Pediatrics

• Thinking about Pediatrics? Well, don’t sweat about the application process. Though many people are concerned about pediatrics becoming more competitive and most residency directors would agree that the number of applicants is increasing, just remember that there are TONS of programs (about 200) and therefore TONS of spots (over 2,500). Do as much as you can to help yourself by learning as much as possible about the application process, plan to submit your application early, and everything will be fine!
• Most students apply for “categorical” positions in pediatrics. This means that the programs expect the applicant to complete three years of training in general pediatrics. There are several combined programs: Med-Peds, Triple Board (Peds, Adult Psych, Child Psych), EMPeds, Peds-Neuro, Peds-Neurodev (boarded in neurology, pediatrics, and neurodevelopment), peds-genetics, peds-anesthesia. These programs vary in the number of actual pediatric years of training. Pediatric fellowships exist in all the traditional subspecialties: cardio, GI, critical care, etc. There are also several fellowships unique to pediatrics: genetics, developmental peds, neonatology, etc. Most fellowships are three years long. There are some 1 year fellowships gaining popularity like palliative care or academic medicine.
• An increasing number of programs have developed two tracks to provide a more “primary care/outpatient” based or advocacy based training for those interested. You often have to specify on your ERAS application whether you want to be considered for a particular track. You are not locked into anything at this point. It just indicates which program(s) you want to be considered for.

Last Revision: February 19, 2020

TALK TO PEOPLE ABOUT PEDIATRICS

• Attend the department dinner for students interested in pediatrics (you will receive emails about this from the Pediatrics department). . The pediatrics department will also have additional meetings about interviewing, etc. throughout 4th year which they will contact you about.
• Your advisor: It can be extremely helpful to find an advisor in Pediatrics at the end of third year/start of fourth year.
• Tap into resources within our own pediatric residency program. For example, current program director Dr. Guidice trained at Maryland and Dr. Cater trained at Children's National. They are both very knowledgeable about different programs and what the programs are looking for, very nice and approachable and willing to help you out. The deans in OSA who will be writing your MSPE letters are also a wonderful resource, and can give you some insight into pediatrics from an outsider’s perspective.
• The department chairman, Dr. Steven Czinn, is a nationally known pediatric gastroenterologist. He trained at Rainbow Babies and Children’s Hospital in Cleveland. Some programs require a letter of recommendation from the department chair. You will have to be proactive to schedule an appointment to meet with him so he can get to know you before writing a letter. You will need to provide him with a copy of your personal statement, most recent CV, and any completed evaluations from pediatric rotations. Information about when and how to set up your appointment will be given to you at the meeting for students interested in pediatrics.
• Any other faculty members...just keep talking to as many people as you can. Just remember that a lot of things may have changed since these people have finished their training.
• Fourth year students who have recently finished the interviewing process - while we are still around.
• Other residents and faculty in our pediatrics department are also a great resource as they may have had exposures to other programs.
• Pretty much anyone you ask will give you their opinion about residency programs. Just remember that things have changed at all programs recently and not to take all this advice as gospel. You need to go and see for yourself if you’re genuinely interested in a program. Also remember that people may like or dislike programs for their own reasons which may not pertain to you so just because someone hated a program doesn’t mean that you yourself won’t love it.

START YOUR APPLICATION EARLY

• Update your resume/curriculum vitae NOW. . . it will come in handy for the application as well as for your letters of recommendation. As busy as you might feel right now, when it comes time to do your ERAS application, if your CV is totally finished it will be much less of a chore. Recently OSA has required submission of an updated CV well before ERAS has opened, so you should be well prepared. The application itself is not painful at all and is basically just retyping your CV in a different format.
• Upload your personal statement into ERAS early and check the length using the print preview function. One page in word is bigger than one page in ERAS. You may need to trim your PS down to get it to fit.
• Visit the ERAS website at http://www.aamc.org/students/eras/start.htm and become familiar with the application process, timeline, and fee structure.
• You will receive an electronic code from OSA in the summer in order to register with ERAS.

• DO YOUR HOMEWORK ABOUT RESIDENCIES

• Search for pediatric residency programs using the FREIDA
• Visit program websites (most have links in their FREIDA entry) to learn what makes the program unique and to get a sense of its “personality”. The website is where you can see the breakdown of categorical vs. med-peds vs. primary care vs. triple board residents. It is also helpful to see where the current residents went to medical school to assess whether your background is similar or if the program is more of a “reach” or includes trainees from different types of programs (DO, Caribbean, IMG).

