the challenge of interviewing medical students for residency

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rehab_sports_dr

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I read this article on Sunday, and interviewed some residency candidates the next day:

http://gladwell.com/2000/2000_05_29_a_interview.htm

I think it encapsulates a lot of my personal feelings on the interview process

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Basically, most interviews have two parts:
1. The interviewer makes an initial impression of the interviewee within 10 seconds or so
2. The rest of the interview is an exercise in confirming that initial impression

To generate an interview that will actually give insight into future performance, the interviewee has to be brought out of their comfort zone. Rather than asking questions that test whether the interviewee knows the "proper" answers ("I am looking for a well-rounded program", "My biggest weakness is that I am sometimes too hard of a worker"), you have to give scenarios that create a conflict between competing values (impossible situations where you have to make a tough choice).

Most people don't like these interviews, because they are uncomfortable, but otherwise you don't really learn much about a person
 
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Basically, most interviews have two parts:
1. The interviewer makes an initial impression of the interviewee within 10 seconds or so
2. The rest of the interview is an exercise in confirming that initial impression

To generate an interview that will actually give insight into future performance, the interviewee has to be brought out of their comfort zone. Rather than asking questions that test whether the interviewee knows the "proper" answers ("I am looking for a well-rounded program", "My biggest weakness is that I am sometimes too hard of a worker"), you have to give scenarios that create a conflict between competing values (impossible situations where you have to make a tough choice).

Most people don't like these interviews, because they are uncomfortable, but otherwise you don't really learn much about a person


It's called behavioral interviewing. I like questions like, "Describe a time you witnessed someone in a position of authority or responsibility do something wrong and how did you respond to it?" Or, "Tell me about a time you had a choice between doing "the right thing" or "the fastest thing" which did you choose and why?
 
It's called behavioral interviewing. I like questions like, "Describe a time you witnessed someone in a position of authority or responsibility do something wrong and how did you respond to it?" Or, "Tell me about a time you had a choice between doing "the right thing" or "the fastest thing" which did you choose and why?

Right idea, but still probably not specific enough

This is a specific excerpt (copywrite the New Yorker and Malcolm Gladwell) that gets at the issue:

"Consider, he told me, a commonly asked question like "Describe a few situations in which your work was criticized. How did you handle the criticism?" The problem, Menkes said, is that it's much too obvious what the interviewee is supposed to say. "There was a situation where I was working on a project, and I didn't do as well as I could have," he said, adopting a mock-sincere singsong. "My boss gave me some constructive criticism. And I redid the project. It hurt. Yet we worked it out." The same is true of the question "What would your friends say about you?"--to which the correct answer (preferably preceded by a pause, as if to suggest that it had never dawned on you that someone would ask such a question) is "My guess is that they would call me a people person--either that or a hard worker."

Myers and I had talked about obvious questions, too. "What is your greatest weakness?" I asked him. He answered, "I tried to work on a project my freshman year, a children's festival. I was trying to start a festival as a benefit here in Boston. And I had a number of guys working with me. I started getting concerned with the scope of the project we were working on--how much responsibility we had, getting things done. I really put the brakes on, but in retrospect I really think we could have done it and done a great job."

Then Myers grinned and said, as an aside, "Do I truly think that is a fault? Honestly, no." And, of course, he's right. All I'd really asked him was whether he could describe a personal strength as if it were a weakness, and, in answering as he did, he had merely demonstrated his knowledge of the unwritten rules of the interview.

But, Menkes said, what if those questions were rephrased so that the answers weren't obvious? For example: "At your weekly team meetings, your boss unexpectedly begins aggressively critiquing your performance on a current project. What do you do?"

I felt a twinge of anxiety. What would I do? I remembered a terrible boss I'd had years ago. "I'd probably be upset," I said. "But I doubt I'd say anything. I'd probably just walk away." Menkes gave no indication whether he was concerned or pleased by that answer. He simply pointed out that another person might well have said something like "I'd go and see my boss later in private, and confront him about why he embarrassed me in front of my team." I was saying that I would probably handle criticism--even inappropriate criticism--from a superior with stoicism; in the second case, the applicant was saying he or she would adopt a more confrontational style. Or, at least, we were telling the interviewer that the workplace demands either stoicism or confrontation--and to Menkes these are revealing and pertinent pieces of information.

