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The Residency Interview: Making the Most of It

Phyllis Kopriva, Director,  American Medical Association Women and Minority Services

 Setting Up Your Interviews
Make arrangements for your interviews as early as possible without scheduling them so early as to look pushy or over-anxious. Certain programs interview by invitation only. In those cases you must send in your application and hope for the best. If you are extremely interested in a program, consider doing a visiting elective there before your fourth year.

About the Match Process
As a rule of thumb, program directors would like to be finished with their interviews by January so they can attend to the administrative details in order to meet the National Resident Matching Program (NRMP) deadlines.

The NRMP is sponsored by five organizations, the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), and the Council of Medical Specialty Societies (CMSS). Each year, the NRMP conducts a match that is designed to optimize the rank ordered choices of students and program directors. Registration opens in August with a final deadline of December 1. From mid January through February, candidates and programs submit their preference lists. In the third week of March, the results of the Match are announced.

It is a good idea, however, to get a few interviews under your belt before you go to the ones that you regard as the most important. And it is reasonable to expect that after a dozen interviews you will be battle-weary. Therefore, scheduling your most prized interviews in the middle might promote the best results.

Research the Program
Research the program as much as possible before you go so that you will be able to target your questions for that program, rather than doing a generic interview. You might check to see if any graduates of your medical school are there, and if so, consider getting in touch with them. Do some research on the latest developments in the specialty that you’re interested in, including what types of people they’re looking for. Different specialty programs may have different priorities - leadership, community involvement, research, or clinical abilities.

Review your application, personal statement and curriculum vitae and prepare yourself to discuss anything that you’ve mentioned on them, including any research that you’ve done. Prepare a list of questions that you want to have answered during your stay. And remember, you don’t have to memorize your questions; you can take your notes into the interview.

Plan Your Trip Well
Housing. Some students find it helpful to make prior arrangements for housing in residents’ quarters. At the same time, check to see if you can schedule an interview on a day when you can attend morning rounds or a teaching conference. If you have the time, stay an extra day to talk with residents. Time and again, respondents reported the value of information gained from this source.

(For help in finding local housing during your interviews, you can also call the American Medical Association.The AMA Alliance, in partnership with the AMAResident and Fellow and Medical Student Sections, runs the Community Welcoming Program -- which finds on-site hosts for fourth-year medical students and their families as they interview for residency. This helps medical students minimize travel costs while keeping them connected with organized medicine. More information about the Community Welcoming Program, including how to request housing and how to become a host, is available on the AMA Alliance website )

What to Pack: A residency interview is a job interview, and the propriety of  your dress reflects a sense of being in touch with the world.  Your choice of a residency, and their choice of a candidate to whom they can entrust patients, is serious business.  For men and for women, suits are serious clothes and are appropriate for interviews.  Failure to wear professional-looking clothes might not cost you a placement, but it can distract the interviewer.  Sweaters and slacks are okay when you're on call in certain programs, but your safest bet when you interview is to dress for success.  Business schools impart lots of information to their graduates about how to dress for job interviews; medical schools do not.  But don't be fooled.  Although you may not be going for job in banking, you are interviewing for a professional position.

In addition to carefully planning what clothes to bring, run through the other possibilities that may arise while you’re away. You may go for a meal with one of the residents. It could rain, so take an umbrella. It is easy to spill something on a shirt, spot a tie, or rip a seam. Pack accordingly.

The First Impression
Students often go into the interview room very nervous. Most adjust quickly, but wish they could avoid the early jitters. If this applies to you, and it probably does, follow these helpful hints:

  • Be on time.
  • Get the names, including spellings, of the interviewers from the departmental secretary so that you know who you’re seeing.
  • Look your interviews in the eye, greet them by name and offer your hand for a firm handshake.
  • Smile.
  • Let everyone else sit down first (old fashioned manners).
  • If you’re offered coffee or tea, but you’re pretty shaky, refuse it.
  • Take a deep breath and proceed.

 During the Interview
Selecting your residency program  is a major decision a decision that you will have to make after very brief contact with people who may be your associates for a long time.  Value the impressions that you make of the program and the people, and keep track of those feelings about the interview to assess how suitable the fit is between you and the program.

Direct each question to the appropriate interviewer (i.e. program funding to the director and call schedules to the residents). Consider which questions are appropriate for the interview, and which are for a less formal setting. For example:

Think about your real priorities and make sure you express them. And, ask your questions at the appropriate times. The beginning of the interview is not the best moment to ask about salary, benefits and call schedules. Although they are legitimate questions, bad timing or asking the wrong people could make your interviewers uncomfortable about your values. In addition, questions that challenge or confront interviewers can be alienating; nuances such as tone and word choice are important. “What is wrong with your program?” is more difficult to answer than “What are some of the challenges that I might face here?”

Investigate each year of residency; students often direct their focus only on the first year. And don’t try to buddy up with faculty by telling each of them that you want to go into their specialty - they might compare notes later.

