Facing the stress of your pharmacy residency rank list

For years, I’ve witnessed the stress of PharmD students and PGY1 residents navigate the residency application, interview, and match process. It is fair to say the stress is not lessening year to year. As we finish the interview season and applicants are preparing their final rank lists for the match, I want to share some of the advice I’ve given students, residents, and coaching clients.

This is not the typical advice about ranking do’s and don’ts.   I think it is important for candidates to explore why they are feeling overwhelmed with their options.  Below are the top 5 themes of the conversations I’ve been having with residency candidates. Please share with any residency applicant in your life who may benefit from these insights.

1.       Revisit and refresh your “WHY” for residency.
The reason why you started pursuing a residency may have changed during your search and interview process, so it is important to revisit. Explore if and why your primary reasons for residency are different now. Your why for residency should guide your priorities for ranking one program over another. Everyone’s why is different and understanding yours should give you clarity to what is most important to you. If you notice your reason for pursuing residency changed during this process, then explore the reasons behind this shift. Make sure your motivations are truly yours and not simply reflections of the application and interview process.  When you feel conflicted about comparing all the pros and cons of a program, measure them against your primary motivation for residency training and look for alignment. 

2.       Double check your expectations.
You may have gone to one program after another hoping the next will be just a bit better, just a bit more aligned with your goals, just have the perfect mix of everything you want and everything you don’t want. When something doesn’t measure up to your expectations, it is okay to feel disappointed. Don’t let the disappointment lead to you dismissing otherwise great opportunities. Remember, every program comes with tradeoffs and no program is stagnant. Things will change in the next year, so this is not the time to cling to a romanticized view of a perfect program. If you feel a mismatch with a program you interviewed, ask yourself if this misalignment is something you can live with (and rank) or if this is an indication you should leave it off the list. Is this something you can commit to for the year? If not, no one will know you did or did not rank a program. 

3.       Focus on one life-changing decision at a time.
So many candidates have the added pressure of hoping for an early PGY2 commitment to their preferred specialty, a long-term job opportunity as a result of their residency, or getting a residency in their desired long-term location. These are all great considerations and they likely informed your application list, but these goals could also create conflicting goals for residency now that it is time to rank. None of these outcomes are guaranteed, so it can be a gamble to take a lesser fit of a program because of the opportunity that may or may not present itself later.  Some candidates may benefit by just focusing on the next 12 months. Ask yourself, “What is the best program for me for the next phase of my training?” and weigh that answer against the possibility of longer-term opportunities.  Letting go of a preconceived idea of what will happen in two years may give you clarity regarding the best opportunities in front of you right now.

4.       Define what “best” means to you.
It is so tempting to give your top ranking to the program with the best reputation according to the preceptors, mentors, and faculty members supporting you. It can be hard to look past the perception of prestige.  While your mentors may have the best of intentions, keep in mind that their perceptions may be based on factors that don’t align with your actual circumstances and goals (See “revisit your why” above).  Can you articulate clearly what is most important to you in a quality program? If so, use these attributes to guide your rankings. If you have trouble articulating and prioritizing what is important to you, then spend some time thinking about this before making your rankings.

5.       Seek advice, not opinions.
Many candidates find clarity by verbalizing their thoughts and perspectives to friendly listeners. Take note if your friend, colleague, or mentor is giving you biased opinions or sage advice. Good advice will help you find clarity and prompt better understanding of your own perspectives, needs, and anxieties. Advice is nuanced and sometimes challenging to hear. If you are receiving straight-forward opinions about which programs you should or should not rank, you may be receiving well-intentioned but biased information. This often leaves you feeling more conflicted about your decision. If you’re getting more opinions than advice, consider diversifying your pool of listeners and gather more perspectives.  You should feel empowered to rank your possible programs based on your values.

Yes, it is time for some heavy professional reflection on your training and professional growth. However, if you did your due diligence during your selection, application, and interview processes, then you likely have several great options in front of you. Make your rank list a reflection of your values and you will be served well regardless of the outcome.