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How To Master MyERAS, The Medical Residency Interview, and Common Residency Interview Questions

How To Master MyERAS, The Medical Residency Interview, and Common Residency Interview Questions

Part 1: Introduction moving beyond MyERAS

Once you have completed your work on MyERAS and have been invited to a residency interview, how you are perceived on interview day becomes the most crucial factor in determining how you will be ranked. It is important to understand what interviewers are looking for within the context of your experience. Residency applicants often fail to make a good impression when they try to tell interviewers what they think they want to hear instead of representing themselves honestly and authentically.

Since your grades, USMLE scores, ERAS application, and letters of reference will be used to evaluate your academic aptitude, interviewers are trying to assess something else – they want to know if you are really committed to the specialty to which you are applying, that you have a mature sense of what it means to practice your specialty and how good your interpersonal and communication skills are – among other attributes.

Above all, interviewers are trying assess your “fit” for a program. Residency is intense and you will be spending a lot of time with the individual interviewer, his colleagues and his residents. So, your interviewer is fundamentally trying to determine if he likes you and would be happy to see you at 3 AM when he is tired. Residency interviewers are not looking for the same subtleties that your medical school interviewers were; they assume that you want to be a doctor.

You should, in part, view your residency interview as a job interview; they want to know that you can get the job done reliably and competently. Interviewers also want to rule out any red flags, such as gaps in time on your application. And, above all, they want to figure out if you are likable and would make a positive addition to the program.

This article will help you understand how to approach your residency interview so you know what to expect on interview day and how to do well. Authored by Dr. Jessica Freedman, author of The Residency Interview and a former admissions officer, you will get the inside scoop on how to shine!

Part 2: How Applicants are Selected for Interviews after completing MyERAS.

Typically only one to three people are responsible for screening residency applications, and how they do it is important to understand. Since some programs may have up to 500 (or even 1,000) applications for only 100 interview slots, for example, it becomes the responsibility of those reviewing applications to decide who will be invited. I can tell you from experience that making these decisions is a daunting task. To decrease the work load, many program directors apply filters to applications to decrease the number of applications that must be reviewed to a reasonable quantity.

What kinds of “filters” are used? There are many. Some filters may be applied so program directors only review applications who have a certain United States Medical Licensing Exam (USMLE) step 1 score as a threshold, others may use a filter that only views applicants who have graduated within five years, while others may use no filters and manually review every application submitted. Some programs then assign “points” for everything: research, USMLE scores, and letters of recommendation; you are invited for an interview only when your “score” meets a minimum number. More often, however, a great deal of subjectivity goes into the decision to invite an applicant for an interview, whatever the grading system.

Often, the screener’s personal interests and outlook play a part in the review of your application–especially if you are a “borderline” applicant. For example, if reviewer A always had to struggle with standardized tests yet managed to succeed while reviewer B always had board scores in the top 5th percentile, reviewer A is much more likely than reviewer B to screen in an application with lower-than-average board scores.

The person reading your application might have years of admissions experience or he or she could be a novice, such as a junior faculty member or a very fresh assistant program director. Both the level of experience of the screener and his or her own biases and preferences often determine whether or not you are granted an interview. This is why norms for a program can change dramatically from year to year.

If a new program director who is a Caribbean medical school graduate comes on board, for example, a program may suddenly become “Caribbean medical school graduate friendly” and may go from matching with no Caribbean medical students to filling 70% of their slots with them. Also, although the person reading your application might have hours to peruse through all of your materials, it is more likely that she is tired and rushed and has a large pile of applications to review. If your application follows one that is more stellar, yours may pale in comparison. On the other hand, if the pile contains mostly mediocre-to-poor applications, yours may stand out.

Most reviewers also review applications in a systematic way and everyone has their own style. Since applications are typically reviewed on a computer rather than a printed hard copy of your application, the reviewer can choose which portions of your application to review and in what order. When I reviewed applications as the associate program director, my preferred order was as follows:

  • Applicant’s demographic information, including where he or she went to school
  • USMLE scores. Even though I knew that these scores did not always predict who would be a good resident and I often felt guilty for considering them in my evaluation, it was the only way for me to compare “apples to apples” so it became an important factor.
  • Letters of reference, looking first at those from people whom I knew and from people within the specialty. I would then consider other letters of reference.
  • Grades (especially those in the specialty to which the applicant is applying)
  • Applicant’s activities
  • Personal statement
  • Medical School Performance Evaluation (MSPE)

Based on my overall assessment, I would then decide if the applicant should be invited for an interview. But, if my decision was made after step 4 and I felt I had enough information to make a decision, I might only skim the applicant’s other materials. For the applicant who was “on the fence,” the activities descriptions, personal statement and MSPE became more important.

