General Surgery

1. Academic vs. Community Programs: Are you interested in academic surgery or community practice? Going to an academic program does not preclude you from going into a community-based practice, or vice versa, but doing residency in a community-based program may limit your fellowship prospects in the future. However, many community programs have become hybrids that are now affiliated with universities. For those interested in community-based practice, community programs can afford higher case numbers and more technical practice.
2. Specialization: : Are you interested in general surgery or do you think you may want to do a fellowship and specialize in Cardiothoracic, Transplant, Pediatric, Plastics, Vascular, Trauma/Critical Care/Acute Care, Surgical Oncology, Colorectal, Minimally Invasive, etc.? The majority of general surgery graduates go into fellowship (85-90%). If you think you will end up specializing further, look at which sub-specialties and fellowship programs are represented by recent graduates. If you think you want to go into community-based practice, see if graduates go into private practice.
3. Location: A good place to start is to decide if you want to practice in an urban setting or not. Beyond that, do you have a preference regarding the geographic location of the program? Make sure you only apply places you would actually spend the next five to seven years (or more) of your life. If applicable, speak to your significant other or family regarding their preferences. If you have a strong geographic preference (especially on the West Coast), it’s important to voice your particular interest to programs. There are >1,500 applicants in general surgery, so if it doesn’t seem to a program that you would actually venture that far away, they might not interview you unless you personally reach out!
4. Research: If you are considering a competitive sub-specialty (like Pediatric Surgery or Surgical Oncology) you will likely have to do two years of research during your residency to be competitive for fellowship. Some programs have two mandatory years of research for all residents, some send a specified number into the lab each year, others have no built-in research time. Most of those that do not are open to their residents taking one or two years during their residency to do research or a critical care fellowship (critical care fellowships are usually only available after PGY-3). Be sure to ask the program what the policy is on research and whether they will provide funding. Programs which fund research may have clinical obligations (2-4 monthly shifts) or allow moonlighting during research years, if you ask about this on an interview, make sure to clarify that you are specifically asking about the research years (otherwise it can sound like you don’t think you’ll already be working the full 80-hour work weeks). Programs have varying degrees of flexibility in terms of how many years you can do research, what degrees you can earn, and who will pay for your degrees/research. These are all important questions to ask while on the interview trail.
5. Program Specifics
6. • Fellows: Does the program have fellows? This is a double-edged sword. A program that can support fellows means that they do a lot of cases in those subspecialties, but it also means that the fellows may have priority in such cases. However, it can be beneficial to go to a place that has a fellowship in your area of interest as fellowships are also more likely to take their own residents, and you can get strong letters of recommendation from important people in the field. Generally speaking, fellows enhance your training at the junior level when they are the ones teaching you the case; but, may detract from your training at the senior level if you have to share your case load with them.
   • Experience: How much do the residents operate, and what sort of cases do they do? General surgery residency is as much about learning how to take care of patients as it is about learning to operate, so a resident who graduates with 1400 cases is not necessarily a better surgeon than one who graduates with 1100. Breadth of cases is also important. Generally speaking, academic programs send residents to the OR later in their training than community programs. There are minimum case requirements set nationally by the ACGME both set by year and by procedure type. Make sure there are no deficiencies or difficulties in meeting these requirements. Also ask about midlevel providers/physician extenders (NPs and PAs), because they are often the key to getting into the operating room as a junior resident. Finally, if you’re interested in teaching, it’s important to ask about teaching cases and autonomy, as you want to find a program that will allow you to lead a junior resident through a reasonable case by the time you are a chief resident.

Resources

Who do I reach out to?

• Our Interim Chair, Dr. Christine Lau
• Our Program Director, Dr. Stephen Kavic
• Other Faculty: General surgery has many subspecialties. When talking to a faculty member, they tend to know the best programs for their subdivisions. Speak to faculty in different divisions to give you a better idea of what the best programs for you are. It is likely that by this point you have developed relationships with the surgical faculty and perhaps have some mentors. Approach these people during the process and keep them involved. They give great advice and can really help you out at all stages of the process! Remember!! Faculty impressions of different programs may be outdated so don’t let a faculty opinion ruin a program for you. Go and find out for yourself!
• Residents and Fellows: These are the people who have gone through the process most recently so they can give you a great up-to-date perspective on the whole process. Additionally, ask them which programs they liked when they applied and how the program was at their medical school.
• Senior Medical Students: Ask us questions while we are still around! We are finishing up the process so the details are fresh in our minds and we can give you tips on navigating the process as well as programs we liked.
• Recent Maryland graduates: While they are likely quite busy, they will often remember programs that stood out to them. OSA can usually direct you to a recent alum that will be helpful.

Hints 

• All of the above people can tell you how competitive a candidate you are and give you ideas about where to apply; keep in mind that surgery as compared to other fields of medicine tends to be a little more self-directed during this whole process. If you feel lost just ask any of the above people for advice.
• People you can always reach out to with questions are Dr. Kavic , Dr. Buchanan , and Dr. Gens.
• Have a SURGEON read your personal statement.

