Preparing for Residency

How to address a medical school misstep in residency interviews

Brendan Murphy , Senior News Writer

AMA News Wire

How to address a medical school misstep in residency interviews

Oct 30, 2023

Not everything goes according to plan in medical school.

If your time as a medical student has included a misstep in your past, it doesn’t necessarily reflect the physician you will be in the future. Still, some of those adverse results are communicated to residency programs with the information that is included with your application. Will they come up during interviews—and if so, how should you address them?

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Ami DeWaters, MD, MSc, is associate professor of medicine at Pennsylvania State University College of Medicine. She has worked as a mentor to numerous medical students during the residency-selection process. Dr. DeWaters offered insight on how a past mistake could be effectively addressed during residency interviews.

Residency program officials will see any failed attempts at board exams or courses a student fails during their training. Gaps in training—though generally not frowned upon the way they were in the past—will also appear on your transcript. Another potential area of concern Dr. DeWaters highlighted could include professionalism violations that are mentioned in your Medical Student Performance Evaluation, formerly known as the Dean’s Letter.

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If you have one of these events in your past, the first thing to consider is whether you want to address it, Dr. DeWaters said. If you are taking a proactive approach, you may have already mentioned the event and your response in your personal statement.

“There are two schools of thought,” Dr. DeWaters said. “There are some people who say it’s best not to draw attention to these events. I’m in the other camp. I think it’s best to be proactive. So, you don’t necessarily have to bring it up in every interview, but if you do, make sure you bring it up with emotional intelligence, in other words, demonstrate mature reflection about the circumstances that led to the challenge you faced.”

Even if you don’t bring up a past mistake, interviewers might. However, if it comes up, it’s vital to take personal responsibility.

“You have to exhibit strong emotional intelligence in the interview setting when talking about these things, and it's extremely important not to be defensive,” Dr. DeWaters said. “It will read very badly if you're blaming others. So you need to take ownership for what happened.”

Don’t minimize, downplay or mislead about an event, even if something isn’t included in your application packet.

“There are other ways to get communication about your application,” Dr. DeWaters said. “As an applicant you need to be aware of that fact. Let's say you are applying to your home residency program, where you went to medical school. Some of the people on that residency-application committee may have been on your medical school’s academic oversight committee. They may have heard about an issue you had.

“If you are dishonest about what happened, that really sets you up for disaster because that person's going to know immediately,” Dr. DeWaters said.

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A mistake is a chance for growth. Demonstrate that when addressing it in an interview. Dr. DeWaters used the example of failing a United States Medical Licensing Examination Step 1 exam to demonstrate what that looks like in action.

“I would say something like: ‘These are the factors that I think contributed to that Step 1 fail and here are the very specific steps I took to make sure that that didn't happen again. Then I took Step 2 and passed, and that proves that I was able to fix some of those things that I had going on in the first round.’”

Any sort of misstep could be related to personal circumstances. Certainly, Dr. DeWaters said, a gap in training for nonacademic reasons likely is because of something unrelated to your studies.

“If something happened because of personal or family health reasons, what I usually advise applicants is that you share what feels most comfortable to you to share,” Dr. DeWaters said. “Obviously there are personal health reasons that people do not want to share, and that should be respected, so those individuals are going to want to practice their response to questions about the gap in training.”

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Do keep in mind that interviewers have gone through the rigors of medical training, and they are going to be empathetic to a student’s situation more often than not. Context around a situation—within the bounds of what a residency applicant is comfortable sharing—can be helpful.

If you had a family emergency hours before you had to take an exam that you failed, for instance, Dr. DeWaters said that could be useful information to bring up.

“Providing context into why something happened and trying to deliver excuses come across differently,” she said.

One bad result doesn’t mean you won’t match, and if you’ve reached the interview stage, a program is obviously interested in your application.

“I’ve seen many examples of students who were able to overcome setbacks to match into a program they really wanted to be in, in a location they really wanted to be in and then they did really well during their intern year,” Dr. DeWaters said.

The AMA Road to Residency series gives medical students, international medical graduates and others guidance on preparing for residency application, acing your residency interview, putting together your rank-order list and more.