and

Ohio. It's been fun to visit these sites and watch collaborations start to come together. I think people see the potential from the point of view of how you can engage people in advocacy and how to improve things in your state. I believe it has a lot of promise. It's also interesting because each state has such a unique culture in the types of things they are advocating for.

How are you synthesizing what you've learned by studying what advocacy training looks like at the medical student, resident, and institutional level through the population based projects, Child Advocacy Curriculum, and the and the Collaborative respectively?

LC: I think the main thing I've learned is to seriously consider the scope of the project the learner is interested in taking on. The amount of time a medical student or resident has is limited and varies. Depending upon their amount of protected time, population-based projects and curricula will need to be significantly tailored. What I've learned about advocacy training through the Col​​laborative is that every institution is unique, it has its own culture and strengths. Those factors will influence the training that is put it place – and it should – training cannot be imported in a cookie-cutter fashion.

What does the future of advocacy in medical or resident education look like to you? Is there scope for a multi-disciplinary approach with schools of law and public health?

LC: Absolutely. We are interested in working across different schools. It's hard because there is a lot of work that needs to be done in terms of developing relationships.

There are some who disagree that advocating at a policy level is not within the professional obligation required of physicians, and may unnecessarily "politicize" the field of medicine (i.e. Huddle, "Perspective: Medical professionalism and medical education should not involve commitments to advocacy.") [4]. Have you run into pushback from students or colleagues along the way regarding incorporation of advocacy into medical education? How do you respond?

LC: You know I really haven't experienced very much push back at all, and my colleagues haven't either. I think it's because we see the consequences of the current state of affairs in society and medicine. Our advocacy is focused on taking evidence to policymakers. If evidence is used and incorporated into clinical practice, it helps patients. I appreciate the Huddle article and often use it to prompt discussion with my students because I think it's important to thoughtfully consider and rethink what th​​e role of medicine should be. The greatest burdens of disease in pediatrics are asthma and obesity, and they disproportionately affect those in poverty. How can we not be acting at the population level to address these issues? These problems require doctors to develop tools to address populations because these diseases are so deeply embedded in a socioeconomic

What skills should a good advocate have?

LC: Have a lot passion and be in it for the long haul. Advocacy requires long-term engagement. It requires the ability to persevere. Specific skills include media skills, and the ability to communicate that evidence in lay terms in order to convey your message clearly. You also have to ​understand the evidence around your field. The ability to listen to the needs of the community is also very important. Sometimes I think we doctors are in too much of a hurry to really listen.

What advice do you have for medical students who are interested in keeping their interest in advocacy alive into residency and beyond?

LC: This is such a good question. It's so hard in residency. As a resident, you have multiple demanding obligations. It's an enormous responsibility to be a doctor. I think you should look for the incorporation of advocacy training in a residency program. Ask if they have the faculty to engage at the advocacy level, if they have educational curriculum around health disparities and community engagement. If they have faculty who are engaged in advocacy, they will inspire you as a resident and help you develop those advocacy skills. If the program does not have it, then it may not be a good fit. You hav​​e to actively assess how much work they do around advocacy. Are there scholarly tracks? Are there pathways to explore what interests you? It's important to ask so you can take the time to stay connected to those advocacy roots. I think advocacy training can be an empowering thing in your life and can keep you going. Look for a program that has those aspects so you can keep that part of yourself alive and never forget it. It may be a hard but it's worth it.

Interview with Marsha D. Raulerson, MD, M.Ed., FAAP currently serves as the Chairperson of AAP's Committee on Federal Affairs (June 2013)

As a medical student and resident at the University of Florida, you were encouraged to be a patient advocate.  Will you share a couple of your early experiences?

M.R.: Dr. Gerold Schiebler, Pediatric Residency Program Director, was my first mentor in child advocacy. When I was a resident, he used to say that if you want to make changes in how health care is provided, you have to talk to the legislators. At the time, he served as the medical school's liaison to the state government. He constantly reminded us of how important it was to be involved. As part of our training, my colleagues and I took a van to rural areas across Central Florida to reach out to children who did not otherwise have access to health care. Because of my background in education and involvement in the Civil Rights Movement, I always knew that I wanted to practice in underserved areas, but this outreach program taught me first-hand about children's health care needs.

Eventually, an opportunity in your husband's career took you to Brewton, AL where you started your own pediatric practice. What led you to quickly take on the role of advocate for your patients in this new town?

