ASRS 2018: Surgical Case Conference


Yoshihiro Yonekawa, MD Eric Nudleman, MD, PhD Jonathan Prenner, MD RETINA Roundup Editors It's early December. While most of the country is recovering from Thanksgiving travel and transitioning to holiday gift lists, the pressure is on for residents applying for retina fellowships. December 6th is the deadline for submission of rank lists. Applicants rank the fellowship programs on the San Francisco Match website, where an algorithm generates matches between programs and applicants, based on the respective rank lists. Residency and fellowship matches are nerve racking, because unlike medical school, results of the match are binding. Last academic year, we interviewed 15 fellowship program directors for their candid thoughts on the process and advice for applicants: We are following up this year with an additional post from the three of us, who have spent the last few weeks discussing the rank list with our residents. Having little control can be difficult for a cohort of highly motivated, hard working, goal-oriented, likely type-A personalities of varying degrees (hopefully there's no spike in the incidence of central serous chorioretinopathy). However, we believe that applicants should feel empowered in their final step before becoming officially initiated into the best field of medicine. First, you've already accomplished a tremendous amount and be proud. Be grateful for the support that you have received from family, friends, mentors, and your co-residents to get where you are. Chances are, you will match and become a retina specialist. That's pretty cool. Second, the matching algorithm gives preference to the applicant's rank list, not the programs'. Say Eric ranked programs A, B and C, as #1, #2, and #3, respectively. He really wants to go to program A, and would trade one of his kids for the spot. Program A enjoyed meeting him during the interview and Eric is ranked highly, but not in the top 3. He's ranked #4. (This is all hypothetical, as Eric was obviously ranked #1 at every program he interviewed with). But program B was insightful enough to foresee that Eric will one day cure all retinal blindness, and ranked him #1. Does Eric match at program A, or program B? It depends. If program A has 3 spots a year, unless the #1, #2, and #3 ranked applicants also rank program A highly and match with program A, Eric will match with program A. Program B really wanted Eric and ranked him #1, but because Eric chose to rank program A ahead of program B, he will spend his next 2 years at program A, where he wanted to be. So residents, you need to rank programs based on where you want to go. Not based on which programs you think ranked you highly. The latter may take away a small piece of uncertainly, but that's a high-risk guessing game, and obviously not the spirit of the match. Thankfully, Eric ranked program A because he wanted to go there, and not program B because he sensed (correctly) that he would be ranked to match. That was the most important message that we wanted to get across. The real variables to consider when making the rank list will depend on every applicant, and there is no magic formula. Be sure to rank all programs. If you want to become a retina specialist, no program is not good enough for you. Thankfully, our field has so many amazing fellowships that you usually cannot go wrong. For the rare instances where strong applicants do not match, it's often because of a curtailed rank list. Ultimately, based on our personal experiences and hearing from many others, it comes down to your gut feeling. Trust that, as it has led you well to this point and trumps excel spreadsheets for this kind of complex decision making. We wish all 3rd year ophthalmology residents the best of luck. In case you haven't marked it in bold on your calendar 10 times yet, the match results are announced on December 13th. You all know what your rank lists should be. There's not much strategy but to go with your heart.