• LEARN ABOUT THE MATCH

• Visit the National Residency Matching Program (NRMP) website to learn about the match algorithm. You’d be amazed at the number of misconceptions are out there regarding how the match actually works. It will save you a lot of grief by understanding the algorithm. It will also help you avoid the confusing advice people will give you about “match strategy”. Overall, the advice heard over and over again is to simply rank in the order in which you liked each program (for whichever reasons are important to you) without taking into account where they may rank you. The Match always favors the applicant!
• Become familiar with the Main Residency Match Schedule! There is also some useful data tables of the PGY1 positions offered and filled by specialty.

As far as Sub-I’s go: many students do both of their sub-I’s in pediatrics, but this is mainly because they enjoy them rather than it being required. Doing a month on the Peds floor can help boost your confidence for intern year, and many feel a month in the PICU or NICU is helpful in orienting you to the unique ICU environment. That being said, some students do sub- I’s in other specialties to get some variety during 4th year, which is perfectly fine as well.

Personal statements are rarely something that make or break your application, but nevertheless they are important. Many people are happy to look over your personal statement for content and reassure you that you are on track with your personal statement. Feel free to ask people in OSA: Dr. Thom, Dr. Lamos, or Dr. Allen. Dr. Giudice - Residency Program Director, or Dr. Carter , a trusted attending, or your letter writers.

DON’T FORGET TO APPLY FOR THE MATCH on the NRMP website. It is a separate application from ERAS. The registration deadline is in November (OSA will remind you of this as the deadline approaches).

• Away electives are not required for Pediatrics. That being said, if you have a program/location you are particularly interested in, or one that may be a reach for you, doing an away elective can demonstrate your interest in the program to the intern selection committee and get your name out to faculty and residents who already work there. They are also helpful to gain a better understanding of programs that function differently than UMD (i.e. stand alone children’s hospital, or a small program – whatever your interest is!).
• If you decide to do an away rotation, it is highly recommended to do an elective (rather than a Sub-I). It can take some time to get to know a new hospital, EMR, etc., which could negatively affect your performance on a Sub-I when your responsibility level is typically much higher than when you are on an elective.
• Get your application and other requirements (i.e. immunization records) in as early as possible. Even if you are not positive you will do an away rotation and are unsure of where/when, is a good idea to check the immunization requirements of the specific programs that may be of interest to you. Some programs require titers that are not required at Maryland, which could hold up your application if you do not have them completed. Consider beginning the application process during the early spring of 3rd year.
• Most people aimed to do away electives early in fourth year, but you’ll have to decide based on your schedule. An away elective at any time during the summer or interview season will help you show interest in a program. Don’t worry if you can’t get one during the summer months. It is more important to do an early sub-I than an away elective.
• Many places require that you have completed all the core rotations (medicine, peds, surgery, and ob/gyn), which is proven by your transcript. If your grades are not on your transcript, you can ask the clerkship director to write a short note verifying you will have completed their clerkship by the time you do an away rotation. Again, if you choose to do an away rotation, you should try to get a letter from that elective.

• Try to do a sub-I at the end of third year (if your schedule permits) or in the fall of forth year early in the yearif you can. If you cannot, it’s not the end of the world!. There are only a limited number of sub-I spots, so depending on the number of students applying for pediatrics in any given year, it may not be possible to do a sub-I at that time. If you are unable to do an early sub-I, If you can’t do a sub-I early, try to do a few more involved electives in Pediatrics early on (some good options include Heme/Onc, ID, GI, Nephro). These electives are also a great way to get letters of recommendation. You must complete either one elective OR one sub-I in medicine, otherwise everything else can be peds. For AHEC, you can also specify that you are interested in pediatrics, and they will try to set you up with the opportunity to see kids.
• You get 8 weeks off in 4th year (between July and May). Most people will take off either Nov, Dec, or Jan to interview, as the majority of pediatric interviews are held late October to mid-January. The other break time is up to you. It’s a good idea to either take another 4 week break to study for step 2 clinical knowledge (especially if you really want to improve on your Step 1 scores) Interview season is fun and exciting, but also very stressful. It would be hard to study for Step 2 CK while interviewing. If you want to use the other month to interview, take Step 2 CK during an easy elective (i.e radiology)
• If you want to take Step 2 Clinical Skills in Philadelphia, you need to register for that right away because the spots there fill up quickly. "Right away" means March/April of third year - sooner than you think! CS can typically be completed later than CK, as there is a high pass rate and programs typically don’t place much weight on this (though of course you should pass).
• If you’re not sure how important your CK score is for your application, talk to the OSA deans about whether you should do it earlier so that your score is back by the time you submit your application (around Sept 15). If your score is not back by this day, you can always submit/send your application to schools without your CK and/or CS score - just remember to re-submit your score card whenever they do come in, because almost all programs will require these before they will commit to ranking a student.

