If you’re creating your rank list for general surgery residency programs, congratulations on making it to your final step before Match! In such a competitive specialty, you should be proud of yourself for making it this far in your journey—this path will surely open many doors for you as a medical professional.

So, now that you’re here, how do you rank and select general surgery residency programs, knowing they can be tough to get into? In this post, we’ll discuss various aspects of general surgery residency to help you rank and select a program best suited for you.

Let’s begin by looking at some numbers for general surgery residency applicants.

General Surgery Residencies By the Numbers

As I’ve done with the other posts in this series, I’d like to begin by sharing some data. 

Compared to the other residencies covered in the series thus far, general surgery is more competitive and matching into residency for it in the US isn’t a cake walk.

To shed some light on the matter, here are some numbers:

In 2022, over 3,000 medical students applied to the categorical general surgery residency and 1,619 matched successfully for an overall 52.7% match rate (NRMP).

For US grads, the numbers looked a bit better, with US MDs matching at 81.60% and 61.50% for US DOs.

Due to the sheer volume of applicants, many surgery programs use standardized screens to weed out those that are less qualified. The most competitive applicants will have first-time passing scores on USMLE/COMLEX exams, honors in their surgical rotations/electives, as well as exemplary letters of recommendation and dean’s letters.

Interpreting the Data

I mention all of this to show that you should be confident (but cautious) in your application to general surgery. Confidence in your application and during interviews means you can be selective about which programs you rank and have more say in where you ultimately end up training.

As an applicant, you can expect interviews to take place from October to late December. Historically, most general surgery interview invites occur before December 31st, but reach out to programs to eek out that last possible interview slot. Because general surgery is competitive, you’ll want to try and get as many interviews as you can to ensure a higher chance of matching.

So, those are some basic stats/details to keep in mind when applying to general surgery residencies. Now, let’s take a look at some specific things you’ll want to consider when it comes to ranking and choosing a general surgery residency program.

10 Things to Consider When Selecting a General Surgery Residency

Generally, when selecting a residency program, it’s natural to choose one based on location, program size, as well as pay and benefits. When deciding on general surgery residency programs, there are a multitude of factors to consider.

Keeping your personal career goals and preferences in mind, check out the following considerations that are more nuanced and tailored to those who are applying for general surgery. Remember that your rank list is your decision, so choose and weigh the factors that are most important to you.

That said, here’s 10 things to keep in mind when it comes to ranking and selecting general surgery residency programs:

1. How competitive of an applicant are you?

Given the competitiveness of the general surgery field, it is crucial that you assess where your application stands relative to those of your peers.This will not only affect which interviews you get, but also how you rank programs.

Ask yourself, how many interviews have I received? Is my USMLE Step 2 score above 240, or are my COMLEX level 1 and 2 scores averaging over 600? Do I have a handful of first authorship publications/presentations? Or at least a dozen abstracts and case reports? Am I part of AOA or another honor society? Did I go to a top 50 medical school in the US? Am I dual degree, such as MD/PhD or MD/MPH? If so, you’re fairly competitive!

If you have fewer than 10 interviews, consider ranking most, if not all of them (even if some are less than ideal) to maximize your chances at matching. Or if you’re a highly competitive applicant with over 20 interviews, rank the ones you like and include a few “safety” programs.

Of course, I’m not advising you to rank the program with dozens of red flags that’s about to lose funding for its residents. However, please don’t rule out a program just because you didn’t vibe with one of the residents (heck they may graduate the year you start).

What if you’re not a competitive applicant?

Now, what if you’re not a competitive applicant? What if you don’t have a 260 Step 2 score with dozens of first author publications? Or you’re not AOA and president of your class? It’s okay, most people aren’t.

This just means you’re an average applicant. You can still match into general surgery residency—in fact, most average applicants match.

If you’re not as confident about your application or the amount of interviews you’ve received, then consider a prelim year, which is a one-year position. Matching into categorical general surgery is much more competitive than matching into prelim. In 2022, only 3 categorical positions were left unfilled, but over 500 preliminary positions remained open!

Upon completing your prelim training year, you’ll have four more years of required training, which you must apply for and there’s no guarantee you’ll get it. Overall, a prelim year is flexible but the subsequent training to complete a general surgery residency isn’t a given. There are various opportunities within and outside of surgery after you finish your prelim year.

