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What to Consider When Ranking Internal Medicine Programs

  • by Dr. Mike Ren
  • Jan 18, 2024
  • Reviewed by: Amy Rontal

Choosing an internal medicine residency program marks a significant and impactful step in your career, often driven by a passion for tending to the health and wellness of adults. And yet, while you’ve taken this step, you probably have some questions about what to look for in a residency program.

To help you find one that works for you, this post is a continuation in our series about things to consider when applying for residency in a particular speciality. In this installment, I’m going to discuss various aspects of internal medicine residency to help you rank and select an IM program most suitable to you.

Let’s begin by taking a look at some of the basic stats for IM residency applications. As you’ll see, the odds are in your favor!

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IM Residencies by the Numbers 

During the 2023 match cycle, IM had a total of 11,598 applicants for 9,809 spots. 3,689 US MD seniors applied, and only 73 didn’t match or withdrew from the match. US DO applicants had similar percentages: of the 1,596 DOs who applied, 1,503 matched, for a 94.2% match rate.

As for IMGs, internal medicine is considered IMG-friendly. Of the 9,345 IM residency spots in the US, 3,859 or 41.3% were filled by IMGs, with 1,200 US citizen IMGs and 2,659 non-US IMGs. (These data were gathered from the NRMP.)

I mention these statistics to show that you should be confident in your application to internal medicine. Historically, internal medicine has not been a particularly competitive speciality and it remains that way. Confidence in your application and during interviews means you can be selective in which IM programs you rank and have more say in where you end up training.

As an applicant, you can expect interviews to take place from October to late January. Reach out to programs you have an interest in if you haven’t heard from them by then. Once you have around a dozen interviews under your belt, you can consider being more selective about the future interviews you do and the programs you rank.

When deciding on internal medicine residency programs, many factors should be considered to determine which are the best fit for your career goals and personal preferences. General factors that go into your decision include location, program size, and pay/benefits. The following are additional considerations that are more nuanced and tailored to those applying to IM. Remember that your rank list is your decision, so choose the factors that will be most impactful for you. 

10 Things to Consider When Selecting an Internal Medicine Residency

1. Quality of Opportunity

Fellowships

If general internal medicine, aka hospitalist positions or primary care is not your cup of tea, you’re likely already considering subspecialization. If so, value programs that have a strong track record in fellowship match rates. Inquire about the post-graduation paths of former graduates. Did fellow program graduates subspecialize? If so, how successful were they in securing their desired fellowship positions?

Additionally, review the program’s curriculum and rotation schedule, and make sure it provides time for elective options. Having both time and faculty who support your pursuit of one of the many IM fellowships is crucial. A program with strong connections and opportunities can provide you with valuable experience during residency, allow you to gather necessary support letters from veteran faculty, and help you reach your post-training career goals.

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

Research & Academia

For others that have a desire for research and academia, seek out a program with three things: funding, faculty, and allotted time for research. A program that supports your research interest with access to dedicated mentorship and seasoned faculty members who produce quality research publications will play a pivotal role in shaping your experience and development as a trainee. Consider faculty credentials, their engagement in research and mentorship, and their experiences as educators.

Equally important is that the program offers dedicated research months for those interested in scholarly pursuits. Talk to current trainees about their research requirements or opportunities. How much time do the residents at this program have to produce research and attend conferences?

Inquire about recently published work the program faculty and residents have produced. In particular, look for dual authorship papers, which have both resident researcher and their supporting faculty mentioned in the same publication. This is usually a good sign that the residents are involved in academia.

Primary Care

Alright, maybe you don’t particularly care for research and you don’t want to spend more time than necessary as a trainee. Perhaps you want to practice bread and butter internal medicine. That is perfectly fine and you don’t need to seek out academic programs or residencies with heavy emphasis on subspecialization. In fact, only about a quarter of IM graduates end up specializing, while most go on to practice general IM.

For those interested in general internal medicine, you want a holistic IM experience that prepares you for the real world of IM. If that sounds more like you, seek a program that takes a deeper dive into primary care and health systems with options like a primary care track, which provides residents with increased exposure to general outpatient and inpatient internal medicine.

Primary care track residents will have options to a broad variety of careers after training including inpatient or outpatient clinical medicine, involvement in medical school curriculum and education, research, or administration. Further primary care training can give you the close follow ups with patients as well as an expanded perspective on how the healthcare system works in your community. Of note, many programs have a primary care track for those particularly interested in outpatient clinical medicine in addition to a hospitalist track for those more interested in inpatient care.

2. Quality of Training (Didactics)

Didactics refers to a resident’s designated time to learn medicine from the program. It plays a crucial role in the training of internal medicine residents for many reasons, such as building your IM knowledge base, emphasizing the importance of evidence-based practice, teaching residents how to critically appraise medical literature, learning research methodologies, and applying findings to patient care.

Furthermore, didactics contributes to professional development and can help IM trainees with board preparation and the inevitable job hunt.

Be aware of your program’s didactic schedule. For instance, is it a daily morning report or noon lecture during which the program provides food? Or do residents get a half-day of protected time for lectures? Perhaps it’s a combination of both, depending on the service you’re on that month.

Key Factors to Consider

In addition to finding out those answers, consider these key factors when it comes to didactics:

Relevance

Ensure the content covered aligns with the needs of internal medicine practice. Look for a curriculum that includes a broad spectrum of topics relevant to both bread and butter IM pathologies, as well as the rare but interesting zebra cases. 

Interactive Learning

Look for sessions that encourage active participation, discussions, case-based learning, and opportunities for hands-on experiences such as procedure workshops that can hone your skills. 

Quality of Instructors

You want to learn from a variety of generalists and specialists that are willing to share their knowledge and skills.

Feedback and Improvement

A program that seeks and implements feedback for continuous improvement demonstrates a commitment to enhancing the learning experience for residents. For example, if the program recently had a lecture that had little relevance to resident training, it should be tossed and replaced with something residents can better learn from.

Balance of Lecture and Clinical Time

Consider programs that strike a balance between didactic sessions, clinical rotations, and other aspects of training. For example, an eight-hour day of didactics impedes clinical exposure and let’s be real, you’d be texting, checking emails, managing your clinical in-basket, or online shopping for at least two or three of those hours.

Questions to Ask About Didactics

“Are the sessions/lectures in person or virtual?”

“Who are the primary didactic leaders, are they faculty, residents or other staff?”

“Are there visiting lecturers, and if so, how much voting power do the residents have to decide the topics they want to discuss and learn about?”

“Is the content focused solely on clinical medicine, or are there lectures on medical ethics, research, etc.? Are there practical lectures on how to build a CV or interview for a fellowship/job?”

“How dedicated are the faculty to teaching (vs. research and other professional obligations)?”

There are pros and cons to each approach, so consider what you’re looking for when it comes to didactics. To truly grasp what a residency’s educational content is like, see if you can attend a didactic session. Many programs offer them for students in the area, or perhaps you can join for a virtual core session.

If you’re curious, reaching out to the program coordinator via email is a great idea. They might be delighted to have you join, as it shows enthusiasm and interest in their program. Of course, be respectful with your request.

3. Program Structure and Curriculum

Review the curriculum and rotation schedule, along with elective options.

Ensure the program provides a well-rounded experience in various areas of internal medicine, such as a mix of inpatient and outpatient, procedural training, and board preparation. A well-structured curriculum should offer various elective options that allow residents to hone their skills and develop interest in various fellowships such as GI and cardiology.

Furthermore, the program should have faculty in such fields, teaching and leading the electives in their particular specialty to ensure the program’s residents receive top-notch training and recommendation letters, both of which are essential for the fellowship match.

An evolving curriculum is a good sign the program faculty review it and accept feedback to make improvements and properly prepare their residents. Pay attention to how much inpatient vs clinic rotations you’ll have. For instance, if you want to practice as an IM hospitalist, you’ll want more inpatient training hours during residency. Having that experience will help you manage codes, be more efficient during rounds, etc.

4. Patient Population

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

Also, think about the program’s standing within its community. If it’s important for you, seek programs that provide opportunities for community engagement, advocacy training, and experiences in underserved areas.

This exposure can deepen your understanding of public health and community-based care. Get comfortable managing a wide spectrum of cases, from decompensated cirrhosis to acute MI to heart failure. For a wide spectrum, think not only about a patient’s age, but health literacy, socioeconomic status, race, gender, access to healthcare, etc.

5. Resident Autonomy

To learn effectively, you 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, diagnosis, improved procedural skills, and higher engagements in learning to name a few.

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

6. Patient Volume

Medicine is a numbers game. The more variety of patients and illnesses you see, diagnose, and manage, the more prepared you’ll be as a trainee finishing up residency. However, there is a tradeoff with this.

As the number of patients you see climbs, the amount you learn from them becomes less and less (see the figure below). It’s important to find a good balance between seeing more patients and having time to participate in extracurriculars like research and self-care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710390/ Positive linear association (solid): each additional encounter provides educational value to the learner. Threshold (dashed): a linear relationship until a threshold is reached, above which point no additional knowledge is gained from each subsequent encounter. Yerkes Dodson curve (gray): increased knowledge acquisition up to a critical point; residents beyond the peak do not have time to synthesize the educational opportunity or are otherwise stressed by the workload such that their educational performance is poorer when compared to their colleagues with fewer encounters.

7. Board Prep

Either by checking the program’s website or by asking during an interview, seek answers to the following questions: 

“Does the program cover MKSAP and exam fees?” 

“What other resources are offered to residents?”

“How does the program monitor your progression of medical knowledge as you graduate from an intern to PGY2 and PGY3? What remediation is offered if you’re not progressing as expected?”

“Do you have dedicated sessions during didactics for board review?”

“What’s the program’s board pass rate?” (The graduating residents’ board scores can be an indicator of how well the program trains them for their future jobs as evidence-based medical practitioners.)

8. Quality of Life

IM residency programs are often affiliated with a medical school. Many residencies have additional sites (such as outpatient clinical sites) to provide exposure to experiences not offered at the primary hospital.

Consider the pros and cons of each learning environment. For instance, having to drive 50 minutes during your lunch hour to your outpatient clinic after a tough morning of inpatient orders and notes might be off-putting enough for you to not rank a program.

Furthermore, consider the number of hospitals where you’ll have to rotate. Do they all operate and use the same EMR? How many badges do you need and how often will you have to renew certifications? (Trust me, these are a pain to do.)

Regarding scheduling, how often do residents have to work nights/weekends/calls, and how flexible are they in terms of swapping? Finally, are residents able to instill change, for example, making a change in the holiday call schedule that’s better for everyone? You want a program with reasonable leadership that’ll respond to feedback.

9. Residency Wellness and Satisfaction

Are residents working over the allotted duty hours set by ACGME? Pay attention to your schedule as you progress through training. The number of difficult inpatient months (wards, nights, ICU months) usually decreases over the course of your training as you become more senior. Research on burnout has shown that physicians, residents and attendings alike cite time off for personal needs as a crucial factor for burnout prevention.

Thus, applicants should seek programs that provide adequate clinical exposure for training, but at the same time consider their personal lives and well-being. Furthermore, the IM residents should be working with a supportive staff, including faculty, lab techs, and nurses.

10. Diversity, Equity, and Inclusion

If it’s important to you, find a program that promotes DEI. This will be evident in the program’s efforts to improve diversity and inclusion and there’s usually a DEI committee that does so. Most academic programs or residencies tied to a medical school will have an office of DEI.

Further Reading

Each program will present pros and cons. Your IM mentors, clinical advisors, and upperclassmen can offer valuable insight into finding the right residency for you. Most importantly, the interview process will help crystallize priorities and clarify options. Ask questions and use the tips above to evaluate IM residency programs, ensuring that the program you select aligns with your career aspirations and provides a well-rounded training experience in internal medicine.

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

About the Author

Mike is a driven tutor and supportive advisor. He received his MD from Baylor College of Medicine and then stayed for residency. He has recently taken a faculty position at Baylor because of his love for teaching. Mike’s philosophy is to elevate his students to their full potential with excellent exam scores, and successful interviews at top-tier programs. He holds the belief that you learn best from those close to you in training. Dr. Ren is passionate about his role as a mentor and has taught for much of his life – as an SAT tutor in high school, then as an MCAT instructor for the Princeton Review. At Baylor, he has held review courses for the FM shelf and board exams as Chief Resident.   For years, Dr. Ren has worked closely with the office of student affairs and has experience as an admissions advisor. He has mentored numerous students entering medical and residency and keeps in touch with many of them today as they embark on their road to aspiring physicians. His supportiveness and approachability put his students at ease and provide a safe learning environment where questions and conversation flow. For exam prep, Mike will help you develop critical reasoning skills and as an advisor he will hone your interview skills with insider knowledge to commonly asked admissions questions.