I wish that I knew what I now know ....

[Doctor Bagel]

So with application season almost upon us, I thought it might be fun/educational to give tips to applicants about things we wish we had done, not done, learned about programs, whatever.

I'll start -- ask specific details about the call schedule. These are hard things to wrap your mind around, and it's hard to compare programs because call schedules are so different. Ask about specific schedules and ask what you're expected to cover when on call (how many hospitals, etc). And "home call" -- big freaking lie. Be suspicious of programs with really frequent call who claim it's OK because it's "home call."

All programs have flaws. The trick is finding the flaws you can deal with.

---

Members don't see this ad.

 

[nitemagi]

Do an away rotation on a fairly cush or familiar rotation, not a ball-busting one in a hospital where no one will have time to get you up to speed on how the whole system works. You look like an idiot and it doesn't help your application much.

 

[digitlnoize]

This is a great idea! Thanks for the help!

I'll contribute my primary resource for checking out cities: www.city-data.com

It gives excellent data on everything from weather, housing prices, common religions, local radio stations, schools, crime...pretty much everything you'd want to know about a place. If that's not enough, there's also a forum for pretty much every city where people will answer your questions (or you can just lurk).

 

[Sophie]

Really listen to your gut, and be true to yourself. I hate call, knew I hated call, but convinced myself I was just being a wuss and that I shouldn't let call schedule (or salary) influence my decision (something about not letting superficial desires get in the way of great training). I know other people who felt a program was wrong in their gut, but convinced themselves that it was so prestigious their gut didn't matter, and then ended up unhappy.

Also good to know: I obviously can't speak for all programs, but at my program residents have A LOT of input regarding how candidates are ranked. We have a number of meetings with attendings and residents to review each candidate, the people who met them each give their opinions, and then a consensus is reached regarding where they should go on the list. If someone (including a resident) decides to really argue for or against a candidate it will affect their placement. So be nice to us. Looking interested, asking good questions, writing a thank you email or card, etc, all get mentioned in the meeting and do matter.

 

[Sophie]

Reading the 2011-2012 interview/match thread made me think of another thing I wished I'd known. I neurotically applied to way more programs than were necessary (~25) and then got burnt out by a few months into interviews. I ended up cancelling several, but still went to 16 interviews, which was also way too much - financially, time-wise, and emotionally. Also, clustering interviews on the opposite coast may seem brilliant at the time, but once you're stuck on interview #4 in 5 days you will hate your life, and likely have a really hard time looking like you give a **** during your interview.

 

[digitlnoize]

Yeah, I'm pretty sure I over applied, but I'd rather have to turn down interviews than not get enough. I'm not planning on going on more than a dozen if I get that many invites...we'll see!

 

[Sneezing]

Ask residents about the opportunities for moonlighting and the PD about their beliefs for residents at their institution doing so. I believe it can say a lot about the culture of a program right there. Moonlighting is a good thing.

Ask about the call schedule and don't stop asking about it until you understand it. As a component of this understand how many locations the program has you cover call for. Some places cover three hospitals, this could mean more call total over the four years. Look closely at these details.

Ask about the DIVERSITY of rotations.

Ask residents about the history of people being let go. If there is a trend this is a red flag.

Ask residents how much social worker scut they have to do when on call for admitting patients. There is a program in my town where the residents do everything including insurance prior authorization in the middle of the night type of stuff. You don't want to go to a program that makes you deal with that!

 

[Dr1216]

Just popped in to say thanks for starting this thread! Very helpful information.

 

[DrGoHuskies]

What a great idea!

My two cents:

Location is EVERYTHING! Of course the quality of your program is important, but one of the perks of being a psych resident is that you do actually have time to have a real life for the most part. Friends who matched in cities that weren't good fits for them have really regretted it, regardless of how much they like their program.

As one of the above posters mentioned, residents at most places have a lot of input into the selection process, so behave yourself at dinner with the residents!

Keep track of the Big Picture: depending on what type of future career you want, the reputation of your program is huge when it comes to fellowships, research opportunities, etc. The ability to network is an under-rated asset and not something I thought about as an applicant, but as a PGY-3--it's a big deal!

Let your top choice(s) know how interested you are.

I think that's all I've got...
(Ahhh to be young again!

