Beyond the Sexy: Seven ESSENTIALS to look for in a residency program (or medical school.)

Am I wrong for thinking out the box from where I stay?

Am I wrong for saying that I choose another way?

I ain't tryna do what everybody else doing

Just 'cause everybody doing what they all do

If one thing I know, I'll fall but I'll grow

I'm walking down this road of mine, this road that I call home

So am I wrong

For thinking that we could be something for real?

Now am I wrong

For trying to reach the things that I can't see?

But that's just how I feel,

That's just how I feel

That's just how I feel

Trying to reach the things that I can't see

Am I tripping for having a vision?

My prediction: I'mma be on the top of the world

Walk your walk and don't look back, always do what you decide

Don't let them control your life, that's just how I feel

Fight for yours and don't let go, don't let them compare you, no

Don't worry, you're not alone, that's just how we feel

~ Nico & Vinz "Am I Wrong"

_________________________________________________________

Choosing a residency program is such a tricky thing for medical students. After working so hard, it only seems right to climb on what most would agree is the highest ladder rung attainable. In every specialty, certain programs at certain hospitals hold that distinction. Those sit high on shiny platinum pedestals far out of the reach of most. These are the ones that you utter aloud and immediately garner raised eyebrows. Not the suspicious kind but the affirming kind that say, "Daaaaaamn. It's like that?"

Yeah.

Honestly, I'm not fully sure how it all happens. And by "it" I mean a residency program becoming so sexy that everyone loses sight of the details of what really should be considered in such an important choice. The name flies so high like a gigantic flag in the sky that what it represents (or even if the place is right for a particular individual) becomes moot. Everyone wants to be down with them and thus, one of the cool kids. It isn't a far cry from middle school, actually.

Yeah. I said it.

In all fairness, I should say that there are sexy, platinum programs in every specialty that are perfect fits for certain folks and also ones filled with people dedicated to creating great learning and training climates. But I guess what I'm thinking about right now is this simple truth:

Just because a residency program, or even medical school, is the most recognizable and shiny on paper doesn't mean it is the very best one for you.

Nope.

I will never forget my residency application process. I'd done fairly well in med school and was a student leader. As an underrepresented minority to boot, sexy programs found me sexy, too. And I hope everyone is getting my use of that word--sexy. I mean it in the "it place" and "thing-of-the-moment" way. Not the Pretty Woman-knee-high-patent-leather-boots way.

Just saying.

Okay, so where was I? Oh. Yes. Me applying to residency. So yeah, I applied to these sexy places and they granted me interviews. I'd walk in and see how I felt and hope for something inside of me to ignite so I'd know. That was my experience with medical school and college. That "eureka!" feeling.  But for the majority of my residency trail, it just wasn't happening.

Ugggh.

I was flattered by the number of interviews I received. I caught planes, trains and automobiles to places that any and every person, even the non-medical ones, would recognize when they saw the name. My chest would poke out a bit and my step would pep up some, too. And that? Yeah. That was cool.

The thing, though, was that nothing ever really stood out to me. I mean, the names sure did when I told people, but when I was in my quiet time, nothing else did. And here's the thing: I know I'm scrappy and that no matter where I went, it would ultimately be fine. But some piece of me kept hoping that "being fine" wouldn't have to be the goal. I wanted to be more than fine and I kept hoping  that, just maybe, one of these places would blend the sexy with the tailor-made fit I was looking for.

It came to a head half way through yet another two day interview back in 1995. I was shuffling around in my taupe heels and feeling mostly "meh" about this program that I was supposed to be jumping for joy over. I smiled politely during the resident lunch and asked a few questions. But mostly I was lost in my own thoughts.

What was I looking for? I think up until that moment, I had only asked myself that in a general sense. Again, I was just aiming for the highest rung on the ladder; the places that would puff my parents' and my deans'  chests out and garner the eyebrow raise of approval when spoken out loud.

Yep.

But in that moment, I realized that this wasn't enough. So I began to really, truly think about it. Finally, I distilled my needs down to seven critical things--the absolute essentials without which it might be a deal breaker. And in full transparency--NO, this wasn't written down in a journal back in 1995. But I did shift my thinking to reflect these things that I'm about to share.

