How to nail that Residency interview?


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How to nail that Residency interview?

  1. 1. The InterviewThe process of applying and interviewing for a residency position is frequently astressful one. This process involves both selling yourself to a program, as well ascollecting the information that you will need in deciding how to rank the variousprograms. 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 primaryimportance to the prospective house officer. The investments involved in this ventureusually include a month of the applicants time and a monetary expenditure inquadruple digits. The outcome of the interview process will have a major effect on theresidency program finally selected, and can have implications for the future medicalcareer of the applicant. Because the stakes of this game are so high, it is of vital interestto the interviewee that he or she derives the maximum benefit from the investmentmade.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 andsecond, to achieve a successful interview such that the selection committee will realizethe merit of the applicant. The time allowed for the latter is limited by protocol; the timefor the former, however, is determined by the applicant and should by no means belimited to the formal arrangements made in advance by the interview committee.The applicant should thoroughly familiarize himself with all prepared information suchas brochures, etc. prior to visiting each institution. Before ever leaving home, theapplicant should seek out all faculty and house staff who has had personal experiencewith the residency programs in question. These individuals can be excellent sources ofinformation, since they are in a position to discuss the advantages and disadvantages ofa given training program from the same perspective as the applicant. For the same © 1
  2. 2. reason, the applicant should attempt to meet with any faculty or house staff at eachinstitution he visits that received some part of their training.Preparation: It is essential that you have questions to ask the faculty and residents onyour interview in order to make an informed decision. Every interviewer will ask you ifyou 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 afavorable impression upon the selection committee of the desired residency program. Inorder to achieve a successful interview, it is first important to identify the goals of theinterviewer. Almost universally now, the intense grill session is a thing of the past.Selection committees now tend to rely on medical school grades, Deans letters andletters of recommendation to base their evaluation of each applicants medicalcompetence. The purpose of the interview is for the selection committee to identify thepersonal characteristics of each applicant, which may determine how he will function asa house officer. These attributes are not easy to specify, but include interpersonal skillsand abilities to interact with superiors, peers, and subordinates. The interviewer willneed 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 applicanthandles pressure and responds to adversity, as this is certainly a valid concern of theselection committee. Thus it is important not only to identify what the interviewer isasking, but why he is asking it. Selection committees are seeking integrity anddependability in their house officers; questions should be answered honestly andsincerely.There are certain questions, which an applicant can anticipate and should be preparedto answer. These include why you have chosen this particular specialty, what your futureplans are, what you consider important in a training program and why you have appliedto this one in particular, how you have done in medical school, what you consider yourpersonal strong and weak points, and what qualifications you have that set you apartfrom your fellow applicants. On the other hand, an applicant should also have somequestions, which he has prepared to ask of the interviewer. Although physicians byprofession should be excellent interviewers, an applicant will inevitably run acrosssomeone who does not know how to conduct a proper interview and will instead leave itup to the applicant to carry the interaction. In this case, it is the applicantsresponsibility to ask intelligent, appropriate questions to occupy the duration of theinterview. If the staff physician believes he has carried out a good interview, he is verylikely to make a favorable report to the selection committee.The only vestige of the grill session, which remains popular among some interviewers, isthat of having the applicant present an interesting case. Although even this isuncommon today, each applicant should probably be prepared to make a brief two tothree minute presentations and to intelligently discuss the patho-physiology anddifferential diagnosis of the case presented.Just as the applicant finds many intangible factors influencing his evaluation of eachresidency program, so the interviewer will base his evaluation of each applicant onperceptions not easily identified. A firm handshake, confident manner, and good eyecontact can go a long way in this respect. It is certainly important that the applicant be © 2
  3. 3. himself, but he must do so in a way that puts his best foot forward. Thus, the interviewerwill 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-pressureconversation, and can be quite enjoyable to the applicant and interviewer alike. Theprepared applicant who well understands the purpose of the interview process will findthat he can quite favorably affect his chances of being selected for the residency programof his choice.What do Interviewers ask?The following are examples of frequent questions asked applicants. Though youshouldnt memorize answers, it would be to your advantage to write out your responsesso 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 dont 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 residents 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? © 3
