Ken Iserson's Global Life

Fascinating (to me, at least), informative, and sometimes a bit scary, I'll be posting interesting photos, articles and information related to my life in International and Disaster Medicine and about my books: "Getting Into a Residency"--8th edition, "Death to Dust: What Happens to Dead Bodies?", "Improvised Medicine" ,"Demon Doctors: Physician Serial Killers"; "Grave Words: Notifying Survivors About Sudden, Unexpected Deaths;" and more. Enjoy!

[keniserson]

How should you Rank Residency Programs on your ROL?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

              Using the “Must/Want” Analysis. Once you have finished your interviews, you should have a file of completed “Must/Want” Analysis forms (Iserson’s Getting Into a Residency. http://bit.ly/17iIQAd)—one for each program with which you have interviewed. Now you will see their true benefit. Rather than relying on a gestalt or gut feeling of your impressions, you can use your completed “Must/Want” Analysis forms to give you an accurate picture of how well each program meets your self-designated needs. (For a description of the Must-Want Analysis, see my prior blog post, “Residency Interview Checklists.”)

Rank the programs by using the “Program Evaluation Score” that you assigned to each program. Simply arrange the forms with the Program Evaluation Scores in numerical order to find out what your Rank-Order List (ROL) for the Match should look like. The program with the highest Program Evaluation Score should be at the top (listed first) of your ROL and the one with the lowest score at the bottom (listed last), if at all.

One key point, however. You may be somewhat depressed after first having ascertained what you want in a program and then interviewing. You probably found that no program meets every one of your expectations. Hey, that is what life is all about. There is no utopia. In looking for a residency, as with any job search, some compromises are necessary. You should choose the program that best fits your own needs. The “Must/Want” analyses help you do this. 

            List Enough Programs to Be Sure You Match. One of the keys to success in the Match is to rank enough programs. (It should go without saying that you must have interviewed at the programs that you list.) Several factors coincide to determine how many programs are “enough.” The first is the specialty that you are trying to enter: The number of applications submitted and the percentage of unmatched students in different specialties varies widely. By now you should know whether the specialty you have chosen is a “tough” or an “easy” match. If you still need some guidance, see each specialty’s difficulty rating in Chapter 3 of Iserson’s Getting Into a Residency (http://bit.ly/17iIQAd). The tougher the specialty is to match in, the more programs you will have to interview with and rank.

Geography also plays a part in the decision about how many programs to list. Some parts of the country are less desirable to medical school graduates than are others. It often relates to how medical students perceive the area’s lifestyle. You might want to rank programs in one of these locales if you are not the strongest of candidates.

Program match rates also depend upon the type of institution in which they are located. If you are looking mainly at university and major-medical-center programs, be prepared for stiff competition. While not necessarily the best, these programs are where most students apply.

Your own competitiveness really determines how many programs you rank. The greatest danger is that you will overrate yourself, interview at and rank too few programs, and then be left without a position. If in doubt, apply to a few extra programs. This will provide a greater chance of success, as well as more peace of mind, until you receive the Match results. 

            Hedge Your Bets as Necessary. Even if you have listed more programs than you think you will need to successfully match in your specialty, do not discard programs that you consider “sure bets” (i.e., weaker programs than those you have already ranked). Until you have a piece of paper in your hand stating that you have a residency position, nothing is certain.

Your best strategy, especially in the difficult-to-match-with specialties, is to list some “sure bets” at the bottom of your ROL, even if each of these is a slightly weaker program than others you have seen. Ask yourself, “Would I rather match at that program in the specialty of my choice, or not match in the specialty and take a chance in the Supplemental Offer and Acceptance Program (SOAP) during Match Week?” If you can answer that question, you will know how to fill out the bottom of your ROL. 

            Go for the Gold. The preceding comments should not deter you from trying to secure the best residency position you can obtain.

As has already been mentioned, many of you will underestimate your own abilities and competitiveness; a few of you will overestimate your chances. Extend your sights and apply to the programs that you think will be the best for you. And, after you have applied and interviewed, make certain that you rank your top choices first.

            Do not fill out your ROL in the order in which you think you will be selected by the programs. This will only decrease your chance of getting into the program you really desire. Put your prime program choices at the top of the list. Then rank the others in descending order of preference. That way, when Match Day rolls around, you can be confident that you have matched with the best program possible.

[keniserson]

How well did I do during the residency visit?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd) 

            There are two tasks to complete when analyzing your visit to each program: (1) Determine how well you performed and (2) Determine how well the program meets your needs. Let’s discuss the personal analysis first.

The following questions will help you determine how well you did at the program, particularly in the interview setting. Your analysis will also highlight problem areas to modify prior to visiting the next residency program on your schedule.

  Did I look as good as I am capable of looking?

Could I have known more about the program and the specialty?

Was I relaxed and in control of myself?

Did I answer the questions in a way that stressed my ability, enthusiasm, and suitability for that program?

Did I listen closely to the interviewers?

Did I unobtrusively steer questions toward points I wanted to stress?

Did I tailor my answers to fit each type of interviewer?

Did I present an accurate and favorable picture of myself to everyone that I met? 

Your second task is to analyze how well the program did. Use your previously prepared “Must/Want” Analysis form for the program (Iserson’s Getting Into a Residency. http://bit.ly/17iIQAd). Fill it out immediately. Rate the program’s strength for each factor you listed. Use the 1-to-10 rating scale, with “10” being perfect.

