CHAPTER 24
Residency Interviews
I am not now
That which I have been.
—LORD BYRON
DUST OFF YOUR suit and polish your smile. It’s time to hit the interview trail again. After several weeks of waiting with bated breath, residencyinterview offers will start to arrive. As you wait, spend some time refreshing your interview skills. Remember all that practice in talking confidently about yourself and your application? Remember developing insightful questions for each program? Your residency interviews will be very similar to your medical-school interviews. Begin your preparation by turning back to chapter 8 and reviewing the basics.
HOW THEY’RE DIFFERENT FROM ADMISSIONS INTERVIEWS
The good news is that your residency interviews will be much less stressful than your medical-school-admissions interviews were. You’re much more knowledgeable now, and you’ve already gained some practical experience in the field you want to pursue. If you’ve been offered an interview, you know that you’ve passed the threshold academic criteria for the program.
Good programs will make you feel immediately welcomed. There will typically be a presentation and tour that give the program a chance to strut its stuff and highlight its strengths. The interview segment will follow, which truthfully is more a series of conversations than an inquisition. The fundamental goal here for both sides is to determine fit. Unlike your life in medical school, you’ll be working many, many hours with the same relatively small group of people, so it becomes imperative for both sides that personalities mesh and work ethic aligns. In the small confines of a residency program, a single problem resident can be a disaster.
INTERVIEW TACTICS
Interviewing is very much a two-way street. You project a certain persona, and in turn you take away an impression of the interviewer and the program as a whole. When you sit down with a residency interviewer, you want to make certain that you leave a strong overall impression and convey one or two key things you want them to remember as they go back to discuss that day’s candidates.
Projecting an overall image has a lot to do with your body language, your tone, and the flow of the conversation. Obviously you want to be open, friendly, and confident without being cocky. Try also to be relaxed without being a slouch. Your enthusiasm for the specialty and program must shine through. In almost any interview, you will be given some sort of open-ended question to highlight your record or your perspective. Have in mind two or three key points that you want to make sure the interviewer walks away with. Be clear and concise. At this point you should have a growing perspective on the specialty, so make it clear you have some specific goals for your future in the field.
“Be yourself in the interview,” Kate advises. “The residency knows how you look on paper. Now they want to find out how you are in person—can you interact well, are you poised, can you communicate? Are you a fit for their program? What else do you enjoy besides medicine? Can you hold a conversation? Sounds simple, but it’s probably the most important aspect of your application. So be you. Be honest. Avoid prescripted answers.”
HOW TO EVALUATE PROGRAMS
The impression you take away from a program will be the result of your interviews and experiences. You should cover some key questions as you evaluate each program on your list in order to develop better this impression and to compare and contrast individual programs. First, do the residents in the program seem happy? Have many left the program, and if so why? How stable is the faculty roster? Has the program achieved accreditation by the Accreditation Council for Graduate Medical Education (ACGME, at www.acgme.org), meaning that it is an approved residency program? If not, where did it fail, and what is being done to remedy the situation? Even if it achieved accreditation, were there any concerns or areas of improvement noted at the last review? What is the patient population like, and what is the resident workload like? Will you see enough volume and diversity to satisfy your training requirements? Will you see too much volume to allow any time for teaching? What are the facilities like? What is the program’s policy on moonlighting? Where have the program’s graduates gotten jobs or fellowships?
These are just a few of the questions you might want to ask. You’ll add to this list as you become a more experienced interviewer and gain more perspective on the ubiquitous and the unique in each program you review.
“Prepare good questions to ask, as the interview day is really structured to inform you about a program,” Adam suggests. “Do not ask inane questions just to appear interested. We had a student ask several different residents how much they paid for parking. Who cares? This did not make the best impression. It’s like asking how many books are in the library.”
SCHEDULING YOUR INTERVIEWS
Scheduling your interviews will prove a challenge, just as it was in the medical-school process. It seems like no matter how much you try to orchestrate your interviews, you’ll still be crisscrossing the country trying to fit them all in efficiently. This is a time-consuming and costly process. Most schools offer additional financial-aid loans to senior students to help cover the costs of travel for interviews. The farther you get down the interview trail, the more informed a consumer you will become. Toward the end of your interview sequence, you may feel you want to curtail your remaining list somewhat in light of what you’ve already seen. Providing you’ve covered a good range of options already, including some top choices and some safer choices, this may be a reasonable thing to do. As always, you should alert a program as soon as you’re sure you’re going to decline their offer to interview so that others can take your spot. If you’ve been wait-listed for an interview anywhere, make sure you check in with the program frequently and reassert your interest. Don’t pester and don’t be overbearing, but do remain active and politely enthusiastic. By the end of the interview season, many candidates start canceling interviews, and programs begin calling people from their interview wait list. If you’re patient and persistent, chances are good you’ll get your interview.
