Abstract
Interviews and program visits play a major role in the National Resident Matching Program application process. They are a great opportunity for programs to assess applicants and vice versa. Irrespective of all other elements in the application profile, these can make it or break it for an applicant. In this article, we assist applicants in planning their residency interviews and program visits. We elaborate on the keys to success, including planning of the interviews in a proper and timely fashion, searching programs individually, conducting mock interviews, following interview and program visit etiquette, and carefully scheduling and making travel arrangements. We also guide applicants through what to expect and is expected of them during their interview and visit.
Keywords
Introduction
Deciding where to do residency can be exceptionally daunting to many applicants. “The Match” encompasses key stressors that include moving to a new city, making new friends, and the major transition from being a medical student to a house officer. The program where the applicant eventually matches will play an important role in the course of his or her professional and personal life. The purpose of this article is to assist applicants in planning their residency interviews and program visits. Keys to success include proper and timely awareness and planning of the interviews, individual program research, the mock interview, interview and program visit etiquette, and carefully crafted scheduling and travel arrangements.
The interview has a significant impact on the order of the rank lists of both the applicant and the program. DeSantis found that the 5 most common factors cited by applicants when selecting a residency were friendliness, environment, interview day, academics and location (
1
). These factors are critical for applicants to remember. Program directors report that the interview is second only to emergency medicine (EM) rotation grades when ranking an applicant (2
). According to the 2018 National Resident Matching Program (NRMP) Program Director Survey, the applicants’ interactions with the faculty and house staff during the interview and visit as well as their interpersonal skills are considered the most important factors when ranking applicants (3
).Results of the 2018 NRMP program director survey. National Resident Matching Program (NRMP).
https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf
Date accessed: March 29, 2019
There are several texts to assist with acquiring interview skills, including some written specifically for residency applicants (
4
). Helpful online sites include the Resident and Student Association’s “Get Involved” page (https://www.aaemrsa.org/get-involved/students), the Emergency Medicine Resident Association’s student page (http://www.emra.org), and the Student Doctor Network (http://www.studentdoctor.net). Your medical school will likely also have good resources available in the student affairs office and the dean’s office.Mock Interview
The mock interview should be considered as a simulation case. It allows applicants to practice in a “safe” environment. Applicants should choose an interviewer who knows them and their goals, someone who is familiar with the interview process, and someone who is prepared to ask challenging questions and give constructive criticism (
4
). Most applicants will have already sought advice about EM from someone at their home institution, and that person will frequently be the person asked to help with a mock interview. Video or audio recording of the mock interview can be helpful. When participating in a mock interview, applicants should dress and act the part.Interview Questions
Preparation for all interviews should include researching each program, developing answers to probable questions, and selecting questions to ask the interviewer. Applicants are advised to read over and prepare answers for some of the typical, challenging questions (Appendix 1) and be prepared to address any gaps or red flags in their application.
During the interview, the applicant’s job is to engage the listener. Accordingly, he or she should practice reading social cues. For example, he or she should make appropriate eye contact and know when to stop talking (
5
). In addition, the applicant should be prepared to discuss topics such as his or her childhood, work and college experiences, activities outside of medicine, and medical school experience. Questions can be straightforward or off-the-wall. Preparation, flexibility, and confidence are needed through the process.Before the interview, applicants should revisit the program’s website to review a wealth of information allowing them to demonstrate their interest in a program, attention to detail, and thoughtful preparedness for their interview.
Online search of program leadership via MEDLINE/PubMed will help the applicants formulate questions for the interview (
6
). Also, applicants can write down questions during the interview and practice them before the next interview, improving their skills as you progress along the interview trail. Programs expect applicants to be nervous in their first interview, but most will expect a more relaxed performance as it gets closer to the end of the interview season.Inappropriate Interview Questions
Any job interview is subject to legal constraints designed to guard against discrimination in hiring. However, if the applicant broaches (either at the interview or on written application material) any of these subjects, they become fair game for discussion. See Appendix 1 for a sampling of questions that are inappropriate in any job interview.