 

[F0nzie]

Ask about the DIVERSITY of rotations.

I did 80% of my inpatient psych work at a VA. I consider myself an expert in Axis II and malingering.

 

[BobA]

Really listen to your gut, and be true to yourself. I hate call, knew I hated call, but convinced myself I was just being a wuss and that I shouldn't let call schedule (or salary) influence my decision (something about not letting superficial desires get in the way of great training). I know other people who felt a program was wrong in their gut, but convinced themselves that it was so prestigious their gut didn't matter, and then ended up unhappy.

Also good to know: I obviously can't speak for all programs, but at my program residents have A LOT of input regarding how candidates are ranked. We have a number of meetings with attendings and residents to review each candidate, the people who met them each give their opinions, and then a consensus is reached regarding where they should go on the list. If someone (including a resident) decides to really argue for or against a candidate it will affect their placement. So be nice to us. Looking interested, asking good questions, writing a thank you email or card, etc, all get mentioned in the meeting and do matter.

This is good advice.
1) This is your LIFE, not just your job. Take your life seriously as well!
2) I'm surprised by how much input the non-interviewers seem to have in resident selection. Be nice to everyone.

 

[kugel]

Ask some residents, "You know, this program sounds great and you all seem to get along so well, but that can't be the entire story. No program is perfect. What do you dislike most about this program and this city?" If you can ask this in a group setting, residents will likely begin a list of their pet peeves, from which you can probably infer a pattern. But remember, almost none of these residents have ever been a resident anyplace else, so their ideas of how it is elsewhere are hearsay and imagination.

Ask the residents who the best teachers are among the attendings. Often, the biggest names, most published, hottest on the speaker tours, are Not the best teachers. If the big names are not good teachers, or you just never get time with them at all, what use are they to you as a resident?

Be prepared to identify a few flaws of your own, and how you will spin those so that interviewers will come to the conclusion that you will use them as strengths. If you can't identify your own flaws, you are either untruthful or un-insightful.

 

[flash]

Great advice so far.
1) Agree with suggestion to know the call schedule in detail. Beyond hours, know what you'll be covering, the type of work you'll be doing and how busy it is. Don't accept "it's doable" without all the details and you should, as earlier poster suggested, ask everyone until you feel you understand it. In a mature, profession manner, of course. Oh, and be sure to look beyond PGY1...PGY2 may be worse at some places and the year moves fast.
2) City-data.com rocks. I wanted to relocate and interviewed in many places far from home and this was a great resource.
3) Stay open-minded about the differences between programs. Don't rush to label differences as good or bad, as a strength or weakness. This may apply less for those who have strong geographic preferences.
4) There will always be an element of uncertainty. You will not be able to get a complete idea of what a program is like until you're already apart of it. Figure out what is important to you and focus on understanding these aspects. Go with your gut during rank list time.
4.5) I would usually find a current resident at interviews who came across as honest, down to earth, genuine, interested in the process. Remember their names, get contact info, target follow-up questions to them.
5) Note taking during the process is crucial. Pros/Cons/Questions/Call/Moonlight/Observations. Do this during or within a day of your interview..you will forget a good deal quickly. I still have my little black book from interviews and it's really interesting read 'till this day.
5.5) If totally new city/state/region, try and stay a day or two to check out the place if $$$, time allows. Particularly if you think it may be high on your list.
6) Reflect on your interview experiences and your fit with programs. I was surprised how my thoughts about programs changed as a result of having a few beers and envisioning myself at different places. For me, 'prestige' and brand became much less important, ultimately leading to a match list that better fit my personality.
6.5) Find people who make you laugh to vent to/with
7) As hectic and nerve racking as the entire process is, it'll all work out fine. Easier said than done, but attempt to leave some room to believe this.

 

[Sneezing]

1) Notes. Take notes! Don't worry about paper because every program will through a bunch at you.
2) Its okay to drink a glass of wine or beer with your meals the night before. If that's who you are, then drink! (but don't over do it)

 

[Doctor Bagel]

I did 80% of my inpatient psych work at a VA. I consider myself an expert in Axis II and malingering.

Ha! I don't think I could do that. We do about 50%, which is probably 40% too much for me. I loved doing medicine in the VA (those old guys with CHF are pretty awesome, honestly), but not so much for psych.