What is most important varies from reviewer to reviewer, however. But keep in mind that the most recent Program Director’s Survey by the National Residency Matching Program indicates that the MSPE, grades, letters of reference, USMLE Step 1/COMLEX score and personal statement are the top factors across all specialties. 
So, you can understand the importance of making your application as distinctive as possible which will increase the likelihood you will be invited for an interview. If the application bores the person reading it, the person reviewing your application will likely click the “hold” or “rejection” box on the application system. But you must also understand that many applicants to residency are highly qualified and that many steps in the selection process are out of your control. This is a hard truth to accept, and you can only hope that your application and letters of reference are appealing enough to trigger some interview invitations. Each interview is a chance to be ranked highly, so it is essential to be prepared and know what to expect.

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Part 3: Before The Interview

Responding To Interview Requests

You can start receiving residency interview requests very soon after you submit your ERAS application. Generally speaking, less competitive programs extend interviews early (mid/late September) while more competitive specialties and programs will extend interview requests in October or early November. 

Interview requests will arrive via email and we encourage applicants to check email often and respond to interview requests as soon as possible since interview slots can fill up quickly in the application process. Some requests will come through services called interviewbroker.com or thalamusgme.com where you can select available interview dates from an online calendar. A few programs do things the old fashioned way and will email you a list of possible dates and ask for an email reply with your first, second, and third choices. 

Research The Program

Since programs not only want to find the best applicants but also those who are the best fit for their individual program, you must know the details about each and every program where you interview. Review the program’s curriculum, clinical sites where you will be doing rotations, faculty and resident interests and any recent changes they are promoting. Have an idea of what the residency is “known for.”

For example, does the program emphasize research or teaching? Seeking out information may be easy for some programs, but others may have poor websites. For programs that have less than stellar websites, you should seek out information from current residents or recent graduates or rely on interview day to become informed about the school. You should also research the current chair, program director or any other significant leadership or faculty so you know about their interests; this will give you an idea of the program’s strengths. Also be sure to know something about the city where the program is located and be able to express why you would be happy living there. Feel free to bring up whatever you have learned through your research when asked “Why our program?” You may be able to glean some information if the program offers a dinner or happy hour before interview day.

Part 4: Residency Interview Questions

Below are some common questions you are likely to hear on the interview trail.

  • Tell me about yourself.
  • Why this specialty?
  • Tell me about a negative aspect of the specialty.
  • Where do you see yourself in the future?
  • What is your greatest strength/weakness?
  • If you had a free day what would you do?
  • How do you achieve balance in your life? 
  • Tell me a joke.
  • Teach me something.
  • What experience(s) made you want to pursue this specialty?
  • How would your best friend describe you? 
  • What would he or she say is your greatest weakness?
  • Tell me about an interesting case.
  • What is the one thing you tried really hard at something but didn’t turn out as expected or what has been your greatest challenge?
  • Did you ever have to work to help support yourself or fund your education?
  • How do you remember everything you have to do?
  • Would you change anything in your background? 
  • Tell me about your research/clinical work/volunteer experience.
  • Explain your academic path.
  • What strengths would you bring to our program?
  • Explain your poor grade/USMLE/academic performance.
  • Tell me about an ethical dilemma.
  • What qualities do you possess that will help you to become a great XXX specialist?
  • Tell me about the most influential person in your life.
  • Tell me about your most valued mentor.
  • What is your most valuable accomplishment?
  • What leadership roles have you held?
  • Why should we choose you?
  • Describe your perfect day.
  • Where do you see yourself in the future (10, 20 or 30 years)?
  • If you could change anything about your education, what would that be and why?
  • What kinds of books do you read? Tell me about the book you read most recently. 
  • What do you do for fun?
  • In closing, is there anything else you would like to tell me?
  • Do you have any questions for me?

Prohibited Questions

Programs are not allowed to ask you questions about ranking programs, where you are interviewing, your sexual orientation, race, age, religious affiliation, marital status or plans to have children. However, sometimes interviewers ask questions that touch on these topics, often by accident. Sometimes interviewers will push for you to offer specifics. If they do, you are in a bad spot and you should be honest. Programs also should not pressure you to tell them where you are ranking them. Assuming there is no malintent or bias involved and you don’t want to “call out your interviewer” for asking an illegal question, we suggest gently redirecting the question with your answer. Three examples are below:

  1. Where else you are interviewing?

If you are asked this question, I suggest you politely say something like, I am interviewing at a range of programs on the East Coast primarily. However, I really like this program for the following reasons (list them).”

2. How you will be ranking our program?

This question is a violation of the Match Participation Agreement. Interviewers cannot not ask about your rank order list. It’s best to respond like this: “I really have no idea how I will be ranking programs right now. I have really enjoyed learning about this program, however, for the following reasons.”