Residency applicants are protected against discriminatory employment practices by the amended Title VII of the Civil Rights Act of 1964 (
7
). This federal statute prohibits employers from making hiring decisions on the basis of sex, color, race, religion, or national origin. Other federal nondiscrimination statutes and amendments, as well as some state laws, also prohibit such discrimination on the basis of veteran’s status, disabilities, age, pregnancy, marital status, or sexual orientation.When they are listed as part of an applicant’s record, asking about criminal convictions is legal if the applicant has a criminal conviction (
7
). These are reasonable questions, especially if the record includes issues of drug, child, or elder abuse, considering how EM provides frequent access to drugs and encounters with these vulnerable populations.The Electronic Residency Application Service (ERAS) specifically prohibits questions about an applicant’s ranking preferences, asking an applicant to reveal the names or identities of programs to which they have or may apply, and offering postgraduate year 1 positions to senior U.S. students outside of the Match. However, even with these constraints, almost two-thirds (64.8%) of U.S. medical school applicants during 2006–2007 reported that they were asked at least 1 potentially illegal question. Most illegal questions were related to marital status (
7
, 8
). Being asked illegal questions has a negative effect on how applicants rank a program (8
, 9
). Hern et al. suggested developing a formal interview code of conduct that addresses both applicants and programs as a possible solution (8
). In addition, evidence of discrimination in the selection process against international medical students has been reported. In a survey by Moore et al., more than two-thirds of program directors reported feeling that international medical students are discriminated against (9
, 10
).If the interviewer asks a question that the applicant feels is inappropriate, he or she may refuse to answer or simply respond in relation to the job; for example, “I would never let my marital status interfere with my job performance.” Questions about the rank list or interest in a program can be fielded with, “I am interested in your program and would like to engage in such deliberation with you. However, my advisor has repeatedly stressed to me the importance of avoiding such a discussion with any program, if you do not mind.” If the interviewer insists, the applicant can explain that he or she had been warned that this would be a breech in the Match Agreement, and he or she would not want to cause such inconvenience to anyone.
Scheduling Interviews
ERAS is the Association of American Medical Colleges–sponsored, web-based service for the compilation and distribution of residency applications. Applicants may start applying to EM programs via ERAS in early September. The historical practice of offering interviews only after receiving the Medical Student Performance Evaluation letter (MSPE)—traditionally known as the Dean’s Letter—on November 1st fell out of practice (
11
). In fact, data from the 2018 Match showed that 65% of program directors extended interview spots before November 1st (3
). The start date for offering interview spots has been under scrutiny as the date for the MSPE release is changing (Results of the 2018 NRMP program director survey. National Resident Matching Program (NRMP).
https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf
Date accessed: March 29, 2019
12
). For the 2018 Match, Educational Commission for Foreign Medical Graduates (ECFMG) recommended having the MSPE submitted by September 22nd, 2018 to ensure that the document had been uploaded into ERAS by October 1st (13
). Therefore, given that the current MSPE release date is October 1st, most programs will wait for that date before offering interviews. Nonetheless, according to the NPRM program director survey, 18% of the programs extended their interviews before October 1st (2018-19 Residency application cycle. Complete IMG timeline and checklist. Match a resident.
http://blog.matcharesident.com/2018-19-residency-application-cycle-complete-img-timeline-checklist/
Date accessed: March 29, 2019
3
). In order to obtain those early interview spots is it wise to assure that EM rotation grades and letters of recommendation from EM faculty are in early—these continue to be cited as the most important part of the EM application (Results of the 2018 NRMP program director survey. National Resident Matching Program (NRMP).
https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf
Date accessed: March 29, 2019
12
).Interview offers are typically sent via email through ERAS, although some are occasionally offered via telephone or direct email. Applicants should reply immediately if they are interested because interview spots can fill up within the week. Many applicants schedule their first interview at their home institution, allowing time to improve their interview skills in a more comfortable environment.
Some authorities recommend scheduling interviews at more desirable programs later in the season, theoretically to make a lasting impression using your well-honed interview skills (
4
, 14
). However, a study that investigated the role of the interview date in determining whether it has an impact on applicants’ position on the rank list of EM programs found no significant temporal correlation between the two (15
). Applicants that may experience “burn-out” should interview earlier in the season.ERAS does not impose a minimum or maximum number of application submissions. According to the 2017 NRMP Applicant Survey, the average EM applicant from a U.S. allopathic medical school submitted 41 applications, were offered 17 interviews, attended 13 interviews, and ranked 13 programs (
16
). In general, each applicant should assess their strengths and weaknesses and apply to a mixture of competitive and less competitive programs where they would be willing to train (Results of the 2017 NRMP applicant survey. National Resident Matching Program (NRMP).