M.R.: When I got to Alabama, I was shocked to learn that they did not have the appropriate equipment to take care of high-risk deliveries and sick newborns. Thankfully, during my first month, Dr. Hollis Wiseman, neonatologist at University of South Alabama called me and asked what I needed. In exchange for his help, I agreed to serve on the Southwest Alabama Perinatal Advisory Committee, my first formal advocacy position in Alabama.  Soon, the Health Department recruited me to provide care at a local well-child clinic and Dr. Carden Johnson, president of the Alabama Chapter of the AAP (who later became AAP President), invited me to participate in a day of strategic planning. Working with the AAP toward the passage of the first child seat restraint law in Alabama, I got my first look into​ state government.  But, it wasn't easy! In fact, during the legislative session, an article was published on the front page of our newspaper in which the governor was quoted saying "If my grandson wants to stand up in the front seat of my pickup truck, nobody is going to tell me he can't."

Even your first encounter with state legislation in Alabama was met with pushback from government officials. Was this a common theme in your advocacy experience?

​M.R.: We are experiencing more push back now than in a long time, mostly because of the cost of health care. Although the main driver of these increasing costs is not our children, but rather our growing population of elderly with more health issues, when people look at cost, they want to cut social programs that affect our kids. But, many people don't understand the social determinants of health. Only a small percentage of "health" happens in a doctor's office or hospital. In fa​ct, the number one determinant of health in a community is the education level. Taking money out of preschool programs and HeadStart will indirectly impact the health of our children. In addition, cities that value parks, playgrounds, community gardens, and sidewalks are healthier communities.  Because children cannot vote, we have to be their voice to the legislators. ​

Speaking of investing in our children, the 2013 SOMSRFT advocacy cause is child literacy. You have spent your career encouraging your patients and their parents to read through your involvement with the Reach Out & Read program. What is Reach Out & Read and how did you get involved?

M.R.: With my background in education, reading has always been an important part of my life. As a teacher, I taught and tutored reading. I have learned that the ability to read starts in the first few months of life with the bond between a mother and baby. This attachment determines language skills and the ability for an infant to interact with his or her environment.  I first learned about Reach Out & Read eighteen years ago when it was a fairly new program. To me, it was the key to development! Reach Out & Read encourages pediatricians to distribute an age-appropriate book at every well-child visit, allowing them to simultaneously talk about developmental milestones associated. In the early months, the baby immediately puts the books in his or her mouth and the mother is educated on the normal activities of a six month old. Later, we are able to discuss books as a part of a normal bedtime routine. I see this program as a teen-pregnancy, high school dropout, and drug abuse prevention project. When children learn about books early and love to read them, they see a whole new world and realize the opportunities that e​​xist for their future. Waiting rooms are filled with older kids reading to their younger siblings, cousins, nieces, and nephews. It has become part of the culture in my office and in our community.

It sounds like you have made an incredible impact in your 30+ years as a pediatrician in Brewton. What have you learned about advocacy since you started your career?

M.R.: First, show up. Use every opportunity to share what you know about children. Tell their stories. And, finally, listen to the people in medicine you adm​​ire.

Thank you so much for sharing your experiences with us! What advice do you have for medical students interested in pediatrics as they start their career as pediatricians and child advocates?

M.R.: Listen to your patients' stories. Listen to parents and watch how they interact with their children. I have started taking photos of mothers and their newbo​​rns in the hospital, encouraging parents to make early connections with their infant, and have had some great successes. I had one young mother tell me "I didn't know I could love this baby so much." As the children grow, the parents love to go back through pictures at their next visit to see how much the baby has changed and grown.

Interview with Dr. Sean Palfrey "Preventing Gun Deaths in Children" (March 2013)

What inspired you and your wife to write this piece in the NEJM?

S.P.: We were shocked by what happened at Sandy Hook. As pediatricians caring for an inner city population, it reminded us of a patient of Judy's, a 12 year old boy who had been killed on the way to the grocery store with his mother after being caught in the crossfire of a gun battle. These kinds of experiences give pediatricians a voice in legislative advocacy. Because we are on the ground, we can say, 'this is what we see day to day. We see this and live with it, and we are shocked and saddened.' 

What is the most important role for pediatricians in regards to child safety and guns?

S.P.: Don't fear to ask. People are often gr​​ateful that they are asked because they understand that we care about the child's life. Find the right words to ask about risk factors, such as drugs, alcohol, and abuse in the home. At a legislative level, to protect our legal right to ask.

​In your experience as a clinician, what are the best ways/questions to approach the gun/safety issues with families?

