Interview skills

[LeaveNoTrace]

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Last year, I interviewed for psych residency but didn't make it; I think that my interview skills were to blame. How might I improve my interview skills? I've been reading books on acting and improv and practicing to improve my somewhat nasally, monotone voice with mild success; however, I feel as if interviewers are looking for very graceful, very skilled interviewees. I've had a couple of mock interviews and the feedback I've gotten was to be more confident and that I was somewhat awkward at baseline. Is it possible that awkwardness can sink an applicant - and is a deep lack of confidence really that important? I've also heard that a lack of confidence was more important or a bigger weakness.

Is there anything I can do - even if it takes several years - to do REALLY well at psych interviews? I would naively imagine putting in an order of magnitude more effort would at least make me average if not above average: becoming a decent amateur actor, having a Zoom background and setup that is worthy of an interior designer and professional YouTuber, having the fashion sense of a professional stylist, and spending hundreds if not thousands of hours on interview prep over the course of years.

 

[splik]

Let's face it, there are a lot of awkward psychiatrists out there. So no, you do not need to be a "very graceful, skilled interviewee." The most polished interviewees are psychopaths. That said, faculty interviewers are going to be thinking "is this someone I want to be supervising and treating my patients?" and resident interviewees will be thinking "is this someone I want to work with?" and that is the bar you need to cross.

Rather than trying to be something that you are not, I would encourage you to lean into accepting your quirks. If you are comfortable with yourself, other people will feel comfortable with you, even if you are a bit awkward. Honestly, my PD was super awkward (as are many people in academics!)

If you can come across as curious, easy to talk to, lots of good questions at the ready, and able to effectively answer the common questions that come up you should be good.

You say you have a "deep lack of confidence" which is actually different from awkwardness. One can be awkward and confident (which goes to being comfortable in your skin). But if you are deeply lacking in confidence, you will give off bad vibes and no one is going to believe in you or want to work with you. This is also different from imposter syndrome (which I think many of us have). If not already working with a good therapist, this could help not only with building confidence and self-compassion but also in your self-awareness and interviewing skills. But please do not spend time on money on acting, stylists or other things that are not genuine or embracing yourself and differences. You can't fake authenticity.

 

[LeaveNoTrace]

Let's face it, there are a lot of awkward psychiatrists out there. So no, you do not need to be a "very graceful, skilled interviewee." The most polished interviewees are psychopaths. That said, faculty interviewers are going to be thinking "is this someone I want to be supervising and treating my patients?" and resident interviewees will be thinking "is this someone I want to work with?" and that is the bar you need to cross.

Rather than trying to be something that you are not, I would encourage you to lean into accepting your quirks. If you are comfortable with yourself, other people will feel comfortable with you, even if you are a bit awkward. Honestly, my PD was super awkward (as are many people in academics!)

If you can come across as curious, easy to talk to, lots of good questions at the ready, and able to effectively answer the common questions that come up you should be good.

You say you have a "deep lack of confidence" which is actually different from awkwardness. One can be awkward and confident (which goes to being comfortable in your skin). But if you are deeply lacking in confidence, you will give off bad vibes and no one is going to believe in you or want to work with you. This is also different from imposter syndrome (which I think many of us have). If not already working with a good therapist, this could help not only with building confidence and self-compassion but also in your self-awareness and interviewing skills. But please do not spend time on money on acting, stylists or other things that are not genuine or embracing yourself and differences. You can't fake authenticity.

I am autistic.

I believe that I offend people in some way simply by existing and that every word and gesture needs to be a flawless work of art - or close to it - simply for me to be considered average. I am no professional actor, diplomat, salesman, or politician. As I am now, people are secretly disgusted by or contemptuous of me, and I see those looks of contempt and disgust as soon as I walk in the room and say a few words. I do not understand why a delusional belief that I do not in fact suck would be in any way helpful. It seems like adding delusion to incompetence - and that seems to add fuel to an already blazing fire. What good does completely misplaced confidence do?

Apparently, I will always be awkward - and therefore always offend people; there may be ways to compensate for this. Maybe you MIGHT be able to be tolerated, put up with, if you are comfortable with yourself...but that seems to be something that medical people are able to do better than people who do not see deformity and disease on a daily basis.

 

[clausewitz2]

I am autistic.

I believe that I offend people in some way simply by existing and that every word and gesture needs to be a flawless work of art - or close to it - simply for me to be considered average. I am no professional actor, diplomat, salesman, or politician. As I am now, people are secretly disgusted by or contemptuous of me, and I see those looks of contempt and disgust as soon as I walk in the room and say a few words. I do not understand why a delusional belief that I do not in fact suck would be in any way helpful. It seems like adding delusion to incompetence - and that seems to add fuel to an already blazing fire. What good does completely misplaced confidence do?