Hand over heart.

My hope is that by sharing them, someone who is preparing to start this process for residency--or even medical school or a fellowship--can use them as a springboard to think of their own specific needs.

Oh, and spoiler alert: It probably isn't the stuff you think it is. Although hopefully after this it will be.

Like to hear it? Here it go.

Seven ESSENTIALS to look for in a residency program, medical school or fellowship program beyond just how SEXY the name and reputation are

Need #1  Genuine interest in me as an individual

No. Not the fake kind where you shake my hand and act all nice for a few moments. I needed to feel like someone there would be genuinely advocating for me, on my team and slugging it out with me to help me succeed. That would require time over time. Interest. Sacrifice.

Yes.

How could I tell? Well, for starters, the places where folks were genuinely invested in my potential there were prepared. It was obvious that at least someone in leadership had not only read but thought about my application and how I'd fit in. Some piece of my interview day was built with this knowledge in mind, too. They made eye contact with me and listened when I spoke instead of clearly calculating their next talk point during mine.

Yes. That.

We all know it when we feel it. And we all know it when it's absent. The key is just to not ignore the truth when someone is, well, blowing you off.

Need #2  A climate that won't force me to assimilate into someone I'm not

Look, y'all. I'm a black girl from inner city Inglewood, California. My high school was pretty much 80% African-American, 15% Mexican, 5% Pacific Islander and 0% anything else---and I attended both a historically black undergraduate college and medical school. Sure, I can speak standard English as well as the best of them and my fund of knowledge isn't or wasn't inferior to my non-black counterparts.

But.

By this point, I'd had 25 years of experience at being comfortable in my own skin. I am a woman who identifies with black culture and doesn't pretend it doesn't exist. I'm down with celebrating all that is you but don't really see the need to downplay my own identity in the process. And I learned quick that not every place is good for that kind of person. I'm not one of those people who, like plain yogurt, takes on the flavor of whatever gets mixed into it. I guess I like it more when our ingredients enhance but don't overpower. But still pop out as their own to create an awesome blend. So that? That was important to me.

Yeah.

Need #3  People in leadership with whom I can identify

I'll be completely transparent and admit that it definitely was a common practice amongst my Meharry classmates and me to immediately open a brochure (this was pre-internet, remember?) and count up the black faces in the residency program and on the faculty. Yup. That said, this need isn't only about how many underrepresented minority folks there are in the midst.

Nope.

So check it. You ever meet someone or watch someone in action and think, "That person? Now that's somebody I'd like to be like." Or even, "That person? He/She is my kind of people, man." And it's cool when you say that about someone who could be a potential peer. But man, oh man is it uber-awesome to be able to say that about one of the head honchos.

Okay, so the race thing. Let me go on ahead and further address that before going further. If you are an underrepresented minority (which, in my case you should read to specifically mean black person) whether or not a place hires and retains a significant number of people who look like you should be noted. If there is only one or two total in a really big program? Well. Honestly, that doesn't portend the best prognosis for a person like me.

I'm sorry if that sounds harsh. It's true, though.

Remember in that old movie "Do the Right Thing" by Spike Lee when that character Buggin' Out rolled up in the pizza spot and asked Sal, the owner:

"Ay yo, Sal! How come it ain't no brothas on the wall up in here?"

I mean, I'm not saying you should say it like Buggin' Out did, or even at all. But you should note it if you are an underrepresented minority in 2015 thinking about going there. Am I saying DON'T go? No. But I am saying, make a note of it.

Yeah man.

Okay, so with all THAT said, here's another thing I know for sure: It is not a prerequisite for someone to share my race or gender to be one with whom I can identify. Case in point: During my interview day at the program where I trained, I had an interview with two individuals that blew my mind. Seriously, they did. And guess what? Both of them were--wait for it--white men.

Yup.

They were both enthusiastic teachers and in love with caring for patients in the indigent setting. Even though they were leaders, they were still very much entrenched in clinical care and teaching. They were nice to their secretaries (which I always notice) and they also called nearly every person they encountered by name.

Including me.