S.P.: It is very effective to incorporate these questions into anticipatory guidance about the child's development. For example, for the parent of a child turning two, you can counsel them by saying: 'Your child's almost two years old, and soon they're going to be curious, active, and getting into everything in the house. Are there locks on the cabinets in the home? Are the family's medication bottles kept in a safe, locked place? Are there things like guns in the home? If so, are they kept loaded, or is the ammunition stored separately? Guns should be routinely included in conversations about home safety.

In light of these tragedies, do you think that it is pediatricians' duty now to take this issue up outside the medical setting?

S.P.: Our posture is to ask, talk, listen, counsel, and advise. Advising can include attending town meetings, sitting on town councils, or meeting with parents on school committees. There are some with a narrow view of what it means to be a physician, limiting the ro​​le of the physician to just those seven minutes with a patient. Others, oftentimes in rural and inner city populations, take into account all the aspects that factor into health and expand the definition of physician'.

​What do you think is the best way for medical students interested in pediatrics to advance this issue both inside and outside the medical setting?

S.P.: Legislators are actually waiting to hear from their constituents- they want to hear from the people who vote in their districts and who have opinions on current issues. Scheduling visits, making phone calls, and writing letters are all effective ways to have your voice heard. One phone call to talk about one issue can make a big difference.​

In regards to the specific measures outlined in your NEJM piece, are there any that you think best lend themselves to physician advocacy in conversations with families and/or in the legislature? The response is three-fold:

a) Defending the right to ask about guns in the home and the right to collect data on these issues. The collection of this kind of data comes very naturally out of our role and the conversations we have with families. We want answers to be tallied and studies to be d​one about the best policies and procedures to prevent gun violence.

b) Counseling families about limiting screen time and limiting the amount of violence viewed by children. In movies and video games children learn to shoot enemies and animals. The games seem so harmless, but outcomes can be lethal if fear and anger become stimulants and shooting becomes reflexive.

c) Advocating for funding for effective mental health support for troubled children and adolescents as well as participating in school meetings and helping to support children that seem aggressive, depressed, or isolated.

As a practicing primary care pediatrician in an academic setting, what are your thoughts on pediatric residents training on guns/safety?

S.P.: There is certainly a place for it. The question is where to put it in the curriculum. Should it be taught to students and/or residents? And should it be required or elective? The most important aspect of this training would be practice with wording. The way our electronic medical record is set up now, the question of 'guns in the home?' comes up as part of a checklist on safety, which may or may not be an effective method of asking when pressed for time. However, real, live, practiced questions, incorporated into a conversation about ways to safeguard the home can allow physicians discuss these topics in a low-key and non-judgmental way. Students and residents should be encouraged by school and residency programs to take on advocacy initiatives, to connect students to those in the field so that they can follow through with these initiatives, and maybe even make it their life's work.​

Dr. Ted Sectish, Program Director of the Boston Combined Residency Program (BCRP) – Children's Hospital Boston (June 2012)

Many 2ndyear medical students are currently receiving or have received their Step I board scores and are beginning to think about where to apply for pediatric residency. In your presentation last October, you showed data from a national survey of program directors both from medicine and pediatrics. Step I scores were ranked as the #2 most important factor for all residency directors outside pediatrics and #8 among pediatric residency directors. Why do you think there is a discrepancy between the two? Also, do pediatric programs typically have cut-offs for how high a Step I score must be for an applicant to be considered?

T.S.: I can only really comment on pediatrics and, more specifically, my thoughts concerning the Step I scores. I personally do not believe that test scores are an important factor in becoming an excellent pediatrician. Some people are better test takers than others, and some of those who are poor test takers turn out to be excellent pediatricians. With this in mind, I bel​ieve pediatric residency directors tend to emphasize other portions of the application more, as best shown by the study I cited. For example, Step II scores (Clinical Knowledge and Clinical Skills) are ranked higher in evaluating pediatric residency applicants, as they are better indicators of how proficient individuals will be as clinicians. In terms of cut-offs for Step I board scores, our program does not use cut-offs.

Can you please comment further on how much emphasis is placed on research? For example, what type of research is important, and how much research should a medical student complete before applying to residency?

T.S.: It is dependent on programs. Some institutions emphasize research experience over other factors when evaluating an applicant. This is usually clear when applying to programs as those who value research will emphasize it. In terms of what type of research, it is a common misconception among applicants that pediatric research is more important than non-pediatric research. What is more important for medical students interested in pediatrics who participat​​e in research is that they show a commitment to the research and produce scholarly work in the form of publication(s) and/or presenting it at a conference. Other things that typically impress program directors are first author publications and publications in a high-impact journal, but these are certainly not necessary. Overall, any scholarly work is looked favorably upon, whether the focus is in pediatrics or in adult oncology for example.