  4. 4. 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 programs strengths/programs 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, andsalaries 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 andresidents who make up each training program. For the most part, these people are quitecandid and willing to discuss any aspect of their residency program. It is to theseindividuals that the pragmatic questions should be addressed, such as salary; callschedules, moonlighting, etc. Questions pertaining to the strengths and weaknesses ofthe program are also best directed to these people, as some faculties are offended bysuch inquiries. Most importantly, the applicant should attempt to determine the generalhappiness of the house staff, and whether he would be happy in the same situation. Theapplicant should also make observations concerning the esprit de corps and whether hewould fit in well with the existing group of house officers. Most interview schedules allotat least one hour for the applicant to interact with the current house staff for theprocurement of such information. Often this time is inadequate, however, especially ifthe ratio of applicants to house officers is high. A seldom utilized but highlyrecommended practice is that of visiting the hospital the evening before the scheduledinterview. If not too busy, the house officers on call are usually more than willing todiscuss their residency program at length, and tend to be more candid in this setting. Inaddition, the applicant may have the opportunity to see parts of the hospital and gaininsights into the actual day to day realities of the training program that are not availableto the average interviewee. The importance of the night-before visit and its potentialyield of information cannot be over-emphasized.What questions do I ask house staff?General Questions1. What features of the program do residents like or dislike?2. How strong are the residents? From where did they graduate? © 4
  5. 5. Reputation1. Do graduates of the program have problems finding jobs?2. How difficult is it for residents to get a good fellowship?Education1. 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 Environment1. 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?Salary1. 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?Benefits1. What health benefits are available?2. What is the maternity/paternity leave policy? © 5
  6. 6. 3. Is parking provided? Is subsidized housing available? What is the vacation scheduleQuestions to Ask Yourself1. 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, AGuide 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 applicants problems, dullness).The bottom line in the interview is that you have to sell yourself. Key personality traitssought by interviewers to keep in mind: drive, motivation, communication skills, energy,determination, confidence, reliability, honesty/integrity, pride, dedication, analyticalskills, listening skills. You can include these "key words" into your personal statementand 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 mindthat most interviewers are conservative. Above all, dress neatly. Men: two piece suits ina solid color (gray, black or navy). Does not need to be expensive, but it should be well-cult and tailored. If you dont have or cannot afford a suit, wear a navy blue sport jacketwith 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-likeportfolio to take notes. Besides, it looks good.... Women: two piece suit or a well tailoreddress. Simple blouse (watch the neck line...). Shoes should be simple pumps, low heeledin a dark or neutral color. The less jewelry you wear the better. Carrying a purse isdebatable. Some say to never carry one. If you have an attaché case, place all your stuffin that as well as a notepad (portfolio style as above). If you can get away with it, justcarry 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. © 6
  7. 7. • Pen (a nice one).• Money-in case you have to pay for parking or lunch.• Parking ticket to have validated by the secretary.Program EvaluationThere is no hard data available by which one can evaluate the various training programsso the applicant must base his decisions on personal observations and word-of mouthinformation obtained from the sources discussed above. Because much of this type ofdata is subjective, the applicant must attempt to base his conclusions on the largestpossible data base. In each instance, of course, the source of information must beconsidered. While it is not mandatory that each intern be overjoyed with his current lotin life, he should be able to smile and to say positive things concerning his trainingprogram. It is probably a good idea to make an attempt to convert subjectiveobservations into objective data by means of some scoring system following your visit toeach institution. Each applicant must determine beforehand the aspects of a trainingprogram 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 sometimesdifficult at the end of a long interview trip to recall the positive and negative attributes ofeach 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 ratingIn the final analysis, you will find that your ultimate decision on how to rank theprograms to which you have applied will be based largely on intangible factors. You willlike 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 ofpersonal observation and word-of-mouth testimonials, the more likely it will be that hisgut feelings about that training program are accurate. © 7
  8. 8. Follow-UpThe latest addition to the interview process, which has become popular, recently is thatof the follow-up letter. Type follow-up letters promptly after interviewing, thanking theprogram director for the opportunity to interview and for any lodging and meals theyprovided. 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 memberswho wrote your letters of recommendation thanking them and informing them of yourmatch. Of less certain propriety is the practice by which applicants inform their mostfavored residency programs of their ranking intentions, as many selection committeesview this with distrust. The effect of such a letter on ones chances of being selected arequestionable, and in any case such letters would be appropriate only for the institutionsat the top of ones ranking order.If one thing should be added to the foregoing discussion, it is that the entire interviewprocess should be initiated as early as possible. Requests for prepared information fromeach program can be sent as early as June, and requests for letters of recommendationshould 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, sothat the interview date of choice can be arranged. The selection committee asresponsible views the applicant who makes his plans well in advance, preparedindividual who is certain of his goals and how to achieve them.Good Luck!!Raj © 8