2. Try talking with everyone you can about a general surgery program you’re interested in.

I realize that you won’t have a chance to meet or talk with everyone between interview day and second looks. However, try your best to talk with as many people as you can and gather as much information as possible as you create your rank list. Some high-yield contacts to chat with if you get a chance are the department’s leadership and core faculty, as well as current fellows and residents, especially the chiefs.

And you can always talk with senior medical students at your school (or others) who have matched into the programs you’re interested in. Ask them about everything, from the various training opportunities, to what a day in the life is like, or how it is to spend winter in that area of the country. Of course, be tactful in your approach, don’t be annoying or ask inappropriate or offensive questions.

3. Evaluate the expertise and reputation of the general surgery program and its faculty members.

Strong mentorship is crucial for professional development during residency, especially if you plan to pursue academia, research, or a fellowship. To demonstrate your interest, some appropriate and insightful questions you can ask are:

1. How many of the program’s graduates go on to do fellowships, and which ones in particular? 
2. How does this residency program prepare you for X (research, fellowship etc)?
3. What is the program’s accreditation status, and have there been any citations in the past few years? If so, how did the program react to and address those issues?
4. What is the American Board of Surgery (ABS) exam pass rate for recent graduates?
5. What is the national presence of the program in terms of research? How much are core faculty involved in research? What are some projects currently in the works?

4. What population will you be serving and what opportunities are there for engagement?

Consider the patient population you would care for. Urban settings often have more diverse medical pathologies and patient populations (more health literacy and socioeconomic variance) compared to suburban or rural programs. Exposure to a wide variety of surgical cases, often seen with complex and diverse patient populations can prepare you for broader practice as an attending.

Also, if it’s important for you, seek programs that provide opportunities for community engagement, advocacy training, working in underserved areas, and global health opportunities such as fixing cleft palates in developing countries.

5. How much autonomy do the general surgery residents have?

To learn effectively, you’ll have to be granted a certain level of responsibility. Autonomy is essential in any pedagogical training process.

Decades of research has shown the benefits of guided autonomy for trainees, which include increased medical resident confidence in making clinical decisions, making accurate diagnoses, improved procedural skills, and higher engagements in learning.

The level of autonomy that’s granted is a delicate balance dictated by the program, which is ever-changing to meet the needs of each residency class and ACGME requirements. The balance is based primarily on educational merit and patient safety.

Basically, you don’t need someone holding your hand as you scrub into your 299th case as a PGY-5 about to graduate. However, you also don’t want to be left completely alone when you do your first hernia repair.

6. What can you expect in terms of case variety and volume?

Surgery is a numbers game. The more patients you see, diagnose, and operate on, the more prepared you’ll be as an attending surgeon. However, you can get diminishing returns because as those numbers climb, the amount you learn becomes less and less.

To put it bluntly, the marginal amount of practice you get from doing one extra routine appendectomy on your last belly-beeper shift as a PGY-4 senior is minimal. You’d probably rather catch some shut-eye. 

Find a good balance between having more patients/cases and having time to participate in extracurriculars like research or attend to self-care.

Some questions to ask programs in this regard are:

1. How do residents get credit and log surgical cases?
2. How much do you have to compete with other departments or even colleagues for OR time and cases?  
3. How much time do residents spend in didactics and how protected is that time? Are lectures and workshops in-person or asynchronous?
4. What’s the balance between clinical/floor time vs time in the OR? How does this change as trainees progress (from intern year to senior year)? 
5. How is feedback provided to residents and how is proficiency assessed? 
6. Can you tell me about the experience I’ll get for various aspects of general surgery?
   (For example, some programs may offer limited exposure to transplant surgery, while being heavy in trauma. You’ll want to have experience in all aspects of general surgery and should expect to be tested on them.)

In general, look for programs that offer a diverse range of surgical cases and a high surgical volume. Exposure to various procedures contributes to a well-rounded education.

7. Does the program adequately prepare its residents for the surgery boards?

I alluded to board pass rates earlier in this article. For most residents, after completing the required period of training in a residency program, they’re eligible to take the board examination.

Board certification by the American Board of Surgery means a doctor has met ABS standards specifically in the area of general surgery and its related specialties. Board certification is different from possessing a medical license, which is the minimum required by law to practice medicine and is not specialty specific.