What other skills, experiences, etc. do program directors generally value? Are there other things that your program generally looks at more favorably in an applicant?

T.S.: It depends on the individual program. As for our program, we look strongly for leadership skills in an applicant. An applicant who shows initiative and starts his or her own public health program in medical school for example, or someone who is highly involved w​ith leadership at the medical school level is typically looked favorably upon. Showing initiative and organizational ability are two important traits for our program overall.

Referring back to the survey of national program directors, both medicine and pediatric

Residency program directors ranked "Grades in Required Clerkships" as the #1 most important factor for evaluating medical students. What are your thoughts on why this is #1?

T.S.: It is because the grades are standardized across the board. Clerkship directors see hundreds of students and are able to provide a direct comparison between students. We want students who have the potential to be excellent doctors, and ex​​​cellent doctors are well-rounded clinicians who do well in pediatric clerkships and in Ob/Gyn, Surgery,etc.

Are there any particular elective rotations that you would recommend for medical students interested in pediatrics? For example, if a medical school curriculum is not as strong in dermatology, radiology, etc. do you think it is important for medical students to pursue these areas to be a better resident and pediatrician?

T.S.: I know our program does not generally evaluate elective content for residency. I do not think there is any special formula for elective rotations that will make you a better resident and pediatrician. I would encourage every student to do what he/she wants. ​​Most students benefit from sub-internship electives, and I would highly recommend these as they can provide evidence of efficiency in a clinical environment.

Do you have any tips for students who become interested in pediatrics later in medical school (as a 3rd year)?

T.S.: I think organizing visiting rotations and sub-int​​ernships is the most important tip for those who become interested in pediatrics later in medical school. It is also very important to show commitment to pediatrics. If applicants were previously interested in orthopedics (for example), explain the change in their application. I would also encourage students to become involved in their pediatric interest group and to secure a good advisor in pediatrics as soon as possible​

Should residency applicants indicate if they are interested in a specific fellowship/specialty? What are the advantages/disadvantages of speaking with programs about their interests?

T.S.: I think there are several advantages for a program and an applicant. For the applicant, it shows the program that he/she has a well-thought-out plan. For the applicant and the program, it would be beneficial so the applicant could be paired up with faculty with similar i​​nterests as soon as possible. For the program, it could help promote balance in the class. It would be undesirable for a program to have 20 residents who all want to be pediatric cardiologists.

Although the next question is not specifically related to how to be a competitive pediatric residency applicant, it is still important for those considering pediatric residency in the future. How will the cuts in federal funding for Children's Hospital Graduate Medical Education (CGME) affect your program and other institutions? Do you see this as a serious problem moving forward?

T.S.: As you know, everything is on the table in terms of health care costs. I think in the next few years all residency program directors, even those outside pediatric​s, will be forced to take a look at the size of their programs. I know children's hospitals will remain dedicated to educating future pediatricians, but the size of the programs will most likely be scrutinized.

What are some things about yourself you would be willing to share? Such as– where did you grow up? Where did you attend medical school? Etc. etc.

T.S.: I grew up in Eastern Pennsylvania. I attended medical school at Johns Hopkins and did my residency here at Children's Hospital Boston. I was a general pediatrician for a number of years in Salinas, CA, and was also formerly the residency program director at Stanford. I came to Children's for a number of reasons, including location (returning back to the east coast), I did my residency here, and CHB is an excellent hospital with a distinguished, large program. I still serve as a hospitalist and make a yearly commitment to be on service when the new interns arrive.

Any last thoughts for medical students pursuing a pediatric residency?

T.S.: Some very important things to think about are location, finding an environment that serves your needs, meeting residents and faculty who you would want to be coll​​eagues with, and which program would best stimulate you intellectually.

2014 National Conference & Exhibition Residency Panel excerpt

The following is a student-led Question and Answer excerpt from the Residency Panel at the 2014 AAP National Conference and Exhibition held in San Diego, Ca from October 11-14. The three panelists in attendance were:

  • Dr. Lisa Chamberlain (LC): Medical Director- Pediatric Advocacy Program and Associate Professor of Pediatrics, Stanford School of Medicine
  • Dr. Jason (Jay) Homme (JH): Pediatric & Adolescent Residency Program Director, Mayo Clinic
  • Dr. Adam Rosenberg (AR): Pediatric Residency Program Director, University of Colorado School of Medicine

What kinds of skills or experiences can you gain while in medical school that will allow you to become empowered residents in the future?

