Looking back, what mattered on interview trail?

[mrbreakfast]

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Posting this in med students because it seems like a lot of residents/physicians read this forum, but may post in resident forum.

We M4s get a lot of advice on what to look at in terms of evaluating residency programs during interviews: would you like to live here? are the residents happy? opportunities for research/subspecialty training? gut feeling? etc. I've been trying to do this and have realized that I'm already having trouble deciding between programs that are strong in some areas and less so in others.

So, looking back, what things that you looked at in programs really mattered? Prestige, resident cohort, location, etc?
For example (actual question for me):
-Program A is top-10 ranked, nationally recognized, huge academic powerhouse, every possible subspecialty, etc, but I didn't really click with the residents/faculty I met or love the location that much.
-Program B is top-20 and fairly prestigious (not program-A level, but up there), liked the "feel" and the residents, but in a smaller town I'm worried I might get bored in (it's not Mayo, but think Mayo in terms of location).
-Program C had a great feel, clicked with residents well, absolutely loved location, but it's an above-average but not amazing program (top-30) and probably wouldn't make anyone's "short list" in the field.

In your experience, does anything we're told to focus on really matter more, or matter less, once you actually got to residency?
I know it's ultimately personal preference, and I obviously want a resident cohort I connect well with in a location I love, but (as someone interested in fellowship and academic clinical medicine) I don't want to shoot myself in the foot by not picking the "top" program I can.

 

[sloop]

I think that "fit" in terms of meshing with the existing residents is important but I would also say not to underestimate the value of going to a "name" place. My institution is very esteemed and with that, to be frank, comes a sort of culture of pride that motivates excellence.

 

[ortnakas]

Current IM intern: I went with "fit" and location and have zero regrets.
Caveats: I'm married so location mattered more than it might to you, and I don't have fellowship aspirations making prestige less important.

 

[fasteddie911]

What specialty? Depends on what your career and life goals are. If you're doing IM, interested in GI and a high powered academic career. I'd lean towards the biggest name IM program over fit, unless the program felt awful and toxic. But if you're interested in hem/onc and want to work part-time at a small-town academic hospital, then that changes things. Fit and comfort does matter, but program prestige (for fellowship especially, even academic career) matters as well. Gut feeling, fit, location, etc. are all important factors, but it's very individual and has to be weighed against your personality, goals, interests, etc.

 

[Redpancreas]

I think you should perceive places you interview at just like they perceive you. Their rank list is based off of USMLE Step 1, Clerkship Grades, and the MSPE. Yours should be based off location and name brand if you want fellowship. Likewise, the interview should only be perceived as a chance to identify if the program is normal. Any noise you hear on the spreadsheets, SDN, etc. needs to be validated with multiple in-person sources before you can trust it. That said, I'm just an intern.

 

[Rekt]

I'm applying, but for me;

1: Moonlighting. How much? How many residents utilize it? Earliest you can start?
2: Location. Anywhere that makes me pay for parking is gone. Am I going to murdered leaving a shift?
3: Benefits. How much is insurance? Shared or paid? Food allowance?
4: Shifts (EM). 12s are out. 9-10s are fine. Overlap is even better.
5: Volume. Is it going up or down. ESI breakdown is even better.
6: Gut feeling? 7 II deep and have only had programs drop to the bottom of my list. Still waiting for that magical feeling of love.

Pretty much nothing else matters to me and is all fluff.

 

[UnoMas]

IMO fit is pretty overrated unless you’ll feel completely out of place or they are so obnoxious that you just cant deal with. Most of my interviews so far, the residents have been so so, people I feel like I can hang with. Only 1 place so far has turned me off so bad I dont think I will even rank them. It’s nice that you can make life long friendships during a residency but that’s not a big requirement for me. Things like that come naturally and you cant force it. I just want respectful, chill people who pull their own weight. How many people are all best friends with their coworkers?
Look for the education, resources, support from staff, location and where their grads are going, are you going to be treated like a doctor in training of some grunt who is there to get the work done.


Sent from my iPhone using SDN mobile

 

[mrbreakfast]

What specialty? Depends on what your career and life goals are.