Menkes moved on to another area--handling stress. A typical question in this area is something like "Tell me about a time when you had to do several things at once. How did you handle the situation? How did you decide what to do first?" Menkes says this is also too easy. "I just had to be very organized," he began again in his mock-sincere singsong. "I had to multitask. I had to prioritize and delegate appropriately. I checked in frequently with my boss." Here's how Menkes rephrased it: "You're in a situation where you have two very important responsibilities that both have a deadline that is impossible to meet. You cannot accomplish both. How do you handle that situation?"

"Well," I said, "I would look at the two and decide what I was best at, and then go to my boss and say, 'It's better that I do one well than both poorly,' and we'd figure out who else could do the other task."

Menkes immediately seized on a telling detail in my answer. I was in-terested in what job I would do best. But isn't the key issue what job the company most needed to have done? With that comment, I had revealed some-thing valuable: that in a time of work-related crisis I start from a self-centered consideration. "Perhaps you are a bit of a solo practitioner," Menkes said diplomatically. "That's an essential bit of information."
 
So, we need to make applicants a little more uncomfortable? I can do that…

I prefer, and try to adhere to the structured interviewing format. Asking everyone the exact same questions best allows me to compare one applicant to another. I admittedly ask some obvious questions, simply because I want to see if the applicant is prepared for the interview. But I also throw a few curveball questions. I’m a fan of these questions because they require self-reflection, improvisation – basically they make you think on your feet. Not only do I pay attention to the content of the answer (which, as illustrated by Menkes, can be quite revealing), but the manner in which someone answers is just as telling. Are you squirmy, visibly uncomfortable in a slightly more stressful situation? Or do your eyes light up at the opportunity to be challenged? Are you someone who can handle our program?

But I don’t think you want to completely exclude the emotional, social aspect of the interview. We are a personable field. Part of being a successful physiatrist is being able to quickly connect with all sorts of people – especially patients with new life-altering disabilities. Plus, I gotta spend months one-on-one with this individual. Is this someone I’m going to enjoy teaching?

It is important however to remember that these interviews go both ways. Candidates should be interviewing programs just as much as we are interviewing them. This is a match after all. When someone asks, “do you have any questions for me?” - here’s your chance to further impress and challenge us, and gain some insight as well.

As an aside, a colleague of mine shared a recent interview anecdote. She asked a candidate what he was looking for in a program. The applicant answered “a program that’s challenging. But not TOO challenging.” :eek:
 
I do things differently (big surprise there, I know).

I see interviews as social. To me, the applicant has the numbers and the recommendations, or they wouldn't have gotten this far. If they are smart enough to have gotten to this point, they are also also smart enough to have chosen people who will write them good letters, so those are almost always of no help. At this point in their lives, they have interviewed enough, that they have thought through the answers to the typical questions, and if they have been on the interview trail long enough, have well rehearsed answers.

To me, the only question I want to answer in an interview setting is will I like working with this person. An interview is a stressful enough situation, so I don't particularly see what is gained by stressing the applicant further. Instead, I want to see if the guy or girl has three heads, can speak in complete sentences, and is someone I would want to go out and share a beer with after work. Is he or she off-putting? Awkward? Shy? Personable? Will he/she mix well with the other folks (residents, attendings, nurses, therapists).

I leave the rote questions, pimp questions, and stressful vignettes to my fellow interviewers. I want the candidate as relaxed and calm as they can possibly be. If, in that comfort zone, they STILL are off-putting, odd, or just give off a weird vibe, recognizing THAT, at least to me, is my primary role in the selection process.
 
I think ampaphb raises some good points

I think social style interviews help distinguish the really bad from the good, but I think they are poor at distinguishing the good from the great. If you are at an institution aspiring for greatness, I think that is important to try and screen for.