LC: There are millions of opportunities while you are in medical school, from writing op-eds to newsletter submissions to engaging in local activities. All of these are things that you could add to your CV, to show that you are a person who is proficient at writing, passionate, and willing to raise your voice to take a stance about issues around you. Empowered medical student​​s and residents are those who will get involved and get engaged. There are opportunities all around you as medical students. Don't feel like you need a large amount of experience when entering residency, instead it is our job to train you. However, the above-mentioned items are how you could get a good start that will put you ahead of the curve.

AR: The hardest job that we have as program directors is selecting a residency class. It is an enormous task and takes a lot of work to be able to choose a small number of individuals from a huge group of intelligent people. Two things that stand out to us are being involved in those sorts of activities that indicate your passion for pediatrics and devotion to specific interests shown thr​​oughout your application. Commitment to a single area or a few areas is a great attribute to have.

JH: Screening through applications can move quickly when using ERAS, in that it gives us numbers and allows us to click through experiences. The difference in those who we have chosen to accept is that they have done things that have mattered to them. Specifically, there is a difference between quantity and the longitudinal nature of activities. We are looking for things like advocacy that matter to you. Do things that make a difference to you, and in doing so you will be able to tell us what you will bring to our program.

What do you think makes your residency program unique?

JH: Every program is unique, even though we follow the same set of requirements as residency programs throughout the country. We now have more flexibility in the ways in which we are able to train our residents. In that way, when applying to residency programs, you should be looking for a "goodness of fit". You can do your training at many good programs, or great programs, loca​ted throughout the country. However, the program that is the best for you is the one that meshes with your interests and learning style. For example, one of the strengths of our program at Mayo Clinic is that we draw patients regionally, nationally and globally but we are not a high-volume training environment.  You'll see a wide variety of patients but also have time to spend reading about them and spending more time with them if needed. At other programs you learn by the volume of patients with less time to sit and talk or read but more direct exposure to patients. You need to figure out how you learn best- one learning style is not better than the other, however you learn best is what's best for you but one program may then be a better fit for your learning style. Another factor to consider is the availability of resources for doing scholarly activities. Most residency programs require some sort of scholarly work, but you should see if they have provided ample time, resources, and mentors to create great research opportunities for their residents. 

AR: The philosophy behind the residency program is that it is YOUR training, so we try to individualize it as much as we can to try to train you for what you're going to become, whether you are planning on going on to a fellowship or primary care. When looking at different resid​encies, you have an important job- look as to what residents do with their discretionary time, i.e. how much of that time is taken up by extra clinical service rotations. It is important to find a good fit for you; we find that every year, classes come in and bond very well and establish great camaraderie that allows for great opportunities for learning. What we, as residency Program Directors, are most proud of is our residents. They are terrific people who grow into excellent pediatricians with a great commitment to advocacy, are highly productive in their academic careers, and have a strong dedication to underserved patients.

LC: I think the best way to view the application process is to approach it as dating because ultimately you are looking for a good fit. There are all different kinds of fits and you need to find the one that works best for you. Yet, in doing that, you need to know who you are and who you are not. For example, consider if you want a program all at one site or rotating in and out of different settings. You need to be honest with yourself and then assess the programs. We have recently gained more flexibility as residency programs, and in doing so, this allows us to differentiate our programs. For example, at Stanford, we look for curious residents who want to learn, actively ask questions, and then seek the answers. We look for analytic thinkers who are committed to patient care. When you go on your interviews, you need to determine where you feel comfortable, look back and think, "where was I really happy on that day?"

What are some really good questions that you have heard from interviewees that make them stand out from other members of the applicant pool? What are some questions to consider when figuring out if a particular program is a good fit for you?

AR: The most important part of the interview day is when you meet the residents. They are the ones to ask the questions of what goes on day in and day out. Th​​ey can provide their honest opinion as to what to expect as a resident at our institution.

