How to Choose a Residency

Once you’ve decided on a specialty, the hard part is over, right? Sorta… you still have to tour the country and rank the programs at which you’ve interviewed. After having all of medical school to decide what kind of doctor to be, the decision of where to go seems almost rushed considering it is based on impressions from as little as a one-day visit.

Applying to residency is one part knowing your career goals and one part honoring your lifestyle preferences. In a way, lifestyle preferences may be more immutable. They reflect values and tend to be more innate. A person is unlikely to suddenly prefer large cities if she’s preferred small towns her whole life, whereas career goals can develop over time depending on the context.

On the other hand, residency is a perfect time to make a major life change. Given the limited duration, it is totally acceptable to consider residency another experimental life phase.  This is the last time in our lives that we’ll be in a formal training position, so it also makes sense to base the decision purely on the strength of the program.

This ambivalence brings me to the two ways in which I approach making hard choices.

Prospective-meaning-making vs. deferred-meaning-making

Let me first say that I don’t spend much mental energy on ‘easy’ choices (i.e. decisions between two options where one is apparently better, or in which the decision is purely arbitrary). Residency is not an easy choice.

Hard choices, according to psychologist Ruth Chang, are decisions between ‘equally good’ options. In her TED Talk she makes a compelling case for the virtue of hard choices. Hard choices, she says, are opportunities to decide what we want our identity to be. Not merely align our choices with who we are, but truly create who we are based on the decisions we make. I think of this as Prospective-meaning-making. We decide on the meaning of a decision as we are making it. Am I the kind of person who trains at an urban academic center or a community-focused rural program? Am I a person who starts a family or puts it off?

The other approach, and the one that is well known to intuitive types, is what many call a ‘gut decision’. I like to think of this in terms of deferred-meaning-making, when a decision feels right, but it would be hard to articulate why. It is a useful strategy when making decisions too complex and nuanced for our conscious minds. In many of life’s biggest decisions, like a career or marriage, the best initial decision is to follow your intuition. The meaning-making then happens after the decision is made, possibly well after. For example, if you follow your gut to a specific residency program, and then two years in you have a life-affirming moment at work, you could rightly say “This is the reason I came here!” This is a very healthy approach in which confirmation bias can work to help affirm that the hard choices we made were the right ones indeed. If, at the end of the day, we perceive our life as meaningful, then it is meaningful.

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