Apparently, I will always be awkward - and therefore always offend people; there may be ways to compensate for this. Maybe you MIGHT be able to be tolerated, put up with, if you are comfortable with yourself...but that seems to be something that medical people are able to do better than people who do not see deformity and disease on a daily basis.

Do...do you not see how a therapist might be helpful with the belief structure you are articulating?

 

[LeaveNoTrace]

Do...do you not see how a therapist might be helpful with the belief structure you are articulating?

Hmm. The belief structure might be off-putting because a lack of self-confidence is offputting; however, I am not sure whether completely misplaced self-confidence is any better. If you aren't any good at something and believe that you are good at it, that doesn't magically make you good. Putting lipstick on a pig doesn't make it stop being a pig.

 

[hamstergang]

Do you believe you can be trained to be a decent psychiatrist?

 

[clausewitz2]

EDIT: was going to leave a Wikipedia link for the OP to taijin kyofusho but the url includes the four letter sequence of s, h, i, and t in a longer string. So it got broken by auto filter, good job, filter bot.

EDIT EDIT: all I'll say OP is that plenty of autistic people definitely do speak in an unusual fashion but please trust the word of a former linguist when I say that there is no specific 'autistic accent'. This is not a thing.

 

[shoomer]

As I am now, people are secretly disgusted by or contemptuous of me, and I see those looks of contempt and disgust as soon as I walk in the room and say a few words. I do not understand why a delusional belief that I do not in fact suck would be in any way helpful. It seems like adding delusion to incompetence - and that seems to add fuel to an already blazing fire. What good does completely misplaced confidence do?

This is a cognitive distortion, likely stemming from being autistic and misinterpreting expressions/social cues as well as accompanying social anxiety. You need to address this, probably through therapy as alluded to by others, before anything else because this is detrimental not just to your interviewing, but your overall functioning across social and professional settings.

 

[smalltownpsych]

Good psychotherapy will help a person be more realistic in your appraisal of interpersonal skills and practice improving them in a safe environment. Also, reduction of the anxiety and distress that one is experiencing will always help one to function more optimally. This is the case even if they have little awareness of the emotional distress because they have a weakness in emotional awareness which is typical in people with autistic disorders or are just really good at using old fashioned defense mechanisms. Anyone with ability to do med school can improve their cognitive abilities and come up with compensatory strategies so the upside is big. The biggest challenge is to find a therapist that has enough intellectual acumen to not be frustrating.

 

[LeaveNoTrace]

plenty of autistic people definitely do speak in an unusual fashion but please trust the word of a former linguist when I say that there is no specific 'autistic accent'. This is not a thing.

THAT is interesting; as I understand it there are things that are more common in autistic people. Such as: cluttering, over-enunciation, overly nasal timbre, lack of variation in pitch, timbre, and frequency. Machine learning was able to pick these things up in both English speakers and Cantonese speakers; I don't know if you could call it an accent but there does seem to be an unusual speech pattern.

 

[LeaveNoTrace]

Do you believe you can be trained to be a decent psychiatrist?

I hope so but am unsure; also it seems like one of those things where you need to believe that it is possible in order to have a chance.

 

[mistafab]

If you plan to reenter the match then I recommend also applying for another specialty alongside psych.

Pick a secondary specialty where you can fit your interests. Interestingly, neurology tends to be much more welcoming to autistic physicians than psych. You are not expected to have great rapport or be tuned into feelings.

Psych is probably one of the toughest fields for someone with autism. Not impossible, but if you can’t make it twice, you can’t make it. Simply put, if you can’t make it through the interview stage anywhere - you won’t make it through residency.

Best of luck.

 

[LeaveNoTrace]

Psych is probably one of the toughest fields for someone with autism. Not impossible, but if you can’t make it twice, you can’t make it. Simply put, if you can’t make it through the interview stage anywhere - you won’t make it through residency.

Best of luck.

I've been thinking about it and talking with a professional. That, and some feedback from one of the psychologists that was shadowing me during one of my IM clinic visits, taught me a few things:

- The way I talk, gesture, etc. are generally OK. Perhaps a little awkward, but OK.
- The feelings of self-disgust I have are not entirely inaccurate, but also reinforce themselves and cloud perceptions of what is really going on.
- I am reasonably good at reading facial expressions and body language, and am able to change what I am doing in conversations and build rapport with patients effectively. The mistake I kept making was trying to be more energetic or funny when people weren't matching that, and I had thought it was because I wasn't positive enough or smiling enough. Not true.
- I personally know more than a few autistic psychiatrists. I suspect that there is something going on where interviewing psychiatrists are slightly biased: they see an autistic interviewee and are reminded of all of their patients. They don't see the autistic people that are doing well and do not come to the attention of mental health providers as much - and so their view of what is possible or what is realistic may be a little pessimistic.