City-data is awesome. Another thing that I wish I did was set aside more time to spent in each unfamiliar town I interviewed in. Hard to get a feel for a place when you're only there for a day.

And if you get a bad feeling, pay attention to it. Don't try to argue it away because you think the program would otherwise be awesome. I also think it's pretty reasonable to ask residents what they don't like about the program.

I will note, though, that I got burned by what I thought was my favorite question when I interviewed -- change? I always asked this and wound up at a program that had a ridiculous amount of changes last year that I heard nothing about when interviewing. Of course the nature of the changes (like the pd leaving when that wasn't even solidified for him yet) weren't things you'd tell applicants. I did think it was a good sign, though, when programs had a pretty proactive approach to things like duty hour changes. I interviewed at one place where the PD was pretty sure those ACGME changes would happen and was already thinking about solutions more than a year in advance. That's a good sign.

 

[WhoisJohnGalt]

i did 80% of my inpatient psych work at a va. I consider myself an expert in axis ii and malingering.

+1

 

[peppy]

1) Do not believe anything the program director says about how they want you at their program. No, seriously, don't. When someone at your #1 choice says something encouraging you are going to be very tempted to believe that this time it's an exception and it means something in *this* case, but you'll be better off if you can just put the positive comments out of your mind and not let it influence your decisions about how many interviews to go on or how to rank places. Some places are pretty shameless about trying to give every interviewed applicant the impression that they will be "ranked highly".

2) While I absolutely agree that knowing details like call is important, be careful about *how* you ask about things like call schedules, sick/maternity leave, etc. You don't want to leave them with the impression you're a slacker looking to get out of working hard.

3) Do your best to attend the dinners. Even though they are often technically optional, sometimes I do think they perceive it as "lack of interest" if you don't come. At the very least, a resident might be more likely to put in a good word for you if they feel like they got to know you a bit at dinner than if they only saw you in passing on interview day.

4) Recognize that the interview day is a sales pitch and don't be surprised if you don't hear the whole truth even when you ask residents one on one.
Remember that residents have a vested interest in staying on the good side of the program leadership and they are probably not going to tell you that the program is crappy even if they really believe that, because they don't want it to get back to the program leaders that they are "scaring off" applicants. Additionally, in many places, the residents who are involved in recruitment activities are the ones who volunteered to be involved and therefore are more likely to put a positive spin on things. As in my first point of advice, be skeptical and don't take everything you hear from programs at face value!

5) Remember, in the end, you'll wind up becoming a psychiatrist no matter where you end up, and psychiatry is pretty awesome, so don't worry too much about this process. The majority of people end up being satisfied with the place they match at, even if it wasn't their first choice.

 

[DrFrasierCrane]

I will note, though, that I got burned by what I thought was my favorite question when I interviewed -- change? I always asked this and wound up at a program that had a ridiculous amount of changes last year that I heard nothing about when interviewing. Of course the nature of the changes (like the pd leaving when that wasn't even solidified for him yet) weren't things you'd tell applicants. I did think it was a good sign, though, when programs had a pretty proactive approach to things like duty hour changes. I interviewed at one place where the PD was pretty sure those ACGME changes would happen and was already thinking about solutions more than a year in advance. That's a good sign.

Dr. B you are depressing me! Your program is (was) at the top of my list this year but your multitude of posts are seriously making me reconsider...

 

[Doctor Bagel]

Dr. B you are depressing me! Your program is (was) at the top of my list this year but your multitude of posts are seriously making me reconsider...

Dude, I bitch a lot. Last year was a hard year, but I think things honestly are better now. We have a new PD who's not leaving. That's huge. Of course, the big changes that were going to hit last year (namely the PD leaving) weren't things the PD could tell me in an interview. I'm sure he was interviewing already, but he hadn't told the program yet so he couldn't exactly tell applicants.

I actually for the most part like my program now, although we definitely still have flaws. I think our program a few years ago, especially regarding the 1st and 2nd years, wasn't that great. In the past, there was too much call, too little supervision and too little help from upper levels who were all apparently checked out after getting killed 1st and 2nd year. Now our call schedule is reasonable, supervision in the inpatient unit is improving and upper levels actually are helpful. Apparently 3rd and 4th year have always been good, but that still seems so far away to me.