JH: The best source for information about a program is to talk to the residents. We also get good information about applicants from our residents- they will meet and talk with every applicant.  We look for consistency of message between what information we receive as the residency director and what the residents have to share. If these two messages contradict, it can be a big red flag.  Residents are basically recruiting their replacements or people who will help them in the future. The residents' job is not to interview you; however, the ways you interact with them will make an impact. For example, texting on your phone during dinner does not reflect well for you. Overall, we look for consistency of message. In terms of fit, one of the biggest things that will impact your experience is the other residents who will be in your intern class. However, you will have no control over that. Yet, what you can do is ask residents or program directors what sort of attributes they are looking for, or who they are trying to recruit as residents. As program directors, we all think that we have the best residents in the world- yet, it's all about the fit, when the right people come together.

LC: One way to determine what attributes we value as a residency program is to think about who we view as our most exemplary residents and what are the qualities that they have. We look for individuals who are self-starters, curious, make things happen and are hard working, hard working, hard working.  Different programs may say different things; it's a culture.

Considering your most recent intern class, what is one thing they didn't learn in medical school that you wish they had?

LC: I feel like the understanding of what it is like for families who live in poverty is something that not many interns come in fully realizing. We will sometimes encounter dismissiveness in interns that they are just not getting it. However, that is why you train as a resi​​dent and hopefully, that understanding will come with time. Medical school has a difficult time conveying the social determinants of health, yet this is something you see daily when practicing in the field.

JH: You don't become a pediatrician by graduating medical school. Further, you don't become a pediatrician even when you complete your residency program. Rather, these are the building blocks; the first years of practice are when you become a pediatrician. Medical school doesn't lack too much. If I would say anything it would be the ability to relate to different people because everyone's needs are different, but just as important to them. In the community where I work, I can see kids who have significant medical needs requiring medication and intervention to those whose parents want to know how many activities to enroll their 5-year-old child in. Even though these two scenarios are highly different, it is equally real for them. Being able to understand these problems, no matter how small they may seem to you, are beyond important to them. Where you come in, is "how can I help with the problem?"

AR: I can't point to one thing because you are getting a very broad introduction in medical school. We are even getting better at dealing with other things in medicine, rather than just the statistics and facts.   The next step is a three-year residency that is focused on children, and I agree with Dr. Homme in that training is a series of milestones that will allow you to become a proficient pediatrician, it is a lifelong process of learning.

What is the biggest difference between medical school and residency?

JH: Medical school can be associated with a sense of competition, in that you may be constantly trying to out-perform or get above others. Residency isn't like that, we are all working together. In the future, if you are looking to get into a competitive fellowship, there are things you can do to allow yourself to stand out; but the pie is not limited, you do not need to compete with each other when in residency.

LC: I agree with Dr. Homme there is a distinct shift to a team-based approach that will allow you to take care of a community of patients. That's why the fit we talked about before is so important. The other residents are your teammates who will be irreplaceable when trying to take care of the patients we see in the community.

A lot of us in the room have recently submitted our application, and this time in the process is like a waiting game. If we haven't heard back yet, when is it too early to contact a program to check in?

JH: The competitiveness of pediatric residency programs is becoming an increasing problem in that the number of applications is logarithmic now. For example, w​​e have 970 applications for 12 positions, that's a big stack of applications to get through. Around this time may be a good time to contact a few programs that you may be highly interested in because we have all the information now. Yet, since we have so many applications, it may just be that we haven't contacted you because we haven't been able to get to yours yet. If you send mass e-mails to numerous programs, it can complicate the issue because we may be getting inundated with e-mails from many other students as well.

AR: I would echo what Dr. Homme said; we have a huge number of applications and a small number of people going through those applications.  We can't realistically start to review applications until around October 1. Every application has an ERAS form, letters of recommendation, personal statements, and dean's letter- meaning a lot for us to get through. A realistic target is to get through all applications in the month of October.  I limit myself to reviewing no more than 8-10 applications in one sitting; otherwise, we aren't doing you, as the applicant justice. To do justice and give everyone a fair look, it takes some time. It's only October 11, so give some more time before you contact various programs.

LC: At this point, patience and knowing silence isn't a negative thing are two good things to keep in mind.

Since applying to residency has become increasingly competitive, in that you need better board and clinical scores, it doesn't seem to lend time to extracurricular activities. How should we best manage our time and should we prioritize some activities over others?

JH: You are right, it is becoming more competitive. But I can say that if you are a US trained medical student, then there is most likely a position for you as long as you dot your I's and cross your T's. Yet, you still need to self-evaluate and determine how competitive you are.  This may not be the case as the number of medical students is growing and residency positions are not ke​​eping pace. Yet, your question how do you get to everything in 24 hours, is a common one. It's important to remember to be who you are and do what's important to you. In doing so, this will give you energy and allow you to do more of what you love because this will improve your mood and boost your energy.