          Once you have completed the score for each factor (for example, Faculty Availability), multiply its “Weight” by its “Score” to get a “Total” for that factor. Then add up the factor “Totals” to give the final Total (“Program Evaluation Score”) for the program. You may now put this sheet away until you have completed a similar form for each program that you visit.

          When you get around to completing your rank list (Rank Order List) for the Match, you will use these scores based on your own wants and needs to put the programs in an appropriate order.

[keniserson]

Residency Interview: How to respond to illegal questions?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

  Interviewers continue to ask many applicants blatantly illegal questions. Those are questions barred from pre-employment screening by federal and state civil rights acts. They include questions about your race, sex, age, height, weight, national origin, military discharge status, arrest record, marital status or who lives with you, physical disability, and religion. They cannot ask about these topics unless they directly affect the job requirements or you bring them up in the interview or your written materials.

One survey found that 86% of residency applicants had been asked illegal questions. The most common of these are about marriage and family plans. Indeed, asking women about childbearing and childcare is the most common gaffe interviewers make.

Another set of illegal questions relates to disabilities. Under the Americans With Disabilities Act, even if an individual has a visible disability (for example, uses a wheelchair or guide dog) or discloses voluntarily that he or she has a disability, the interviewer may not ask about its nature, its severity, the condition causing the disability, the prognosis, or treatments. However, they may ask about the applicant’s ability to satisfy essential functions or requirements of the position, as long as all applicants are asked the same questions.

Since illegal questions are still being asked of all applicants (why this is allowed to continue is uncertain), it is important for you to be prepared for these questions. 

How Should You React to Illegal Questions?

First, remember that, in general, the programs are not being malicious in their use of these questions. Many times they are merely ignorant of the law. There is a fine line between questions that are illegal and those that are simply inept, curious, or friendly. Don’t approach these questions in a hostile manner. Second, look over your Dean’s letter, transcript, and other reference letters. How much new information are you supplying by answering these questions? Probably not much.

If you are asked these questions, there are three possible ways to respond:

Refuse to answer the query, perhaps stating that it is illegal to ask such questions or that it is none of the interviewer’s business. Such an answer, however, while it is perfectly correct and legitimate, is likely to ensure that you will not get a residency position at that site.

Finesse the question. One way to do this is to ask the interviewer whether this information is really pertinent to obtaining a residency position. This gives the interviewer, who probably has been poorly prepared to do this type of interviewing, a chance to back off and save face at the same time. However, finessing a question must be handled with skill. Smile and be very pleasant while you parry these pointed questions. If you handle it correctly, you will still be a viable candidate for the program.

Answer the question. Most applicants take this tack, both in the medical field and in other employment situations. You can use either direct or indirect answers. For example, if asked about plans for a family and children, the direct answer might be “I plan to have children near the end of my residency.” Since you might find this option distasteful, you could use an indirect answer, such as “My training comes first.” These answers usually will not jeopardize your chance of obtaining a residency training position. 

[keniserson]

Why do Residency Interviews Fail?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

  Inadequate Preparation

            The first reason that interviews fail is that applicants do not know enough about the specialty, the program, the faculty, their own ambitions and desires, and the questions that they will probably be asked during interviews. It takes hard work to get ready for interviews, but in the end it is worth it. 

Not Listening To Questions

            The second reason is because the applicant does not listen to the interviewer’s questions. The result is discommunication, distorting the messages coming in and going out. This is what happens when you let your mind wander during an interview—and it spells disaster.

            Use “active listening.” This involves briefly summarizing what you think the speaker has just said. It shows that you are carefully listening, allows the speaker to correct any misimpressions you may have gotten, and helps the conversation move forward.

            Since many residency interviews are conducted in busy offices, clinical settings, or even hallways, you may have to concentrate very hard on the interview to avoid the ever-present distractions, sometimes justifiably called “interview blockers” (Figure 18.1). This can be difficult, but your experiences working in noisy patient-care areas should help you to concentrate on the task at hand. And don’t just listen to the question; listen to how the question is asked. Many times an interviewer will give the astute listener clues to the answer that he or she is looking for.

            Occasionally your mind may go blank during an interview. It’s okay. Just apologize to the interviewer and simply ask for a moment to think about the question or, second best, ask the interviewer to repeat the question. As Sam Donaldson, the former television newsman, said, “Even the pros get tongue-tied.”

            If you really listen, and you still can’t understand what an interviewer is looking for, ask for clarification. This might also work (once) if you miss a question completely—but it would be unwise to count on using it repeatedly. Remember that the most ego-gratifying thing you can do for interviewers is to listen to them.

            If you are asked a question you just don’t know how to answer, be honest and say so. Perhaps you can say, “I’ll have to think about that. Can we come back to that later?” Normally, the interviewer will oblige. It is then your responsibility to return to the question before the end of the interview. At that point, if you still cannot come up with an answer, say that you will continue to think about it and get back to the interviewer by letter. Then, in your thank- you letter, give that interviewer an answer to his or her question. In these cases, honesty (and thoughtfulness in later responding by letter), rather than bluffing your way through an answer, may be your key to success. 

Answering Questions Not Asked

            A third reason for interview failures is that interviewers may get annoyed by having questions answered that were not asked. Many students, while attempting to highlight their strengths, routinely give answers that have no relation at all to the questions that were asked (much like politicians).

            Here, you are treading the fine line between guiding the interview and destroying it. Answering a question about your spare-time activities with a description of your medical school awards makes no sense. Rather, talk about the rock band you organized or the Internet bulletin board you established. These both answer the question and highlight your initiative and talents. 

