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Academic Medicine

An Insider’s Guide To The Medical Residency Interview

After more than 30 years of interviewing senior medical students for our internal medicine residency and interviewing residents for our pulmonary and critical care fellowship, I have interviewed hundreds of applicants. Every interviewer is different – we all prioritize different medical school metrics differently and we all prioritize different personal traits in an applicant differently. So, what impresses me may not be what impresses another interviewer. Nevertheless, here is what I looked for in all of those interviews. Although my background has been interviewing for internal medicine applicants, most of my thoughts apply to interviewing for a residency in any specialty.

Your best preparation is a good night’s sleep

During your interviews, you will have to be able to think quickly and think on your feet. If you only got 4 hours of sleep the night before, you will not be as mentally sharp. Furthermore, you will look tired and that is not the impression you want to give.

If you are a coffee drinker, drink judiciously the morning of your interview. On the one hand, you don’t want to experience acute caffeine deficiency during your interviews. And you definitely do NOT want to fall asleep during the grand rounds lecture that you attend as part of the interview day. But on the other hand, you don’t want to be squirming during your interviews because the 16 ounce Pistachio Mocha Frappuccino that you gulped down an hour ago is not fitting in your 10 ounce bladder. When in doubt, drink espresso.

Look the part

As doctors, we rely first and foremost on our physical exams to diagnose patients – and that exam always starts with observation. The same holds for a resident interview – the interviewer has already formed an opinion about you from the way you look, even before the conversation starts. You don’t have to wear formalwear but you do have to look neat.

If you are a guy and shave, make sure you shave that morning; if you have a beard, make sure it is trimmed. If you are due for a haircut, get one. Avoid appearances that make a statement because not every interviewer will interpret that statement the way you mean it. For example, the week before your interview is not the time to put blue and pink highlights in your hair – you may think it is fashionably avant-garde but the baby boomer cardiologist who is interviewing you may think it just looks weird. The same goes for tattoos – you never know what the interviewer thinks about them so you are better off wearing long sleeves. If you have piercings (other than earrings), take them out. Make sure your nails are trimmed and you don’t wear French Tips or artificial nails since most hospitals don’t allow them for employees, anyway. Avoid excessive jewelry, bling, cologne, or perfume.

When it comes to clothes, it is better to be over-dressed than to be under-dressed. For men, that means a dark suit and a tie (in a few hospitals, such as the Mayo Clinic, suits are required to be worn by physicians and students). For women, a dark skirt suit or pant suit is best. Your residency interview is arguably the most important job interview of your career so invest in it. If the suit you used four years ago when interviewing for medical school no longer fits or looks old, then get tailored alterations so it fits well or (better yet) buy a new one. This is not the time to borrow a suit from your brother who is 2 inches shorter and 20 pounds heavier than you. You only need one suit; no-one at the various hospitals you interview at will see you more than once. Don’t look rumpled – a permanent press shirt works best and if your hotel room has an iron, use it that morning. And don’t wear the shoes that you’ve been wearing on all of your clinical rotations that have gotten slimed by numerous patient bodily secretions for the past year. For women – similar recommendations. Avoid open toe shoes (most hospitals don’t allow employees to wear them). When in doubt about what to wear or not wear, look at the hospital’s dress code for employees – they are generally available on-line. Avoid wearing anything that could be polarizing – don’t wear your University of Georgia Bulldog tie when you are interviewing at the University of Alabama. And speaking of your tie, make sure the knot is neat and the bottom of the tie should just touch the top of your belt – it should not be higher or lower. Religious clothing accessories are fine – just be sure that they are clean and conservative.

The bottom line is that you want to be remembered for what you say during the interview and not what you wore during the interview. The attending physicians who interview you are going to interview dozens of other applicants over a 2-3 month period and you don’t want to be the one who is remembered as “…the guy with the nose ring and the skull and crossbones tattoo waring the too-short neon pink tie and tennis shoes“.