But yeah, getting back to my original post. I did not get an honest answer regarding change in my interview here. I think the current PD actually would give an honest answer, though.

 

[Doctor Bagel]

Adding that I probably didn't fairly assess my program because I wanted to be here primarily because of the location. Consequently, I didn't think as critically about the details of the program as I should have and wound up feeling a little surprised when I showed up here. That's where I guess self honesty is an important part of the process.

Overall, I think from an educational perspective, I would prefer a program with lighter call, with more time for reading and with more time for formal didactic types of education. I don't think I was as true to these needs as I should have been throughout the whole interview process. But then location was another huge priority for me, and I was pretty good at assessing this preference during interviews. We make compromises, I guess.

Last year did suck, though. This year is better. My program is honestly a better program, too, which is reassuring.

And I am using the word "honestly" entirely too much these days. What's up with that?

 

[PistolPete]

2) While I absolutely agree that knowing details like call is important, be careful about *how* you ask about things like call schedules, sick/maternity leave, etc. You don't want to leave them with the impression you're a slacker looking to get out of working hard.

How do you then suggest that this be done tactfully?

 

[Sneezing]

Say what you are after.
"Hey, Dr. John Doe, I really want to understand what call here entails. Can explain it to me or evening help diagram it on this paper for me? You know as a med student this call thing is kind of foreign to me and I want to walk into this with my eyes wide open. Thanks man."

 

[WhoisJohnGalt]

Say what you are after.
"Hey, Dr. John Doe, I really want to understand what call here entails. Can explain it to me or evening help diagram it on this paper for me? You know as a med student this call thing is kind of foreign to me and I want to walk into this with my eyes wide open. Thanks man."

This sounds perfect, and would totally get me to spill the real deal about our call schedule without thinking you were a slacker.

 

[Doctor Bagel]

Say what you are after.
"Hey, Dr. John Doe, I really want to understand what call here entails. Can explain it to me or evening help diagram it on this paper for me? You know as a med student this call thing is kind of foreign to me and I want to walk into this with my eyes wide open. Thanks man."

Sounds good to me, too. I'm probably not the right person to judge, though, because I wouldn't mind being asked about the call schedule anyway. People who know what they're getting into are less likely to be angry when they feel unexpectedly overworked. Asking about things like maternity leave and benefits wouldn't bug me either. Now if you mentioned some disability that prevented you from pulling your full share, I probably wouldn't be thrilled for you to come to my program. Not nice but true. As I mentioned in the other thread about absences, programs can handle 6 week absences. Months of absences are a little harder.

Speaking of applying etiquette, it's true that leaving a bad impression with anyone can hurt you. Seriously, don't be mean to the program coordinator or to any of the residents.

Of course, we all have different biases, so it's hard to know what would bug one person but not another. As mentioned above, I would have no problem with people asking me serious questions about the realities of work. If you ask me a really boneheaded question about residency in general or about the city or anything like that, I might judge you to be a flake, and flakes aren't great coworkers in a busy work environment. We had an applicant last year who seemed shocked that our city has homeless people. Seriously, dude? I also observed a really painful medical student/resident interaction for another specialty (internal medicine) where the medical student asked "what's the schedule like?" Not asking more specific questions like "what's the schedule like on your VA ICU rotation?" made the person look uninformed about residencies in that field in general. Your questions should convey that you've put some effort into researching the program and the town on your own.

 

[notdeadyet]

This sounds obvious to the point of duh, but know what the hell are you looking for. Before going to a single interview, sit down and have a concrete list of what things you're looking for in a program and how important it is to you. If you don't do this, you'll find it hard to be objective and you'll start seeing things to like in programs that were pet favorites based on name value before you interviewed.

Make this list incredibly specific. For instance, don't list "reputation." Why is reputation important important to you? "To help me get a C&L fellowship in the Pacific Northwest." Fine, then one of your criteria is a program that will help you do just that, which isn't necessarily the same thing as something amorphous like "reputation."

Make this list incredibly personal. Don't be ashamed. For example, I was interested in a program near a good body of water. Am I interested in aquaphobia research? No, I'm just a water guy. It's important to me. How important? Would I be willing to take a program with heavier call if it's on the coast? Would I be willing to take a program without a forensic fellowship if I had access to great diving? These are things that sound silly but are pretty important to know ahead of time.

