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Mastering the Residency Interview

You’ve spent months—even years—preparing your applications to U.S. residency programs… researching programs, gathering supporting documents, requesting letters of recommendation, compiling a CV, crafting the perfect personal statement, ensuring everything was submitted on time. You sent your applications and waited patiently for interview invitations. But what happens when you get that long-awaited invitation for an interview?

ERAS Support Services at ECFMG conducted a survey of international medical students and graduates who participated in the 2012 Match. Of the respondents, nearly half—44.8%—were invited for between one and five interviews. That means they had fewer than five chances to stand out, to show the person behind the CV, to demonstrate why a program should select them to fill one of its finite number of positions. Success in the residency application process requires making every one of those interview opportunities count, and the key to doing that is, in a word, preparation.

Even before you get that first interview invitation, you should begin to prepare by educating yourself about what to expect from the residency interview process. Such preparations should include understanding the key components that will make up the interview day, practicing for frequently asked questions you might expect, developing a list of appropriate questions you can ask your interviewers, and planning how to best present yourself throughout the process. You will find that the time you invest in preparing now will help you make the most of those critical interview opportunities.

What to Expect
The structure of the residency interview process varies from program to program. You may be invited to an informal dinner with program residents the night before your interview. Your day may start with a presentation on the program or it may start with a hospital tour where you are introduced to the staff. You may be the only candidate that day or you may be one in a group as large as 30. Many programs will inform you in advance how the interview day will be conducted, so you have an idea of what to expect when you arrive.

Although structures vary, most interview days will include an overview of the program presented by the program director, program staff, and/or chief residents on key components of the program, its philosophy and structure, and future goals. Pay close attention during these presentations, both to hear more about the program, and to be able to ask clarifying questions if needed. Most programs also will offer a tour of their facilities, highlighting the common areas for residents, such as outpatient and inpatient settings, conference rooms, cafeteria, simulation center, and library. Observation of a clinical conference, such as morning report, grand rounds, or board review also may be a part of the interview day. Observing activities like this will give you valuable insight into a program’s learning environment.

Of course, there is also the portion of the day devoted to the actual interviews. During this time you will meet with one or more physicians in the specialty to which you are applying. These physician interviewers likely will have reviewed your application beforehand and therefore already will be familiar with your qualifications. The actual interviews may be one on one, ranging usually from 10 to 30 minutes in length, or in a group setting where you meet with multiple physicians for a longer period of time. Whatever the format, this is your crucial opportunity to communicate directly with these physicians and make a good impression.

The interview day also usually involves informal activities such as breakfast, lunch, and sometimes a dinner the night beforehand. These less structured events provide you with the opportunity to interact with and ask questions of the residents, program staff, and even other applicants in attendance. However, Glenn Eiger, MD, Program Director of the Internal Medicine and Transitional Year Residency Programs at Albert Einstein Healthcare Network, in Philadelphia, Pennsylvania, emphasizes the importance of knowing that everyone you meet during the interview day is part of the interview process. Therefore it is important to remain professional at all times.

How to “Wow”
You can’t control how the interview day is structured, who you meet with, or what questions you are asked, but one thing you can control is how you present yourself. Strive to make good first impressions by being on time, dressing professionally, smiling, and appearing calm and confident throughout the process. If appearing cheerful, composed, and self-assured in such a stressful situation seems a daunting task, remember that the more prepared you are, the more relaxed you will be on interview day. As part of this preparation, Sabesan Karuppiah, M.D., Assistant Director at Altoona Family Medicine Residency Program, in Altoona, Pennsylvania, recommends practicing beforehand by doing mock interviews to familiarize yourself with what might otherwise be an unfamiliar and even uncomfortable situation. Strive to make your mock interviews as realistic as possible—interview with people who are unfamiliar to you, not with friends, and dress as you would for an actual interview. Such experiences may be offered through professional medical associations, your medical school, or a career development or counseling center in your area.

Communicate effectively. Communication is key in the team-based environment of U.S. health care. Studies have shown that the failure to properly communicate information is one of the most common causes of serious medical errors. As such, your communication skills will be assessed throughout the interview process. If English is not your native language, interviewers also will use this as an opportunity to evaluate your English proficiency. Throughout the interview session be honest, speak clearly, and take your time in answering questions. It’s perfectly acceptable to pause for a moment to think through your answer before beginning, advises Dr. Eiger. It is also important to answer the question that is asked rather than seem as though you are giving a prepared speech, suggests Dr. Karuppiah.

Talk about yourself. While specific questions will vary from program to program and even interviewer to interviewer, they will all have one common objective: Determining if you are right for the program. “We want to get to know the applicant beyond his or her CV,” states Dr. Eiger. “We like to see if the applicant is a good fit for our program with regard to personality, work ethic, and ability to work as part of a team.”

To get at this central point, interviewers will ask a variety of targeted questions about your strengths, your weaknesses, your accomplishments, and your career goals. As an IMG, you likely also will be asked specific questions about why you want to pursue residency training in the United States. This is a chance for you to highlight some of the experiences and accomplishments that have influenced you and the research, fellowship, and academic options you wish to pursue in the future.

