The Successful Match: How to Succeed in your Residency Interview

For most residency applicants, the arrival of November marks the beginning of the interview season. This often brings back memories of the medical school admission interview, with the ubiquitous “Why do you want to be a doctor?” question.

Four years later, you find yourself in a similar situation – this time, hoping to land a position in the specialty and residency program of your choice. “Why do you want to be a doctor?” is now replaced with “Why do you want to go into [this specialty]?” and “Why are you interested in our residency program?” While the questions will differ to some extent, you may be experiencing the same gamut of emotions – uncertainty, nervousness, and perhaps even fear.
Given the highly evaluative nature of the interview process and its importance in the residency selection process, this anxiety is well-placed. Over the years, many surveys of program directors have inquired about the importance of the interview. Recently, the National Resident Match Program surveyed 1,840 program directors representing the nineteen largest specialties to determine the factors used for ranking applicants.¹ Ranked number one, even higher than clerkship grades and USMLE scores, was the residency interview. A number of previous studies substantiate this finding. In one study done at the Children’s Hospital of Pennsylvania, interview scores were found to be the most important tool for the ranking of applicants.² In a survey of family medicine and obstetrics/gynecology residency program directors, the residency interview was found to be most valuable in the ranking of applicants.³ Program directors of internal medicine residency programs have also rated the interview as most useful for ranking decisions, with 96% of respondents reporting the interview to be highly or moderately useful.⁴

While receiving an interview invitation is an honor, simply being interviewed does not guarantee a place on a program’s rank list. In a study of emergency medicine residency programs, with data obtained from 3,800 individual interviews, a total of 14% of interviews resulted in unranked applicants.⁵ In another study, one third of applicants were actually ranked less favorably following the interview.⁶ Dr. Reilly, former program director of the University of Texas medical school at Houston psychiatry residency program, states that a “good interview can save someone with the less than perfect application. A bad interview cannot always be salvaged by a paper record.”⁷ The conclusion here is that the interview is critical to your chances of a successful outcome.
Recognizing the importance of the interview, we have devoted four chapters and nearly fifty rules to the interview process in our book, The Successful Match: 200 Rules to Succeed in the Residency Match. In this column, we discuss three of the most important rules for interview success.

Dig deep

The primary goal of an interview is to impress upon the decision-makers that your unique qualifications are exactly what they seek.  Many decision-makers refer to this as “fit.” Will your strengths and aspirations help the program achieve its own goals? Are your proven qualities the type necessary to achieve success as a resident in their program? In order to convey this message, you need to know yourself, and you need to know the program, and you need to be able to convey this knowledge during the interview.

Conveying this message starts with demonstrating a strong and sincere interest in this particular residency program. One of the easiest ways to impress an interviewer is to arrive well prepared, having thoroughly researched the residency program. Start with the program’s website. What is the program’s philosophy? Is the program known to produce academicians? Is it recognized for its contributions to community service? Is research an area of key emphasis in the department? What is the program looking for in a resident?  With this knowledge in hand, you will be better prepared to demonstrate to the program that you are precisely the type of individual they seek. Equally important, the information that you gain will help you decide if this is a program where you would like to train.

While most applicants will review the program’s website, too often the research begins and ends there. We recommend that you dig deeper. Perform an internet search to learn more about the program, its faculty, the hospital, and the city. Well before your interview, contact graduates of your medical school who are residents or faculty at the program. Locate physicians in your area who trained at that program. These individuals can provide valuable information about the program, which you, in turn, can refer to during the interview. For example, “Dr. Ran, the chairman at my medical school, was recently a visiting professor in your department. In speaking with him, I learned about how your program really pioneered human simulation training as a teaching tool. I’ve been looking forward to learning more about that during this interview.” Candidates who make the effort to take these steps can convincingly demonstrate that they are truly interested in the program.
Many applicants do an excellent job in researching a program in advance. Unfortunately, many don’t know how to, or don’t feel comfortable, demonstrating this knowledge. They may end up making no reference to the specific information that they have read or learned about the program, or they may ask the type of basic questions that could have been asked by any other applicant.  The end result is a generic interview, and a lost opportunity to demonstrate your strong interest in the program.

