How to nail that Residency interview?

The Interview

The process of applying and interviewing for a residency position is frequently a stressful one. This process involves both selling yourself to a program, as well as collecting the information that you will need in deciding how to rank the various programs. Programs that you consider will all have different strengths and weaknesses - some of which may not be apparent by a cursory look at the program. The interview process is an aspect of residency application, which is of primary importance to the prospective house officer. The investments involved in this venture usually include a month of the applicant's time and a monetary expenditure in quadruple digits. The outcome of the interview process will have a major effect on the residency program finally selected, and can have implications for the future medical career of the applicant. Because the stakes of this game are so high, it is of vital interest to the interviewee that he or she derives the maximum benefit from the investment made. The applicant should strive to achieve two basic goals at each institution he visits: first, to gather information to help determine the merit of a given residency program and second, to achieve a successful interview such that the selection committee will realize the merit of the applicant. The time allowed for the latter is limited by protocol; the time for the former, however, is determined by the applicant and should by no means be limited to the formal arrangements made in advance by the interview committee. The applicant should thoroughly familiarize himself with all prepared information such as brochures, etc. prior to visiting each institution. Before ever leaving home, the applicant should seek out all faculty and house staff who has had personal experience with the residency programs in question. These individuals can be excellent sources of information, since they are in a position to discuss the advantages and disadvantages of a given training program from the same perspective as the applicant. For the same

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reason, the applicant should attempt to meet with any faculty or house staff at each institution he visits that received some part of their training. Preparation: It is essential that you have questions to ask the faculty and residents on your interview in order to make an informed decision. Every interviewer will ask you if you have any questions. It is okay to ask the same question of different interviewers. All of the effort in the foregoing discussion is wasted if the applicant fails to make a favorable impression upon the selection committee of the desired residency program. In order to achieve a successful interview, it is first important to identify the goals of the interviewer. Almost universally now, the intense grill session is a thing of the past. Selection committees now tend to rely on medical school grades, Dean's letters and letters of recommendation to base their evaluation of each applicant's medical competence. The purpose of the interview is for the selection committee to identify the personal characteristics of each applicant, which may determine how he will function as a house officer. These attributes are not easy to specify, but include interpersonal skills and abilities to interact with superiors, peers, and subordinates. The interviewer will need to evaluate how he thinks the applicant will fit in with the existing house staff. Some of the more skilled interviewers will make an attempt to judge how the applicant handles pressure and responds to adversity, as this is certainly a valid concern of the selection committee. Thus it is important not only to identify what the interviewer is asking, but why he is asking it. Selection committees are seeking integrity and dependability in their house officers; questions should be answered honestly and sincerely. There are certain questions, which an applicant can anticipate and should be prepared to answer. These include why you have chosen this particular specialty, what your future plans are, what you consider important in a training program and why you have applied to this one in particular, how you have done in medical school, what you consider your personal strong and weak points, and what qualifications you have that set you apart from your fellow applicants. On the other hand, an applicant should also have some questions, which he has prepared to ask of the interviewer. Although physicians by profession should be excellent interviewers, an applicant will inevitably run across someone who does not know how to conduct a proper interview and will instead leave it up to the applicant to carry the interaction. In this case, it is the applicant's responsibility to ask intelligent, appropriate questions to occupy the duration of the interview. If the staff physician believes he has carried out a good interview, he is very likely to make a favorable report to the selection committee. The only vestige of the grill session, which remains popular among some interviewers, is that of having the applicant present an interesting case. Although even this is uncommon today, each applicant should probably be prepared to make a brief two to three minute presentations and to intelligently discuss the patho-physiology and differential diagnosis of the case presented. Just as the applicant finds many intangible factors influencing his evaluation of each residency program, so the interviewer will base his evaluation of each applicant on perceptions not easily identified. A firm handshake, confident manner, and good eye contact can go a long way in this respect. It is certainly important that the applicant be


himself, but he must do so in a way that puts his best foot forward. Thus, the interviewer will not only be judging what an applicant says, but how he says it as well. The interview process today in general takes the form of a relaxed, low-pressure conversation, and can be quite enjoyable to the applicant and interviewer alike. The prepared applicant who well understands the purpose of the interview process will find that he can quite favorably affect his chances of being selected for the residency program of his choice. What do Interviewers ask? The following are examples of frequent questions asked applicants. Though you shouldn't memorize answers, it would be to your advantage to write out your responses so that your responses will be fluent and thought-out. 1. Tell me about the patient you learned the most from? 2. Why did you apply to this program? 3. What are you looking for in a program? 4. What do you see as the negative and positive features of this specialty? 5. What problems do you think the specialty faces? 6. How do you see the delivery of health care evolving? 7. What if you don't match? 8. What do you do in your spare time? 9. What are your plans for a family? 10. What are your strengths and weaknesses? 11. Tell me about yourself? 12. Why are you interested in our program? 13. What are you looking for in a program? 14. Why should we choose you? 15. Can you tell me about this deficiency on your record? 16. Why are you interested in this specialty? 17. What do you see yourself doing in the future? 18. How do you think the current changes in health care will affect the specialty? 19. Describe an interesting case that you had? What do I ask Interviewer? 1. Where are your graduates? Where do they come from and where do they go? 2. How have the graduates done on the USMLE Step 3 and specialty boards? 3. How much didactics? Are the resident's relieved of clinical duties to attend? 4. Patient population? 5. Is attendance at national/regional conferences encouraged and funded? 6. Is this program affiliated with a medical school? 7. What teaching responsibilities for medical students are expected of residents? 8. If residents have teaching responsibilities, approximately how much time each week