LC: There is a distinct shifting of gears from getting into medical school to getting into residency. In applying to residency, we are looking for one or two things that you have done more deeply, shown commitment to and provided sufficient time and energy. This change of strategy is a better way to go in terms of strength in your application and also will provide better quality of life if you are doing things that you truly enjoy.

What is the outlook of the field of pediatrics in 10 years? What should we expect as future practicing pediatricians?

LC: This is the absolute greatest time to enter the field of pediatrics. Dr. Perrin's team approach that he mentioned in his opening address is brilliant because it unburdens you. The team approach is what will allow you to do a thorough job. As the field moves toward ​​a more comprehensive approach, it allows us to feel like we are doing a better, more cohesive job to be proud of. The opportunity to talk to kids and being the trusted person in their lives is such a privilege and a gift.

JH: There will always be children who need our medical care and expertise as kind and compassionate practitioners. When looking at the burnout rate, in the field of medicine it is frighteningly high, but luckily pediatrics is one of the lowest in the field. I believe this is because we participate in work that matters.  In 10 years, this field will be great.  In 30 years, it may even be better. ​

AR: There are so many great challenges out there for us that continually motivate us to do better. One of the favorite roles of my job is being able to work in a Special Needs Clinic where I follow up with former patients of the NICU. It is such a gratifying part of what I do because I have known these patients since birth and their parents may not trust or want anyone else to take care of their child. This truly is an honor and a gift that makes coming to work beyond worthwhile. Looking towards the future, there will be many challenges on the horizon from mental health to providing care to special needs patients to the creation of a medical home. Having challenges won't change, yet you as the future of this field will have the opportunity to work through and help with many of these obstacles.

When creating our application, do you suggest stating that we are interested in going into a specific subspecialty or fellowship after residency?​

AR: You need to be true to yourself. If you have wanted to be something since you were eight years of age then bring that out in your application.  Yet, it is absolutely not critical at this point in time. Arriving at the conclusion that you want to be in the field of pediatri​​cs is more than enough.

JH: If you are seriously considering either a fellowship or a career as a generalist, it will help you determine if a residency program is a good fit or not. Specifically, you can look at the outcome measures to find out how competitive graduates are when applying for fellowship positions. A lot of interns come in and just don't know, but that is completely fine because your experience in a residency program will help you decide. Don't overreach on your application, don't feel like you have to say what type of pediatrician you want to be when you may not be sure.

LC: Sometimes it can be good to be an undifferentiated stem cell. Just be honest when completing your application if you know then you know. But at the same time, there is no problem being open to opportunities because more likely than not, you haven't been exposed to everything yet.

How important are letters of recommendation when reviewing applications for your residency program?

LC: Letters of recommendation are critical. One unique thing that I advise medical students to do is to envision himself or herself as the person who is receiving their own application packet. Overall, we are looking for you to tell a story about yourself through 2-3 things such as ​research or community service projects. It would help if you had your potential letter writers focus on different areas of your journey as a student, thus allowing all three letters to show different aspects of you as an applicant. One thing to always ensure you ask the person is, "Do you feel comfortable writing a very strong letter on my behalf?  If so, could you speak to this?" Then provide bullet points with items you would like he or she to mention in the letter. In doing this, a story will be able to come through your application. If you don't give those who are writing the letters any guidance, they may speak to the same qualities about you. Being strategic in who you choose to write your letters is very important. Someone who knows you because you have done 1-2 things longitudinally really reflects integrity, which is a quality at the end of the day that we are really looking for in our future residents.

JH: It is easy to tell when a letter is merely a regurgitation of your CV versus when the letter writer truly knows you. With the large number of applications that we, as program directors, receive per year, sometimes less is more. For example, your personal statement and letters of recommendation should ideally be one page or less. Sometimes generating a letter from someone outside the realm of pediatrics can be very telling of your characteristics and attributes. For example, a surgeon speaking on your behalf saying that they would want you to take care of their grandkids some day is a very powerful statement.

AR: A couple of things I can't emphasize enough, is that the people who are writing your letters should really know you through spending time with you and can write a letter that you would want to have. Letters from the chair of pediatrics at your program rarely tell us who you are as a person and so are less valuable than those that are written by someone who you have spent a lot of time with. One other very valuable point that we see when reviewing applications is you need to ask people to write letters who have experience in writing letters on behalf of medical students. For example, you may work with someone at a foundations experience or a clinic in a community setting one day a week over a period of a year, setting you up for an ideal relationship for a letter. Yet, they may not know exactly what to write or how to write it.  You need to strategize along those lines.