Residency programs aim to prepare their trainees for the surgical specialty boards through the use of in-training examinations or ITEs, which are tests given each winter to assess the progress of residents in various stages of training. They are purely an assessment tool to test the residents’ knowledge of the diagnosis and management of clinical problems related to general surgery.

Residency programs with high board pass rates, systems in place for remediation or supplemental learning, and resources such as books and question banks to help boost ITE scores and board exam pass rates are desirable.

8. What kinds of research/fellowship opportunities are there?

If clinical research is a priority for you, strongly consider the program’s research opportunities, resources, and the level of support provided for residents engaged in scholarly activities from faculty regarding funding and protected time.

Find out what special requirements the program may have, such as number of publications, didactic attendance, medical student evaluations, or a minimum score on your in-service examinations.

Additionally, review the program’s curriculum and rotation schedule, and make sure it provides time for elective options, which is particularly important for those who elect to pursue fellowship or research. Having time, the opportunity, and the faculty who will guide your career pursuits is crucial.

A program with strong connections and opportunities for professional growth during and after training can help you reach your career goals as you gain valuable exposure and experience during residency. You can also use this time to build strong relationships and gather the necessary support letters from seasoned faculty.

For individuals inclined towards fellowships or those discovering a newfound interest in specialized training, research a program’s fellowship placement rates: the rate at which graduates secure fellowship positions. A program’s success in placing residents in desired fellowships speaks volumes about the quality of trainees the program produces.

9. Consider the residency program’s culture and environment.

Take into account the overall culture and environment of the residency program. A supportive, collaborative atmosphere can enhance your learning experience and job satisfaction.

Take note of the faculty and residents’ attitudes towards colleagues, as well as the training they receive.

10. Take into account what the general surgery program does for resident quality of life.

It’s a given that general surgery residency is tough. Surgeons often work long, demanding hours, including nights and weekends.

In addition, the pressure of making critical decisions in the operating room and dealing with life-and-death situations can contribute to high levels of stress. Residency demands a significant time commitment, leaving less time for personal activities, hobbies, and family.

All of these factors together contribute to higher burnout rates, and so good programs have tried to reduce stress in any way possible.

Seemingly little things like the following can really help:

1. Free hospital food, since no one wants to cook after a long call shift;
2. Easily accessible parking, since no resident wants to walk more than 10 minutes to the hospital or clinic;
3. A gym or workout space at the hospital, so you can attempt to stay in shape during residency; (Performing surgeries is physically demanding, and long hours in the operating room may contribute to fatigue and physical strain as well as neck and back pain.)
4. PTO, since more days off is often a good thing;
5. Free board prep materials, as they will certainly come in handy; 
6.  CME funding to cover your research and conference pursuits; 
7.  Sick and maternity leave, if you have chronic conditions or plan to start a family; 
8.  Counseling services, as dealing with unsuccessful patient outcomes and competitive colleagues can take an emotional toll on surgeons;  
9. State-of-the-art equipment (such as da Vinci and SI surgical systems), AEM instrumentation, and simulation training for the OR, since those things contribute to a conducive learning environment. 

These are just a few examples of perks that can improve your quality of life during a general surgery residency.

Final Thoughts

Residency programs vary greatly in their shape and size. Independent programs may have very different training goals from school-based programs. Does the program mostly train residents who will practice globally, caring for underserved patients in developing countries? Do their graduates go into academia and research, inventing new surgical instruments and techniques? Or do most graduates go on to practice bread and butter general surgery, helping patients in their local communities? 

The point is, you want to select a program that aligns with your career goals. And remember, when making your ranking choices, avoid extreme decisions. Don’t rank a program with numerous red flags and imminent funding issues for its residents. 

Similarly, don’t dismiss a program solely because you didn’t enjoy the hospital cafeteria. Strive for a balanced and strategic approach to increase your chances of securing a favorable match. Keep these 10 things in mind, and good luck with your rank list!

Looking for more (free!) tips for Match season? Check out these other posts from Blueprint tutors on the Med School blog!

• Going Back to In-Person Residency Interviews: How to Prepare & What to Expect
• How to Make A Residency Rank List That Puts Your Happiness First
• 6 Stress Management Tips for Residency Match Week