First impressions can make or break you

Multiple studies have shown that creating a favorable first impression is critical to interview success.  In one study done by Thomas Dougherty, chair of business and economics at the University of Missouri, a favorable first impression led to an easier and more successful interview. Interviewers who are more favorably impressed by interviewees during the first few minutes went on to treat those applicants more positively. They spoke with a more positive vocal style, engaged in more active recruiting of the applicant, and asked less questions.⁸ Although this study was in another field, medical faculty interviewers are not unlike those in other fields. The impressions they form of you through your first interactions will play a pivotal role in your interview success, or lack thereof.

The obvious measures in managing first impressions remain critical. One should arrive early and be well-dressed and impeccably groomed. The ability to maintain appropriate eye contact and shake hands properly are little discussed in medicine, yet are no less important. One article in the Lancet found a strong correlation “between a firm handshake – as evidenced by strength, vigor, duration, completeness of grip, and eye contact – and a good first impression.”⁹ It is important to be able to walk into a room and project self-confidence through your body language, facial expressions, and tone. In addition, the ability to engage in small talk is more important than many applicants realize. Dr. Jamie Collings, program director of the emergency residency program at Northwestern University, states that “whether the topic is the weather, current events, or sports, you’re expected to participate.”¹⁰ She encourages applicants to get “up to date on current events, see a movie, read a non-medical book, and read the paper regularly.”

Dr. Ziegelstein, associate program director of the internal medicine residency at Johns Hopkins Bayview Medical Center, states that “individuals who interview and judge others for a living (e.g., program directors) often form very strong first impressions. Typically, those individuals are flexible and those impressions are changeable, but those first impressions are nevertheless important.”¹¹ In our experience helping applicants prepare for interviews, we know that applicants spend considerable time preparing for anticipated questions. Unfortunately, most applicants then give little or no thought to the factors involved in a favorable first impression. Preparing for the subjective factors involved in first impressions is just as important as preparing for the typical interview questions. If you’re uncomfortable with small talk, practice with others. Mock interviews with friends, colleagues, and mentors may highlight weaknesses, and are an important tool in interview preparation. Make sure you’ve received honest feedback on your interview performance.

Stand out from the rest of the crowd

You are competing with, perhaps, hundreds of other applicants. It is critical that you ask yourself “What is it that sets me apart from the other candidates?” Through our own experiences interviewing applicants, and through discussions we have had with other faculty interviewers, we know that few applicants make a concerted effort to stand out from the rest of the pack. We agree with Dr. Krogh, former faculty member of the department of family practice and community medicine at the University of Minnesota, who reminds applicants that “programs interview hundreds of applicants, many of whom are compatible with the program. Make yourself noticeable enough. How you do it is up to you but many unfortunately do not even try to do it.”¹²

We understand that you may not consider yourself unique. In fact, parts of your background and qualifications are likely to be similar to other applicants – good grades, solid USMLE score, and good medical school. Is there anything truly unique about this package? Not on the face of it. But there can be. Many applicants have remarkable accomplishments, but fail to recognize or discuss them. Others have unique strengths or particularly strong qualities that they fail to emphasize in their application materials and interview.

Did you have a fantastic overseas international health experience during medical school? Were you involved in cutting edge research? Do you have a special or unusual talent? Have you gone out of your way on clinical rotations to emphasize patient education and the provision of patient educational materials? Do you have an aptitude for teaching, and have you demonstrated that through your activities in medical school? Were you the founder of your medical school’s pathology club or the president of AMSA? If so, the interview represents a wonderful opportunity to highlight these accomplishments.