is spent with students? 9. Is there formal training of residents on how to effectively teach and evaluate

medical students?


10. Are the clerkship objectives for students shared with the residents? 11. How are residents evaluated? 12. Are there other hospitals used for rotations or electives? 13. What type of attending backup support is available when residents are on call? 14. Are residents assisted in find a job when completed? 15. Do residents have any problems finding jobs? 16. Do residents moonlight? 17. What changes do you see in the program during the next few years? 18. Have any residents left the program recently? 19. What are the program's strengths/program's weaknesses? 20. What do you like most about your training program? In what areas can the

program improve itself? 21. What process do you have for improving the residency? For evaluating rotations? 22. What recent changes has the program undergone? What changes do you foresee? 23. What research opportunities are available? What is the availability of funding for

research? What kind of mentor support is available from the faculty? 24. How well do residents perform on board certification exams? 25. What is the structure of the last year of residency? 26. Does the program offer elective time? Mini-fellowships? Avoid questions during the interview about call schedules, moonlighting, vacation, and salaries and benefits, other aspects of the day-to-day operations of the program. The best sources of information for the prospective house officer are the interns and residents who make up each training program. For the most part, these people are quite candid and willing to discuss any aspect of their residency program. It is to these individuals that the pragmatic questions should be addressed, such as salary; call schedules, moonlighting, etc. Questions pertaining to the strengths and weaknesses of the program are also best directed to these people, as some faculties are offended by such inquiries. Most importantly, the applicant should attempt to determine the general happiness of the house staff, and whether he would be happy in the same situation. The applicant should also make observations concerning the esprit de corps and whether he would fit in well with the existing group of house officers. Most interview schedules allot at least one hour for the applicant to interact with the current house staff for the procurement of such information. Often this time is inadequate, however, especially if the ratio of applicants to house officers is high. A seldom utilized but highly recommended practice is that of visiting the hospital the evening before the scheduled interview. If not too busy, the house officers on call are usually more than willing to discuss their residency program at length, and tend to be more candid in this setting. In addition, the applicant may have the opportunity to see parts of the hospital and gain insights into the actual day to day realities of the training program that are not available to the average interviewee. The importance of the night-before visit and its potential yield of information cannot be over-emphasized. What questions do I ask house staff? General Questions 1. What features of the program do residents like or dislike? 2. How strong are the residents? From where did they graduate?


Reputation 1. Do graduates of the program have problems finding jobs? 2. How difficult is it for residents to get a good fellowship?

Education

1. Is the program fully accredited? 2. How are the residents evaluated? By whom? 3. Is there an organized curriculum? What is the emphasis? 4. How many conferences/week are there? Do conferences emphasize practical

knowledge or state-of-the-art research? 5. What is the quality of the attending? What are their responsibilities? 6. How interested are the faculty in the education and welfare of the house staff? 7. What proportions of the attendings are private? 8. Are there medical students on the wards? What school(s) do they represent? What

are the residents teaching responsibilities to the students? 9. What research opportunities are there?

Work Environment

1. What is the patient load like? 2. What are the typical admissions diagnoses? 3. How many cases are treated by the average resident? 4. Is the case load sufficiently varied? 5. How much autonomy do residents have to manage patients? 6. What is the patient population like? Ethnicity/Language? SES? 7. Is there continuity of care for patients after discharge? 8. What is the quality of the ambulatory experience? 9. How strong is nursing support? Consult services? Radiology? 10. Pathology? ER services? 11. What is the typical call schedule? 12. How does the work environment vary from service to service? From hospital to

hospital? 13. How busy are call nights? How much sleep do you usually get? 14. How available are the attendings? Can you call them at night? 15. Is there a backup available when you are on call? Is there a night float system? 16. How many hours do you work each night? 17. How much time do you get off each week?

Salary

1. What is the starting salary for an intern? For an R2? 2. What about the cost of living in the area? 3. Is moonlighting permitted? If so, how does it work around here?

Benefits

1. What health benefits are available? 2. What is the maternity/paternity leave policy?


3. Is parking provided? Is subsidized housing available? What is the vacation schedule

Questions to Ask Yourself 1. Can I be happy working in this program and with these people? 2. Are there factors that make this city an attractive place for me to live during my

residency? Presenting Yourself: Dr. Iverson lists in his book Getting into a Residency, A Guide for Medical Students, five reasons why interviews fail.