Rambling

            A fourth way to wreck your interview is to ramble, thus providing superfluous information. Interviewers are easily bored—not surprising given the number of applicants they must often see in one day. If you have a lot of information to impart in answer to a specific question, tell the interviewer the main points, and then ask if he or she would like you to continue. Since you are watching the interviewer while you answer, you may note nonverbal cues indicating that you have said enough. In general, keep your answers brief, to the point, and interesting. 

Giving Warning Signals

            The fifth reason that interviews fail is that the applicant inadvertently gives warning signals to the interviewer that there may be an unstable personality lurking behind a deceptive smile. Trained interviewers seek specific warning signs (below). 

Warning Signs for Interviewers

Inconsistent answers during the interview.

Inconsistencies between what is said in the interview and past performance.

Abrasiveness or any other personality quirk that makes the interviewer uncomfortable.

Evasiveness.

A pattern of unhappiness in former jobs.

Blaming others for all the applicant’s problems.

Dullness when responding to questions.

A pattern of taking advantage of, or of deceiving, other people. 

            Very few faculty interviewers are sophisticated enough in the techniques of employment interviewing to consciously recognize these signs. Being good clinicians, though, they unconsciously assimilate clues and will give the applicant a poor rating. It would be a good idea to review the warning signs and make certain that you do not demonstrate any unintentionally.

[keniserson]

Residency Interviews: What will they ask? How do you answer?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            The following are 3 of the 48 questions, with suitable answers and alternative forms of questions that are discussed in Iserson’s Getting Into a Residency (Galen Press April 2013. http://bit.ly/17iIQAd). These are questions that residency applicants have been asked over the years. In the book, the prototypical question and a discussion of possible answers is followed by a list of similar questions that applicants have been asked. It is impossible, of course, to prepare for or predict every possible question. However, if you have prepared for the questions listed in the book, you will have the self-confidence to answer anything an interviewer asks. 

1. How are you today?

          What a pleasant way for an interviewer to begin. A simple ice-breaker, you think. Wrong! Sophisticated interviewers use this, and similar questions, as rapid and effective screening tools. “Gee, it’s raining outside and I got soaked coming here,” said one applicant. “I’m really frustrated that my plane was late and that I had trouble getting a cab,” whined another. These are the wrong answers.

          “Great!” “Wonderful!” or “Really happy to be here!” should always be your reply to this question.

          Residency interviewers look for individuals whose demeanor stays upbeat even under adversity. The travails on the interview circuit are insignificant compared to those during residency. Simple opening questions delivered in an off-hand manner will often expose an applicant’s true personality far better than the well-rehearsed “deep” questions that most applicants expect. Remember, there are no innocent questions! 

Do you know much about our program?

If you were in my (the interviewer’s) seat, what would you ask? Okay, now answer those questions. 

2. Do you have any questions?

          This is the “behavioral” interviewer’s classic opening. The interviewee is expected to take the initiative right from the start. Many applicants respond to this by asking standard questions and, therefore, waste this opportunity. When the “any questions” opportunity begins an interview, ask questions that highlight your strengths and knowledge of the specialty. Get this information from reading recent online news magazines for the specialty, such as Internal Medicine News or ACS Surgery News.

          Use this question to show interviewers the special expertise you can add to their program, and that you are achievement-oriented. An example might be, “I recently read in Family Practice News that Family Medicine is very involved in sports medicine. I have a real interest in this area based on my work as a football trainer in college, and I have taught new trainers. Do other people at this program also have an interest in sports medicine?”

          Faculty members actually may ask this question because they do not know what else to ask. Since many applicants report that this is the most common question that faculty ask, make a long list of your own questions to use as answers. Never answer “No,” since, no matter what the situation, a negative answer indicates that you have a less-than-serious interest in that program. 

Do you know much about our program?

If you were in my (the interviewer’s) seat, what would you ask? Okay, now answer those questions. 

3. What are your strengths and weaknesses?

          This question represents the “Tell me about yourself” question phrased negatively. It asks, “Tell me what’s wrong with you.” Would you want to answer that question? Of course not.

          An inquiry about your strengths and weaknesses, essentially the same question, is very common. Basically, the interviewer asks you to jump off a cliff of your own design. All you need to do is to redesign the cliff so you can climb rather than jump.

          First, answer the question about your strengths concisely. The only danger is talking too much. Then work on the dangerous half of the question.

          Everyone has weaknesses. “Each and every one of you has something that makes you a jerk,” said a Lieutenant Colonel briefing a group of officers about to be promoted to General. “Get in touch with your ‘inner jerk’ and work on losing that ugly part of your personality.” Okay, so a little bit of you is a “jerk.” How do you respond?

          You must turn your “weaknesses” into more strengths. What character flaws would the faculty in this specialty approve of? Is your weakness that you are obsessive about completing your work in an exacting manner? Or is it intolerance for clinicians who do not perform their patient-related tasks with a professional attitude? Maybe it is an inability to go home at night unless all your work is completed. These are, undoubtedly, the types of “failings” that the faculty will be interested in encouraging rather than disparaging. But in relating these faults, show at least a little remorse about having them. Don’t be glib. 

Are there any skeletons in your closet that you want to tell me about?

What is your pet peeve?

If you could change one thing about your personality, what would it be?

[keniserson]

Residency Program Visits: What NOT to ask?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            There are specific questions that you should not ask during an interview, even though they are important to you. These questions basically involve four areas: salary, benefits, vacation, and competition. The right source for the first three is usually the program’s website, their housestaff office, or FREIDA. Don’t ask about your competition.