3. Congratulations on your marriage. Do you think you will be having children soon?

“My husband and I are really excited about this next step of my medical training and right now our focus is on enjoying interviews and travel and finding out where I will match in March.”

For more information read the Match Communication Code of Conduct.

Part 5: During The Interview

Basic Guidelines

There are some basic guidelines to follow that will help your interview day go smoothly.

Greeting People

Make eye contact with and introduce yourself to everyone you meet and smile naturally! Never call anyone by his or her first name; use his title and last name. If you aren’t sure of the person’s title, it is always safe to start off with “Dr. XX.” Do not extend your hand when you meet someone; instead let him take this initiative since he is senior to you. Have your right hand free so you are prepared and shake hands firmly if presented with this opportunity. Respect the personal space of everyone you meet. Throughout your interview day, be sure to speak at a normal pace, with clear diction, in a normal tone and volume and in a formal conversational manner. Speaking informally or using slang words anytime during the interview day puts you at risk for being perceived in the wrong way.

In The Office

As you enter someone’s office, allow her to suggest where you should sit. If she doesn’t do this, wait for her to sit down first and then sit across from her where it seems most natural. Sit up straight and do not slouch. Place anything you are holding on the floor beside you. If you aren’t sure what to do with your hands, fold them comfortably into your lap. It is okay to use gestures while you converse, but don’t go overboard. Do not forget to smile and try to appear positive, energetic, enthusiastic and warm. Be sure to make eye contact with your interviewer throughout the interview, especially when she is talking. This demonstrates that you are attentive. This behavior will make your interviewer like you—a primary goal. Do not be offended if your interviewer’s pager or cell phone goes off and she needs to answer a call. This is medicine and things come up. That said, your phone should not be visible or audible during interview day.

Make A Good First Impression

Even if it is subconscious, your interviewer makes a judgment about you within the first five to 10 minutes of your interview.  An initial positive impression causes a “halo effect” and will affect everything you say in a good way. Similarly, an initial negative impression will cast a shadow, making it tough to redeem yourself. Making a good first impression is based not only on what you say but on your general demeanor. Are you professional, poised, energetic, positive and enthusiastic? Do you smile and make eye contact? Are you well-groomed?

The impression you convey in the first few minutes by your overall attitude, energy, tone of voice, expression and posture will set the stage for everything that follows. Remember never to say anything negative during an interview about other schools or people, which may give a poor impression.   

Even small talk at the appropriate time can have an important effect, either positive or negative. You might find yourself speaking with a member of the faculty who is not interviewing you before the program presentation, for example. If this person has a strong impression of you, whether positive or negative, she will likely express it when your candidacy is discussed.

Create Your Own Agenda

By agenda, I mean an outline in your mind (you don’t want to display a crib sheet) of the key things about you and your experiences that you would like to discuss. This is essential because you cannot rely on your interviewer to ask about everything you would like to discuss, even all of your key experiences; you must take responsibility for bringing them up even if you wrote about them in your application. Remember that even if an interview is open file, your interviewer may not have had the time to review your materials. Also, think about how your experiences and values are similar to those of the program and speak about them within this context. Also, if you have any future rotations or experiences planned later in the year that are related to the specialty, be sure to bring them up. 

Make The Interviewer’s Job Easy

When I interviewed applicants, the most painful interviews were those that made me feel that getting information from an applicant was “like pulling teeth.” In contrast, the easiest interviews were with candidates who had a lot to say that was pertinent and important. These interviewees were obviously better prepared, which impressed me because it indicated that they were taking the interview seriously enough to practice. Applicants who gave brief answers forced me to dip into my “interview questions bank” since they said so little. Ideally, you should make your interviewer’s job easy by providing her with insights and anecdotes and making segues. You don’t want to ramble, but as long as you stick to the agenda you’ve created, it’s most likely that you will stick to pertinent topics while making things simpler for your interviewer.

Make Segues And Give Complete Answers

Again, this comes back to the idea that you are in control. Make segues to topics you would like to discuss. For example, if you are asked why you want to pursue a certain specialty, explain not only “why” but “when” and “what.” Tell the interviewer when your interest started and what you have done to explore it. If you practice doing this, your segues should become natural and conversational, and your interviewer will remain engaged in what you are saying. By making these references and elaborating, you will naturally inspire further discussion and create prompts for your interviewer.

Try Your Best To Make Your Interview Conversational

The more experienced interviewers will naturally try to make your interview conversational but, just like any conversation, your interview is a give and take so do your best to keep the flow going. At the same time, be sure that you keep an air of formality to your interview even if your interviewer becomes too informal. Also, try not to dwell too much on one topic or to get off topic. Unless you are interviewing with a  chairperson or someone who is very experienced and you feel like you have already covered many of the basics of your experience and motivations, it is usually only an inexperienced interviewer who allows the interview to get off track. It is your job to make sure this doesn’t happen.