Likely academic, so 98% chance I will do a fellowship. I'm only considering strong academic programs (mostly top-25 according to doximity anyway, which I know is a bad metric) but I'm worried about choosing a program that might turn out to be a clear step down in a fellowship director/employer's mind.
I definitely need to do more research into "reputation" if I'm going to be going off of that, but it's hard to know which programs are good, which are great, and which are exceptional in terms of "name."

Gut feeling? 7 II deep and have only had programs drop to the bottom of my list. Still waiting for that magical feeling of love.

Most of my interviews so far, the residents have been so so, people I feel like I can hang with.

The thing is I've also been waiting for that "magical feel of love" for a program and am worried it's not coming. I've had only a few interviews where I thought "wow, I could actually hang out with these people." I've had a lot of interviews where I felt completely ambivalent about the residents. They seemed like the kind of people I'd talk to but never actually spend time with outside of work, and at a number of programs, I've had a tough time stayin.

I'm into the double digits of interviews and am getting progressively more worried that I'll have to choose between a bigger name and being happy during residency. If residency is going to be as tough as it seems, I want to have a close group of friends I can rely on.

tl;dr at every resident dinner thus far, people tell me they chose the program for the "people," and often the location, and then add it's a great program (as everyone says it's a great program). Also, most residents imply the program was their #1 choice.
I have a clear #1 for people + location thus far; in terms of prestige, it's going to be 9th among my interviews. I also have a clear #1 for program strength/prestige, but right now it'd be 6th in people/location. I think I've got a pretty good chance at matching at whichever I put first, and am honestly not sure which I should value more.

I'll do some soul-searching, but am curious if anyone else had to make this decision.

 

[UnoMas]

Likely academic, so 98% chance I will do a fellowship. I'm only considering strong academic programs (mostly top-25 according to doximity anyway, which I know is a bad metric) but I'm worried about choosing a program that might turn out to be a clear step down in a fellowship director/employer's mind.
I definitely need to do more research into "reputation" if I'm going to be going off of that, but it's hard to know which programs are good, which are great, and which are exceptional in terms of "name."



The thing is I've also been waiting for that "magical feel of love" for a program and am worried it's not coming. I've had only a few interviews where I thought "wow, I could actually hang out with these people." I've had a lot of interviews where I felt completely ambivalent about the residents. They seemed like the kind of people I'd talk to but never actually spend time with outside of work, and at a number of programs, I've had a tough time stayin.

I'm into the double digits of interviews and am getting progressively more worried that I'll have to choose between a bigger name and being happy during residency. If residency is going to be as tough as it seems, I want to have a close group of friends I can rely on.

tl;dr at every resident dinner thus far, people tell me they chose the program for the "people," and often the location, and then add it's a great program (as everyone says it's a great program). Also, most residents imply the program was their #1 choice.
I have a clear #1 for people + location thus far; in terms of prestige, it's going to be 9th among my interviews. I also have a clear #1 for program strength/prestige, but right now it'd be 6th in people/location. I think I've got a pretty good chance at matching at whichever I put first, and am honestly not sure which I should value more.

I'll do some soul-searching, but am curious if anyone else had to make this decision.

The problem with choosing for the 'people' is you are basing your decision on the current residents. not your class.

 

[mrbreakfast]

The problem with choosing for the 'people' is you are basing your decision on the current residents. not your class.

You're absolutely right, especially because at many interviews I'm mostly meeting PGY3s and 4s, who I'll never actually work with.

On the other hand, it's tough to ignore the feel you get from the dinner + day. It's the only insight into the people.

 

[getdown]

I used the "how many hot girls are in the area" test. Walked into the interview location and saw no less than 5 very attractive admin support staff ladies and ranked that program #1. Also didn't hurt being in Cali with the weather and all. Matched there and now I'm working here except now I'm married.

 

[fasteddie911]

What specialty, what fellowship and what career goals? Again, if you want to do IM, then GI and be a big-time academic, then go to the biggest name program. If you want to do IM, endocrine and small town academic, then probably doesn't matter where you go.

 

[sloop]

I think that what others have said about taking experiences with residents with a bit of a grain of salt is accurate.

