Preventive Medicine Residency: Healing Before it Hurts

The Best Preventive Medicine Residency Programs in the US

1. Johns Hopkins University Medical School
2. Emory Medical School
3. Mayo Medical School
4. Yale Medical School

Want to know the most competitive and least competitive residencies? Watch this video:

The Best Preventive Medicine Residency Programs in Canada

1. Northern Ontario School of Medicine
2. University of Ottawa Faculty of Medicine
3. Michael G. DeGroote School of Medicine at McMaster University
4. University of British Columbia Faculty of Medicine
5. University of Manitoba Max Rady College of Medicine 

What is a Preventive Medicine Residency?

“The purpose of medicine is to prevent disease and prolong life, the ideal of medicine is to eliminate the need of a physician” - William J. Mayo

The above quote from William J. Mayo gets at the heart of what preventative medicine hopes to achieve, although taken to an illustrative extreme. A preventive medicine residency is a highly-specialized program where you will learn more about epidemiology, data-gathering, occupational health and environmental factors affecting the health of millions rather than focusing solely on one patient. But the specialty also involves much more.

Preventive medicine also deals with non-medicine related topics such as bioinformatics, and socio-economic determinants of health, both physical and mental. You will have to look more at the causes and possible preventive measures that entire societies can take to stop disease or improve people’s lives. Preventive medicine is reactive as well. You need only look at the COVID-19 pandemic for the ways that public health officers all over the world went into action to prevent the spread of the virus.

Social distancing, mask-wearing, hand-washing, and being inoculated – were all measures that public health and preventive medicine specialists advocated as part of their duty to prevent disease and illness on a macro-level. However, if you are interested in preventive medicine, you do not have to go into the public health sector necessarily. You can still incorporate the tenets of preventive medicine into your private practice as a family doctor and try to do the same on micro-level. 

The training that goes into a preventive medicine residency is multi-disciplinary. You will be exposed to a different variety of medical specialties through a preventive medicine residency than you would normally see in any other residency, such as an emergency medicine residency. You’ll learn more about environment or occupational medicine, but also learn about healthcare administration and management. Depending on your career goals, you can choose to pursue another specialty afterward or go into a local or national public health department, such as the Centers for Disease Control and Prevention, in the US.

What’s Involved in a Preventive Medicine Residency (US) 

In the US, a preventive medicine residency is for any medical school graduate who has also earned a Master of Public Health, as having a degree in public health is usually an admissions requirement for most of the close to 70 preventive medicine residency programs in the States. You usually need to have completed at least a family medicine residency or internal medicine residency beforehand, but not all programs will require it.

However, even if you’ve done a yearlong residency in another specialty, many preventive medicine residency programs in the US will still put you in clinical environments to learn patient-facing skills. Some programs even have a set number of direct patient hours you must complete as part of the program requirements. You will still have to train in basic medicine and clinical skills, as you would in any other residency, but your training will also require a lot more research, learning, and working directly in public health settings, either local, state or federal through practicums.

You may also take away rotations in outpatient clinics or in rural settings where there is a lack of preventive medicine initiatives. There are only 2 preventive medicine doctors per 100,000 people in the US, so there is a dearth of people who patients can turn to when looking for ways to prevent disease and illness, which has ripple effects on all other parts of the healthcare system. Preventive medicine may not seem like an ideal choice if you want to excel in a specific field, such as surgery, but if you are more interested in helping people before they get sick and working with a large team of people to address those issues, you should consider a preventive medicine residency.

Some of the specialties you can choose post-residency include:

• Travel and tropical medicine
• Occupational medicine
• Aerospace medicine
• Enviornmental medicine

Applying to a Preventive Medicine Residency (US) 

The preventive medicine residency programs throughout the US do not always use ERAS (but some do) as many have their own application process. Some programs will use the American College of Preventive Medicine's Standardized Acceptance Process (SAP) as a way to accept applications.

But the CDC is different, as you have to apply directly to the center, and it uses an online application form. The CDC has a variety of preventive medicine residency programs, from a 2-year to a one-year residency, and does not participate in the match or use any of the other popular residency match services in the US.