The pre-interview dinner

If there is a dinner or reception the night before the regular interview, dress based on the venue. If you aren’t sure what to wear, Google image search the restaurant to see what customers typically wear. Once again, being a bit over-dressed is better than being under-dressed. Nice-looking jeans and a blazer works for a casual venue, Kakis and a blazer usually works for nicer venues.

The pre-interview dinner is usually with a group of current residents. This is a great time to find out about “life as a resident” details. Usually, the residents will be able to tell you about how the call schedule works, the specific rotations assigned each year, the resident continuity clinic, etc. far better than the faculty members who do the actual interviews the following day.

What you say and do during the pre-interview dinner usually doesn’t help you to get into a residency but it can hurt you. The residents will report back to the residency program director if an applicant throws up red flags during the dinner. And don’t be lured by free food and alcohol – moderation with both is safest. If you drink alcohol, limit yourself to one drink for the evening. If the dinner is a la carte, don’t order the most expensive items on the menu.

Put your phone away

For many Americans, the cellphone is their reflexive default activity. Waiting at the airport? Pull out your cellphone. Commercial break on TV? Pull out your cellphone. Waiting for water to boil? Pull out your cellphone. But during a residency interview, your cellphone is a dangerous weapon that can cause self-inflicted fatal injury to your interview. If your phone ringtone goes off in the middle of an interview – you’re toast. If the residency program director hears you playing Super Mario in-between interviews – you’re toast. If an interviewer walks into the interview room and sees you watching replays of The Simpsons – you’re toast.

As interviewers, we are looking for applicants who are friendly, focused, undistracted, and professional. And nothing says “I’m bored” more than having your head buried in your phone. If you absolutely must have your phone with you in order to exchange contact information with interviewers or other applicants, then keep it turned completely off except when needed. Otherwise, you are probably better off leaving it locked up in your car to avoid temptation to use it. Most of us turn to our phones if we don’t have anything to do. There will be moments like that on interview days but you are far better off reading through the printed material that the residency program hands out (even if you have to read it 4 or 5 times), looking at stuff pinned to the bulletin board, or striking up conversations with other applicants.

When you have breaks in the interview day schedule, it is a good idea to write down your thoughts about different people that you interview with, features of the hospital, and unique aspects of the residency program. You are better off using a notepad than your phone or iPad – you don’t want to be misconstrued as playing video games when you are actually jotting down details about the hospital call rooms. You’ll end up with stuff you have to carry – a notepad, the brochure they give you when you arrive for your interview, your interview schedule, etc. But in this situation, less is more. If you can fit most of your stuff in your jacket pocket leaving you to only have to carry the brochure folder, that is ideal. If you must take some kind of accessory to carry your stuff in, make it small and new-looking. You DO NOT want to be carrying your backpack from one interview to another.

The office staff are more important than you think

I used my office assistant and my office manager as my spies. Most applicants can pull it together long enough to put their best face forward for a 30-minute interview with the attending physician but they often let their guard down when that attending physician is not around. They say things to the office staff that they wouldn’t say to an interviewer. An applicant who was rude or aloof to the staff while sitting in the waiting area earned a “thumb’s down” for the interview, no matter how good they seem on paper or how good they were when I met with them. How an applicant treats the office staff on interview day is an indication of how that applicant will deal with the nurses, respiratory therapists, pharmacists, custodial staff, and everyone else who works in a hospital that does not have an MD or DO after their name. Be friendly, stand up when they approach you, make eye contact when talking to them, and smile. Make small talk but don’t distract them from their work. The bottom line is to assume you are on-stage and someone is watching you from the minute you walk into the hospital until the minute you walk out.

Similarly, the residents who take you on a tour of the hospital, have dinner with you the evening before, or take you to lunch will report back to the program director or the the program’s administrative staff about applicants that stick out (either good or bad). Although it is true that you can often ask the residents questions that you are best not asking attending physicians during an interviewer, remember that those residents’ observations about you are part of your evaluation.