Interview Length, Schedule & Format

Interview visits typically consist of a “night before gathering” and the interview day itself both of which which are explained in greater detail below.

Pre-Interview Day Gatherings

Many programs have a dinner or happy hour the night before interview days. These events are generally recruitment efforts and are usually attended by current residents and applicants. You should dress in “business casual” attire for these events and can bring a “significant other” only if the program offers this option. You want to be social at these events but do not be too informal. Don’t say anything that you wouldn’t say directly to the program director. My residents would routinely come to my office the day after these dinners to tell me whom they did and did not like. So, even though you aren’t being formally evaluated at these dinners, it’s wise to try to make a good impression.

Here are some general guidelines for these “evening before” gatherings:

  1. Don’t say anything that you wouldn’t want the program director to hear.
  2. Don’t spend time chatting with another applicant about another program.
  3. Order one alcoholic drink if everyone else is having a drink and you want one – but only if you are used to drinking alcohol. Do not order more than one drink.
  4. If you are ordering from a menu, do not order the filet mignon for $45 if everyone else is ordering a burger for $15.
  5. Go home after the event. Even if the residents invite you out for more social activities, kindly decline the offer and say, “I really want to get some sleep. Tomorrow’s interview is really important to me.”
  6. Take note of whether or not residents are at the dinner. Sometimes the guests primarily are faculty,  but typically these functions are intended to provide informal opportunities for candidates to talk to the residents. You should be skeptical if your contact with the residents is limited. This may mean that either the residents opt out of events or residents were not invited. In both cases, this may imply that residents are not happy with the program.

Interview Day Schedule

Interview days vary but follow a general pattern. Typically, smaller programs will have only two to three interviews of 30 minutes each. But, larger or very competitive programs, may have up to ten very brief interviews lasting 15 minutes each.

Below is a typical interview day schedule:

  • 8:30 AM:  Arrive at the interview office
  • 9:00 AM: Presentation by program director 
  • 10:30 AM: Tour of facilities
  • 12 noon: Lunch with residents
  • 1:00 PM – 3:00 PM: Interviews

The presentation and tour can give you tremendous insight into a program’s philosophy, structure and stability. For example, if the program director is not present on interview day and the assistant director is is instead giving the introduction, you should be concerned about the program director’s commitment to the program, her organizational skills and the training that you might obtain in this program. Conversely, when the department chairperson makes it a point to speak to applicants on interview day, it suggests that the departmental leadership is invested in resident education. This is essential because the chairperson typically determines how much funding is allocated to the residency, which directly impacts resident education.  In addition, the chairperson’s involvement in resident selection suggests that the residency and departmental leadership collaborate, an important aspect of running a department that is truly focused on education. 

Do not feel you must ask questions during the orientation and tour. One or two applicants usually dominate these sessions and, unless they have an established rapport with the presenters, these individuals are not usually perceived in the best light. It is best to pay close attention and to show that you are doing so by making eye contact with the speaker. You may take notes during a program presentation but, as mentioned elsewhere in this book, do not take notes during your actual interviews.

Since many programs interview multiple candidates on any given day, a tremendous amount of planning and coordination is required to keep everyone on schedule. For this reason, interviews often run late, residency coordinators knock on interviewers’ doors five minutes before interviews are scheduled to end to “keep things moving” or may even call interviewers when time is up. If a program is seriously behind schedule, however, you should wonder about the overall organization of the program. It is not your responsibility to keep your interviewer on schedule, however. Allow your interviewer to decide when your interview will conclude and to keep track of time. Every program has faculty who are notorious for “going over.” If you are late for an interview because the previous one was longer than expected, you can apologize and say, “I am sorry I am late. My last interview went over.” 

Interviewers

You may be interviewed by faculty, residency leadership (including the program director and associate program director) and current residents. Because your interviewer is your advocate and the primary support for your candidacy, it is essential to get on her good side. You should wear professional attire and always be respectful. She (or he) will “sell you” to the other faculty. Your interviewer typically makes or breaks your acceptance. If she thinks highly of you, you will be ranked highly, but if you don’t make a good impression, she will not support you. Remember your interviewer is human and, most of the time, is not trying to “get you.” She wants to find out about you as a person and if you will be a good fit for the program. Because you cannot predict or control who your interviewer will be, it is important to have broad appeal as an interviewee and prepare yourself for the interview process and multiple scenarios.

Part 6: What are Interviewers Looking For?