1. Inadequate preparation. 2. Applicant does not listen to the questions being asked. 3. Interviewers may get annoyed by having questions answered that were not asked. 4. Rambling, providing superfluous information. 5. Applicant inadvertently gives warning signals to the interviewer (inconsistent

answers, abrasiveness, evasiveness, blaming others for applicant's problems, dullness).

The bottom line in the interview is that you have to sell yourself. Key personality traits sought by interviewers to keep in mind: drive, motivation, communication skills, energy, determination, confidence, reliability, honesty/integrity, pride, dedication, analytical skills, listening skills. You can include these "key words" into your personal statement and in your responses during the interview. Interview attire: "In your town, your reputation counts; in another, your clothes do." Talmud, Shabboth. Appropriate dress is an essential part of any interview. Keep in mind that most interviewers are conservative. Above all, dress neatly. Men: two piece suits in a solid color (gray, black or navy). Does not need to be expensive, but it should be well-cult and tailored. If you don't have or cannot afford a suit, wear a navy blue sport jacket with matching pants. The shirt should be plain white long sleeve with a conservative tie. Be sure your shoes are well polished. Carry a notepad, preferably in a leather-like portfolio to take notes. Besides, it looks good.... Women: two piece suit or a well tailored dress. Simple blouse (watch the neck line...). Shoes should be simple pumps, low heeled in a dark or neutral color. The less jewelry you wear the better. Carrying a purse is debatable. Some say to never carry one. If you have an attaché case, place all your stuff in that as well as a notepad (portfolio style as above). If you can get away with it, just carry a notepad-it will be easier on you. Materials to Bring On Interview: • Copies of CV, Personal Statement, application, board scores, extra picture. • Materials from the program to review the night before. • Notepad portfolio to take notes on. It is okay, and probably shows organization and

interest, to take notes during the presentations. You especially need to write down impressions immediately after the interview because you will soon forget all that you heard. Write down the interviewers names, the residents who took you out to lunch etc. so that you can thank them by name in the follow-up letter.


• Pen (a nice one). • Money-in case you have to pay for parking or lunch. • Parking ticket to have validated by the secretary. Program Evaluation There is no hard data available by which one can evaluate the various training programs so the applicant must base his decisions on personal observations and word-of mouth information obtained from the sources discussed above. Because much of this type of data is subjective, the applicant must attempt to base his conclusions on the largest possible data base. In each instance, of course, the source of information must be considered. While it is not mandatory that each intern be overjoyed with his current lot in life, he should be able to smile and to say positive things concerning his training program. It is probably a good idea to make an attempt to convert subjective observations into objective data by means of some scoring system following your visit to each institution. Each applicant must determine beforehand the aspects of a training program which are important to him, and then grade on a scale of 1 to 5, for example, how every program fulfills each of the requirements. If this is not done, it is sometimes difficult at the end of a long interview trip to recall the positive and negative attributes of each residency program. Rate the following as Good, Average or Poor: • Area surrounding hospital: safe, well lit, parking close • Diverse socio-economic patient population • Residents are happy • Location acceptable • Cost of living manageable • Accreditation of program unquestionable • Number of hospitals in rotation • How far away are rotations • Job opportunities upon completion • Acceptable salary • Vacation benefits • Insurance coverage • Impression of faculty • Impression of residents • Overall program rating In the final analysis, you will find that your ultimate decision on how to rank the programs to which you have applied will be based largely on intangible factors. You will like or dislike the various training programs for reasons that you cannot easily identify. The more exposure an applicant has to each institution he visits, both in terms of personal observation and word-of-mouth testimonials, the more likely it will be that his gut feelings about that training program are accurate.



Follow-Up

The latest addition to the interview process, which has become popular, recently is that of the follow-up letter. Type follow-up letters promptly after interviewing, thanking the program director for the opportunity to interview and for any lodging and meals they provided. Be sure to mention the interviewers and the residents by name in your letter. Also, at this time or definitely after the match, write a letter to those faculty members who wrote your letters of recommendation thanking them and informing them of your match. Of less certain propriety is the practice by which applicants inform their most favored residency programs of their ranking intentions, as many selection committees view this with distrust. The effect of such a letter on one's chances of being selected are questionable, and in any case such letters would be appropriate only for the institutions at the top of one's ranking order. If one thing should be added to the foregoing discussion, it is that the entire interview process should be initiated as early as possible. Requests for prepared information from each program can be sent as early as June, and requests for letters of recommendation should be made in August. If one plans on interviewing during the month of November, the residency program should receive applications in late August or early September, so that the interview date of choice can be arranged. The selection committee as responsible views the applicant who makes his plans well in advance, prepared individual who is certain of his goals and how to achieve them. Good Luck!! Raj