The Interview

[The Trifling Jester]

http://www.acponline.org/journals/impact/winter2004.htm?hp

The 411 on Acing the Residency Interview

It's interview day with a room full of applicants. For some, this is their first interview; for others, it is their fourth or fifth. Some are very serious, some are cocky, and some are not even interested at all—they're just in town for a vacation. For those of you that are serious, read on. For those on vacation, bring us back some souvenirs, will ya?
Interviews are usually good experiences for most applicants, though many do get burned out after six or seven interviews. It is important to remember that the interview is not only a way for a program to get to know you but a way to see if you fit in with the program. After all, this is where you'll be sweating out the next few years of your life.
Preparation
Do your homework! There's nothing worse than not knowing the basics about a program before you get there. If you want to make a bad impression, that's certainly the way to do it. Research the program on their Web site, and study materials received from the program. Gather information on the program's curriculum, commitment to education, faculty-resident ratios, call schedule, work hours, ancillary staff, and benefits.
Be prepared to answer both simple and challenging questions: "Applicants should be able to articulate their career plans and defend their choices" (1). Develop answers to probable questions, such as "Tell me about yourself," "Where do you see yourself in 10 years?" "What do you look for in a program?" "What are your strengths and weaknesses?" "What do you like about internal medicine?" More challenging questions include the following: "What was your biggest mistake?" "If you come here, what complaints will we have about you?" "If you could have lunch with anyone, who would it be?" "What did you learn from the last book you read?" "What was your most embarrassing moment?"
Do a mock interview with your advisor, a faculty member, or someone who knows you well and isn't afraid to critique you. Get guidance on the difficult questions. It is also advisable to do "practice" interviews at programs low on your list so that you can become somewhat "experienced" before you get to your higher-rated programs. If possible, your higher-rated programs should be scheduled in the middle of interview season, before you get tired of asking and answering the same questions over and over again.
Interview Day
First, do the obvious: Look clean and professional. As Dr. Dayton Daberkow, Program Director of Internal Medicine at Louisiana State University in New Orleans, Louisiana, puts it, "Look professional-like five patients were going to meet you and decide on a long-term relationship based on this 1-day meeting." Second, do the next obvious: Be on time, give a firm handshake, smile, look interested, and lean forward and pay attention to the interviewer. Also, be nice to everyone. This includes administrative staff, secretaries, tour guides, and anyone else involved in putting together the program. Remember, you are under their microscope throughout the day. And don't complain about anything to the other students. You never know who's listening.
Talk to the residents! They are your biggest source of information. They will tell you what they like and what they don't like about the program. These are also the people with whom you'll be working during the next few years. Ask yourself, do they seem happy? Challenged? Disgruntled? Would you fit in with this crowd? At 4:00 a.m., you don't want to be around someone with a lousy attitude.
Take notes throughout the day while your thoughts are still fresh. This will help you prepare questions and help you later when writing thank-you notes. According to an article in The New Physician, "Students also need to gauge their questions according to the position of the interviewer" (1). For instance, questions about housing, benefits, and salary should be directed to the residents, while questions about the goals, vision, and philosophy of the program are more appropriate for the department chair. Dr. John Fitzgibbons, Associate Program Director at Lehigh Valley Hospital and President-Elect of the Association for Program Directors in Internal Medicine, says, "Ask unique questions. Something that will make the interviewer remember you." When asking about weaknesses of the program, phrase your question in a nonoffensive way. For instance, instead of asking, "What are your program's weaknesses?" you can ask, "If you had unlimited resources as a program director, what would you improve in the program?" (1).
While the primary goal of interview day is to screen and rank applicants, the secondary goal is to sell the program to the applicants. Don't forget that they also are trying to impress you so that you will rank them highly and tell all your friends how great they are.
Postinterview
Applicants should obtain the e-mail addresses of faculty and residents in case any follow-up questions arise. Hopefully, you've written down and remembered the names of your interviewers and anyone else who spent time with you on interview day, because you'll need these for your thank-you notes. Try to make the notes personalized by referring to the conversation you had with that person. The note to the program director should state how much you enjoyed visiting the program and describe the key program features that attract you. Remember, though, your rank list is private! You can write that you really like a program, but never tell them that you will rank them number 1. Dr. Fitzgibbons reiterates this: "Don't tell a program 'You are my first choice' in your thank-you notes; instead, you can tell them they are high on your list and you enjoyed meeting them."
As far as receiving postinterview correspondence from a program, it varies. Some programs send nice letters to everyone, while others don't send anything to anyone. Be patient, and be prepared for anything. Dr. James Wagner from University of Texas Southwestern Medical Center in Dallas, Texas, writes, "Don't get depressed if you hear nothing from a program. It's just too difficult to decipher what nothing means. Conversely, don't get too excited if you get a positive letter or a telephone call from a program … though nice and ego-stroking, [this] assures you of nothing, so be sure NOT to change your cautious behavior based on any program comments" (2).
After all is said and done, just remember to be honest, be yourself, and act interested. As recommended in The New Physician, "In order to be happy with their choice, applicants should walk away from an interview feeling, 'This is where I want to train for the next several years of my life'" (1).
Nita Kohli
Council of Student Members Representative, Southwestern Region
Louisiana State University School of Medicine, New Orleans, 2004
Acknowledgements
The author would like to thank internal medicine residency program directors Dr. Dayton Daberkow of Louisiana State University in New Orleans and Dr. John Fitzgibbons of Lehigh Valley Hospital in Pennsylvania for their time and comments in support of this article.
References
1. Wiebe C. New Physician. 1994;?:15-7.
2. Wagner J. The Match: Southwestern Style. Spring 2003. Accessed on 8 January 2004.
An Inside Look at the Residency Application/Interview Process: View from the Internal Medicine Program Director's Seat