It is important to understand what interviewers are looking for within the context of your experience. Residency applicants often fail to make a good impression when they try to tell interviewers what they think they want to hear instead of representing themselves honestly and authentically. Since your grades, USLMLE scores and letters of reference will be used to evaluate your academic aptitude, interviewers are trying to assess something else– they want to know if you are really committed to the specialty to which you are applying, that you have a mature sense of what it means to practice your specialty and how good your interpersonal and communication skills are—among other attributes. Above all, interviewers are trying assess your “fit” for a program.

Residency is intense and you will be spending a lot of time with the individual interviewer, his colleagues and his residents. So, your interviewer is fundamentally trying to determine if he likes you and would be happy to see you at 3 AM when he is tired. Residency interviewers are not looking for the same subtleties that your medical school interviewers were; they assume that you want to be a doctor. You should, in part, view your residency interview as a job interview; they want to know that you can get the job done reliably and competently. Interviewers also want to rule out any red flags, such as gaps in time on your record, many changes in careers or interests or any signs of personal instability.

Do you have a demonstrated commitment to and understanding of the specialty to which you are applying?

Interviewers are trying to assess first and foremost your motivation to pursue your desired specialty. They want to hear about when and why you decided to pursue this specialty, and they want to know that your background justifies your claim that you want to practice this specialty. For example, if you are interviewing for a residency in anesthesiology, it won’t be very convincing to the person interviewing you that you are committed if your only experience in anesthesiology was a two-week stint during your surgery rotation. In contrast, the person who has done that two-week stint plus two full rotations in the specialty and has more rotations planned later in the year that will prepare them for residency presents a much more convincing argument. Interviewers also want to know that you understand what you are getting yourself in to, that you understand the pros and cons of practicing your desired specialty and have a realistic idea of the challenges you will face. They will assess your understanding of what you will actually do in your desired specialty. Interviewers may also ask about health care reform and specifically how it may affect your specialty. They want to know that you aren’t living in a cave and that you understand that reforms are likely in your future.

Do you have what it takes to make it through residency training and a future medical career?

It takes a tremendous amount of dedication, hard work, resilience and perseverance to do well in residency training, which can be very rigorous. With the exception of only a few specialties, residency demands functioning well despite working long hours and many nights and weekends. While interviewers will glean information about your strengths based on your letters of reference, they are also trying to assess these qualities during your interview. Residency training also presents intellectual, emotional and physical challenges that a medical school student cannot appreciate. So, it is your interviewer’s job to decide if you have the characteristics that make it likely you will be able to cope and succeed throughout your training and in your future career. They want to know that you will work hard, that you are emotionally stable and that you will be able to learn and apply what you will learn during your training.

Are you confident yet humble?

Even a hint of arrogance or self-righteousness might destroy your chances of being ranked. Humility is much preferred over self-centeredness and a fine line sometimes differentiates confidence from overconfidence. Be sure not to do anything that might suggest you are overconfident, for example by acting too informal or familiar, appearing too comfortable, dropping names or obviously promoting yourself. Let your accomplishments speak for themselves and hope that your letter writers wrote about your positive qualities and attributes. An attending’s greatest fear is to end up with a resident who is overconfident; such an individual may not be “teachable,” which ultimately can jeopardize patient care.

Would the interviewers enjoy spending long periods of time with you?

In emergency medicine, we often asked ourselves, “Could I spend an 8 hour overnight shift with this person?” If the answer was “No way, he would really make me nuts,” the applicant typically would not be ranked. The residency faculty will be your teachers, colleagues and even friends for three to five years. So, you must convince them that having you around would be comfortable and pleasant. This is why small talk matters during your interview day; interviewers want to know that you are personable and, bottom line, good company.

Can you recognize your faults and admit when you are wrong?

No one expects you to be perfect. In fact, program directors want to know that you can recognize your faults and that you can make improvements or modify your behaviors accordingly. Faculty members want to see that you have learned from any flaws they identify. They also want to know that you are aware of your limitations. An important part of being a great doctor is knowing when it is time to ask for help and to be aware of your own strengths, expertise and weaknesses. Having a resident who doesn’t recognize her own limits can negatively impact patient care.

What is your demeanor and how do you communicate?

Residency applicants are judged on whether they are articulate, poised, enthusiastic, mature and, bottom line, pleasant to be around. The best applicants smile, make good eye contact and are engaging, interesting, enthusiastic and warm. People with “sparkling personalities” always do better on interviews than their more sullen, stone faced or negative peers. Since communication skills, great interpersonal skills and the ability to relate to people are necessary to practice any specialty, you may be dinged if your interviewer thinks you have difficulty in these areas. But, at the same time, you must be true to yourself because not doing so may hinder your success. If you are not a smiley, energetic, and enthusiastic person, trying to be this person on your interview will seem unnatural and will make you anxious, which will undermine your success. What is most important is that you communicate articulately and that you are personable.