Just as it was with medical-school interviews, your postinterview follow-up letter is key to your overall strategy. Immediately after spending the day at a program, you should write a thank-you note to the program director and to any interviewers with whom you felt you made a good personal connection. The note should be brief, succinct, friendly, and professional. Where possible, customize each note to reflect some specifics from your experience or from your conversation with that person.
As the season progresses you will start to get a feel for which programs you’re especially interested in. When communicating with your top-choice programs, you must strike that delicate balance between leaving a lasting impression and making your name familiar to the residents and faculty, without being overbearing or pushy. You may want to contact some residents with specific follow-up questions. Another excellent technique can be scheduling a “second look” visit. This is an opportunity for you to visit the program on a noninterview day, to spend some more time clinically with the residents, and to chat some more with the program director and faculty. This will help cement you in their minds, and may offer you a deeper insight into the program, confirming or dispelling your initial interest.
Another key to keeping your application fresh in the program director’s mind is to continually update your file. Anytime you receive awards or accolades, anytime you get an article published or have some particularly unique experience, update your ERAS file and consider sending a brief letter summarizing the update to your programs. Don’t do this weekly—that’s annoying—but if you have some substantive additions that will highlight your candidacy, consider doing it at least once in January as programs begin making their match decisions.
CHAPTER 25
The Match
The die is cast!
—SUETONIUS
WITH INTERVIEWS NOW under your belt, it’s time to put together your match list. This is the sequential ranking of programs you applied to and interviewed at. Onc
e you assemble this list, the NRMP will combine your list with each program’s corresponding list to match you to the highest-ranked program on your list that offered you a spot. This list, therefore, is critically important. Follow these few simple rules to make creating your list a snap and ensure you match at the best place you can.
MAKING YOUR LIST
The fundamental rule to making your list is: be honest. It’s tempting to try to game the system, hedging on the algorithm by ranking programs you’re especially excited about slightly further down your list on the misguided notion that you probably won’t get your first choice but are likely to get your second, third, or fourth choices. Don’t play games with the process—it just isn’t worth doing.
The simple way to construct the ideal rank list is to sit down with the list of places you interviewed and organize them according to where you want to go. Look over the list, reflect on why you applied to each program and how your experiences there did or did not confirm your interest. Write out a list of pros and cons for each program, if that helps. Talk it through with a friend, a family member, a trusted classmate, or your mentor. Review the criteria for selecting a program discussed in the previous chapter and reaffirm what the most important features of your ideal program are—these may have changed now that you’ve interviewed and have a much broader perspective on residencies and the specialty.
Now make your list. Just like that, write it all down, number one to however many programs you have, and then put your list aside and walk away for a day or two.
After a couple of days, pick a quiet hour and sit down with the list one more time. Glance down at your top three choices and gauge your visceral response to these programs.
Do you get a tingle of excitement at the idea of going to these programs?
Now look down at the next seven programs. Still kinda tingly? Still some pretty cool places?
Perfect.
Now look over the entire list and ask yourself this critical question: is there any program on that list that you would not be excited to go to if you matched? If there is, drop that program from your list. Remember that the match is a binding contract, and you could theoretically end up at any program on your list. Life is too short to spend a residency somewhere you don’t want to be. Strike all programs about which you have uncertainties from your list before you submit it.
Assuming that you’ve carefully considered your options, surveyed the field, interviewed and discussed the various programs, and crafted your rank list, go to the ERAS Web site (www.aamc.org/students/eras/start.htm), type in your list, check it for accuracy, and hit “Submit.”
You’re done.
Walk away with a grin and the knowledge that you’re going to end up somewhere you’re excited to go. Spend the next few weeks focusing on your rotations and enjoying your senior year. Let go of the stress and strain of the match—it will take care of itself and there’s nothing more you can do about it.
MATCH NUMBERS AND “THE SCRAMBLE”
Though you can’t do anything about it, you’re not technically out of the woods completely once your rank list is submitted. As the NRMP cranks through everyone’s rank lists, it does run into scenarios where there is no achievable match for a candidate or where it is unable to fill all the positions in a given program. In these cases the process reverts to good old-fashioned human networking.
Welcome to “The Scramble.”
Match Day is typically mid-March, usually around the eighteenth of the month. Several days prior to this, NRMP will alert you whether or not you matched. It won’t tell you where you matched, just whether or not you did. If you failed to match, you will automatically be eligible for The Scramble.