Do a little research

Read over the material on the residency program’s website and brochure. During the interview, if you ask questions about features of the program that are stated on the website, you will look like you didn’t care enough about the program to learn about it. The residency program director(s) and staff spent a lot of time creating that website and brochure and if it looks like you never bothered to read it, they will be disappointed. So, for example, if the website says that “First year residents get 2 months of electives.“, don’t ask “Do residents get any elective months?”. Instead ask, “I saw on your website that first year residents get 2 months of electives. What type of electives do most residents do?”. After 8 or 10 interviews, all programs start to sound a like so take some notes about each program from your research and re-read your notes just before the interview. It is a good idea to identify aspects of the residency program, the hospital, or the community that you have questions with after reading the program’s website. Write down those questions ahead of time and them take them with you on interview day.

It’s all about communication

As an interviewer, I have found that there is only so much I can learn about a person from a 30-minute interview. I learn the least from the standard questions like “Why did you choose internal medicine?” (I can get the answer from the personal statement in the application). Or, “Where do you see yourself in 10 years?” (most senior medical students do not have a clue and those that think they do are ultimately usually wrong). Instead, the three things that I look for during an interview are (1) overt psychopathology, (2) good communication skills, and (3) someone that I can trust to take care of my patients.

You can’t always identify psychopathology during an interview but there are frequently clues. Residents with psychopathology made my life as an attending physician worse. Clues that an interviewee will be belligerent as a resident, has an alcohol or drug use disorder, or has a personality disorder are red flags that the interviewee is going to be a problem child as a resident. For the ultimate psychopath who wriggled his way into internship, read the book “Blind Eye” that tells the story of serial killer Michael Swango, who killed at least 60 people, including several at the Ohio State University Medical Center when he was an intern. I was a senior medical student on-call in the ICU the night that one of his attempted murders by succinylcholine injection of a patient resulted in the patient being resuscitated and sent to our ICU. I can remember seeing him in the ICU that night – he had not been caught yet but I vividly remember looking at his wild-looking eyes and thinking at the time – “This dude definitely ain’t quite right“.

When it comes to communication skills, most people think about verbal communication. But there is far more to communication than just words. In the middle of the night, when a patient has a cardiac arrest and gets transferred to the ICU, I expect more from a resident meeting with the family than just the ability to speak English. Communication starts when you meet your interviewer – stand up, introduce yourself, shake hands (neither squeezing too firmly nor too softly), and wait to sit until the interviewer sits or directs you to sit. Eye contact is essential. Whether or not an applicant made good eye contact with me appeared on just about every interview summary that I’ve done for at least 20 years. You don’t need to constantly stare to the point of being annoying but keep coming back to the interviewer’s eye’s. Be relaxed with good posture. Using your hands as you talk is OK – just don’t overdo it. Don’t be checking your watch or a clock on the hall – it is the interviewer’s job to be aware of the time (or more likely an office staff member will knock on the door to give a 5-minute warning). Smiles can win hearts, especially when combined with eye contact.

I’m neutral about post-interview thank-you notes or emails. They seem like they have become almost obligatory and they all seem to end with the meaningless sentence: “I will be ranking your residency program highly.” The truth is that I fill out my evaluation of each applicant immediately after finishing my interview and by the time I get a thank-you note, I’ve already submitted my evaluation. My overall take is that thank-you notes don’t really help you but they don’t really hurt you either. If you do decide to send them, then whatever you do, proof-read them twice before sending. Nothing screams “I’m an idiot.” more than misspellings and bad grammar.

What about questions?

You can find loads of websites that list common questions that interviewers ask but the reality is that each interviewer is different. Be prepared for the questions that seem to come up consistently on the various websites and have general answers formulated in your mind. But as an interviewer, if I think your answers are overly rehearsed, I’m going to lower your final rank score for the interview. My practice was to read over the applicant’s application before the interview and pick out things that stood out as unique and then use those as the basis for my questions. So, if an applicant wrote down in their application that they spent a month in Guatemala at a missionary clinic in the mountains, I wanted to hear about it. Same with working at free clinics, gap year experiences, clinical electives out of state, or research. Be ready to talk about these experiences and make your answers like you are telling a story about those experiences and not just stating the facts about them. I also like to ask questions about hobbies and interests outside of medicine.

