Tyler Berzin, MD'03

Why did I choose internal medicine?

I certainly didn’t plan to pursue this field initially. I had been intending to do something in neuroscience- maybe neurology or neuroradiology. But what I really ended up enjoying most about internal medicine was that it required a strong grasp of pathophysiology. Granted, every field requires a certain mastery of pathophys, but I felt that internal medicine was the most intellectually demanding in this respect, whether you're caring for a patient with heart failure, renal insufficiency, or portal hypertension. Additionally, internal medicine is a particularly academic field and the amount of teaching and the level of discussion that occurs during the course of a typical day were very appealing to me. Finally, as much as I enjoyed my surgery rotation, I'd rather spend the majority of my day with patients who are not under general anesthesia.

There is a huge variety of very different pathways you can take within internal medicine- from interventional cardiology to primary care- and depending on what you prefer- you could end up in the hospital nearly 100% of the time and doing tons of procedures, or in the office nearly 100% of the time, or anywhere in between.

How to schedule your year…

At Brown, you have no choice but to do your medicine clerkship during the first three quarters, and any one of those periods is fine. It's worth scheduling your sub-internship any time between late spring and mid-summer. Residency programs often like to see your evaluations from this month. Grades from rotations that are started after July may not make it onto your transcript (although they could still get mentioned in your Dean's Letter)
I think one or two months in a subspecialty of IM can be useful at some point before your residency applications go out, because these consult rotations may give you the best chance to get a recommendation from an attending. Getting started on a longitudinal rotation by the summer may also give you a good source for another recommendation letter.
Away rotations are not absolutely necessary- they could help a little bit if you happen to run into an attending that could write you a letter or put a word in for you- but mostly it's a chance for you to decide whether or not you like a place. One away rotation is usually enough- do more if you want, or do none. Most people schedule away rotations for the summer or early fall. Usually students will do an away rotation on a consult/specialty service, rather than trying to do another medicine sub-I.

What are programs looking for?

Well, it depends on where you want to go. Internal medicine is a big field with lots of residency positions. Cast a reasonably wide net and you will match. On the other hand, getting into a top medicine program is just as difficult as getting into a top program in any other field. Your clinical grades are important- your medicine clerkship and sub-I are key- but the rest of your clinical performance will also help. I've heard some attendings recommend that if you don't get honors in medicine- doing well in an ICU rotation can help you down the road.

Having some research under your belt can be important for the big academic programs- these places want to churn out academic physicians- and they want evidence that you're interested in this. USMLE scores can absolutely help you, but if they're not as high as you'd like, they shouldn't keep you from getting interviews at any but a small handful of programs. Taking step II in the fall is a wise move if you feel like you could top a lackluster step I score, otherwise wait to take step II in late winter or spring.

Interviews etc.:

Internal medicine interview days usually consist of touring the hospital, hearing a presentation from the program directors, and splitting up to have between one and three interviews with faculty members for maybe a half-hour each. One notable hospital in Boston actually tosses you into a room in which you're interviewed by a six-person panel (although they're actually quite friendly), but this is the exception.

Interview questions usually revolve around why you chose the field, what you see yourself doing in a few years (at very academic hospitals, "private practice" is usually not the correct answer). And of course, absolutely anything you write down in your application is fair game. Be certain that you can clearly explain any research that you may have done. Also, do your homework before each interview be prepared to answer exactly why you would like to go to their particular program. Finally, you'd better be able to come up with something thoughtful when you're asked if you have any questions.

I think it's a good idea to schedule your most important interviews in the middle of your interviewing season- you'll definitely get more comfortable answering common questions by your 2nd or 3rd interview stop. On the other hand, by your 9th and 10th interviews you can lose a little steam- you'll start tuning out during hospital tours and daydreaming during the program director's presentation. Oh, and definitely try using priceline.com or hotwire.com to find hotel rooms- you can really end up saving a lot of cash.

Other thoughts:

Get in touch with the Brown grads who are at the programs you're interested in. We have people at most of the big programs in the Northeast, and a lot of great places throughout the U.S. Alums will be able to give you a sense of how their program compares to Brown- and they're usually happy to help another Brown student out. The student affairs office keeps a binder listing where every Brown medical student ended up for residency during the last 5 or 10 years.

Send thank-you letters promptly after your interview. These should definitely be sent to the program director, and possibly to your interviewers, depending on how much energy you have. Once you've wrapped up all of your interviews, you're allowed to let your top choice know that they're your top choice. You can send a 2nd letter or e-mail to the program director stating this and you might have your dean's letter writer or some other attending put a call into the program. The time to do this sort of thing is around the first week of February.
In retrospect, I think the importance of getting a well-known attending to write you a letter is a bit over-rated. I had interviewers occasionally comment on the content of certain letters, but rarely did they focus on who wrote the letter. That said, a strong, detailed, and personal recommendation letter from a well-known attending can't be beat.