http://www.nrmp.org/wp-content/uploads/2017/09/Applicant-Survey-Report-2017.pdf
Date accessed: March 29, 2019
4
). Applicants are advised to meet with their academic advisors early to obtain an honest appraisal of their competitiveness. If the application is below average, it may be wise to apply to a few programs in a less competitive specialty as a backup to EM.Applicants with a strong academic profile may end up receiving too many interviews and should give their colleagues and the programs the courtesy of an early notification that they are declining their offer or canceling an interview. In the event of a “no show” or late cancellation to a scheduled interview, some programs directors may notify the dean or the individuals who wrote the applicant’s a letter of recommendation. The world of EM is small, and the applicant does not want to be the subject of such a discussion between program directors.
Peri-Interview Interactions
Once the interview is scheduled, the applicant will be mailed or emailed a description of that program’s interview process, a tentative schedule, and travel and lodging information. If the applicant is in town before the interview, he or she should plan to attend the preinterview social and arrange to visit the ED. Spending extra time in the ED either during the interview visit or as a second look can give the applicant an insight into the program. It will expose him or her to more faculty and residents and it shows interest and sets him or her apart from other applicants (
6
). It can also give the applicant specific examples about the program to discuss during the interview and may generate more detailed questions.Residency coordinators are a hybrid of secretary, administrative assistant, caterer, tour guide, and receptionist. They are who the individuals applicants speak to when they call for directions, add a letter of recommendation, or schedule their interview. Assisting them on the interview day will make an applicant stand out. It is important for the applicant to remember that every step of the selection process is part of the job interview. Interactions with the residency coordinator can influence how the applicant is perceived by the program director (
6
). Applicants should keep in mind that they are being observed throughout their visit. While visiting a program, applicants will meet many people; they should be nice to all of them and write down their names or collect business cards to send them thank you notes later.Travel
Travel can be as simple as taking the subway across town or as complicated as flying coast to coast after working a 12-hour night shift. Travel remains the most expensive part of the interview process. Special residency relocation loans exist for students for travel during the interview season and moving for residency. Driving may be an attractive option if the applicants’ interviews are clustered in a geographic region, given that they have a reliable automobile. Also, applicants should know that the interview season runs from November to February and winter storms will affect travel. Accordingly, applicants should ensure extra time to compensate for weather or traffic delays.
Travel plans should include researching directions and maps. Preparation is crucial before applicants arrive in the city. While most people tend to rely on smart phone map applications and global positioning satellite systems for directions, these can fail or be inaccurate. Thus, applicants are advised to consider bringing a map or looking up the location ahead of time.
Lodging
Obtaining appropriate accommodations can also be challenging. Few programs provide accommodations for the night before the interview, but many have set up discounts at local hotels. Occasionally, programs will list residents willing to host applicants for the night before the interview. This option provides an inside look at resident life, reveals potential housing locations, and allows unstructured time with a resident to discuss the program. The disadvantage of this option is the likely possibility that this time will provide the program further time to include their experience with you as part of the interview process. Other options include assistance and guidance from friends and family who live in the region or residents at the institution or program who recently graduated from your medical school.
Vacationing and away Electives
Medical students frequently attempt to arrange vacation or away elective time in concert with the interview schedule. Therefore, applicants should determine their medical school’s policy regarding time off from clinical rotations for interviewing. This way, they can seek away electives at times and in cities where they have the chance to interview at more than one program while rotating through to save on travel and lodging costs. If possible, applicants are also advised to schedule their interviews during a vacation month or around an away elective to optimize their experience and to better know the city where they may end up living.
Attire
The dress code for the interview is professional business attire for both men and women. Suits should be dark and conservative. Applicants should show their individuality through their application and interview responses, not through their attire. Individuality will shine through in the applicants’ mannerisms and speech. They should appear confident, enthusiastic, and composed, while not appearing cocky, out of control, or aloof (
5
).Most applicants bring a professional folder or notebook for taking notes, driving directions, the interview schedule, and a copy of prepared standard and specific questions. Also, it is recommended that applicants bring a copy of their curriculum vitae, personal statement, publications, and any other documents or items that will set them apart. They should avoid carrying pens from pharmaceutical companies; there are specific policies in place in most programs that frown on industry impact on medical practice.