Beyond the Questions
In answering questions about what kind of person you are, why you went to medical school, and what you want to accomplish, you will want to try and distinguish yourself from the other interviewees. However, that is often difficult to do. Many have reported that the most common questions were sometimes the hardest to answer, for example, “Why to you want to be a doctor?” Most of us become physicians for the same reasons -- to “save lives”, “improve health care in America, “help people”, “make a contribution to society,” and so forth. That is not to say that you should not say those things; by all means do so. After all, that probably is what you hope that you will be contributing.

But in addition to your heartfelt answers to those questions, you can distinguish yourself by showing that you have spent time in introspection and that you understand how your experiences have shaped you and influenced your decisions about becoming a physician and choosing your residency. One experienced interviewer told us, “Everyone has a story, but many of the students we see don’t seem as if they know their own particular stories. Many have not really thought through their lives and what they want.” Spend some time with yourself before the interview; ask yourself these questions:

  • What are your expectations of what your life will be like after residency? What’s your visual image of your life as a doctor?
  • What have you done in your life that shows that you are a hard working and dedicated? (Remember, it doesn’t have to be restricted to medicine.)
  • What besides medicine do you have in your life that you feel passionate about?

What About “Lifestyle”
The medical profession continues to debate the advantages and disadvantages of the intensity of the residency demands and schedules. Long resident work hours, sleep deprivation, high stress levels, relationship interruptions -- these are somewhat par for the course in a typical residency program, but of legitimate concern nonetheless -- particularly as you may think about your now or future spouse or children.

It’s appropriate to ask about call schedules such as “How often will I be taking call” or “What are the expectations for a new resident…” But too many questions about time off will make you look like you’re picking your residency on that basis, which does not speak well to the program. It’s a fine balance.

After the Interview
Go back to your housing and immediately write down your impressions of the interview. After a few interviews, you will tend to start forgetting what happened where. Write a description or make a list of what you liked and didn’t like, and do it right after the interview because you won’t remember later.

Don’t rank a program you will feel uncomfortable working for. If you’re going to interview at many programs, it’s a good idea to prepare a checklist in advance of the factors that are particularly important to you that you can use for all your interviews. At the end of the process you can then use a consistent rating system to help sort out your decision.

Follow up your interview with a note of thanks -- but not one that sounds like a form letter. Make sure that you sound genuinely interested.

Commonly Asked Questions
Interviewers routinely ask certain questions of applicants, and for some of them you will have ready answers. Interviewees report that they found some questions appropriate; others they felt to be off-limits, though frequently asked. Ranked among the most difficult to answer were vague, open-ended or very general questions. Interviewees reported anxiety about questions like, “Tell me about yourself’, or “What do you want to know about the program?”, and yet those were the kinds of questions they repeatedly faced.

Another common question was about personal weaknesses. As one respondent said: “You should pick something that doesn’t expose some horrible shortcoming -- something that could actually be seen as a strength. For example, you may feel that “I’m a perfectionist, I trust people too much.” Or “I’m too organized.” You certainly can’t respond, “I’m insensitive, cruel and lazy!”

If you are prepared to answer the following list, you should be ready for many of the questions you will face.

  • Why did you choose this specialty?
  • Why are you interested in this program?
  • What are your goals?
  • Tell me about yourself?
  • What did you do before medicine? (To an older student)
  • Why should we pick you?
  • What are your strengths?
  • What are your weaknesses?
  • Where else have you applied?
  • Are you interested in academic or in clinical medicine?
  • Do you want to do research?
  • Where will you rank us?
  • What was the most interesting case that you have been involved in?
  • Present a case that you handled during medical school.
  • Do you plan to do a fellowship?
  • What could you offer this program?
  • How do you rank in your class?
  • Do you see any problems managing a professional and a personal life?
  • Are you prepared for the rigors of residency?
  • Where do you see yourself in 5 years?
  • What questions do you have?

Uncommonly Asked Questions
Beyond the routine questions, there are others that are more difficult, unusual, or even strange inquiries that may not seem to pertain to your future as a doctor. You cannot prepare for all the questions you hear about through the grapevine. Nor can you prepare for all the remote possibilities that you conjure up in your head.

Questions that are unexpected often fall under the general category of getting to know you. It’s a good idea to spend some time on personal reflection before you start the interviewing process; give some thought to who you are in the world both as a doctor and as a person, what you like and dislike, why you’re in medicine and what you want out of your residency.

If you are asked something that seems pretty off-beat, it is probably best to assume that you are being judged on your grace under pressure as much as on the substance of your answer. Some program directors think that the way to test your smarts in the face of medical emergency is to put you into a crisis in your interview.

Remember, not all interviewers are equally skilled. You can correct some of the problems you encounter by keeping the interview focused. When questions are asked that don’t seem germane to the interview, you may tend to over-answer hoping to hit on something your interviewer wants. But don’t go on and on. If you’re asked a question about whether there are any physicians in your family, you needn’t give a monosyllabic yes or no, but don’t do your family tree, either. Rambling in an interview robs you and the interviewer of the opportunity to exchange the information you both need.