Most importantly, have fun! 4th year is a blast – you finally have a say in your education, do things you’ll never get to do again, take lots of vacations, and enjoy lots of traveling during interviews. Do your best not to stress about any aspect of the application process. (If you keep on top of things and do everything as early as you can, you shouldn’t have a reason to stress!!) Enjoy this unique time in your medical education!!

Last Revision: February 18, 2020

1. University (U of MD) vs. Community (Sinai)

2. Within university programs: Freestanding children’s hosp. (CHOP, Children’s National) vs Hospital within a hospital (U of MD, Duke, Columbia)

• Type: This is a big decision. There are major differences in the running of the hospital and the make-up of your colleagues depending on which type of program you choose. In general, free-standing children’s hospitals are busier with more admissions each night and have a lot more pediatric residents. There is no OB dept in house so you will go to an affiliated institution for well-baby and newborn nursery rotations. Freestanding children’s hospitals have their own NICU (generally for referrals/transfers) and residents frequently will also rotate at a smaller NICU in the affiliated adult/women’s hospital. At the freestanding hospital, most (or all) sub-specialties are well represented...and therefore there are more fellows running around. You need to assess how fellows and residents work together and who is running the show. In hospitals within a larger medical center, you will have more interaction with residents of other specialties...but the focus can be less on children in terms of labs, radiology, sedation, phlebotomy, etc.
• However, there is also a wide variety among the hospitals within a hospital (a pediatric service that functions autonomously but does not physically stand apart). There are the “freestanding-look alikes” like Rainbow Babies and Morgan Stanley Children’s Hospital that have the majority of the perks of a free-standing hospital but are still technically part of a larger medical center. There are hospitals like U of MD that are only a floor or two within a university medical center…and everything in between (UNC, Duke). Most pediatric hospitals within a hospital call themselves Children’s Hospitals.
• There is no right or wrong answer here...just things to consider and ask about when visiting. Consider the environment you best learn in - do you work best in a fast-paced environment with repetition in cases or a lower-volume environment that affords time to read about patients, but would expose you to fewer cases overall. Your general career aspirations may also weigh into the decision. If you are interested in academic medicine, research or fellowship, you would probably be better-served by a university program or children’s hospital, mainly because of the networking and exposure to sub-specialists provided by these programs. However, most programs have similar rates of graduates getting into fellowship, so don’t let that be the sole determinant regarding which programs you visit or rank. Also, do not worry if you are unsure if you want to specialize in the future or not when making this decision. If you are unsure about what type of program would serve you best, then apply to a variety of programs to “try them out” during interviews.
• Size: Programs range from “small” (5-10 interns per year/15-30 total residents) to “large” (>20 interns per year/60+ residents total) and many fall into the “medium” category (10-18 per year), including University of Maryland. Think about the benefits and drawbacks to both (eg larger program has easier cross-cover/ more flexible schedule, but smaller programs may have more autonomy and easier to get to know the attendings)
• Curriculum: With standardization of GME requirements and accreditation, most programs’ curricula are very similar to each other. One aspect to consider is how the curriculum is weighted (i.e. is there more emphasis on tertiary care at the expense of outpatient/primary care experience, or are the three years well-rounded?). Again, there is no right or wrong answer here, just attempt to find programs that fit your personal requirements and learning style the best. Keep in mind that some programs have unique programs and requirements such as advocacy projects or research. Many programs are now moving towards “tracks”, for example Subspecialty, Acute Care (NICU, PICU, ED) and Primary Care, where you will select one (usually beginning of second year) based on your future career goals. These tracks look slightly different at each program, but most have some aspect of individualization allowing you to do more of certain rotations.
• Personality: Each program has its own “personality”. Ultimately, most people have a “gut feeling” about which program(s) they will rank highly after interviews. Remember the importance of the dynamic between the residents in a program and whether you feel that you “fit in” there because you will be spending an extraordinary amount of time with your fellow residents in the next three years.