In this minimatch process, all of the available candidates (“free agents,” if you will) are posted on a Web site along with all the unfilled programs. At an appointed hour, applicants across the country can start calling those unfilled programs. Materials are then faxed frantically, and rapid interviews occur over the phone.
Ideally, a good fit is found between an unfulfilled program and a free agent candidate, and both parties win.
Every fourth-year medical student lives in fear of The Scramble. There’s something about medical students that seems to make them seek opportunities to be paranoid and pessimistic. The reality, thankfully, is in your favor.
According to the AAMC, there were 14,719 active applicants from U.S. medical schools enrolled in the 2005 allopathic match. Of these, 93.7 percent matched successfully. Thus only 6.3 percent, or 921 students, were forced into The Scramble. Most of these students did not match primarily because of problems with their match lists—either their list didn’t get submitted on time, if at all (a particularly embarrassing situation to be avoided at all cost), they had an extremely limited rank list, or they applied only to extraordinarily competitive programs in a competitive field without any fall-back choices.
If you follow the advice detailed above, you will avoid most, if not all, of these scenarios.
The numbers are less favorable for non-U.S. medical-school graduates. For Canadian students in the U.S. match, the scramble rate was 27.1 percent; for osteopaths, 31.4 percent; and for foreign graduates, 45.3 percent. If you are applying from one of these groups, it is critical that you play your cards carefully and make a strong impression at your top-choice programs. Your best bet will be figuring out a way to make yourself someone the program can’t imagine living without. If for whatever reason you find yourself in The Scramble, fear not. Out of chaos can come surprising opportunity. Every year, strong and reputable programs fail to fill completely. There are always highly desirable positions available through The Scramble, and with a little effort and quick action you may be surprised to find yourself matched to a program you didn’t even think you had a shot at. Your dean or faculty advisor should be at your side as The Scramble opens to assist you through the process and to help you make your choices. These faculty members have helped scores of others before you through The Scramble, so trust their advice.
In the end, although The Scramble may feel scary, you might just be surprised how well it all works out.
MATCH DAY
At long last, the day of reckoning is upon you. All those years, all those hours of studying are about to culminate in your acceptance to a residency, and your ticket to specialty training and your career in medicine. Most schools have a Match Day ceremony in which you will gather in a large hall with your classmates and open your acceptance letters. This is a dramatic and festive occasion. On the one hand, you are sad to be leaving your classmates and your medicalschool experiences behind. On the other hand . . . hallelujah!!! You’re free! You survived! The last piece of this medical-career puzzle has fallen into place.
CHAPTER 26
Finishing Up
There will come a time when you believe everything is finished.
That will be the beginning.
—LOUIS L’AMOUR
THE LAST FEW weeks of school will go by all too quickly. Your primary focus will, appropriately, be on making the transition to your new life post-medical school. With all of your core requirements completed, you can focus on having fun and relaxing.
ELECTIVE TIME: HAVE FUN, TRY SOMETHING DIFFERENT
Obviously if you have remaining required rotations that must be completed prior to graduation, focus on getting those done immediately. If you have elective time to fill, you might want to consider drumming up some unique experiences you might not get another opportunity to pursue. Travel and international electives are a popular way to round out your medical-school experience and provide very different perspective on health care as a whole. You may be able to arrange a wilderness-medicine elective, or even a liberal-arts elective to focus on a creative endeavor related to medicine.
Deans are typically fairly liberal with what they will allow in these last few months, providing you can demonstrate some medical relevance. Many schools offer preinternship didactic reviews like “Pharmacology for Interns
” or “Effective Laboratory Testing.” These can be helpful reviews, and typically have a very light class schedule that gives you plenty of free time. Finally, you should consider pursuing any last-minute interests or curiosities before you leave the medicalschool nest altogether. In general you will want to avoid intensely time-consuming or exhausting electives at this point. Do you really need another month of critical care now? You’ll have plenty of that in a few months’ time when internship starts.
VACATION!
Most people have a fair amount of vacation stored up toward the end of their senior year. Take it! Enjoy the opportunity to spend longer periods of free time with friends, family, and loved ones. Travel if you can. Get outside. Get back in shape. Get yourself centered and healthy in body and mind.
It will all start again soon enough!
CERTIFICATIONS
Many schools offer some transitional certification classes that can save you time once you get to residency. All residents are required to be certified in Advanced Cardiac Life Support (ACLS) and/or Pediatric Advanced Life Support (PALS). Many services may also require Advanced Trauma Life Support (ATLS). There will be mechanisms in place in your residency to acquire all the certifications you need when you start. Nonetheless, if you can check these classes off your list before you leave medical school it may save you some time when you start your internship. You can contact the coordinator or program director at your new residency for information on what certifications you’ll be required to have.
Med School Confidential Page 26