Applicants must remember to check the weather forecast while planning their attire. The day will include a tour, and depending on the weather, an umbrella, rain or winter coat, and appropriate footwear should be considered. Also, applicants should expect to walk for a good portion of the day; function is more important than fashion in dress shoe selection.
Interview Day Format
The interview day tends to start early. Coffee, bagels, or pastries may be provided the morning of the interview. During the morning introduction period, applicants will typically meet the residency coordinator, program director, chairperson, and a few residents. The format for the remainder of the day will be provided, which enables the applicants to arrange the questions that they have prepared for the faculty.
In many cases, interviews are conducted on conference days or journal clubs. When possible, applicants should attempt to attend these conferences because it allows them the opportunity to meet the staff and observe interactions between residents and faculty. Conferences also are a way for the applicants to observe the teaching style of the program.
Tour
Most interview days include a tour of the ED; some programs will also take the applicants through other areas of the hospital and medical campus. These visits give the applicants the opportunity to observe the faculty and view the resources and working environment. In addition to noting the adequacy of ancillary support staff, applicants may ask about ultrasound machines, digital radiograph viewers, computer stations, and electronic medical records. This may also be a good time to ask about the role of the resident in managing ED flow and crowding. Observations during the tour may help applicants gain an appreciation of the clinical arena, including resident–attending interactions (
17
).Interviews
Although intended to be a smoothly running operation, problems do occur. Interviews take longer than intended, applicants or interviewers arrive late, and the weather can alter the schedule considerably. Flexibility and poise in such situations may move an applicant even further up the rank order list. The interviews can involve either a structured or unstructured format. In the structured format, the interviewer has specific questions to ask to compare the applicants’ responses to the remaining applicant pool. Questions can be ethical, clinical, or social, and are intended to be thought-provoking. The unstructured format involves a less regimented environment, and typically is based on questions about likes and dislikes, with the interviewer developing a gestalt about an applicant.
The program director and assistant or associate directors typically review the applicants’ files before the interview. Some interviewers, however, intentionally do not review the file, theoretically to reduce bias during the brief interaction and provide a more accurate assessment of the applicant’s interpersonal skills. Therefore, the applicants should not be offended if one of the interviewers seems unfamiliar with some of the strong or weak points of their application. Applicants can lead the discussion to some of their accomplishments and the strong points of their application. This would be an appropriate time for the applicants to pull out copies of their curriculum vitae or research activities and will give an impression that they are attentive to detail, organized, and well-prepared.
While the primary goal of the program is to screen and rank applicants, a close second is selling the program to the desired applicant. Demonstrating an intelligent faculty, clinical education and a favorable work (and play) environment are crucial to enticing applicants to rank a program highly. In fact, the desirability of the geographic location was the most important criterion cited by U.S. seniors to EM programs in 2018 (
16
). Other highly rated factors by U.S senior applicants include perceived goodness of fit, quality of educational curriculum and training, quality of residents in program, and house staff morale (Results of the 2017 NRMP applicant survey. National Resident Matching Program (NRMP).
http://www.nrmp.org/wp-content/uploads/2017/09/Applicant-Survey-Report-2017.pdf
Date accessed: March 29, 2019
16
).Results of the 2017 NRMP applicant survey. National Resident Matching Program (NRMP).
http://www.nrmp.org/wp-content/uploads/2017/09/Applicant-Survey-Report-2017.pdf
Date accessed: March 29, 2019
Most programs will provide applicants with ample opportunities to ask questions and cite concerns. Asking the same questions to all programs gives applicants variables that they can compare, but focused questions specific to a program helps to individualize each visit. Koscove published a large question bank that is an excellent reference for developing questions specifically for EM applicants (
17
). Applicants are advised to take notes during the introductory session, interviews and lunch, while their thoughts are fresh. Some applicants use a handheld tape recorder or a recording application on their smart phone to document their thoughts after the interview is completed. These can be reviewed when compiling the rank order list.Lunch
Lunch is the time for applicants to interact with the residents and ask any questions they may still have. Residents tend to be candid about the program, giving information that is not provided in the pamphlet, website, or interviews. They also can give applicants firsthand perspective on what day-to-day life is like. They understand the process and can give applicants insight into why they selected their program over others. It is a chance to assess resident happiness and morale.