If you have gaps in your training or deficiencies in your application, you likely will be asked about these, so prepare answers that are honest and clearly explain the situation. As Dr. Eiger states: “I would rather an applicant provide me with an honest answer than one which the applicant thought I wanted to hear.”

To make sure you communicate all the things you want programs to know about you, Dr. Karuppiah recommends developing a checklist of important points and accomplishments, such as previous publications, U.S. clinical experience, and future career goals. Keep this list with you to help you stay on course and remind yourself of key points you want your answers to highlight.

Know the program. You should also be prepared for questions that are specialty- and program-specific. Dr. Karuppiah stresses the importance of being able to demonstrate that you “know about the specialty, know about the program, and know about the institution.” In particular, Dr. Karuppiah says that he often asks interviewees why they are interested in family medicine, and he is “surprised how many people don’t have a good answer to that question.”

Being able to explain why you are interested in that particular program also is key. “If somebody can make a strong case,” states Dr. Karuppiah, “that will always be considered very highly.” Marygrace Zetkulic, M.D., Associate Program Director of the Internal Medicine Residency Program at Saint Peter’s Healthcare System, New Brunswick, New Jersey, agrees; she commonly asks potential residents how they learned about the program and what qualities they will bring to the program.

Asking these types of questions helps interviewers know why you chose to apply to their program and what you are looking to get out of your residency—both of which will tell them a lot about your career objectives. But while it is important to be enthusiastic and confident, honesty is also key. “We are looking for sincere answers,” states Dr. Zetkulic. “We are very sensitive of people saying things they think we want to hear.” Dr. Eiger reiterates this point, emphasizing that it is okay to answer with a degree of uncertainty, especially with respect to career aspirations.

Demonstrate you’re a team player. Teamwork is a key component of residency training in the United States, so expect interviewers to ask questions about how you work in different team scenarios. As an interviewer, Dr. Zetkulic states that she is less interested in hearing you characterize yourself as “top of my class” or having graduated from “the best medical school” as she is in hearing specific examples of what you have done in the past that will make you a good member of a team. Be prepared to reference times when you worked well in a team environment and how you can uniquely strengthen the teams you will work with during residency. Knowing more about the concept of the health care team in the United States may be helpful in thinking about answers to these types of questions.

Show off your clinical knowledge. Interviews won’t just be all about you; be prepared for medical content questions, such as presenting an interesting clinical case you have seen or discussing a case-based scenario developed by the program. As Dr. Karuppiah notes, interviewers use this kind of question to get a better sense of your overall communication skills and the ways in which you can discuss patient care. Presenting patients and answering case-based questions is something you will have to do throughout residency, and programs want to be confident you will be able to perform this important component of a residency learning environment.

Interviewers also likely will ask you to discuss your clinical experiences, both abroad and in the United States. Dr. Zetkulic cites clinical rotation experiences as something she specifically asks IMGs about, while Dr. Eiger points out that interviewers who are unfamiliar with the medical training systems in the country where you studied may ask you to describe the types of experiences you had there in more detail.

Be inquisitive. Interviewers aren’t the only ones who get to ask questions during the interview, and the questions you ask will demonstrate a lot about you, your interests, and your career objectives.

Thoughtful questions about the program or questions aimed at clarifying specific points are always welcome. Dr. Eiger notes, “I enjoy being asked unique questions about our program. Questions about the curriculum, program philosophy, new programs, and future goals are all good topics.” How the program will meet the applicant’s professional needs and what sets the program apart from others is another strong line of questioning according to Dr. Zetkulic. And questions about the kinds of elective and teaching opportunities the program offers, how the interviewer sees the program changing in the next few years, and what impact U.S. health care reforms have on the program demonstrate insightfulness and a forward-thinking perspective, states Dr. Karuppiah.

The interview is not the time, however, to ask questions about salary, benefits, vacation time, call schedules, and the relative difficulty of the program. Some of these questions would be better addressed by residents during your networking times or by the program’s human resources department. Contract details, such as salary and benefits, may even appear on the program’s website. Prioritizing these issues during your interview can send the wrong message about your goals for residency training.

Just as you prepared a list of things you want the program to know about you, it may be helpful to prepare a list of questions you would like to ask throughout the day. As Dr. Eiger points out, however, try not to sound rehearsed and don’t just ask the standard questions. “Interviewers like spontaneous, appropriate questions that are not cookie-cutter type,” he states. “Some applicants seem to ask questions for the sake of asking rather than for acquiring the answer.” Instead, your questions should demonstrate that you are actively engaged in the interview process and sincerely want to learn more.

Have fun. Throughout the interview process it is important to be professional, stay calm, remain confident, be honest, speak clearly, and make good connections with all the individuals you meet. But it’s also important to relax and be yourself. The interview day may be a stressful one, but try to enjoy this occasion as it is a very important step in your quest to find the residency training program in the United States that is the best fit for you.

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