          Salary.The salary you will receive as a resident will, in large part, depend upon three factors.

The mean salaries of housestaff around the country in the previous year.

The type of institution in which the residency is located.

The region of the country in which the institution is situated.

 Most institutions base their resident salaries upon a variation from the mean salary that residents are receiving nationally. All residents at the same institution at the same postgraduate year generally make the same salary. Salary will keep you alive and pay your bills—but do not try to find out what it will be during the interview.

          Benefits. Benefit packages are very important to you as a resident—as they will be for the rest of your career. Virtually all such packages include malpractice insurance and some type of medical insurance. Other benefits may include food or housing allowances, uniforms, parking, and childcare, to name some common ones. While you might ask residents about some of these benefits, faculty members will normally have no idea what their own benefit package is, let alone yours.

             Vacation. Asking an interviewer about vacation is akin to inquiring whether you would actually have to do any work during the residency. While everyone understands that vacation—even a resident’s vacation—is important, interviewers assume that during the interview you will concentrate on the great educational experience that they offer, rather than your time off.

          Competition. Who is your competition? It doesn’t matter! Asking about other applicants will serve no good purpose and only directs an interviewer’s attention away from you. The key is to put your own best efforts before the residency faculty and let them select you based upon what they see. Forget the others. Concentrate on selling yourself.

[keniserson]

Residency Program Visits: What do you ask the Residents?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

              The residency program visit gives you the opportunity to get the information you need to decide whether to rank that program highly on your Match list. Generally, you will have an opportunity to ask questions of the faculty and residents. When you ask your own questions, do so in a courteous, diplomatic manner. Ask simple, straightforward, open-ended (requiring more than a “yes” or “no” answer) questions.

          Print a list of your questions in advance so that you can easily refer to it (and read it) during your interviews. Ask the right people the right questions. The following are three of the 16 questions in Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, (Galen Press April 2013. http://bit.ly/17iIQAd) to ask the Residents and what you are seeking to discover.

  1.     Would you choose this program again? Why or why not?

          This is the key question to ask residents. It will most likely produce the answers that will best help you to determine your fit with the program. As always, ask this question in a non-confrontational, low-key manner. No doubt this is not the first time the resident has been asked—or contemplated—this question. There is usually a great variation in the answers among the residents. You are looking for general consensus (good or bad), rather than the opinions of “outliers” who love or detest the program for unique reasons.

Faculty members at weak or dysfunctional programs hope that you will not ask this question of their residents. Beware! Some may actually limit your access to residents so that you don’t get this feedback.

Two natural follow-up questions are: Which parts of the program do you like the most? Which do you like the least? And, while free time may not be a large part of your residency existence, you do want to know whether the residents (and their significant others) like the city and the area. Listen closely. You may have to “sell” the city to your family before they consider moving there. 

2.     What contact will I have with the clinical faculty?

          Okay, the program’s website lists 42 faculty members. Did they mention how often you will have contact with all of them? With any of them? The faculty only helps you if you have direct contact with them. If faculty members hide in their offices or labs rather than attend in the clinics, wards, emergency department, or operating rooms, they might as well not be there.

So the questions that you should ask the residents are: “How often are the faculty members present?” and “How often do you want faculty input but find that it is not available?” You might also want to ask “Are they available on nights and weekends?” Certainly, as a resident, you want to be able to exercise some independent thought and judgment. But you need adequate guidance from knowledgeable faculty during residency training. Does this program really offer it?

Also, do the faculty and residents interact informally, such as at holiday parties or on basketball or volley ball teams? This often provides a way to make closer contact with faculty members who may then wish to help you develop your career. 

3.     What has changed since you came to the program?

          How quickly and significantly does this program’s curriculum change? By asking senior residents what has changed since they arrived, you can easily find out this information in a non-threatening way. This is a question to also ask the faculty.

Their answers will provide a picture of the frequency and types of curriculum changes at the program. For example, have there been changes (major or minor) in the program’s curriculum, rotations, or electives? How about the program’s overall structure? Have there been major faculty changes? Most important, have  there  been  changes  in  the  patient  mix  or  resident responsibilities? Do they think that these changes have been good for the program and for their education?

[keniserson]

Residency Program Visits: Why Talk to Residents?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            Talk with the program’s residents to learn what is real and what is only hype about the program.

          If you haven’t talked to the current residents, assume that you really do not know very much about the program. Be very wary of any program that either does not give you the opportunity or does not insist that you talk to some of its residents. Residents often see things quite differently than the attending physicians. And their perspectives, while not necessarily the same as those you might have in the same situation, may be much closer to yours than those of the faculty. These talks are usually informal, and because of limitations on the residents’ time, may occur in a group setting. Nevertheless, the residents’ opinions, viewpoints, and insights about the program should strongly influence how you will rate it for each of the factors on your “Must/Want” Analysis (see Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd.)

          If there is a senior medical student on rotation in the department while you are there, try to talk to him or her. You cannot afford to miss this valuable perspective. One other source of information might be a graduate from your medical school who is currently training at that institution. Even if not in the same program to which you are applying, he or she will have intimate knowledge of the institution, and may even know something about your prospective department. Graduates from your alma mater may also feel some loyalty to you—and give you otherwise “forgotten” information. You will probably be able to locate such graduates through either your Dean of Students or your school’s Alumni Office.

[keniserson]

Residency Program Visits: What do you ask the Faculty?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

           The residency program visit gives you the opportunity to get the information you need to decide whether to rank that program highly on your Match list. Generally, you will have an opportunity to ask questions of the faculty and residents. When you ask your own questions, do so in a courteous, diplomatic manner. Ask simple, straightforward, open-ended (requiring more than a “yes” or “no” answer) questions.