If you start interviewing before doing some navel gazing and figuring out what is important to you, you're going to fall prey to which programs do the best marketing.

And at the end of the day, you can make spreadsheets, formulas, and diagrams, but ultimately, go with your gut when making your ranklist. No matter how people approach the ranking process, it'll come down to your gut.

 

[notdeadyet]

A lot of people sound obsessed with call schedules. Personally, I'd probably reign in that worry a bit. Every program in the country just completely changed their call schedule this year. Many programs are going to take another hack at it next year.

Personally, I wouldn't be so obsessed with what the call schedule is like at a particular program, I'd be more interested in how much open they are to resident feedback in the creation of that call schedule. The call schedule is much more likely to change than an institution's culture for listening to residents.

 

[notdeadyet]

Moonlighting is huge. Programs that offer in-house moonlighting (getting paid for doing extra work at your home institution) is a nice big perk. You may not be interested in moonlighting now, but you will be soon. Being able to do it in the nice warm busom of your own institution is a big plus.

 

[cleareyedguy]

If an applicant asked me about call, salary, and workload , I'd assume they were just the kind of applicant we try to avoid. My program is a relatively hard-working one, however, and we as a group kinda look down on people who don't put their medical training above all else. I'm not saying that's an ideal perspective, but it is in our institutional culture. We also get far more good applicants than we have spots, and so we look for things that allow us to drop someone out of our top cluster; lifestyle worries in an otherwise excellent applicant would be just the thing to drop them to the middle of our list (add in anything actually negative, like a snotty attitude or a comment in the dean's letter that confirms a hint of laziness, and they're dropped off or to the bottom of our list).

And yes, that includes a preoccupation with lifestyle at a resident-only lunch or dinner. It's not just the attendings who want to avoid lazy residents; the residents are even more wary of accepting someone who they'll then have to cover when that person whines about workload.

It's also tough to ask about changes. At least two of the best-known psych residencies have program directors who just announced that they're leaving (one east coast and one west coast; not my place), and so their absences will likely be a topic for this coming interview season. You can try to figure out whether the changes will cause a morale or organizational problem, but if you ask questions of every interviewer in a tone that implies excess wariness or criticism, you are going to sound, well, overly wary and critical. At least for our place, we are looking for robust enthusiasm and a passion for hard work; admittedly, that is a high bar, but nobody really wants to work with churlish bean counters--so if that's your philosophy of life, either rethink your philosophy or hide that version of yourself when you come to my place (otoh, I've been to other places and heard MUCH more open discussion about a preference for light work hours, so I'll reemphasize that my biases may be situation specific).

By the way, about the alcohol.... I'd follow the lead of the majority of residents but would never have more than a glass of wine or beer--you don't want to get toasted, appear toasted, or say things that you otherwise wouldn't. It's NOT a party; it's another interview situation.

 

[notdeadyet]

Know what fellowships are offered by the schools you're applying to (very easy to do with FREIDA). If I was dead-set on Child, I would rank programs without Child fellowships pretty low on my list. If you know you want to do forensics, programs that have forensic fellowships should rank much higher on your list. in general, it's much easier to match at a fellowship at your home institution than at somewhere you have little relationship with.

Besides which, I can't help but feel that you're going to get slightly better training options in the fields offered as fellowships in particular programs. It certainly can't hurt.

 

[digitlnoize]

Know what fellowships are offered by the schools you're applying to (very easy to do with FREIDA). If I was dead-set on Child, I would rank programs without Child fellowships pretty low on my list. If you know you want to do forensics, programs that have forensic fellowships should rank much higher on your list. in general, it's much easier to match at a fellowship at your home institution than at somewhere you have little relationship with.

Besides which, I can't help but feel that you're going to get slightly better training options in the fields offered as fellowships in particular programs. It certainly can't hurt.

Is there a good way to know which program allow fast-tracking into child and which one's don't? I think most of them do allow it, but I'm not sure if they all do.

If a program doesn't allow it, can you still leave after year 3 and start child somewhere else?

Sorry but I'm a little ignorant of this whole thing.