I watched them both in a teaching conference interacting with the house staff and students. What's funny is that I'd made up my mind to go to that interview strictly because I'd waited too late to cancel it--and not showing up at all would be rude. Had this happened in the email and text message era? Chile please. I would've cancelled that interview quicker than you can say Rumpelstiltskin.

Which reminds me: True story--I wore a mustard-colored blazer, black full leg trousers, a multicolored silk neck scarf and a bold red lip. Why? Because it's not like this California girl was going to actually train in Cleveland, Ohio. (Did I mention? It was snowing?) Plus this wasn't even the sexy program for Internal Medicine/Pediatrics in that city. Matter of fact, a lot of folks hadn't even really heard of it outside of the midwest and--real talk--I'd only scheduled the interview because I'd already planned to be in town for another program (the sexy one. Ah hem.)

But.

The first of those two interviews was the first time that whole interview cycle that I felt that feeling that I'd been looking for. These were folks I wanted to be like. And they struck me as the type who'd do any and everything to help me not only be like them but exceed them.

And so. I recognized this as a need. People around me that I'd want to emulate and who had the time and interest in me to let me into their worlds. And--yes--a place with a decent representation of women and underrepresented minorities at all levels. Because even as wonderful as those two guys were--and still are since they remain two of my mentors--never seeing your phenotypic reflection in anyone makes it not only lonely but hard for people there to imagine your full potential.

#truth

Need #4  Openness to innovation and new ideas

For as long as I can remember, I've always been a creative type. Someone shows me something one way and I immediately start brainstorming ways to put a different spin on it. When I don't see what I have in mind, I set out on a plan to build it (within reason, of course.) That's always been my way.

Now. Raise your hand if you know what it's like to suggest something and to have it immediately flicked down like a gnat in someone's ear. Raise your other hand if you've been in that place where every suggestion is met with either a "yeah, but. . " or some other trivializing comment that tells you in so many words to "take a damn seat and go with the status quo"--even when it's an idea worth trying.

I sure have. So, you know? I now know that I don't do so well in such situations. By the time I reached the end of residency, I knew that this would be an absolute need for whatever place signed me on as a faculty member. Room to build, man. And not just tables that welcomed me to sit at them as a leader but a climate open to me busting out my own tool kit with a team--and building some new tables.

Yep.

What I know is that some of the sexiest programs and hospitals--due to their sheer sexiness--don't really have to give a shit about you and your new ideas. They can just look at you or through you and then nudge your little idea to the back burner. No, worse than that. To the trivet behind the back burner where it will go bad and stagnant.

Do some big name places welcome innovative ideas from young faculty and trainees? You bet. But not all. And what I now know for sure is that the platinum pedestal isn't shiny enough to make up for a place that doesn't foster development of new ideas and initiatives from people other than the highest folks on the food chain. I was looking for a place where hard work and a growth mindset mean something--and where ideas are at least genuinely considered.

Do you have to go with all my harebrained schemes? Nope. But I sure appreciate someone listening long enough to think about it.

Need #5  A soft place to land and a place of redemption

Being a doctor is hard. Combine that with life and other factors and it can feel suffocating. Not having a place to turn beyond your peer group makes for some tough terrain. What I know for sure from doing this for this long is that we are all human and humans are guaranteed to get something wrong or not live up to what someone thought we would. The bible calls this "falling short" which always sounds better to me than "screwing up" don't you think?

Ha.

Either way. I want to know that if I do something and it isn't perfect or if I feel lost or lonely or burnt out or upset or overwhelmed or whatever. . . .that there will be somebody there in that hospital standing ready to support me. This is CRITICAL in residency and medical school. Without it, you can make it, yes. But it's exponentially harder and more unpleasant when you are fending for yourself.

I also know that sometimes things just aren't fair for people who look like me. I mean, it just is what it is. So one thing I always hope for is that there's someone fearless and fair high up on the food chain who isn't scared to go to bat or offer another chance should one be needed. And no. Not some hand out of a second chance. Just the same second chance afforded to everyone else.

#truth

Everybody knows that falling down isn't the issue. It's how we get back up again. Having somebody there to give you a ring of gold and redeem you sure as hell helps.