In terms of looking at an application as a whole, how much emphasis do you place on Step 1/Step 2 scores?

LC: These scores do matter. When reading through large numbers of applications, these scores are concrete.  However, if we seem to get to know you or have an understanding of who you are as we read through your applications, it will allow us to take other things into consideration.

JH: I love and hate recruitment season. Recruiting our future residents is one of the most important things we do as a Program Director. I love being able to bring fresh new faces into the program, yet, on the other side of the coin, I hate it because I have to, in some ways, be judgmental. We need something to discriminate applications, so one thing that we can base it on is USMLE scores. Looking at the data from last year, the average Step 1 score for a matched pediatric residency applicant was 226 versus the average score of 206 for an unmatched pediatric resident. Yet, we can take people who are not strong test takers and can help you pass the boards through training acquired in residency. USMLE scores are one piece of information to consider when weighing applicants. So if you haven't taken Step 1 or 2 yet, study hard and take it well because in doing so, it will keep doors open for you in the future. However, if it doesn't turn out how you had imagined, just know that it is not the end all or be all.

AR: I would be lying if I said we didn't look at it. On our initial application screen- there are twelve categories and USMLE Step 1 and Step 2 scores are two out of the twelve. Thus, the scores are in there, but there are many other things to look at to get a good feel for your total application. There have definitely been instances where I have read an application that has managed to paint a picture of a journey through medical student training, yet the scores don't match up well. Yet, I have a 100% feeling in my heart that this student would be a terrific resident and work extremely hard for all three years, then the scores may not matter as much.

Upon transitioning from medical school to residency, how feasible is it for residents to continue their initiatives or community projects that they have started during medical school?

LC: A third of them will continue their projects. It all depends on how much they want to shift gears rather than true feasibility. If this is a project that you love and t​he community partner is happy to continue, then it would definitely be possible to pursue further working in the future.

JH: If it is important to you in medical school and important to you in residency, then there is no reason not to continue your work. Coming into residency, it seems that everyone is interested in global health and advocacy, then life happens and sometimes people can become distracted and lose focus on these initiatives. But really it is up to you and the amount of time and effort you want to put forth into the project.

AR: If you are interested in something, then you can make it happen. There is time in residency that can allow you to do scholarly projects, such as in global health.  If you are willing to spend a considerable amount of time, then those things can happen. When interviewing at a program, it is important to ask directly as to if this would be possible or if there is a mechanism in place by which you could do this.

Final Thoughts

JH: Heading into the process of applying to programs, it is important to know that over the past several years we have been seeing more and more applications, which is a good thing, but it does make the process more difficult. The average number of applications that students are submitting is growing sometimes even exceeding applications to over 20 programs. When the truth of the matter is, you don't need to see over 20 programs to determine goodness of fit.  If you spend time up front, you can figure out what are the make or break issues for you. For example, geography can be ​a principal determinant. Pick a few areas or a few programs- don't go bankrupt interviewing all over. The field of pediatrics will always have a great voice, a voice that we hope your generation will continue. I recommend you keep doing things like this where you are able to meet people, hear others' personal stories and create interconnections which will make your journey very fulfilling.

AR: A couple final pieces of advice, I would agree with Dr. Homme in that most of you have applied to far too many programs. You should plan to apply to a few reach schools, a few where you feel solid in terms of your competitiveness and those that fall in the middle. It's up to you to get organized and determine the places you want to interview and group them accordingly.  For us, in the state of Colorado, we are the only pediatric residency-training program. Because of this, we consider any applicant that comes to look at us as very serious. Think carefully about where you are going to apply, because you should submit enough applications to have interviews to choose from. Yet, if we had fewer applications, we would have more interview spots to go around.

LC: I think it's a scary time, where most of you are probably feeling very vulnerable. But don't let that anxiety overshadow you and force you to seek a comfort zone and project yourself as something that you are not. If you find a program that has an inherently honest fit, you'll be great- not good, but great. You can easily spot someone who is great at what they do, because they are competent, work hard and are passionate. It's that passion that elevates a person to a great hematologist, a great neonatologist or a great generalist. Finally, don't be afraid to utilize resources, such as us as program directors. Don't be afraid to come in and talk with us. Even if it's not about our particular program, we may be able to provide good advice that could ultimately allow you to land your dream residency complete with a resounding goodness of fit.