As the Southwestern Region Representative to the ACP's Council of Student Members and a fourth-year medical student at Louisiana State University in New Orleans, Louisiana, Nita Kohli had the opportunity to attend the ACP's Revitalizing Internal Medicine Summit. There, she was able to meet a few internal medicine program directors and get their perspectives on various aspects of the residency application and interview process.
Dr. Michael Barry is Chair of the Internship Selection Committee and Chief of the General Medicine Unit at Massachusetts General Hospital in Boston, Massachusetts. He attended medical school at the University of Connecticut and completed his residency at Strong Memorial Hospital in Rochester, New York. Dr. John Fitzgibbons is Associate Program Director and Chair of the Department of Medicine at Lehigh Valley Hospital in Pennsylvania. He is also President-Elect of the Association of Program Directors in Internal Medicine. Dr. Fitzgibbons attended medical school at State University of New York, Syracuse, and trained at Boston City Hospital for his PGY-1 and -2 years. He then did 2 years of epidemiologic research at the Mayo Clinic, completed his internal medicine training at University of California, San Francisco, and then did a 3-year nephrology fellowship at Tufts University in Boston, Massachusetts.
IMpact: How do programs prioritize the qualities they look for? Where do grades fall in that list?
Program Director: There is much variability among program directors; however, performance in clinical clerkships, especially clerkships related to the residency of choice, often receives considerable weight. This is because the work in the clerkship is most reflective of the work that a resident does. Basic science course grades from the first 2 years often receive less weight.
IMpact: Do programs rank knowledge over attitude?
Program Director: Again, it's variable. However, many programs probably feel it's easier to teach facts than attitudes during residency (though that's certainly an oversimplification). That might favor taking a more motivated candidate with slightly less knowledge than a less motivated candidate with encyclopedic knowledge.
IMpact: How much is research experience weighted in the application process?
Program Director: Not much, unless you're applying to a big research center. It would enhance an application, but it is not critical.
IMpact: Do internal medicine programs like generic, "safe" personal statements or creative ones?
Program Director: We read about 2000 personal statements in 2 weeks, so it would be nice to see something creative once in a while. It doesn't hurt to be creative, and also include your motivation thus far in medicine. Keep it to 1 to 1.5 pages long.
IMpact: How do programs feel about "older" applicants or applicants with spouses or children?
Program Director: Diversity of people and career directions in a program strengthens the learning environment, so you want all kinds of people. Diversity is the spice of any program!
IMpact: Are away rotations necessary for internal medicine? When is the best time to schedule them?
Program Director: If you really want to go to a place, it's good to rotate there for both the experience and to let the program know you. You can also do stimulating non-internal medicine electives—it doesn't matter what it is, as long as it has substance to it. Where you do the electives does matter—preferably schedule them at a place you are considering applying to. It's okay to do rotations up through January; you're probably fresher in their minds at that time.
IMpact: When is the best time to interview—early or late? Will programs forget you if you interview too early? Will they already have chosen all of their applicants if you interview later in January or February?
Program Director: No, programs will not forget you if you interview early, and they don't choose early. Most programs do a running ranking, so it doesn't matter when you interview. It's also good to have a picture on file to help them remember you.
IMpact: Do you recommend the traditional black/navy blue suit on interview day, or is it okay to wear some other color?
Program Director: Doesn't really matter; just nothing too outlandish. If you do blend in with everyone else, it would be hard to stand out. Also, no propeller hats!
IMpact: What's the best way to respond to an interview question that you don't know, catches you off guard, or you haven't thought about?
Program Director: "I don't know," or, "That's a good question. Let me think about that for a minute." This will allow you some time to collect your thoughts.
IMpact: Any other tips for looking good on interview day?
Program Director: As much as you're trying to impress the program, remember that they are also trying to impress you. Talk to the residents! They're honest and a good source of information. Show some personality; separate from the crowd; ask unique questions.
IMpact: If you haven't heard from a program that you're interested in, is it okay to call them? If you're scheduled to interview at school A in town and school B in the same town hasn't contacted you yet, would it be okay to call school B and let them know you'll be in town?
Program Director: We understand the difficulties of traveling all across the country for interviews, so if you're going to be in a town, it's okay to call that program and ask if you will be offered an interview. We also encourage you to call if you're in town, and look at the program on off-interview days.