          Print a list of your questions in advance so that you can easily refer to it (and read it) during your interviews. Ask the right people the right questions. The following are four of the 23 questions in Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition (Galen Press April 2013. http://bit.ly/17iIQAd) to ask the Faculty.

  1.     How have your graduates done on the specialty’s board exam?

          Although the primary goal of residency training is to prepare you to practice in your chosen field, an important milepost during your career will be passing the specialty’s board examination. In many cases, passing “the Boards” determines the type and level of position you can fill. How have this program’s residents done when they took their specialty board exams? If they have all passed, was this on the first try? This can be asked tactfully, as in “Did any of them have to take their Boards more than once?” Did they fare as well on the oral exams (you should already know if they have these in your chosen specialty) as they did on the written exams?

          Residency directors should know this type of information. Although information on specific graduates is confidential, the cumulative data should be available to all residency applicants. If it isn’t, then there may be a problem.

          You also want to know how residents have done on the specialty’s in-training examinations. These national tests, given annually at nearly all residency programs in most specialties, mirror subsequent performance on specialty board exams. In addition, does the program have any conferences or special programs to help their residents prepare for the specialty’s boards?

          The information you glean from these questions indicates, in part, the amount of didactic teaching, reading time, and interaction with the faculty that you will receive at this program. As might be expected, graduates of high-volume, high-workload programs often have worse records on board examinations than do those from lower volume programs. However, this is not always true, so it is important to get the specifics from each program you visit. 

2.     Is there much faculty turnover?

          Tread gently in this area—it may be very sensitive. But do tread. You need to know about faculty stability. It gives a strong indication about the staff’s and, by extension, the entire program’s esprit de corps. If there is a large or rapid turnover in faculty positions, it may indicate that all is not well, even if there is a pretty façade.

          There are several ways to get this information. The easiest is to simply ask how many of their faculty members will still be there in July. Otherwise, you can ask if any faculty members have recently been added—“As replacements?” you ask not so naively—or if any of the current staff will be leaving in the near future. This last is the least favorable way to ask the question. If you hear (usually from the residents) that either the residency director or the department director is planning to leave, ask multiple interviewers about it for confirmation. These are two changes that can markedly affect the program’s tenor.

          You might feel that faculty turnover is their business, not yours. Wrong! Would you make reservations at an expensive French restaurant for your birthday celebration if you thought that the chef/owner was going on vacation— and being replaced by the short-order cook from the greasy spoon next door? Don’t go hungry. Ask before you commit to a reservation. 

3.     How would you characterize faculty–resident relationships?

          The answer to this question might provide an interesting insight into how the program really functions. Listen for overly positive answers, as well as those that are negative or express indifference about the relationship or about their residents. If you ask several faculty members this question, you may discern a pattern. Most important, you want to compare the answers from the faculty with those from the residents on the same topic.

4.     Is this program particularly strong or well-known in any special areas?

          If you have learned of any special training the residency offers, you may want to ask for more details. You also want to know about additional special courses, some of which may be too new to list in their promotional materials or which have not yet started. These will be extra perquisites of attending this program, and the interviewers will generally be thrilled that you asked. This allows them to show off their program to its best advantage.

          When evaluating the interviewers’ answers, remember that programs in which you do not plan to participate are of no benefit to you. An example would be an international elective that you cannot schedule because you must care for your three young children. Even so, the nature of these programs may demonstrate the program’s educational direction.

[keniserson]

Residency Interview Checklists: Why use the Must-Want Analysis?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            How are you going to decide in which order to list the residency programs you visit? Gut feelings? Intuition? Which one has the best coffee, classiest scrubs or glossiest brochure? How about the one that served you the best lunch? Get real! You need a better system, a system designed for your needs.

          The “Must/Want” Analysis described in Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, (Galen Press April 2013. http://bit.ly/17iIQAd) is just such a personalized checklist that you can use to rate residency programs. As shown in the short example, below, it has you rate the factors important to you (the book describes how to include those factors) and has you rate them. You then use this as your personal checklist for each program.

          Using your “Must/Want” Analysis form both simplifies your evaluation of each program and helps you discriminate among them. Immediately following your visit to each program, score on a 1 to 10 scale (10 is perfect) how well the program does in each category. Even if you have previously given some items “Scores” based on written materials, those “Scores” should be considered tentative until confirmed during the site visit. You end up with a “Program Evaluation Score” for each residency you visit. 

This “Program Evaluation Score” can later be compared to those calculated after you visit other programs. When it comes time to make up your rank-order list for the Matching Program, you simply put the programs in order based on their scoring well in the factors important to you. 

[keniserson]

Residency Program Visits: What are Winning and Losing Behaviors?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

              You have your residency program interviews set up and are ready to go. Remember that it is not only your interview performance, but also how you conduct yourself throughout your entire time at a program that will determine whether the faculty ranks you highly. So here are some last minute tips.

             Timeliness. To mangle an old saying, “Timeliness is next to Godliness.” You will make a significantly negative impact on the program faculty if you are late for your appointments. Excuses don’t work. Of course, unavoidable delays do occur. Unexpected bad weather and transportation breakdowns are the two most common causes, especially during the interview season—with the worst weather of the year. If you run into difficulties that will cause you to be late, have the courtesy to call ahead. They may be able to reschedule people and, possibly, to work you in at a later time or on a later date.