The reason that I find these questions so informative is not because of what the applicant says as answers but how they say it. I don’t know anything about medieval architecture in Prague but if that is what an applicant spent a summer studying when they were in college, I want to know if the applicant can make me understand it and make me interested in it by how he or she tells me about it. Can the applicant convey passion about their past experiences. If they can do that, I’m more confident that they can explain to a patient with angina what it means when their right coronary artery is 85% occluded on their cardiac cath. The other reason I like these kinds of questions is that I get bored after asking 100 applicants the same routine questions and hearing the same routine answers 100 times.

I want to know: is this applicant an interesting person who I (and my colleagues) are going to enjoy working shoulder-to-shoulder with for the next three years? Is this person going to bring unique experiences that are going to make the residency program richer? Can this applicant work as a team member with the other physicians and non-physicians? Can this applicant communicate with patients and their families?

A lot of interviewers will as the question “Tell me about a patient that had a particularly big impact on you“. I personally never really liked that question and only asked it if I ran out of other questions. Nevertheless, if you interview at 13 residency programs, at least one interviewer at some program is going to ask it, so be prepared. But once again, don’t just give the facts, tell the story of the patient.

In days past, there were some interviewers that would treat the interview like an oral exam. Fortunately, those days are pretty much gone but occasional some codger attending will blindside you with: “What would you do if the nurse calls you at 3:00 in the morning with a patient with AML who just spiked a fever to 103 and has a heart rate of 140?” My best advice is do what candidates do at presidential debates: when asked a question you don’t know the answer to, answer some other question that you do know the answer to. So, in this situation, the answer could be: “As an intern, my role is to do an initial assessment perform any emergent stabilization measures and then contact my supervising resident so that together as a team, we can formulate a more definitive management plan.” And then if the interviewer presses you, an acceptable answer to 90% of clinical scenarios is to put the patient on oxygen, start fluids, and get some labs.

Two things to avoid are swearing and jokes. F-bombs are increasingly (and tiringly) ubiquitous in American culture but you are interviewing for a professional position. No swearing and no slang. Humor is not what you think is funny, it is what the person listening to you thinks is funny and you don’t really know what your interviewer thinks is funny. Even the best stand-up comic bombs with some audiences. If 99% of people would laugh at something you say, then the chances are that your interviewer will be the 1 person who is offended by it. You have very little to gain with humor but you do have a lot you can lose.

What questions should you ask?

It is best to let the interviewer take the lead in questions. But if there is a pregnant pause in the interview or if the interviewer leaves time at the end for you to ask some questions, be ready. But don’t be rehearsed – I could usually tell when an applicant asked me a standard question like “What do you think the residency programs strengths are?” immediately after I asked they had any questions for me. Instead, personalize your questions in a way that shows you are interested in that particular interviewer, residency program or hospital. For example, ask what drew the interviewer to work at the hospital. Ask about the interviewer’s area of clinical interest. Ask about how the new hospital wing under construction will impact future patient management.

It is important to be somewhat strategic in your questions and what you ask will depend on who is interviewing you. The program director or department chairman will be knowledgeable about how many residency graduates went on to do fellowships or went into private practice. But the nephrologist who spends 10 months a year in his research lab and 2 months out of the year on the nephrology consultation service may be clueless about these kind of details. Similarly, An attending hospitalist can tell you details about how patient admissions come in from the ER but the outpatient endocrinologist who hasn’t admitted a patient in 15 years probably won’t know a thing. So, have a lot of questions prepared before the interview but ask them selectively based on the specific interviewer. If you get the interview schedule in advance, then pull up each interviewer on the hospital’s website to help you pick questions appropriate to that particular interviewer. Residency programs interview hundreds of applicants each year and each applicant usually has 3 or 4 individual faculty interviews. That means that the residency program administrative assistant has probably been emailing and calling every faculty member they can think of, desperately trying to find someone to fill interview slots. Often the attendings who do the applicant interviews are not those who are most intimately familiar with residency program details.