As varied as the application process, are the application requirements, which vary from program to program. A list of the standard application requirements needed to get into a preventive medicine residency include:

• A MD or DO degree from an accredited medical school in the US or Canada
• Completion of a year-long residency
• USMLE Step 1, USMLE Step 2 CK or COMLEX Level 1 scores
• Letters of recommendation
• Official transcripts

But these are the broadest application requirements. Some programs may require you:

• Have a set amount of direct patient experience (months or hours)
• Have a degree or be near the completion of a degree in public health or a related field
• Have obtained a license to practice medicine

But what are the intangible qualities that residency program directors are looking for?

A lot of what you need to get into a preventive medicine residency has more to do with your knowledge and previous experiences, so if you have worked for a public health office, or even volunteered, then that will make program directors notice your commitment and dedication to population health.

Not all programs will require you have this experience, but it is something that will make you stand out from the rest. Having great letters of recommendation from leaders in public health or related fields will also go a long way to show you have the clinical, interpersonal and communication skills needed for such a diverse specialty.

Are you an IMG applying to residency?

How are Preventive Medicine Residency Programs Structured (US)

There is no one uniform curriculum that each preventive medicine residency program follows, so each program has unique features that may appeal more to you than others. But, as the duration of most preventive medicine residency programs in the US is two years. One aspect of preventive medicine residency programs in the US that is often seen is the varied rotations that you will complete as part of your training.

But a lot depends on what you have before you apply or enter. If you apply with a dual-degree under your belt, you’ll be more prepared and not have to take didactic courses in public health, although the option exists for you to do more rotations if you want to expand your knowledge of public health. You’ll also do a lot of work in the community, either by seeing patients, or working with health authorities in your jurisdiction to get a feel for what it is like to work in public health every day.

However, if you are only applying with an MD, you can also choose to take an MPH during your residency, which is a feature some programs offer. There is also a lot to learn about non-medicine subjects such as advocating for new public health care policies, dealing with various stakeholders to find new ways to solve public health problems, and learning how to manage a public health unit or something similar.

Of course, research is another key component of most preventive medicine residency programs in the US. You may have to complete a research project as part of your training, as investigating and determining new ways to treat the population, stop the spread of communicable diseases, and which healthcare policies are doing more harm than good is one of the fundamental roles of a preventive medicine doctor.

What’s Involved in a Preventive Medicine Residency (Canada) 

Preventive medicine residencies in Canada last much longer than in the US; five years. The difference being that you do not need to have completed any residency training elsewhere as many programs in Canada use an integrated or categorical system with other specialties folded into the curriculum and program requirements. Your first year may even be strictly for you to earn a Master in Public Health and then complete the rest of your required rotations or electives in the subsequent years.

There are also two tracks in Canada to enter into a preventive medicine residency, which are entering into a dedicated preventive medicine residency or a dual-family and preventive medicine residency. This is important because your choice of track can impact where you apply, as the dual-residency program is not available at the same schools as the dedicated preventive medicine program.

Some of the core rotations that many preventive medicine residents must do include:

• Communicable diseases
• Public health policy
• Management and administration
• Health promotion and chronic disease prevention

Research is another key component of many preventive medicine residency programs in Canada. Again, research is usually integrated into the curriculum, so you will have to present or complete a research project, when, is up to your program. If you are earning an MPH while in residency, you may also have to create or participate in a research project as part of completing the degree as well.

Applying to a Preventive Medicine Residency Program (Canada)

There are only 11 residency positions for the dedicated public health and preventive medicine track, and 14 for the dual-preventive and family medicine track, so it is a competitive field, although those numbers represent an increase in positions from the last application cycle. Not all applicants matched into these programs, which could mean a lot of things, as you have to submit similar materials as other residency programs in Canada such as:

• 3 or 4 letters of recommendation
• CaRMS personal letter
• Residency CV
• Official transcripts
• Altus Suite scores (program-dependent)
• Medical Student Performance Record (similar to MSPE)

But here is where your choice of extracurriculars for medical school and work experience will definitely matter, because most program directors want to see how you’ve contributed to public health, awareness, advocacy, or leadership. If you have worked or volunteered in some capacity with a public health unit (local, provincial, or federal), or even a non-profit health organization that is a sure way to impress the admissions committee.