             Confirm Your Interview. It is embarrassing for an applicant to show up on the wrong day for a scheduled interview. The professional way to avoid complications is to call to confirm your interview a day or two before traveling to the program.

             Know the Schedule. If you can get your interview schedule for each program before you arrive, you will also be able to plan specific activities for any “free” blocks of time. Use this time to visit the library, the wards, and the other teaching hospitals in the program if they are nearby. If you cannot get your entire schedule, at least find out what time you begin. It usually helps if you arrive early. Once you get started on your interviews, it is up to the interviewers themselves, and the residency secretary, to keep everyone on schedule.

             Attitude. SMILE! It doesn’t cost you anything. Be pleasant to everyone, and be cheerful at all times. Of course you are prepared to be on your best behavior with interviewers. But astute program directors are just as interested in how you act outside the formal interview setting as in how you act in it. This tells them more about how you will act during day-to-day program activities, how you will interact with your peers, and whether you will be able to get along with the ancillary medical staff. The show doesn’t stop until you walk out the hospital door at the end of the day, and it continues with every phone and written contact you make with the program.

[keniserson]

What must you know before your residency interview?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            For a successful residency interview, applicants must know a significant amount about the specialty for which they are applying as well as about the program at which they are interviewing.

          About the Specialty. You have worked hard to get interviews for a position in your chosen specialty. Be certain you know a great deal about that specialty before you arrive at the programs. This does not mean medical knowledge; you will acquire that during your residency. It means that you should know about the specialty’s culture.

 What do the practitioners in the field really do?

What types of procedures do they perform?

What level of reimbursement should they expect?

How do other specialists perceive them?

Do they have opportunities for subspecialty training?

What are the requirements to take the specialty’s Board examination?

What is the outlook for the specialty in the future?

 These are the types of questions that you should have asked yourself while making an informed decision about which specialty you wanted to enter. Faculty members want to know that you have made the effort to learn about their specialty before committing your entire professional life to it.

If you do not have this information, you may not have fully thought out your decision, and could later be very unhappy. Get this information by talking to specialists in the field, reading their journals and newsletters, and viewing their blogs online. The more you know about a specialty, the more committed to it you will appear. And commitment is one of the most important qualities interviewers seek.

          About the Program. Just as you must know the basic information about your chosen specialty, you also need to know about each program you visit.

You initially received a lot of information from their website and from FREIDA. Get additional information about a program by running a search on their faculty publications. to get an idea of their medical interests. Review this information before going into the interview. No matter whether this is your first interview or the twentieth, it is a major faux pas to confuse basics about the program where you are currently interviewing with information from another program. If necessary, write yourself some notes for reference.

[keniserson]

What do you wear to the interview?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            The key to looking good at your interviews is to do what others do—but better. There is a “uniform” to wear. It is conservative, tasteful, and neat. It looks like upper-middle-class success. And it works.

Ideally, interviewers should not be aware of your clothes; you want them to remember you, not what you wore. The proper dress for residency interviews is essentially identical, no matter where in the country you are applying. Appropriate dress can help you a little. The wrong outfit will destroy you.

 MEN. A suit is the standard dress for an interview. It should be solid or pinstripe, navy or gray. Do not wear a suit with bright or avant-garde colors or designs.

The suit doesn’t have to be expensive or in the latest style, but it should be tailored and well-made. Serious and solid is the image you are looking for in your outfit. And before you show up at your first interview, make sure that your clothes fit well.

                 Wear either a white or pale-blue solid-color shirt. Long sleeves are in order if you plan to remove your jacket. With the top button fastened, your collar should fit snugly, but not so tightly that your eyes bulge.

                 Wear a tie—even if you are a laid-back individual. Your tie should be solid, have repeating stripes (rep), small polka dots, or repeating small insignias (club). The “power colors” are red and navy. Knot the tie so its tip meets your belt and put the back of the tie through the label, so the ends stay together. Do not wear a bow tie. It gives the impression that you’re odd and out of touch with this decade.

Wear a plain, dark leather belt with a small buckle. It should go with your suit and be the same color as your shoes.

          Wear black or very dark brown conservatively designed shoes. Make sure that they are in good repair and shined. Wear calf-length plain socks that match your suit.

          The key to accessories is to be sedate. Limit jewelry to a watch and wedding band (only if you are married). If you wear a watch, avoid anything unusual. No lapel pins, no ID bracelets, no tie clasps—and definitely, no earrings or other implanted jewelry!

          As for personal grooming, be neat, squeaky clean, and conservative. Your hair should be short and a natural color. If it’s shorter than you like, it’s probably close to the right length. Invest in a good haircut about one week before the interview; haircuts look best after one week. If you wear facial hair, it should be neatly trimmed. Avoid goatees and handlebar mustaches as these have strong negative connotations. Keep any tattoos covered. Trim and clean your nails.

The odor the interviewer perceives should be minimal—and then only that of deodorant or nervousness. Avoid after-shave; you are not going on a date. If you are concerned about your breath, carry breath mints. And above all, no alcohol (and, if possible, no tobacco use) within 24 hours of the interview.

 WOMEN. Although styles are changing in the workplace, the standard dress for a woman going to an interview remains the suit, preferably a skirted suit. Find out what woman accountants or lawyers who work for large firms wear. This will be the “classic” style.

Choose wool or linen, or a synthetic that simulates either. The fabric should be solid, tweed, or plaid. For solid suits, the three best colors are gray (a couple of shades lighter than charcoal), medium-range blue, and dark maroon. Stay away from bold, flashy patterns. The skirt should extend to just below the knee (best); it should be no shorter than just above the knee. You should feel comfortable sitting in it. The matching jacket should be a blazer cut with long sleeves.