Are you personable and likable?

At times, applicants are so nervous that they forget to smile. Put yourself in the interviewer’s shoes; wouldn’t you enjoy meeting someone who smiles, exudes enthusiasm and has an overall positive energy about them? You must be true to yourself and trying to be someone you are not may hurt you. But, even the greatest introvert can smile and, in their own way, exhibit enthusiasm and passion for their specialty and the interview day.

Be sure you aren’t be swayed by a negative interviewer. Be sure to greet even the grouchy interviewer happily and warmly and don’t allow them to “bring you down.”

What will you bring to the residency?

Some interviewers also will evaluate how you will add to the learning environment of the residency program but, to some degree, this depends on the prestige of the program. While some programs are looking for “bodies” to take care of patients, the more prestigious programs want to be convinced that you will be an active participant during residency, whether that means taking on an educational or research project, participating in a departmental committee or trying to get involved on a national level.

Are you a good “fit” for the residency?

Program directors are seeking out applicants who are the best fit for their residency. For example, a smaller community-focused residency program may not be interested in the applicant with 10 original publications who wants to make research a part of her career. So, while one applicant may be the ideal resident for one program, she may not be the best fit for another. You therefore should study each program’s website before you interview to have a sense of what it values and what kind of residents it is trying to attract. As already emphasized, who you are on interview day must match the person the program director reads (or will read) about in your application, but you can often spin your experiences a bit to conform to their ideal applicant. Programs also tend to have “personalities,” especially if they are small, so interviewers will try to assess your fit for a program by consciously or subconsciously making this judgment. You can get a sense of a program’s personality based on the program’s presentation and tour and by the demeanor of the attending and residents whom you meet.

Do you have any red flags?

The two most obvious red flags are gaps in time of longer than three months when you cannot account for your activities or frequent jumps in career without any real explanation for these changes. Both of these factors suggest a lack of commitment or some possible underlying problem. Applicants who cannot communicate or are extremely nervous or anxious also raise concern. Interviewers are also trying to identify any major personality disorder or psychopathology that may hinder a candidate’s ability not only to interact with patients and colleagues but their ability to complete residency. Other common “red flags” include a low grade or USMLE score, or withdrawals from classes, but, typically, if you were invited for an interview, these issues were not considered major. That said, you should be able to give explanations for the flaws in your application without making excuses. Also, do not assume that everything in the past is “water under the bridge.” If you gained acceptance to medical school yet had an undergraduate career where you jumped from school to school, for example, assume that someone will pick up on this. We have all been in situations where red flags have been missed by the admissions committees who preceded us, so a keen interviewer will not assume that your application has no underlying issues.

Part 7: After The Interview: Thank you letters

Thank You Letters

Write thank you notes or emails. They are unlikely to influence your candidacy, but it is good manners to write these notes. Make the note short and sweet and mention anything that was a highlight of your interview; also repeat that you are interested in the school and thank the interviewer for her time. Sometimes the residency coordinator will give applicants suggestions for contacting their interviewers so, if they do, be sure to follow their directions. But wait until you get home to send your thank you notes. I remember the candidate who was writing her thank you notes in the conference room during interview day. She handed them to the secretary before she left. This seemed contrived and insincere.

Interview Second Look

The most recent program directors survey indicated that second looks do not impact a candidate’s ranking, but I still suggest that applicants attend second looks if they are offered. Why? Suppose you meet someone on a second look who really thinks you would be a great fit and puts in a good word with the program director on your behalf? Since the residency match has become more competitive, I suggest that applicants do whatever they can to give them an edge. I think second looks are especially important for programs where you interviewed early in the season to remind them of who you are.

Part 8: Residency Letter Of Intent

We encourage applicants to send a letter of intent to their number one choice program. Interestingly, more programs are actually encouraging applicants to communicate interest. We find that a letter of intent, which states that the program is your top choice and you will be ranking them #1, can influence an applicant’s ranking in a positive way since programs would rather match with applicants who are enthusiastic about their program and not go “too far down their rank list.”

Residency Match “Love Letters”

Some programs write “love letters” to applicants after they interview, telling the applicant that she would be a great fit for their program. Based on my experience, I find these letters are often misleading and insincere and in no way guarantee a match. I suggest that applicants reply graciously to such letters but don’t ever think a letter means that you “are in.”

Part 9: Questions to Ask the Faculty and Residents

General
What are the strengths and weaknesses of the program?
How would you describe a typical resident?
What do most residents do after graduation?
Do you anticipate any future changes in the program or department during the time that I would be a resident here?
What is the camaraderie between faculty and residents?
When was the program last accredited?
Is there guidance for job/fellowship searches?
What is the department’s philosophy and attitude toward education?