I've heard variations of the theme of "You never really know someone until you've (played basketball with them/ worked a ward month with them/ taken an extended vacation with them/ dug a ditch with them)" It's easy to be congenial, but you see a person's true character with time and in stressful environments

In terms of finding someone you can work with, it's about more than would they be fun to get a beer with for 20 minutes. I want to know how courteous they are to colleagues, can they think on the fly, are they true to their word, etc. That's hard to glean in conversation

As a related aside- at my very first AAP meeting, I met many people, but the one with whom I have the longest sustained friendship is with ampaphb. I would not have predicted that from our initial meeting, which was fine, but did not give enough real information to determine anything. Our friendship grew over time through multiple interactions and mutal respect. And that is hard to predict from a 20 minute casual conversation.
 
I do things differently (big surprise there, I know).

I see interviews as social. To me, the applicant has the numbers and the recommendations, or they wouldn't have gotten this far. If they are smart enough to have gotten to this point, they are also also smart enough to have chosen people who will write them good letters, so those are almost always of no help. At this point in their lives, they have interviewed enough, that they have thought through the answers to the typical questions, and if they have been on the interview trail long enough, have well rehearsed answers.

To me, the only question I want to answer in an interview setting is will I like working with this person. An interview is a stressful enough situation, so I don't particularly see what is gained by stressing the applicant further. Instead, I want to see if the guy or girl has three heads, can speak in complete sentences, and is someone I would want to go out and share a beer with after work. Is he or she off-putting? Awkward? Shy? Personable? Will he/she mix well with the other folks (residents, attendings, nurses, therapists).

I leave the rote questions, pimp questions, and stressful vignettes to my fellow interviewers. I want the candidate as relaxed and calm as they can possibly be. If, in that comfort zone, they STILL are off-putting, odd, or just give off a weird vibe, recognizing THAT, at least to me, is my primary role in the selection process.

I picked my top residency ranks in a similar fashion. I did my research and knew what each program had to offer from an educational/academic standpoint. I only applied to programs that offered enough of what I wanted. The rest came down to similar criteria as Ampaphb that I judged from my interactions w/ the residents and attendings as well as their interactions w/ each other.
 
When I was in college I went to a few sessions on how to interview.

The first thing that they said is that interviews have absolutely no bearing on how someone will actually perform on a job. IQ and standardized tests are a superior predictor.

But companies/medical schools/hospitals/etc. like interviewing anyway so that's why you're here! :laugh:
 
I see interviews as social. To me, the applicant has the numbers and the recommendations, or they wouldn't have gotten this far. If they are smart enough to have gotten to this point, they are also also smart enough to have chosen people who will write them good letters, so those are almost always of no help. At this point in their lives, they have interviewed enough, that they have thought through the answers to the typical questions, and if they have been on the interview trail long enough, have well rehearsed answers.

You’d be surprised…


The problem with residency interviews, in a 90 second trailer:

http://blog.zap2it.com/frominsidethebox/2009/12/conveyor-belt-of-love-really-abc.html
 
I do things differently (big surprise there, I know).

I see interviews as social. To me, the applicant has the numbers and the recommendations, or they wouldn't have gotten this far. If they are smart enough to have gotten to this point, they are also also smart enough to have chosen people who will write them good letters, so those are almost always of no help. At this point in their lives, they have interviewed enough, that they have thought through the answers to the typical questions, and if they have been on the interview trail long enough, have well rehearsed answers.

To me, the only question I want to answer in an interview setting is will I like working with this person. An interview is a stressful enough situation, so I don't particularly see what is gained by stressing the applicant further. Instead, I want to see if the guy or girl has three heads, can speak in complete sentences, and is someone I would want to go out and share a beer with after work. Is he or she off-putting? Awkward? Shy? Personable? Will he/she mix well with the other folks (residents, attendings, nurses, therapists).

I leave the rote questions, pimp questions, and stressful vignettes to my fellow interviewers. I want the candidate as relaxed and calm as they can possibly be. If, in that comfort zone, they STILL are off-putting, odd, or just give off a weird vibe, recognizing THAT, at least to me, is my primary role in the selection process.