Two alternatives to the suit are a tailored dress or a skirt worn with a jacket. Neither is as powerful as the suit. Experts are unclear as to the effect of pants suits, so you probably want to opt for one of the other choices.

          The blouse should be simply cut, not too frilly or lacy, and the neckline must not be too low. If it’s equivalent to a man’s shirt with one button open, it will be acceptable. The blouse should be cotton, silk, or a look-alike synthetic. Usually it will be white, cream, or pastel—not red or fuchsia. In general, it should be in a solid color that complements the suit.

          Shoes should be simple pumps, closed at the toe and heel, and not brand new. They should be in a dark or neutral color that is compatible with your suit. The heels should not be more than 1.5-inches high. Be sure that you will survive all the walking you will do in the shoes you wear.

          Although a scarf is not as essential as a man’s tie, it can be eye-catching if used properly. Wear silk or a look-alike synthetic and tie it in an ascot, necktie, or scout style. If worn, a scarf must have simple lines and no frills to detract from the center of attention—your face. Hosiery should be skin-colored.

As with men, the less jewelry you wear the better. Aside from a simple watch and wedding ring (if married), be careful about what other ornaments you wear. Very simple earrings or gold studs should be limited to one per ear.

Do not carry a purse. Carry a leather zippered case, attaché case, or leather- bound zippered notebook with any necessities, including any electronic devices. This connotes power and authority.

          As for the more personal items, such as hair, makeup, and perfume, just remember that you are going on a job interview, not on a date. If the interviewer is aware that you are wearing perfume, you are wearing too much. Similarly with makeup—it works best when it is not obvious.

 Wear the “Uniform” Stylishly. Now that you have acquired the uniform, make sure that you get the most out of it. Your clothes must be clean and pressed. Do not travel in your clothes and show up five minutes before the interview looking like a Raggedy Anne doll that has gone through the washer.

Once you have dressed for your interview, forget about your clothes. They should be a natural part of you.

 ***For more information about the resident interview, look at the two free videos at: http://on.fb.me/10hPPTQ***

[keniserson]

How do you prepare for the residency interview?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            No matter how irrational it may seem, the ten- to thirty-minute interviews that you will have at the residency programs will count more, in most cases, toward getting you into the program than the total weight of your previous 3½ years of medical school. It is not only the most important part of the resident-selection process, but also the most costly and most time-consuming. Put your best effort toward doing a good job during your interview.

 The Mock Interview

          How well will you do when you are actually sitting in the hot seat being interviewed for that residency slot you want above all others? Do not wait until you sit in the real chair to find out! When you think that you are prepared to go on the interview circuit, arrange for a mock interview.

Your mock interview should closely imitate the actual interview. You must prepare for it in exactly the same way that you will prepare for your real interviews. Ideally, your mentor and a specialty adviser should conduct the mock interview. You want them to ask you the “difficult” questions and treat you in the same manner they would treat any candidate—not as someone they already know. Then you want feedback on the way you presented yourself, the manner in which you were dressed, how you handled the questions, and an overall assessment of areas to improve before you hit the interview trail.

 Interview Knowledge and Behavior

Besides the formal mock interview, it also helps to go over interview elements in your mind during those times when you are commuting, waiting for others, or holding retractors. Review potential questions and situations, as well as those from previous interviews. To remember the areas you want to review before the real interview, use the mnemonic “SHOWTIME.”

 Self: Have you adequately assessed your own knowledge, skills, and desires?

History: How did you decide to enter this specialty and this program?

Originality: What makes you unique?

World view: How does this program fit your life goals?

Tell: How are you presenting yourself?

Illustrate: Practice non-verbal communication, including maintaining eye contact, sitting forward, gesturing effectively, and smiling.

Manage: Use well-placed questions and time-awareness to manage the interview.

Engage: Throughout the interview, try to discuss those areas about which you are enthusiastic so that your conversation is animated and stimulating for the interviewer.

      While you want to have an idea how to use the SHOWTIME mnemonic, don’t just memorize your points and recite them. Two things you do want to memorize, or at least get down pat enough so that they sound smooth, are your opening introduction to the interviewer and a two- or three-sentence summation of your message (your strengths and desire to come to the program).

    ***For more information about the resident interview, look at the two free videos at: http://on.fb.me/10hPPTQ*** 

[keniserson]

How can pregnancy and family leave fit into my residency plans?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

              Among the most stressful personal situations that residents must deal with are pregnancy and child rearing. Increasing numbers of women are having children during their medical training. Before 1950, 24% of women physicians with children had them during medical training. Since then, more than half of all women physicians with children had their first child during residency.

Many women residents delay childbearing until after residency, believing that pregnancy will be a risk to their career. They reason that pregnancy during residency will extend their time in training (possibly), decrease their chance to obtain a fellowship (probably not), and increase their risk of pregnancy-related complications (it doesn’t), and generally interfere with their career.

     Most women physicians who have been pregnant during their residency report inequitable treatment during the pregnancy, ranging from unconscious slights to actual harassment. To lessen stress, some women physicians suggest trying to plan pregnancies for the time between the second and third years or during the fourth year of medical school, during the senior year of residency (not a surgical residency), during a year off, or after residency. If you become pregnant, give your (hopefully supportive) colleagues adequate notice that you will be taking leave.