 

[Doctor Bagel]

If an applicant asked me about call, salary, and workload , I'd assume they were just the kind of applicant we try to avoid. My program is a relatively hard-working one, however, and we as a group kinda look down on people who don't put their medical training above all else. I'm not saying that's an ideal perspective, but it is in our institutional culture. We also get far more good applicants than we have spots, and so we look for things that allow us to drop someone out of our top cluster; lifestyle worries in an otherwise excellent applicant would be just the thing to drop them to the middle of our list (add in anything actually negative, like a snotty attitude or a comment in the dean's letter that confirms a hint of laziness, and they're dropped off or to the bottom of our list).

And yes, that includes a preoccupation with lifestyle at a resident-only lunch or dinner. It's not just the attendings who want to avoid lazy residents; the residents are even more wary of accepting someone who they'll then have to cover for when that person whines about workload.

By the way, about the alcohol.... I'd follow the lead of the majority of residents but would never have more than a glass of wine or beer--you don't want to get toasted, appear toasted, or say things that you otherwise wouldn't. It's NOT a party; it's another interview situation.

Which still makes call and schedules a useful thing to ask about because I'd probably be miserable at a program like yours. There are people who really value work, and there are people who value their time away from work. Maybe we would reach some mutually selective opting away from each other type of situation. IMO, if it's important to you, ask. If the program is bugged by you asking about stuff that's important to you, that's not a good fit.

 

[cleareyedguy]

Which still makes call and schedules a useful thing to ask about because I'd probably be miserable at a program like yours. There are people who really value work, and there are people who value their time away from work. Maybe we would reach some mutually selective opting away from each other type of situation. IMO, if it's important to you, ask. If the program is bugged by you asking about stuff that's important to you, that's not a good fit.

I wouldn't be bugged about you asking, though attendings are probably not the right people to ask about call, moonlighting, or the outpatient computer system. And it's not that I'd be bugged about you wanting to know about what's important to you; your getting information is an important reason for the interview--and it is your life after all.

If you or anyone seemed strongly concerned about call and a desire to leave work at 5:00, I'd be relieved, not bugged, since I'd then confidently drop you to the bottom of the rank list, and it's hard to know how to do that with most applicants. I would be aware, however, that I was wasting an hour of my life interviewing someone who would not enjoy the sort of educational/training experience that we work very hard to provide, and that person had wasted a day and some money--and so I'd be a little bugged that we had offered the interview in the first place.

Having said that, I should add that I'm a big fan of people having vigorous lives outside of medicine. My bias is, however, that psychiatry is a difficult specialty to learn, especially if you don't really focus on it as a trainee.

 

[cleareyedguy]

Know what fellowships are offered by the schools you're applying to (very easy to do with FREIDA). If I was dead-set on Child, I would rank programs without Child fellowships pretty low on my list. If you know you want to do forensics, programs that have forensic fellowships should rank much higher on your list. in general, it's much easier to match at a fellowship at your home institution than at somewhere you have little relationship with.

Besides which, I can't help but feel that you're going to get slightly better training options in the fields offered as fellowships in particular programs. It certainly can't hurt.

This is a reasonable view, but I would probably emphasize the importance of a good general education. You'll get the fellowship stuff during fellowship.

 

[notdeadyet]

This is a reasonable view, but I would probably emphasize the importance of a good general education. You'll get the fellowship stuff during fellowship.

Agreed, sorry if I wasn't clear. Fundamentals are key, the elective stuff is nice-to-have.

 

[Sneezing]

Asking about call should be directed at residents and at the dinner the night before if at all possible. I'm at a work horse program with a fancy name and I tell applicants we work. There isn't anything wrong with having a work ethic cultural but to discount someone because they are a little on the OCPD traits side for wanting to know the details of the program is a bit harsh. I aim to honestly tell applicants about our schedule and tell them, yes, call here sucks and you will not sleep. You will work non-stop and frankly be quite stressed - but you will learn.

I think a program should rank someone higher for taking the intiative to understand the details - even if call schedule. That is the same type of person who reads contracts before they sign them. That is the same type of person who will double check the medication reconcilliation and go the extra mile for a good sign out. I'm more afraid of applicants who don't ask questions - that's laziness. What else in the future will they not ask about?

 

[Ibid]

I wish that I knew what I know now ....
When you drive to the pub/bar always reverse into your parking space so you can pull straight out when you leave.

This is some of the best advice you will ever get.