I am curious about something, however: suppose I did manage to make my way through the interview stage. How might I then wind up failing in residency? I am guessing a systematic failure to be sensitive or build rapport with patients, leading to well-founded concerns and ultimately the boot.

Finally, I do think that I can gain the skills needed to be a good psychiatrist: empathy, compassion, grace, sensitivity, caring, tact. The awkwardness may be a barrier but not an insurmountable one.

Thank you.

 

[mistafab]

This is in no way to be demeaning or shaming. However, when people say many psychiatrists are 'on the spectrum' - they don't actually mean they carry a diagnosis of autism spectrum disorder. What they mean is there are deficits in communication that makes it hard to work with that person. True ASD in psychiatrists is very, very rare.

If you can't make it through the interview, that probably means there are gross deficits in professional communication that will get in the way of your job. Even without an ASD diagnosis, that is a matter of fact. That coupled with autism spectrum disorder will make psychiatry very difficult. Residency is already so challenging at many programs - throwing this factor in addition to the general stress and culture of residency is not a recipe for success.

This is not to say that autism is a contraindication to psychiatry. Again, however, if the interview stage sifts you out - then there is clearly a deficit there if you're good on paper. Presumably these folks have no idea you have autism spectrum disorder and are simply sniffing out poor communication.

I do wish you best of luck. I would definitely consider a second specialty and dual apply this cycle. You may have to decide if the chance of being a psychiatrist is worth more than practicing in medicine at all. After two failed cycles a career in medicine may be a slim shot.

I've been thinking about it and talking with a professional. That, and some feedback from one of the psychologists that was shadowing me during one of my IM clinic visits, taught me a few things:

- The way I talk, gesture, etc. are generally OK. Perhaps a little awkward, but OK.
- The feelings of self-disgust I have are not entirely inaccurate, but also reinforce themselves and cloud perceptions of what is really going on.
- I am reasonably good at reading facial expressions and body language, and am able to change what I am doing in conversations and build rapport with patients effectively. The mistake I kept making was trying to be more energetic or funny when people weren't matching that, and I had thought it was because I wasn't positive enough or smiling enough. Not true.
- I personally know more than a few autistic psychiatrists. I suspect that there is something going on where interviewing psychiatrists are slightly biased: they see an autistic interviewee and are reminded of all of their patients. They don't see the autistic people that are doing well and do not come to the attention of mental health providers as much - and so their view of what is possible or what is realistic may be a little pessimistic.

I am curious about something, however: suppose I did manage to make my way through the interview stage. How might I then wind up failing in residency? I am guessing a systematic failure to be sensitive or build rapport with patients, leading to well-founded concerns and ultimately the boot.

Finally, I do think that I can gain the skills needed to be a good psychiatrist: empathy, compassion, grace, sensitivity, caring, tact. The awkwardness may be a barrier but not an insurmountable one.

Thank you.

 

[clausewitz2]

I had one attending in residency who I actually do think could have qualified for an ASD diagnosis. He is relatively famous in his corner of the field and quite accomplished. He has made his career laser focused on a single disorder and does clinical work on that and nothing else. So I disagree with the notion that it is entirely impossible.

I think though, OP, targeting that potentially inaccurate self-loathing is going to give you more bang for your buck than ruminating about a diagnostic label.

 

[JerryMouse]

Here are some suggestions for how to get better at interviews and/or obtain a psychiatry residency spot. I have not interacted with you in person, which will limit how helpful these suggestions are.

1. If you are currently in a residency program of a different specialty, consider applying to PGY2 psychiatry spots directly.

2. If you believe that your interview skills are the main cause for why you could not match into psychiatry (instead of something else like scores or grades), consider some long-term work with a psychologist who can give you an honest opinion of your verbal and nonverbal communication skills and help you improve on deficits. If you have close real-life friends who don't sugar coat things, they can potentially be a resource as well.

3. Regarding your interview skills, you wrote: "The way I talk, gesture, etc. are generally OK. Perhaps a little awkward, but OK." "I am reasonably good at reading facial expressions and body language, and am able to change what I am doing in conversations and build rapport with patients effectively. The mistake I kept making was trying to be more energetic or funny when people weren't matching that, and I had thought it was because I wasn't positive enough or smiling enough" If this is an accurate assessment, the interview may not even be the main reason for why you could not get into psychiatry. Interviews are typically superficial, 10-20 minute interactions in which you should do well if you show a pleasantly calm demeanor and engage in reciprocal conversation. Again, getting an honest opinion regarding your social skills from someone who knows you well (or a psychologist who can get to know you) is key to figuring out how to proceed.