Evaluation
How are residents evaluated?
How often are residents evaluated?
Do you have a formal advising or mentorship program?

Curriculum
Do residents have the opportunity to do electives?
Is there a scholarly project and/or research requirement?

Teaching
Is there bedside teaching?
Do faculty actively participate in resident education?

Faculty
How significant is faculty turnover?
What percentage of your faculty are women?

Residents
Do residents participate in research?
Are residents involved in national committees?
Are residents encouraged to attend national meetings?
Have any residents recently left the program?
How do residents perform on board exams?

Patients
What are the demographics of the patient population?
What are the common diseases/cases here?

Questions to ask the residents

General
How would you describe the program?
Are you happy?
Do you feel you are getting excellent training?
Where do most residents live?
Is the program concerned not only with resident education but also with resident well being?
What are the strengths and weaknesses of the program?
Why did you choose this program?
Now that you are a resident, do you feel that the presentation and interview day fairly reflected what to expect from the program?
How would you describe the residency leadership?
Has anyone been asked to leave the residency? Why?

Teaching
How is the quality of didactics?
Is there bedside teaching?
Is most of the teaching done by attendings or your fellow residents?

Curriculum
Is the curriculum well defined?
Are conferences well organized?
Do you have outside speakers?
Does the program allow for a progressive increase in responsibility over the course of the residency?
What percentage of conference time is filled with presentations by residents versus faculty?

Clinical work
What are the strengths of the various clinical sites?
What types of patients and cases do you see?
Do you feel you are seeing a good variety of cases?
Do you think the clinical environment here will prepare you to become a great attending?
What types of procedures do you do and how many? (if applicable.)

Part 10: Sample Residency Interview Questions and Answers

Tell me about yourself.

This is what I call a launching pad question, which can come in other versions, such as “What brings you here today?” or “Tell me why you are here.” This question presents an opportunity to paint a picture of yourself and present all of the information you hope to discuss in your interview. While you don’t want to go into too much detail about any one activity or experience in your response, you do want to give your interviewer enough material so she can ask more questions about the topics you mention. Questions like this one are ice breakers and give you the opportunity to really control an interview and set the stage for what will be discussed.

Sample answer:

I am 27 years old and I am currently a student at XXX medical school. I entered medical school interested in oncology because of my experience working in oncology research before medical school but discovered emergency medicine as a first year medical student when I was a patient in the department. As I watched the attending who was caring for me, I realized that he represented the type of doctor I wanted to become. I immediately sought out opportunities to shadow him in the ED and participate in research .I have done three rotations in emergency medicine and I just love it. I was thrilled to get this interview; I have heard a lot of wonderful things about this program, all of which was confirmed by what I learned today.

What does the applicant demonstrate with this answer?

He creates a clear picture of himself, his motivations and his path, how his interest in emergency medicine evolved and what he had done to develop this interest. Since residency interviews are short, it is important to be brief in an opening question, while providing pertinent information:
1. A little background
2. When his interest in emergency medicine started
3. The research he has done in emergency medicine
4. The rotations he has done in emergency medicine
5. His specific interest in the program

Why do you want to pursue a career in emergency medicine?

It is important to be perceived as 100% committed to your specialty. You never want to convey doubt about the specialty to which you are applying or have someone think that you are interviewing for a certain specialty as a “backup.” It is a major headache for a program director when a resident drops out of a program to pursue another specialty. Although this has happened, often for good reasons, the program director hopes to match with people who are enthusiastic about the specialty and who will complete their training. I am also always a bit surprised when the student fails to mention anything about patient care when I ask this question. Be sure to mention helping patients as the cornerstone of your motivations to pursue any specialty. I encourage most clients to answer this question both in terms of “when” and “why.” This enables you to tell the interviewer about your motivation to pursue a career in your desired specialty. You can also use segues to bring up rotations related to your desired specialty and your future career plans, which will provide your interviewer with more material to ask about. I also advise applicants not to mention salary or lifestyle as a factor in their decision to pursue any given career, even if these considerations weighed heavily in their career choice.

Sample answer:

There are many reasons I want to pursue a career in emergency medicine. First of all, as I mentioned when we started, the emergency physician represents the type of doctor I always wanted to be. They can handle any situation and actually save lives. As important, you also provide reassurance when people come in with problems that aren’t life threatening. During my rotation at University Medical Center, I appreciated all of the opportunity a career in academic medicine offers, such as research and teaching. In contrast, my rotation at Community Medical Center made me appreciate the valuable role the emergency physician plays in this setting. I can really see myself happy in both of these settings and each has unique advantages. I also love caring for acutely ill patients which is why I am doing a rotation in critical care later this year. I enjoy the procedural aspect of the field and the opportunities to collaborate with other specialists. Emergency medicine will allow me to care for a diverse patient population in diverse settings.