The following is a list of some uncommonly asked questions as reported by students:

  • Are you religious?
  • What is the one event you are proudest of in your life?
  • What do you plan to do after residency?
  • What are your hobbies?
  • What do you think about housestaff unionization?
  • How would you redesign the health care system?
  • Why did you get (a certain) low grade?

Of course, no one wants to force the issue, if possible. Instead be ready to use such opportunities to gauge the real environment and philosophy of the institution. For example, you might respond, “I’m glad that you asked that question. It gives me an opportunity to ask you the employee mix and patient demographics here…and your philosophy on teaching cultural competency. I’m very interested in improving the health status of minority populations.”

An approach like this can open a dialogue between you and the interviewer. It also gives you an opportunity to find out how the attitudes of the program reflect (or don’t reflect) your own. In a wider context you question can elicit information about the working conditions of the program, which affect all residents.

Questions to Ask During Interviews
Everyone who interviews for a residency has different priorities and ideas about what they want in a placement. Therefore, there is no way that someone can send you into your interview with a list and tell you that if you ask these questions you will cover everything that you need to know. In addition, different specialties demand that different questions be asked. However, it is very important for two reasons that you develop a set of questions. First, it is imperative that you glean the information that you need to assess the program; as one respondent to the questionnaire said, “You’re interviewing them just as much as they’re interviewing you.” Second, it is a handy emergency procedure in the event that you run into an interviewer who wants you to direct the interview. The following is a list of questions for which you may want answers, broken down into categories which may also be useful as a guideline for developing your own questions. Be careful not to ask a question that is already covered in the literature on that program.

Education/Philosophy:

  • What is the philosophy of the program?
  • Who are the faculty?
  • What kind of curriculum is offered?
  • How many hospitals participate in the program?
  • Is a thesis or publication required during training?
  • Is there time and funding for conferences and meetings?
  • To what extent do residents manage patients?
  • What is the patient mix and what are the community demographics?
  • Do residents perform surgery?
  • Is the program changing, and why?
  • What do residents here like most and least?
  • What are the research, clinical, teaching opportunities?
  • What is the scope of experience I can expect?
  • What is the program like (in the sub-specialty I’m interested in)?
  • Where are the graduates of the program now?
  • How much elective time is there and how is it usually used?
  • Is the Chairperson staying?
  • What percentage of graduates enter fellowships?
  • How is the training divided?
  • What are the weaknesses of the program?
  • Do residents have time to read?
  • How available are the attendings (including nights and weekends)?
  • What were the results of the last accreditation visit?
  • Are there any joint residency activities?
  • What is the patient mix? Does it reflect the community demographics?
  • What kind of community outreach might we be involved in?

Competitiveness of the Program:

  • What do you look for in a candidate?
  • How many people do you rank?
  • How do your residents perform on boards?
  • What is this program most respected for?
  • What is the ownership of this institution?
  • How financially stable is the program?

Quality of Life:

  • What is the mix of married and unmarried residents?
  • What is the racial/ethnic/gender breakdown of residents?
  • Do the residents socialize as a group?
  • Are their support groups?
  • Is there an Office of Minority Affairs? What is its role?
  • How many residents are there?
  • What is call schedule like?
  • What happens if someone is sick?
  • Characterize faculty-resident relationships.
  • What is the relationship between this program and other specialties?
  • Have any housestaff left, and why?
  • What do you expect of your housestaff?
  • Is there a house staff grievance process?
  • How are complaints handled?
  • What is the parental leave policy?

Benefits:

  • Do you offer health, life, disability insurance?
  • What is the salary?
  • What is your meal plan?
  • What kind of vacation time do you offer?
  • Do you have sick days?
  • Do you have maternity/parental leave?
  • Does the curriculum include training in cultural competence?
  • Is training offered in medical Spanish or other languages?
  • Does the program seek and actively recruit minority residents?
  • How many attendings/faculty are minorities, and are efforts being made to actively recruit them as well?
  • Does the medical school have an Office of Minority Affairs?
  • What is the make-up of the patient population?
  • Is the program or hospital involved in any projects to help the undeserved?

Other Things You Might Want to Know
There are other questions that you won’t be asking in the interview but might want to investigate on your own. For example:

Where is it?

  • Do you like the city?
  • Do you like the fact that it’s rural, or in a suburb?
  • What is the community seem like?
  • What is the climate like?
  • What kind of transportation is available?
  • What is the access to theater, movies, sporting facilities, the great outdoors?
  • What are the financial implications of living here?

The Hospital:    

  • How are the individual call rooms?
  • What are the meals like?
  • What is the library like?
  • Can you easily photocopy articles you need?
  • Where are the lockers?
  • Do men and women have equal facilities?
  • Are there fitness facilities?