Other Resources

• Books: So you want to be a Surgeon by Johansen and Heimbach and Iserson’s Getting Into a Residency by Kenneth V. Iserson M.D (not specific to surgery) 
• Doximity Residency Navigator 
• FREIDA Online
• The Match Data Reports
• American Board of Surgery First Time Pass Rates
• Article on Parameters to Evaluate Programs

Scheduling 4th Year

• Sub-Is
• 1. Do at least one early on at UMMC/Shock Trauma (i.e., July or August)
  2. It is best to be known by a wide variety of faculty. Surgery is a small world, so when you’re off on the interview trail, it’s likely that many of your interviewers will know some of our Maryland faculty, but this tends to be specialty-specific. If all of your research is in Trauma, maybe do your sub-I’s in Surg Onc and MIS to get to know more faculty (and vice-versa). The more people that know you, the more people that can vouch for you as a strong applicant and budding surgeon!
  3. If you think you will need two sub-I's to get all your recommendations or you think you want to get your toughest months over with, do 2 sub-internships early on (July-October)
  4. Sub-I’s are a good chance to confirm that surgery is right for you and to get letters of recommendation from faculty
  5. Do a sub-I that will interest you and is possibly in the area of surgery in which you are interested but here is a list of some good sub-internships and potential letter writers:
  6. • ACES – Dr. Diaz
     • Trauma – Dr. Scalea 
     • Cardiothoracic - Dr. Griffith
     • Transplant - Dr. Bromberg
     • Surgical Oncology - Dr. Olson
     • Vascular – Dr. Sarkar
     • Minimally Invasive – Dr. Kavic
• Away electives
• 1. Unlike other specialties, away electives are not a requirement for General Surgery, but they can be a great chance to learn a new hospital system or live in a new city.
  2. If you have a strong interest in a program, doing an elective may help, but bear in mind that a bad performance may hurt your chances as well. An away rotation is a good opportunity to see how another program works and find out what you are looking for in a program. An away rotation only helps/hurts you at that specific program. Another program in the same city will not be impressed or deterred by you spending a month in that city.
  3. Doing an away does not guarantee an interview at that program, but it may help you get an interview at program who might not otherwise consider you. If you do it early enough, it may help get you a letter of recommendation from a surgeon who is not at your home school. Be wary of using a letter of recommendation from an institution that is not your home school. Other schools may or may not look favorably on this.
  4. Scheduling: This is program-specific. Some programs use VSAS for applications (similar to ERAS but for away rotations), which you can access online. The OSA is comfortable helping students with this. Other programs have their own written application that you must submit. The important thing is recognizing that you want to apply to and/or do an away rotation early so you don’t miss any deadlines! These can be as early as April.
• Research
• 1. If you are interested in a career in academic surgery or training at a large academic center, having research is a must.
  2. Many of the surgery faculty at Maryland maintain active laboratories or are involved with clinical trials and are happy to have a 3rd or 4th year do research. You can either just help out on a project or sign up for a formal one or two month elective. Deadlines for applying to the elective are usually six weeks before your desired start date.
  3. If you have already completed a research project, be able to talk about it intelligently. It can be helpful to review your research before interviews, so that you are familiar with important details (like sample size, odds ratios, etc.). Know how your project fits into the greater context of the field and where future directions are going.
  4. Try to get at least a poster presentation or get published by the time you interview. There may still be time to do a small project during your third year (particularly on lighter rotations) and have something submitted or even accepted by interview season. Any projects submitted before ERAS submission should be included, so push to get projects submitted before that deadline. You cannot add or change your ERAS submission once completed with new projects.
• Letters of Recommendation
• 1. Plan on getting 3 letters plus a Chair’s letter from Dr. Lau. It is required by most programs to have at least 2 (plus the Chair’s letter), and you can send up to three (plus the Chair's letter). Programs differ in their requirements, so it is good to check if you plan to apply to a program that requires four letters. Submit only the number of letters of recommendation requested by programs, no more and no less.
  2. Try to ask them in person and while you are working with them (like at the end of a sub-I) so you are fresh in their mind. If you are doing a sub-internship with them closer to the application deadline, it may be helpful to let them know that you are planning on asking them for a letter earlier on so that they can pay more attention to you and have the letter finished shortly after the sub-internship ends.
  3. Meet with Dr. Lau and Dr. Kavic near the end of 3rd year so they know who you are. Then meet with Dr. Lau again in early 4th year to ask for a letter. He writes a letter for all applicants to general surgery so don’t be nervous! Have a CV complete to bring to the meeting and dress nicely (NO scrubs)!
  4. Try to have a packet for each letter writer that contains: a copy of your CV, application, personal statement, transcript, and a list of programs
  5. Ask for letters in July, August, and September. Remember you need to give them time to write the letters and you want to have your application completed ASAP (submitted ON day 1, 9/15)! Let them know the date of the deadline far in advance. Surgeons are busy.
  6. Don’t be afraid to follow up with your letter writers to ask if they have uploaded your LOR. Some letter-writers are notorious for not getting letters in so ask around about this and really (politely) encourage the writer.
  7. In surgery, big names mean more than gushing letters. Surgery is a relatively tight-knit community and people know the stars. A well-known department chair saying you are good is a better letter than an assistant professor saying you are fantastic. That being said, if the department chair has no idea who you are, that letter won’t mean much either. The greatest compliment you can get in a letter is them saying that they want to keep you at Maryland.
• Applications
• 1. Make a list of places in which you are interested and discuss this list with your mentors and potentially Dr. Lau.
  2. Consider too, how many places you want to apply, size of programs, locations, community vs. academic, strength of subspecialty at program.
  3. List a wide range of programs—from “reaches” to those you think you can match into easily.
  4. The interview offers can seem random at times so applying broadly is to your advantage.
  5. The number of programs you apply to varies depending on the applicant:
     • On average most people apply to 25 programs (you can apply to up to 30 programs without incurring any extra costs)
     • Applying to a preliminary position at a program to which you are applying to categorical counts as 1 program.
     • Don’t feel like you have to apply to more or less—just remember that you want to get enough interviews (10-12) so that you can rank 10-12 programs.
     • Apply to the University of Maryland both categorical and preliminary. All Maryland medical school students are automatically guaranteed an interview for a categorical position. All Maryland medical school graduates are guaranteed a preliminary position if something were to go wrong in the match, this is your back-up.
  6.  There is only 1 application to fill out on ERAS.
  7.  Have your application ready for submission by September 15! This is very important! It is NOT a requirement that all of your letters of recommendation be in by the time you certify. You can add them as they are uploaded, but it is nice to have most of them in by this point. Some programs may not offer an interview until your letters are submitted – and the offers can come very early for some programs!
  8. You will receive most of your invitations in October and November. Programs often wait until the MSPE is uploaded (October 1) to start offering interviews. Do not get discouraged or panic when your classmates applying in other specialties tell you that they already have invitations by mid-September. Your time will come!
• Interviewing
• 1. Pre-Interview: This year, Dr. Gens and Dr. Buchanan did mock interview sessions to help us prepare. If you want some practice being put on the spot (they ask everything) and seeing how you sound/appear, do this. They film your interview and give you excellent feedback. Many of the deans are willing to do practice interviews as well.
  2. Interview: Read up on the program prior to the interview so you are educated about why it is a good fit for you (you will likely be asked that). Find out as much as you can about a program by talking to residents and faculty; remember you are going to be at one place for 5-7 years so you better be happy there! GO to the pre-interview “meet and greet” if there is one (and if you can’t go, email the PD or residency coordinator early with your regrets). It’s a great place to ask questions to the residents and see if you will fit in there.
  3. Interview: Be prepared for the common questions: Why surgery? Tell me about yourself. What are your strengths? What are your weaknesses? Then, most programs ask you what type of surgeon you want to be and where you see yourself 10-15 years in the future. Some programs are more intense than others. Generally, you’ll have an orientation in the morning then several faculty interviews. Many programs allow for you to meet with the Program Director(s) and Chair individually or in a group, but not all. Make an effort to meet them if there is no set interview.
  4. HAVE TONS OF QUESTIONS! You will be asked from the moment they meet you until the moment you leave if you have any questions. Programs like it when you have questions specific to their program, but some good standard questions: Fellowship placements? Research opportunities? Funded? What is the biggest strength of program? What is faculty-resident relationship like? Try to ask questions that tie both your specific interests and strengths to the programs'. The interviewers will be meeting many people that day and answering the same questions over and over again, so try to find something unique. Note: instead of asking, “What don’t you like about this program?” it is better to frame the question as, “Are there any ways in which you think your program could improve?” Don’t be negative!
  5. Send thank you notes to all your interviewers and maybe the Chair and Program Directors, especially if you are highly considering the program. Some programs will request (hand-written) thank-you’s. If they do this, then make sure to send them! Otherwise, emails are appropriate. That being said, don’t be a tease! You can be polite and thank someone for the opportunity to interview and learn about their program without absolutely loving everyone you met and hoping for the chance to learn from them (if you get what we mean).
  6. If you accept an interview at a program and later decide you don’t want to attend the interview, let them know as early as possible! It is the polite thing to do for your fellow applicants and future colleagues who may be looking for an interview at that program. Also, simply not showing up reflects poorly both on you, your classmates who are also applying general surgery, and Maryland in general. Programs talk to each other, so you may get a black mark at another program for not showing up to a completely different one!
• Rank Order List
• 1. Discuss your choices with advisors, residents, mentors, etc.
  2. Talk to Dr. Lau and Dr. Kavic — they should be able to make some phone calls on your behalf to your top programs. Other department chairs may be willing to do this as well, particularly if they have a connection to the program. If you know you are ranking a program #1 then it may benefit you to email the program and let them know. If you are in their top group of applicants, knowing that you are ranking them #1 will only help you.
  3. Note: many faculty will only make phone calls on your behalf to your #1 program.
  4. Some programs contact applicants to gauge their interest as well – don’t be surprised to hear from programs during rank-list time.

For more information please contact:
Ilaria Caturegli

Last Revision: February 10, 2020