Way back when when I was interviewing, I felt the same way. When interviewing for real jobs likewise. Interestingly, when I was interviewing for residencies, I only went to interviews that I was willing to rank (except for one place where I did a rotation that I hated, and went to the interview as a courtesy). On one interview (my last) I was pimped something awful. I was so pissed off, I did not rank the program (and almost walked out-I only didn't so I didn't get a bad rep). My rank list was based solely upon gut feel (where did I think I meshed best). My top 5 programs did not change pre/post interview, but the order changed significantly!
 
"On one interview (my last) I was pimped something awful. I was so pissed off, I did not rank the program (and almost walked out-I only didn't so I didn't get a bad rep). My rank list was based solely upon gut feel (where did I think I meshed best). My top 5 programs did not change pre/post interview, but the order changed significantly!"

I ranked programs on gut-feel too, which in retrospect was a mistake. Fortunately, I got into my #1 choice, and I loved my residency experience, but looking at the remainder of my rank list now that I know the attendings at each of these programs, my impressions were way off. To quote high fidelity- "Well, I've been listening to my gut since I was 14 years old, and frankly speaking, I've come to the conclusion that my guts have **** for brains."

Some programs made honest critiques of my academic record, which I took as an insult. In retrospect, they were probing to see if we would be a good fit, and I now appreciate that they were making an extra effort.

The characteristics that make for a "pleasant" interview- chumminess, non-confrontational styles- do not make for good residency training. Residency should be fun, yes, but it should also be challenging. You should want a program that can make an honest assessment of your strengths as something to build on, but you also should want a program that does not see you as a generic space-filling resident, and will work on an individualized program to make you better. And that first step in improvement is honest assessment.

I don't think you can do that in a chummy interview. It doesn't have to be mean, but I do think it needs to be probing.
 
I couple centuries ago, when I applied for residency and Seattle was one of the top programs (is it anymore? I don't hear much about it.) I had a very "chummy" interview with the PD. He was pointing out the campus from his window - places to run, bike, take the family, etc. We talked about hobbies and families. Very little about the residency. I thought I was in.

Didn't match there but ranked it #1.
 
For what it is worth, Seattle is still very much a great program, with strong people in all areas, great program director, great city, etc

I don't have any direct affiliation with the program, but every time I interact with anyone from Seattle, I come away impressed, and they represented themselves well at the ACSM meeting in Seattle last summer.

While we are on the topic- every once in a while on these boards, I hear people allude to malignancy at Seattle. I've asked many people at UW about this, and the consensus is that this is from about 15-20 years ago and multiple chairs ago, but for some reason the reputation has never fully died.

Again, I don't have any direct tie to the program, but it does annoy me to see one of the very best programs in the country besmirched in any way. If I were applying as a resident, it would be very high on my list
 
Just to add in an applicants perspective, I've been on several PM&R interviews where the interview day is designed not to give the interviewer's access to my file prior to the interview - i.e. the time i show up at the interviewer's door is when my file first meets their eyes. Invariably the first 5-10 (or more) interview minutes is spent in three ways:

1. Valuable time passes as an interviewer reads through some of the file prior to asking questions.
2. The interviewer furiously flips through pages to hopefully focus on a relevant topic. Sometimes it isn't, and a skewed picture of the applicant is painted because more time is spent on that topic compared to other ones.
3. The interviewer tries to read and listen at the same time. Both reading and listening comprehension is somewhat compromised, and information from/about the applicant doesn't register.

These "blind" interviews have sometimes been alotted just 15 minutes total. That's painfully short even if the interviewer is already familiar with the applicant.

This interview style benefits no one. It's a letdown as an applicant to submit 3+ years of work, travel to a program, and not have access to interviewers who know your history and can tailor their questions to assess if you and the program will fit together. It also reflects poorly on the program by giving the appearance that there is minimal screening for the candidates. I don't have confidence that my future fellow residents were carefully selected, screened, or ranked in these programs.

I'm sure that getting to know applicants via interview is difficult (per the OP), but there are places that don't even try.
 
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