• CHOP
• Boston Children’s
• Baylor
• Cincinnati
• Hopkins
• UCSF, etc.

These programs are very competitive and people often recommend doing away rotations at these hospitals to increase your chances, but not at all required. The rankings change constantly and everyone will have a different opinion. These are also excellent programs:

• St. Louis Children’s (Wash U)
• Children’s LA
• Seattle
• University of Colorado
• Rainbow Babies (Case Western)
• Pittsburgh
• Lurie (Northwestern)
• DC Children’s
• Columbia
• Stanford, etc.

Talk to as many people as you can. And, remember that rankings in certain magazines rank hospitals not their residency training programs.

• How does the program incorporate work hour regulations into their program? As of 2017, interns can again do 24 hour calls. Since this a recent change, programs have been handling this differently; some programs have interns doing overnight calls on all inpatient rotations, some only on specific rotations and some do not have any interns doing overnight call. It is important to ask how each program will be addressing these new changes with regards to the intern schedule.
• Similarly, what time is sign out (morning and night)? Some programs have short call/long call systems which gives you the opportunity to sign out early several days a week once your work is completed while others have a standard sign out time every day.
• How has the program handled the new resident evaluation requirements? Number of call-free/ light months? How do the residents get along with each other and the faculty? How many hospitals you rotate through and what are the logistics of commuting to each of them? How many electives do you have each year? Is help provided to residents for discharges, social work, blood draws/IV’s, etc. (IV service is key!)
• The aesthetics of the hospital and the creative comforts provided (nice call rooms, free meals on call, free food at morning/afternoon conference, parking, gym privileges) Other requirements like surgery rotation, research, or other interests you may have (such as global health opportunities).
• Is the program expanding or cutting back? This may be hard to assess but you should assess the stability of the faculty and whether they are cutting back the number of residents. You can also ask the program director/chairman about what they envision for the residency program moving forward.
• How does the program listen and respond to resident concerns?
• Who will be cross-covering you when you are an intern? Do you cross-cover other teams on call? Is there night-float? (Night float in particular is a good one to ask about – if the program doesn’t have a night float system, then you may be required to do overnight call frequently throughout residency)
• Vacation amount and when it is taken; whether or not there is a week off after your intern year; group retreats; the number of men vs women in the program; the number of single vs. married residents in the program; social events scheduled for the residents as a group; moonlighting opportunities; how mentors for residents are established at each program; international opportunities; individualized learning plans and curriculum “tracks” or “pathways” for residents (i.e. primary care, hospitalist, global health, research, etc. Financial stability of the hospital.
• Group dynamics and camaraderie is probably one of the most important aspects of a residency program!
• Think about the benefits offered by the program (educational stipend, reimbursement for Step 3/Boards/Board review courses, laptops/phones/tablets, etc.). You have to pay for Step 3 during your intern year and I think everyone remembers that painful feeling of paying for Step 2 during third year!

Peds is on ERAS, so you just have to fill out one common application on the computer. Make sure you think long and hard when selecting the programs you are going to give your ERAS application to. Applying to about 25 is a good number for Pediatrics, but you can always meet with one of the deans in OSA to figure out what numbers are right for you. You will start getting interviews soon after you submit your ERAS application. If you don’t have a significant number of interviews by mid-October, meet with one of the OSA deans to evaluate whether to add more programs. Some programs have application deadlines as early as Oct. 15th, so you want to make the decision to add more programs as early as possible. Once the deadline rolls by, it is difficult to get interviews at schools not on your original list. Remember to check websites of programs you are applying to and that you meet their requirements. (A few programs want additional information in your personal statement, or request LORs from certain people, or require that you have passed Step 1 and Step 2 on the first try.)

When you know that you definitely want to do pediatrics, ask attendings for letters as soon as possible. The more time they have the better. Plus, the sooner you ask, the more likely that you will get a personal letter as the physician will have more accurate memories of you and your work. It also helpful to provide your CV and mention a memorable patient experience when you request a letter. Some attendings may want to meet to talk before they write your letter – this won’t be a very serious or scary meeting, but be prepared to talk about your interest in pediatrics, your CV, and what your plans are in regards to applying to residency programs. Try your hardest to get a recommendation from the attending you worked with most on your sub-I. If you chose to do an away rotation, you should also get a letter from them.