But as an interviewer, there are some questions I don’t want to be asked. And if the last thing that I talk about with the applicant during the interview is something that doesn’t make me happy, that is going to sour my memory of the applicant when I do my final scoring. Here are some of the things I don’t want to be asked about:

  • Resident call rooms. I have no idea, I haven’t slept in one for 35 years. This is a better question to ask the residents.
  • The process about how residents report duty hour violations. That immediately makes me wonder if you’ll be calling the human resources department if you are in the middle of doing CPR on a patient at the stroke of 6:00 PM when shifts change.
  • Politics. I want to know if you are going to be a good doctor and a good team member. Asking me about my opinions about some international conflict or my views on immigration has little or nothing to do with it.
  • Physician unions. Some attending physicians love them, some tolerate them, and some hate them. Unionization can bring good things to workers but unions can also be antagonistic to the hospital and the attending physicians. If residents go on strike, then the attending physicians have to pick up extra patient care duties and that engenders resentment. Like it or not, an applicant who sends signals that he or she wants to unionize the residents sends a signal that he or she is going to be a problem child.
  • “What are your pronouns?” I can’t figure out why some people ask me this – I’m a gray-haired, bearded, bald, 65-year-old who has been happily married for more than 40 years and has 4 kids and a bunch of grandkids. You use pronouns when you are talking about someone, not when you are talking to someone. When you ask a baby boomer what their pronouns are, it just confuses them… and then the’ll tell you to get off their lawn.
  • What are the program’s weaknesses? Some attending physician interviewers take this as a fair question. I always interpreted it as a way to get the dirt on the program. I do think, however, that it is fair game to ask about specific safety concerns, such as what the hospital process is dealing with unruly patients. Just don’t ask open-ended questions about everything and anything bad about the hospital. If I walk out of the interview feeling negative vibes, that affects my overall impression of the applicant.
  • Vacation time and moonlighting policy. These questions leave me wondering if the applicant is really going to be hard-working and focused on the primary job of taking care of patients and learning the practice of medicine. It is safer to ask the residents during the pre-interview dinner.
  • I don’t have any questions. If I ask you if you have any questions with 10 minutes left in the interview and you don’t have any, it means one of two things. Either I was a genius and completely won you over so that there is absolutely no question that you are going to rank our residency program #1 or (exponentially more likely), you’ve made up your mind that you aren’t ranking us and you are just trying to get done with the interview. Always be prepared to ask something. The absolute worst interviews are those when both the interviewer and the applicant run out of things to talk about with 15 minutes still left to go in the interview.

The bottom line

The medical residency interview is really a two-way interview: you are being interviewed by the residency program and the residency program is being interviewed by you. What I am looking for as a faculty interviewer is whether the applicant is going to be an effective member of the healthcare team and whether the applicant will be enjoyable for me to teach medicine to. But the applicant needs to be using the interview as a way to determine if the residency program is a good fit for him or her, also.

The best residency program is the one that is best for you and not necessarily the one that is most famous, most prestigious, or best for someone else. The purpose of a residency is to make you into the best possible physician you can become and central to this is whether you are happy in the residency program. You will probably become a better doctor by attending a good, solid residency that you are happy in than by attending a highly prestigious residency program that you are unhappy in.

Interviewing is a skill and like any skill, you get better with practice. It is a good idea to schedule the first one or two interviews at programs you think you are less likely to attend so that you can hone your interview skills before interviewing at programs that you are most interested in.

Your goal in the interview is to leave the interviewer with the idea that you are intelligent, mature, well-trained, and a hard worker. You want the interviewer to know that you have excellent communication skills, are eager to learn, and understand your role as a member of a healthcare team.

May 1, 2024

By James Allen, MD

I am a Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital