Day 240 A Message of Hope to those who Didn't Match : Metagame yourself into Residency

The word metagame means to play or follow a certain game against the rules, or against the normal strategy that one normally takes when confronting a game or situation.(http://en.wikipedia.org/wiki/Metagame) I would like to apply it to getting a medical residency. There are thousands that struggle with this very "game" of getting residency. There are many strategies posted on the internet and thousands are trying them. Some more successful than others. I would like to talk about some out of the box ideas that are very different, but I believed might be a different approach that will help some in finding their elusive residency. I will propose a few ideas.

Metagame strategy #1 Observership

A lot has been said about observerships. The majority of people believe that they are a waste of time, simply because you are just observing and not "doing" any hands on clinical practice. I would have to disagree with some of these well meaning indivduals. I believe that there is a small chance <10% that it might work. IF it is "correctly" done. For the most part you should enroll in an observation where your chances of getting in are "very" good. Meaning that, you at least fulfill their requirements. There is no sense to doing an observation in a hospital where you might not have a chance of getting in. I'm sure the percentage of you succeeding in getting residency would be less than 3%. I'm not completely dismissing it, because there is a possibility, but it is just very slim. The reason that I'm talking about observationships, is because there are about 3 people in my residency program that did just that!!!! They rotated here about 3-6 months and they met other residents and were very liked my the program director, and they were able to be invited to join the program (categorical too!!) So I believe that it worked, but I believe that they were very lucky. I'm sure no one can argue against that. But reality can argue against any theory that you might have about observationships.

Now it worked for them because they basically found "CONTACTS". They met someone that really liked them, and were invited for interviews and were given a spot. Its a 1/100 chance but
it worked!! NOw, I know that its hard for some people who are foreigners to speak the language, or maybe you are not that friendly of a person, or your flat out not a brown nose. But this isnt about that, this is about meta gaming your self into residency. You have to try something outside the box. I work with these people DAILY. Its a reality. SO its an option you may consider, but it has to be done correctly-AT a hospital that you are applying to, and also on more than one!! The guy that got one of the spots, he had done about 3-4 observationshps!!! already.... and he only had one interview, and that was form this program that he got accepted!! lol... Now that my friends is amazing. But who is to say you can't be that lucky? You will be surprised who you meet at the observationships, or who you can get a letter of recommendation from. So don't rule out observations entirely.

Metagaming strategy #2 clinical Externships

Well a lot has been said about this. You can read it on any forum or any website. There are a lot of companies offering you help in getting us clinical externships. And I would agree with most of them that they are a "hoax"- The majority of them are not what you and I are thinking about in terms of clinical experience. You think that a lot of theses are going to put you in a us clinical externship, and that's not possible because you have to be a us student to do a fully accredited externship. So its not what you are expecting. The majority of them are done at outpatient
clinics and doctors office. Now, in terms of metagaming, this is obviously an out of the box thing to do. They do get you recommendations. The majority of residency programs are looking for "recent" us clnical experience. These programs want someone who is adapted to the us hospital system, and who is aware of how us hopsitals "work". What is important is that whatever office you go to you ask the attending if you can go to the hospital to do rounds with him.
So maybe you can get exposure to it. And you can write that into your cv. It might not sound like much, but it is an idea. We are talking outside the box. Now, the best place to actually do this can be debated. Some say that you don't need
a service if you can convince a doctor at a local office to do that then you can work in his office for free. But I would suggest getting student insurance and then that way he might allow you to to go to the office and you have liability insurance on you. Student insurance cost about 1000$ dollars I think. SO its an option.

Wether they help or not is purely based on where, when and who you do this with? WHat if you were to do a "rotation" at the office of one
of the attendings you are applying for residency too? would that help? I think it would. One of the female residents here in the program was working as a medical assistant, and she use to see the vice president of this hospital!!! Amazing... I was shocked when she said it. She even got recommendation from him. ..lol.... Not bad- recommendation from vice president of hospital
your applying to. That is metagaming your self into residency.

Metagaming #3 Research

A lot has been said about whether or not research matters. and I think a lot of it depends on which program you are applying to. The majority of programs don't put a great deal of importance on it, but others do. I might be kind of bias because I spend 7 months doing clinical research in Columbia University. In fact, the best recommendation I received was from one from a brilliant professor their that I worked with (she had 2 PhD's and a masters). The recommendation she gave me was 2 pages long SINGLE SPACED. We really worked great together. She was a brilliant person and very humble. I truly believe she was instrumental in me getting residency. Why? her RECOMMENDATION was amazing!! On top of it, she is a writer,
so she really expresses her self really really good. lol (not sure that's grammatically correct to say but...lol.) It really maked you stand out of a crowd of applications. I think 3 sentences of true love and appreciating for someone, is worth more than an encyclopedia of facts about someone. Its important to have many recommendation, but if you have one recommendation from someone that has true love and apprecition for you, it will show in their letters.

I think the bottom line with research is that you can use it to build contacts recommendation and to built your CV. But the bulk of your time she be spent trying to build your clinical skills.

Metagaming #4 LOR

I spoke about it previously in the paragrapher before. Try to get LOR from people that KNOW YOU and that LIKE YOU !! Most of the LOR that programs read are positive. I mean, its not gonna be a letter of hate. The program is expecting them to be good. But you want yours to stand out. Maybe the letter is from somoe one that works at the hospital your applying to. Maybe its from a resident at the program or an attending. Maybe its from the vice-president of the hospital!! This is out side the box thinking. don't forget substance. IT matters a lot.
True appreciation and love will stand out, and this goes back to finding contacts and building relationships. Its a very important part of it. Don't miss improving these letters. If you see a letter form an attending that could use some work, tell them if they could write you another
one. I mean, you have to be political about it, but tell them if they mind just giving more detail to your qualities and strength. A lot of attending's are very busy in their work life, so be humble about it and grateful.

Metagaming #5 Dialing God For help

Last but not least, is the MOST important part on this journey to residency. This tip is above all else. If you have not believed anything I have said, believe this one. If you have not paid attention to anything written here, pay attention to this one. I will try to speak to you truthfully and as if you were standing right in front of me.

No one. NO one can truly understand what you are going through right now. No one can completely understand the heart ache that you feel. No one. No one has seen all the tears you have shed at night and throughout the day. You might have friends and family members and people in these forums trying to make you feel better, but no one truly understands what you are going through. And these are good people. they care about you. They want you to feel better.
They want you to achieve something in life. But that doesn't rid the fact that they do not see your heart ache, and your pain.

Only, and ONLY someone that could see Inside your heart. Only someone that could see inside your mind and your thoughts can truly and deeply understand you. And only someone all powerful with supernatural forces and strength can do this. And I believe that person is God. I believe that person is Jesus. God can give you strength in this moment of uncertainty and pain.
GOd can relieve your pain. IT might not be completely eliminated, but God can help you bare the pain. A lot of atheist exist in this world because they have never understood what the bibles says about pain and suffering. God never said that you would not have pain in this world, in fact he said "in this life you will have trouble" John 16:33 (http://www.biblegateway.com/passage/?search=John+16:33) But he has ALSO said "I will be with YOU.
I will walk with you in your pain. We will walk this trauma of life together. I can see your pain, I can feel what you feel. I can give you peace and strength to carry on."

Let us not spent time arguing and debating whether God exist or not. Your tears and pain don't have time for this. Time is passing bye and the heart ache that you feel is real. And I believe
that God is real. He has promised to help you bear with the trying times that you are having now. What would it cost to put a bit of faith in God? He has promised to give you peace. And if he doesn't, then there is no God, because God doesn't break his promises. He has declared himself the good Shepard. Psalm 23 (http://www.biblegateway.com/passage/?search=psalm%2023) He has said he will walk through the valley of death. The valley of shame and disappointment. IT might not make sense how a powerful God would even allow such things to happen to you, but he has offered his help to you. I had gone through the match 3 times and have been rejected countless times. Yet God has grace and was wiling to help me in my life. If it was to be in residency or not.

I have been through the heartache of not having gone through the match. I know the heart and the pain. It is real and its not a theory or joke. Pain is real. But God's peace is also real. And he offers to give us peace in our time in suffering through Jesus. Through his son. God offers you help in your life. he offers you help in becoming a doctor or not. DO not feel that you have
wasted your time all these years in school. God can help you. Meaning and fulfillment in life comes from doing the things on this earth that we were meant to do. If it is meant for you to have residency or if its meant in doing something else. Take time now in your room alone, or later today to talk to God as you were a friend. Dial up God for help by honest sincere prayer. He will answer you in one way or the other.be honest and open about your feelings.. Lean on him when it seems unbearable to keep on applying over and over in the match, year after year.
don't give up.

You are not alone. You have not wasted your time. Lean on God. Lean on Jesus. he cares for you. He has seen what you have seen. And offers in help to you.

God can give you peace. He can do the impossible. He can change your life. he can give you strength to carry on. My life is a testimony to his grace. My residency is a testament to the power of God. Its not simply having residency, but it is seeing the power of God in my life that helps me to bear living, and that helps me to carry on. God can and will bring meaning to your life. And he will if you give him a chance. Test him. Seek him it will come to pass.

I don't mean to "throw" around religion and didn't intend to throw it in anyone's face. This is simply ideas that have helped me. These are situations and feelings that I do based on what I have experienced. God has been good to me. And I can only try to help as many people as I can, and as many people that will believe.

I wish you all Good luck in the scramble and in Life.

God Bless you.

Jesus Loves you. He cares..... He cares.

Dr.Mike