#realtalk

Need #6  Opportunities for growth and challenge--and mentors to help identify the right ones for you

Are you a researcher? Then a place with ongoing research and a track record of funding is definitely one step. But if there isn't room for you in the lab or a chance for you to get involved in something that fits for you? That's a problem. And just because U.S. News said some medical center is THE place for the thing that you were hoping to investigate, unless you have numbers 1 through 4 on this list, it's likely to be a pretty lumpy experience for you.

Yup.

Are you someone who wants to teach? The place for you needs to have the combination of teaching opportunities and mentors who are ready to show you the ropes. Ones that are involved in national organizations and regional meetings that can connect you to people and push you to the next level. Folks who've gone far enough to drop some chafe for you to pick up behind them. And who aren't so caught up in themselves that they only do things out of self interest--not YOU interest.

I should say that sexy places often have money and resources. And, honestly, opportunities do require resources. It's important to consider this--but not at the sacrifice of everything else.

Especially your sanity. Hello?

Here's a question: Are all the leaders at the place you're considering folks who've been in the position for seven thousand trillion years? Are things dynamic--in a good way? Are you interviewing with people who've been on faculty for 25+ years--but who are still at the Assistant Professor level? And for the underrepresented minorities and women, here's another question: Has there ever been a chief resident, chair, dean or program director that looks like you or that has the same number of X chromosomes as you? If you don't ask yourself that question, you should. Because chances are that you aren't the first talented woman/person-of-color to enter that place as of 2015. And you should wonder what's up with that.

Even if no one has noticed or considered it, you should. So if in 2015 you don't see any diversity in leadership? Or some history of it? Something IS up with that.

Yeah, I said it.

Look. I'm just saying--just maybe--no matter how sexy the place is--a homogenous leadership or leadership history just might be a red flag. Or at least a reddish one, depending upon what you have in mind for yourself. It could say something about the amount of opportunity there--just maybe. Especially if you don't fit the look of the homogeneity in the high ranks, nah mean?

Look, man. For somebody with leadership potential who's hungry to go further? This is a big deal. And for me, a black female with interest in such things, this was the case. Which is why this proved to be one of my 7 essential needs.

You feel me?

Need #7  High Expectations and Motivated Peers

Man. This is perhaps the most important one of all. Let me explain.

Okay, so check it. My parents expected SO much of us growing up. They had a fit when we brought home a 'B' in a class where our potential was an 'A' and they never shot down our dreams to try hard things. Expectation is a mighty motivator for young people. Over time, I began to realize it was something that, when absent, caused me to sag like a heavy load.

Yup.

They also put us in activities and challenged us with things in the presence of other kids who were striving to do well. The competition was healthy. Being an intellectual standout around those who don't challenge you can make anyone lazy or bored. And everyone knows that this never ends well.

Nope.

What else? Oh. Yes. With residency and medical school, people select you. I mean, sure, you somewhat have some say in it, too, depending upon how academically superstar-ish you are, but still. The sexiest programs have the most say. And the super-duper-sexy ones have even more say than the top percentile applicants.

Yeah, I said it.

And guess what? I'm also going to say this: Depending on the place, those academic superstars aren't immune from being tossed into a giant stack of nondescript high achievers on a roster. And given not much more than the gold star on their lapel that comes with being a member of the training program at "Sexy-everyone-thinks-it's-awesome Hospital."

Yeah, I said it.

See, just because you got straight A's and were a student leader and got on their radar doesn't guarantee that someone will be there interested in you on a daily basis, pushing you and recognizing your talent enough to expect something uniquely better from you year after year.

Did you catch that? Uniquely better.

That means they have see you. Then recognize your talents and consider you for things that might be a fit. It means checking in with you and seeing if you're following through on things and giving you a kick in the pants when you aren't. Without expectation, it can feel like no one ever knows how hard you're working or worse, they do know but don't care.

And look. Maintaining expectation is exhausting for clinician-educators and administrators. But, in my opinion, any program that isn't willing to work at this for each and every resident or student in their program or school? Well. It simply wasn't the one for me.

Nope.

So. There you have it. My seven essentials.