We’ve spoken to applicants who brainstorm, and don’t feel as though they can discuss anything remarkable or unique about themselves. While that’s hardly ever the case, you can still utilize additional ways to stand out. Impress your interviewers with your level of preparation. Showcase your strong communication skills. Answer each question by taking it one step further than most applicants. For example, applicants often answer the question “What are your strengths?” with a short list of qualities. “My strengths include my attention to detail, interpersonal skills, and ability to persevere.” Most applicants stop there. The few that continue with an example that highlights their strengths succeed in leaving a memorable impression. “My ability to persevere has been central to my success. The pathology interest club that I wanted to set up at my medical school was initially applauded, but my cofounder and I hit many obstacles. Even though I started during first year, the club didn’t come into existence until my third year, and it was my perseverance that kept me going and dealing with all the roadblocks.”

Asking insightful questions is yet another way to distinguish yourself. These can highlight your individual qualities, as well as your interest in the individual program. Dr. Ksiazek, program director of the Pritzker School of Medicine ophthalmology program at the University of Chicago, states that “You do not want to blend into a sea of other applicants by asking the same old questions.”¹³ As interviewers, we’ve all heard the typical “What do you consider to be the weaknesses of the program?” Contrast that with: “In medical school, I have had several international health experiences which I have found very fulfilling. That’s why I was particularly excited to learn about the global health track your residency offers in Kenya. What kind of impact has the global health track had on residents in your program?”

And finally…

As you approach your interviews, focus on how far you’ve come.  By offering you an interview, the program has essentially informed you that you are a competitive candidate. Given that programs routinely receive hundreds or even thousands of applications, an interview invitation is a real honor. Programs only extend these invitations to candidates who are being seriously considered for a residency position. Having come so far, it is essential now that you devote the effort, time, and preparation necessary to sell yourself effectively and convincingly to programs.

References

¹Results of the 2008 NRMP Program Director Survey. Available at http://www.nrmp.org/data/programresultsbyspecialty.pdf.  Accessed on October 26, 2009.
²SwansonWS, Harris MC, Master C, Gallagher PR, Maruo AE, Ludwig S. The impact of the interview in pediatric residency selection. Amb Pediatr 2005; 5 (4): 216-220.
³Taylor CA, Weinstein L, Mayhew HE. The process of resident selection: a view from the residency director’s desk. Obstet Gynecol 1995; 85 (2): 299-303.
⁴Adams LJ, Brandenburg S, Blake M. Factors influencing internal medicine program directors decisions about applicants. Acad Med 2000; 75: 542-543.
⁵Martin-Lee L, Park H, Overton DT. Does interview date affect match list position in the emergency medicine national residency matching program match? Acad Emerg Med 2000; 7 (9): 1022-1026.
⁶Gong H, Parker NH, Agar FA, Shank C. Influence of the interview on ranking in the residency selection process. Med Educ 1984; 18 (5): 366-369.
⁷Reilly E. Career counseling: psychiatry. Available at www.uth.tmc.edu/med/administration/student/ms4/2003CCC.htm.  Accessed October 22, 2008.
⁸Dougherty TW, Turban DB, Callender JC. Confirming first impressions in the employment interview: A field study of interviewer behavior. Journal of Applied Psychology 1994; 79: 659-665.
⁹Larkin M. Getting a grip on handshakes. Lancet 2000; 356: 227.
¹⁰Available at www.saem.org/…/0/…/MSS_CollingsTheInterview2009SAEM.doc.  Accessed on October 22, 2009.
¹¹Ziegelstein RC. “Rocking the match”: applying and getting into residency. J Natl Med Assoc. 2007; 99: 994-999.
¹²Krogh C, Vorheis C, Abbott G. The residency interview: advice from the interviewer. The New Physician 1984; 8.
¹³Ksiazek S, Taylor TL. Pritzker residency process guide: ophthalmology. Available at http://pritzker.uchicago.edu/current/students/ResidencyProcessGuide.pdf.  Accessed on October 22, 2009.