Research can be as important, but so much of public health entails problem-solving, communication and the ability to work with others, so a long-term position within an organization is something that will put you ahead of others.

How are Preventive Medicine Residency Programs Structured (Canada)

In Canada, a lot of residency programs are presaging entry into core rotations with a “boot camp”, where you can learn more about basic clinical skills, and gain the knowledge you need in standard competencies such as taking patient histories. But many programs also throw you into the deep end and start right away with off-service rotations in emergency, geriatric and rural medicine, and in some cases, mental health and addictions.

If you haven’t yet earned a degree in public health, epidemiology, population health or any other related discipline, a lot of the best residency programs in Canada will let you earn one during your residency. So, this is why preventive medicine residency programs are longer in Canada; in the US having completed a 12-month residency AND earning a master’s degree are expected, but in Canada you can do them while in training.

Since Canadian residency programs are switching to a Competence Based Model, the way you progress to the next four stages of the CBD-structured residency has changed. You now have to prove your competency in various tasks that you would perform normally, as part of your day-to-day duties as a practicing physician, to advance. But the educational content and rotation requirements of most programs will stay the same.

Meaning: rotations, rotations, rotations. Mostly in public health and in various formats so there is no urban vs rural residency conundrum in preventive medicine; because you have to treat entire populations, regardless of location and origin. Of course, there are nuances to treating people in urban vs rural settings, but the point is that as, for example, a provincial health officer, you would be responsible for everyone in the province, which is why many programs integrate rural and underserved centers as required rotations.

You will also spend time (usually one year or less) in the public sector at either local, provincial or federal health services centers and learn from current public health directors and associates. As you progress to the final years, your responsibilities in these public health authorities will increase, and you’ll be tasked with performing the duties of a medical health officer along with a support team, much in the same way a chief resident would do in other specialties.

How to Get into a Preventive Medicine Residency

Take Public Health Electives

A lot of programs in Canada and US say this explicitly so it's not a big secret. It makes sense that if you are serious about preventive medicine that you would take public health electives. But another option would be to take global electives that would give you the opportunity to see how jurisdictions in other countries handle public health. It would add a diversity component to your application and also, most importantly, give you more perspective on how to address similar issues later in your career.

Excellent Letters of Recommendation

Good LORs are always important to have, but in some disciplines, like preventive medicine, they count even more. But if you’ve done your time in the trenches of public health, then getting outstanding references shouldn’t be too hard. They should emphasize your non-cognitive qualities – compassion, collaborative spirit, problem-solver – and highlight ways you have gone above and beyond the required (published work, participated in committees, teaching excellence).

Write a Meaningful Personal Statement

“Conscience” is big on residency directors’ list of most important qualities to have as a preventive medicine applicant. You can certainly demonstrate that quality through altruistic works in your extracurriculars and work experience, but you can go a step further with a stellar residency personal statement. In your personal statement, describe your perspective of this work you’ve done, and talk about how it motivated you to pursue preventive medicine. Or you go even further in the past and mention your early interest in outbreaks, viruses, and how to control them.

Show Your Humanity in your Interview

Speaking of conscience, what better way is there to demonstrate your empathy and compassion than when you are face-to-face with residency directors and faculty? Depending on your program, you may have various types of interviews, from a traditional, one-on-one interview to MMI, which is most common in Canada. If it is a traditional interview, you can read over common residency interview questions and do mock interviews to think of answers that tick all the boxes when it comes to demonstrating compassion, advocacy and leadership in preventive medicine. If you are doing an MMI interview, prepare for policy-related or personal questions by using MMI practice questions and draw from your own experiences with these policies, but, don’t be afraid to express your opinion about various facets of public health.

FAQs 

To your success,

Your friends at BeMo

BeMo Academic Consulting

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