Sunday, 3 March 2013

What Makes A Training Program Good: Factor To Consider When Ranking Programs For The Match – Congruence

Part 2 of series titled: what makes a residency training program an excellent choice.


Few days ago, I wrote an article about the educational aspects of what makes a program attractive. Today, I will touch upon another important facet: how well you think you will fit in. Once you match into a program, you will be a part of the machinery in the institution. You will learn how things work, execute actions and yourself become an indispensable widget in the big scheme of things. Hence, it is imperative that you match to a place that you recognize provides an excellent fit as far as work is concerned.

Some problems that may come up as a result of poor adjustment (resident adjustment disorder) can be friction with colleagues, lack of support from faculty, joyless work environment, tedium of daily chores, hardship during training and most of all attrition of resident morale, compromise with educational training and ultimately, effect on patient care. Thus, the consequence of that one small part that does not fit in, is wide and far reaching. There are many areas where incongruence can occur and if not recognized and ameliorated can lead to many of the effects mentioned above.

Emotional in-congruence:
Training in internship and residency is tough. You have to have a certain level of emotional maturity to deal with the long hours, difficult personal and professional decisions, and place above self the welfare of the patient under your care. If there is an attitude and expectation, that you are above the rest, this will very quickly degenerate into a unpleasant situation. One must recognize that you are part of the team and if that sense of team work is lacking then that program is one to steer clear of. See if your personality traits match those of current residents. What drives them? Is it the same for you?

Professional in-congruence:
In almost all programs you will find a multitude of resident personalities. The perennial slackers, those that do just enough to stay in the black and those that go above and beyond the required level to make it better for everyone. Get a good feel for the approximate breakdown for the three types in the program. You can bluntly ask the chief resident “what percent of your current residents do not go that extra mile to get things done? Or like to slack off?” If there is an alarmingly high number [30-40%] of these personality types, then it may become a burden to work there.

Physical in-congruence:
If you are the only foreign medical graduate in a program that has only American graduates this can create a situation of misunderstanding. This physical incongruence should not prevent you from considering ranking the program but should remind you to work at improving communications. What may considered as a norm for most of graduates back home may be in fact a contentious issue for your colleagues. Do not hesitate to explain yourself should you find yourself in a situation where there may be doubt regarding what you mean.

Lock has to fit the key as well, Does the applicant provide a good ‘fit’ for the program?. The programs also keeps an eye out for applicants that will fit in. Remember, match is a two way process and the programs are looking for applicants who will embrace the work ethic, the values of the institution and be almost ‘zero’ maintenance. In fact, an applicant who has awesome scores but has had issues with faculty, insubordination or interpersonal problems may be considered lower than someone who scored lower on exams but is easy going, great to get along with and hard working.

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