What does the applicant demonstrate with this answer?

  1. Provides background to demonstrate the duration of his interest
  2. Demonstrates insight regarding the specialty and that he understand what the practice of the specialty encompasses
  3. Mentions his rotations so the interviewer can ask about these specific rotations if intrigued
  4. Mentions his interest in critical care and that he has plans to do a rotation
  5. Mentions that he understands the difference between academic and community practice, which again shows understanding of his options
  6. Gives an idea of his future plans
  7. Provides segues and prompts for the interviewer to ask more questions
  8. Is positive and engaging

Why are you interested in our program?

Program directors are looking for the best candidates but they are also seeking students who are the best fit for their program. It is essential that you research the program where you are interviewing and have specific reasons why you want to attend. Avoid “telling them what they want to hear” and choose things that are aligned with your demonstrated interests. For example, if you are an avid researcher with five original publications, do not be offended if the program that trains mostly community physicians does not actively recruit you. You must convince the interviewer that you would (MISSING VERB) by training at this program. You must also make interviewers feel that they would like having you around for the duration of your residency.

Sample answer:

I want to train here for many reasons. First of all, I have to say I have enjoyed meeting everyone here and I can see myself fitting in well with the residents and attending. I also like the setting in which residents train because it provides diverse exposure and the opportunity to care for many different patients both in terms of culture and disease process. I am also impressed by the didactics here and am especially interested in participating in the critical care part of the department and seeking out mentors. I would also be thrilled to move to this city and experience a new part of the country.

What does the applicant demonstrate with this answer?

1) Is knowledgeable and informed about the program
2) Identifies specific reasons why he is interested in the program
3) His own interest in critical care, which likely distinguishes him from other applicants and how he envisions making a contribution to the program.
4) Interest in didactics, an important part of residency training
5) That he wants to move to the city in which the program is located

Where do you see yourself in the future?

Many program directors will ask you about your future plans. While people don’t expect you to know exactly what you want to do, they want to know that you have thought about your goals and that you have an understanding of your options. Even if you aren’t 100% sure of your future plans, the more focused and confident you sound, the better. Your answer does not commit you to a given path, and it is expected that your goals may change during your training. It is important to have a clear idea of what you will say in response to this question on your interview day.

Sample answer:

I have thought a lot about this, and I can really see myself in one of two settings. As I have mentioned, I have an interest in critical care and will consider a fellowship in critical care. After that, I am not sure if I will pursue a career in academics or community medicine because I enjoy both settings. I like the research I am doing now and I also enjoy teaching, so I think I would enjoy academics. But I can also envision becoming really active in a large community hospital collaborating with the ICU docs. I hope to meet faculty during residency who can help me to figure out what will be the ideal choice.

What does the applicant demonstrate with this answer?
1) Shows he has thought about his options and appears focused and serious.
2) Mentions his interest in critical care
3) Demonstrates an understanding of two types of practice.
4) Communicates that he will seek out mentorship during residency and thus implies he will be an active resident

Tell me about a negative aspect of our specialty.

The interviewer may also try to get a sense of your full understanding of your specialty. By asking about the negatives, he acknowledges that the specialty is not perfect. The wrong answer is “there are no negatives.” This would demonstrate lack of insight.

Sample answer:

I think that it is sometimes frustrating when, as an emergency physician, you can’t help the patient fully on your own and need to call in a specialist. I think that sometimes the perception is that we can’t handle everything. But, I think one of the key things about EM is that you must know when you need help.

What does the applicant demonstrate with this answer?
1) Is honest and authentic
2) Presents a positive side to what he sees as a negative. 3) Conveys that he is not perfect and demonstrates humility

What is your greatest weakness?

Personally, I can’t stand this question and never asked it. I find that it is typically the unskilled interviewer who poses this question, but residency applicants are always nervous about fielding this question. Most often, applicants are advised to choose a strength that is actually a weakness, such as “I am a perfectionist.” “I have a tough time saying no to opportunities.” “I sometimes work so hard that I sacrifice my free time.” I suggest simply being sincere. Give a real, honest answer but not one that would be a deal breaker for medical school, such as “I can’t work on teams.”

Sample answer:

I tend to procrastinate. I am constantly trying to improve this weakness because my procrastination causes me a lot of stress. And, when I get stressed because I am close to a deadline or exam, I am not very pleasant to be around. But, this stress is also what motivates me to get the job done.

What does the applicant demonstrate with this answer?

  1. Cites a real weakness
  2. Gives it a positive “spin”
  3. Appears authentic and genuine

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