Informal Gathering/Night Before Social
Most residencies offer an informal social gathering with their residents. These events typically take place the evening before the interview, but some programs offer their social events the night after the interview. Typically organized and hosted by the residents, the social gathering offers the applicant a chance to meet with the residents and often their significant others in an informal setting. These events vary widely between programs. Some involve a sit-down meal while others are just an informal gathering at a local hangout or bar. The applicants must remember that while these are casual events, they are still at a job interview.
Applicants should use these events as opportunities to ask resident-specific questions about the specialty, program, or the region. This is especially important given that EM is a relatively young specialty that is rapidly growing with EM residency programs that are continuously developing (
18
, 19
). The residents are a great resource for questions that might not have been answered by a program’s website. In addition, the residents can offer key insights into what to expect on the interview day. The personality of a program and interactions with residents outside of the interview proper more often influence the applicant’s impression of a program (20
). Every effort should be made by the applicant to participate in off-campus gatherings. According to the 2018 NRMP Program Director Survey, feedback from other residents is highly regarded when raking applicants, with a mean importance rating of 4.5 on a scale from 1 (not at all important) to 5 (very important) (3
).Results of the 2018 NRMP program director survey. National Resident Matching Program (NRMP).
https://www.nrmp.org/wp-content/uploads/2018/07/NRMP-2018-Program-Director-Survey-for-WWW.pdf
Date accessed: March 29, 2019
Failure of the Interview
Several factors can result in a poor interview experience. Inadequate preparation is one of them. This includes not knowing the basics about the program, arriving late or failing to follow the schedule, and having conflicting travel arrangements that might reduce the applicants focus on the interview. A second factor could be inadequate answers. Answering questions that were not asked, not being able to account for gaps or flaws in the application, rambling answers, and inconsistency or evasiveness in the answers are examples. Inadequate personal skills, namely skepticism, impoliteness, rude communication style or questions, poor eye contact, poor handshake, chewing gum, and appearing disinterested may jeopardize the interview experience as well. Other “red flags” interviewers look for in an applicant include appearing untrustworthy, appearing depressed or unhappy, criticizing other programs or individuals, overconfidence, lack of confidence, and lack of insight.
Although this list may be incomplete, it provides the applicants with a brief checklist of factors that they must take into consideration through the process of your interview.
After the Interview
Many applicants send thank you notes to the program director; email is considered an acceptable form for this correspondence. They may consider sending a short note to the other faculty members who interviewed them as well. Many programs will add them to the application file and consider them a sign of professionalism when making their rank list. When writing a letter of interest or thank you note, applicants should make it specific. The letter must stand out and make an impact if applicants want it to make an impression (
5
). In addition, the message should be personalized, perhaps by commenting on discussion topics the applicants had with the interviewer(s).Applicants who wish to get the feel of a regular day in the ED of a program can arrange to stay after the interview or arrange a “second look” visit. Spending time in an ED outside of the interview day allows for a more realistic view of the day-to-day ebb and flow of the ED. The second look is not mandatory but can show interest in the program and allows more time to visit with residents and faculty. This can be arranged through the residency coordinator. Observation should be discrete without interfering with the clinical duties or needs of the faculty and residents. If a second visit cannot be arranged, applicants can email or phone residents or faculty with any questions that occur as they formulate their rank list.
Conclusion
Interviews and visits play a major role in the application process. Applicants may move a program up or down their rank order list based on the interview day alone (
1
). An applicant is looking for the right fit for him or her since this will be their new home for the next 3 to 4 years. It should be given the applicant’s most careful attention. He or she should be prepared, attentive, organized, professional, and positive. For all applicants, irrespective of their grades, letters, publications, or other elements of their application profile, this part of the Match can make it or break it.Acknowledgments
Supported by the Department of Emergency Medicine at the American University of Beirut Medical Center. The funding source was not involved in the preparation of the article, writing of the report, or decision to submit the article for publication. This research received a nonrestricted educational grant from the not-for-profit Resident Student Association (American Academy of Emergency Medicine) and the Department of Emergency Medicine at the American University of Beirut.
Supplementary Data
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Article info
Publication history
Published online: July 04, 2019
Accepted:
April 22,
2019
Received:
April 14,
2019
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