Don’t be afraid to get non-pediatric faculty members to write you recommendations (although the majority of your recommendations should be from pediatricians). Most programs require 2-3 letters, and some programs require a letter from the department chairman (this isn’t too common in pediatrics, but its important to research your programs and find out about this requirement as soon as possible so that you can get this letter in time for your ERAS application – if they do require a chairman’s letter, they will state this on their website). Although you can have as many letters as you want uploaded into ERAS, a maximum of 4 letters can be sent to each individual program.

Many people recommend getting a letter from your peds sub-I. If you are unable to complete your sub-I prior to application deadlines, it is not the end of the world. You can submit LORs until the match list is submitted. Try to have three LORs submitted when you submit your ERAS on September 15th (but submit on the 15th whether or not you have 3 letters), so as not to delay your ability to get interviews. If you choose to submit a letter after the MSPE is submitted (around Oct. 1), email the program coordinators (usually their email addresses can be found on ERAS or on the program websites) to let them know that you just submitted an additional letter of recommendation. Great letters can also come from some peds electives where you have more autonomy and one-on-one time with attendings (GI Heme/Onc, Cardiology). Do not stress out if you have a late sub-I; you can still get very good letters!

GET YOUR APPLICATION IN BY SEPTEMBER 15TH WITH AT LEAST 2 LETTERS OF RECOMMENDATION UPLOADED ONTO ERAS…. You will have a better shot of getting interviews when this is all in on time.

• Most of the interviews are very relaxed and conversational as opposed to tense and formal. Typically, you will have two 20-30 minute interviews per program. Interviews can be with residents, faculty and/or program directors. Do not feel that you have to steer the meeting and state your accomplishments, research into the program and career goals. If an interviewer is very relaxed, just go with the flow, listen carefully to their questions and enjoy yourself. Remember that they have a thick file on you and are probably just trying to get to know you. If they begin the conversation with, “So, what questions do you have about our program?” do not panic! It always helps to have a few questions and notes about the program written down ahead of time so you can refer to them. Remember they are evaluating you as a future employee. You look interested and sincere if you have done this homework ahead of time. Most programs have plenty of information on their websites that you can read up on.
• Many of the programs have social opportunities before or after the interview day- GO TO THESE! This is a great chance for you to get to know some of the residents on a more social level so you should really try and work these evenings into your travel plans. This is a great setting to ask informal questions like: cost of living, jobs for spouses, good restaurants, wacky faculty, recreational activities, etc. Don't feel like you have to talk about medicine or the program the whole time! You can tell a lot about a program based on how boring (or fun) your night was! Take note of how the residents are interacting with one another, you can often tell if they are actually friends outside of work at these events. But do not panic if you cannot attend all of the dinners. It will be hard sometimes to coordinate multiple interviews with the dinners as well. They are mostly for your benefit and you will likely have an opportunity to interact with residents throughout the interview day during breakfast, lunch, etc.
• Finally, remember at the end of the day you will likely rank programs based on a “gut” feeling rather than the specifics surrounding the program. So, don’t spend your day at the interview furiously writing down the nitty-gritty details of the program (you'll get a large folder with all of the information you would ever need). Instead, take note of how the residents interact with each other and the hospital staff, whether people genuinely seem happy (this is difficult to do in a few hours), how the program directors work to make resident life more tolerable, and the other applicants interested in that program. It is helpful to quickly jot down a few of these thoughts at the end of the interview day to read over as you make your rank list.
• Second look – no program will require a “second look”, but if you need extra time to evaluate a program you interviewed at, or you want to reassure yourself of the “feeling” of your interview day, then a second look can be useful. Do not worry, however, if you are unable to do a second look at a program because it won’t have a negative impact on your ranking at that program.
• The Match PRISM is an app to help you keep track of your interviews and rank programs throughout the process – you can use it as much or as little as you’d like, but I thought it was a helpful place to jot down notes on the programs and my general feelings after my interview day. The rating system they have on the app is surprisingly helpful! The rank list is generated based on my ratings was very similiar to the one I actually submitted.