Oh. So what does this all mean? Well. It means that there are things far, far more important than being on the platinum pedestal "it program" list. It means that the gold star on your lapel as your only prize short changes you regardless of how dizzy with glee it makes everyone to say when asked about you.

Now. I do need to add this disclaimer:

I know some amazing, amazing human beings at sexy programs--or who trained in those sexy med schools and hospitals--who get all of this. They get that no matter what, every person--students and residents and young faculty included--want to know that someone is seeing them and being intentional about helping with their future. And no, it doesn't have to be everyone. But someone.

Someone.

So that brings it back to me and my experience. College was at Tuskegee University. I am proud of my alma mater, but would be lying if I told you that I've encountered scores and scores of fellow Tuskegee alums at my medical meetings--even all added up after nearly 15 years of going. Nope. As far as being pre-med goes, in the early 1990's when I was there, Tuskegee definitely was not a sexy pre-med choice. It was more of an engineering and pre-vet med place. But did it have #1 - #7? Damn right it did.

Next? Meharry Medical College. Teeny tiny. Historically black. And frustratingly the place that people either mispronounced or looked puzzled over when you told them that you went to medical school in Nashville but didn't attend Vanderbilt. Historic? Absolutely. Sexy? Meh. That said, I left there strong and a leader because of the nurture given to me in the form of #1 through #7.

Yep.

Then came that tricky residency choice. Did I have good interviews? You bet I did. And were a good bit of them sexy? Without question. But the place I chose was the county teaching hospital affiliate of Case Western Reserve University in Cleveland, Ohio--MetroHealth. Those who know Cleveland know that this isn't the "it" program in that city by a long shot. But once I knew what I really and truly needed to succeed and ultimately thrive, that didn't matter. MetroHealth in Cleveland, Ohio was my very first choice on my rank list--and I was delighted to open my envelope on match day and learn that I was among one of theirs, too.

And guess what? Three non-sexy choices later, here I am. Happy. Whole. Confident. And dare I say it? Pretty darn successful so far. I'm proud that these places all get credit.

The take home for any and every person reading this--especially medical students and pre-medical students--is this:

Know what's important. Don't be so caught up in a name or a brand or the reaction you get when mentioning a place that you ignore your own unique needs as an individual applicant. Don't be afraid to rank the place that feels right. You know, the one with the kind, empathic, and innovative program director in the city that you worried wasn't sexy enough or the program that is only sexy-ish. Fight the urge to count that place out. And please-- don't be tricked into thinking that, by definition, just because you performed at a high level academically that you shouldn't look into places that seem like they might have what you need in your #1 - #7--even if they aren't on THE (insert your favorite media source) Top Ten hospitals or programs.

*Eye roll*

Oh, and medical students who just matched? If for some reason you didn't get your first choice and ended up somewhere you didn't expect to get, please--for the love of God--don't show up like a wet noodle or assuming your life has ended. Don't arrive already plotting your transfer or repeatedly telling people about all that is better, shinier, sexier about the other four programs that didn't pick you. Instead, refocus your attitude. This could be the best thing that ever happened to you. Just because people don't wet their pants when you say where you're going doesn't mean it's not a great program. Look for the things in that list. Chances are, if the place has those things, it will work out great.

Take that from a Los Angeles native who spent five years in Cleveland, Ohio. And who has historically chosen places that garnered the other kind of eyebrow raises (amongst majority folks.)

Which brings me to the last point:

This was MY list of seven essential needs. While I do think that most of these are important to any and all people facing this step, maybe some don't. I would urge you to sit down and create your own list. Ponder what you need and push yourself to think of the abstract things that can't be found on program websites or your CV but that can guarantee misery if ignored or not considered.

For me those are:

1. Genuine interest in me
2. Permission to be authentic
3. Some people with whom I can identify (professionally, genotypically and phenotypically)
4. Openness to new ideas and vision
5. A soft place to land
6. Opportunities for growth
7. Great expectations

And you know what? Last time I checked, none of those were among the factors that get any place ranked  number one on any lists.

But you know what? They should be.

That's all I've got. And hey, that's just how I feel. 

***

Happy Sunday. (And congratulations on reading that entire ramble.)

Now playing on my mental iPod. . . .