     Pregnant residents usually have lifestyles that they would not recommend to their patients—long hours, rigorous physical activity, poor eating and sleeping habits, and exposure to disease. Fortunately, studies show that these stressors have little effect on the success of their pregnancies, although there appears to be a higher-than-expected incidence of preeclampsia and preterm labor (but not preterm delivery). If you are considering pregnancy during your training, you may want to look for large training programs that might have more flexibility to modify schedules for pregnancy leave.

     Maternity/paternity leave (often incorporated into “family leave”) has lengthened over time, although women are still unhappy with the amount of time off they receive for pregnancy and childbirth. These policies have been problematic for at least two reasons. First, women residents who have been pregnant feel that the leave, if less than six-weeks-long, is inadequate. Second, because these policies only apply to a subset of residents (parents, usually mothers), extended leave can wreak havoc on schedules and on the baseline educational requirements that must be met for Board certification. All leave policies are ultimately the responsibility of the sponsoring institution, and that information must be included in a resident’s contract.

     In reality, most programs deal with pregnancies on an ad hoc basis. Therefore, how individual programs interpret the requirements varies. Approximately three-fourths of teaching hospitals have a written parental leave policy. At these hospitals, maternity leave averages 64 days (range: 21 to 180 days), and paternity leave averages 46 days (range: 1 to 120 days). At many institutions, much of this time off is unpaid. Male residents may have more difficulty than women getting time off to fulfill their parental responsibilities around the time of birth.

[keniserson]

How do marriage and children fit into my residency plans?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            The problems associated with adjusting to marriage and having children during medical training were once thought to be solely a woman’s concern. Not any longer. While women do have unique biological concerns regarding pregnancy, both men and women physicians now frequently base career decisions, including choosing a residency, on how their family will be affected. The major concerns include maintaining the family relationship, coping with pregnancy, and caring for children.

 Marriage

          Half of all medical students marry during medical school or residency training, and more than 60% of physicians divorce within ten years after completing residency. Psychiatrists and Surgeons have the highest divorce rates. Up to 70% of medical marriages are dysfunctional, partly because physicians often hold a position of unquestioned authority at work and it can be difficult to relinquish this role at home. Residents’ marriages are at particular risk for work-related difficulties, since they work longer hours, have more trouble “winding down” after work, are sleep deprived, and are often too tired to participate in social or leisure-time activities.

Does this mean that your partnership is doomed? No! All new professionals have the same stresses. One key to success is to lend your partner as much support for his or her career as you deserve for your own. Another is for both partners to recognize that, at least during residency, theirs will not be the idyllic marriage that balances a thriving career with a loving and active family life.

Dual-physician marriages have their own difficulties. In physician–physician marriages, both earn less money individually than other physicians, and each person is less likely to feel that their career takes precedence over their spouse’s. However, both usually feel as successful as other physicians in achieving their career and family goals, and they benefit more from shared work interests. Nevertheless, the women in these partnerships are more likely to make professional sacrifices for their spouses than are their cohorts who are married to non-physicians. Compared with women physicians partnered with non-physicians (usually other professionals), the women in physician–physician relationships are more likely to bear the primary responsibility of caring for their children and home.

In the end, however, marriage enhances well-being. Married men and women are generally happier and less stressed than single people. Men benefit more from marriage than do women. However, both show decreased stress, which can help to enhance physicians’ lives—especially during residency.

 Children

          Childcare can be an enormous burden for residents, especially if both parents work. Women carry most of the child-rearing burdens in our society, and cannot be both residents and parents without some help. Childcare facilities, although relatively common in the business world, have yet to appear in the medical field on a regular basis.

            It is very difficult to find routine childcare services that can accommodate a resident’s extremely long (and sometimes unexpectedly longer) hours. Start searching for childcare during pregnancy. Consider a nanny service, a live-in helper, a regular baby-sitter, or a day care center. Make sure that you have a back-up plan in case something unexpected happens at the hospital.

                I will discuss Pregnancy and Family Leave in the next blog post.

[keniserson]

Sexual Harassment in medicine: Is it still with us?

(Adapted from Iserson’s Getting Into a Residency: A Guide for Medical Students, 8th edition, Galen Press April 2013. http://bit.ly/17iIQAd)

            Sexual harassment, including physical harassment, sexual slurs, sexual advances, and educational inequalities based on sex, is common. The EEOC’s definition of sexual harassment is:

    Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when:

 submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment;

submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual; or

such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile, or offensive working environment.

  Unfortunately, nearly half of women physicians report having been harassed on the basis of gender, and more than a third report having been sexually harassed by patients, peers, or attending physicians. The frequency of both is about the same during medical school and training. (It decreases somewhat when the physicians enter practice.) It is experienced more frequently by women than men and, in residency, varies by specialty (Figure).

 Figure: Relative Incidence of Sexual Harassment in 10 Specialties*

 1. Urology

2. Family Medicine

3. Psychiatry

4. Emergency Medicine

5. Obstetrics/Gynecology

                                                    17. Dermatology

18. Transitional Year

19. Anesthesiology

20. Ophthalmology

21. Pathology

  * Ranked from highest (1) incidence to lowest (21) incidence. (Adapted from: Acad Med. 2001;76(10):S5-7)

     Gender discrimination and sexual harassment affect specialty choices. The greatest impact occurs during core electives and elective clerkships. In addition, experiences during the residency selection process affect how applicants rank programs. Observing and hearing about such discrimination or harassment may affect applicants’ choices as much as experiencing it.

    During the residency selection process, women are also often asked sexist, blatantly illegal questions. (See the two free “Interview” videos at http://on.fb.me/10hPPTQ and my other blogs discussing interviewing.)