It is valuable to get an idea of the culture of programs you’re looking at. However, there is the problem that your class may be significantly different than other classes (I happen to really love my class of co-residents and we are also noticeably different than the other classes, who are likeable in other ways).

The other problem is that if a class has a lot of introverts, you might get the impression of “pleasant, but maybe a bit boring” or that you might work fine with them but don’t see yourself being friends with the existing residents. The reality is that most of these people at good programs are actually very interesting people and many of them are super fun to be around/hang out with once you get to know them and they become comfortable with you in a casual way. This almost inevitably happens, as residency (Intern year in particular) has a way of forging people together even if those people are actually pretty different.

Trust me, you’ll be surprised who you become good friends with after a few months of covering each other’s call shifts, taking a late admission/taking sign out on patients so that they can get to their kid’s important sports event, or covering for someone for a couple days so they can attend a family funeral. This stuff doesn’t happen a lot but it happens enough that I think most groups of generally well-meaning, decent residents will grow close and supportive of each other.

Not everybody will see it this way because people have different ways of conceptualizing this stuff, but I think a lot of people think of their co-residents as something like a family. I think this is apt because you don’t actually get a say in who they are, specifically, but you have long-term obligations to one another that you can’t avoid. Your happiness depends on people being reciprocally good to each other and standing up for one another when it counts. In some ways, you can expect things from your colleagues that you wouldn’t even expect from a mere friend (Example: “Hey, I have a bad family emergency and need to go home for the weekend, can you drop the plans you may have had for months and cover me?”)

I guess my point is that if people meet a threshold level of agreeableness and conscientiousness, you’re probably going to form good relationships with them in residency no matter what. It’s important to make sure you’re not ranking highly places that are full of jerks, but putting too much weight on the specific personalities of the people you interact with might constitute privileging something that won’t matter much in the end.

 

[VA Hopeful Dr]

The problem with choosing for the 'people' is you are basing your decision on the current residents. not your class.

While true, lots of programs manage to get similar people year after year so that the program culture (for lack of a better word) remains similar. This is especially true if you meet residents from each year and get along well with all of them.

 

[Angus Avagadro]

OP has stated they are interested in academics and fellowship. I would choose the program that gets me to the goal line, regardless of location or people. Worked for me. Once you determine academic vs clinical, then it makes things easier. Wife never wanted academics, was an elite student, turned down ivy med and university residency to go with best fit for her. When I meet her colleagues, they routinely tell me she is the best (specialist) they know. All she ever wanted was to take care of people. Fit IMO is overrated, but wasnt for my wife. OP should strive to go to the program that gets them the fellowship and position they desire

 

[UnoMas]

While true, lots of programs manage to get similar people year after year so that the program culture (for lack of a better word) remains similar. This is especially true if you meet residents from each year and get along well with all of them.

Yes I do get that feeling as well as residents from different years at the same program do seem to have very similar personality.

 

[GoSpursGo]

FWIW, I think there's a loud mantra that gets repeated over and over on SDN that "prestige" and "rank" doesn't matter. Over the years, I have come to believe that's probably not entirely true when it comes to applying to medical school (ie, coming from an Ivy definitely gets you seen more favorably than a small state school when you're on the residency trail). However, I think it's less relevant once you get to residency and then fellowship. There's a big difference between a "top 10" academic program and a small rural program, but whether you're at a "top 10" vs "top 30" program, once you're at a sufficiently "big" and "rigorous" program, probably makes little difference. The experience you get is going to be sufficient to give you the training you need to be a competent physician, and should be well-set-up to be a competitive fellowship applicant if that's your thing.

So unless you have your heart set on going to a fellowship at program A because they have some world expert doing research on something that you're specifically interested in, I'd probably go with B or C. Assuming you are looking primarily at strong academic programs, fit and location above everything else with the caveat that I would take fellowship ranks at the institutions that you are considering into account.

 

[mrbreakfast]

However, I think it's less relevant once you get to residency and then fellowship. There's a big difference between a "top 10" academic program and a small rural program, but whether you're at a "top 10" vs "top 30" program, once you're at a sufficiently "big" and "rigorous" program, probably makes little difference. The experience you get is going to be sufficient to give you the training you need to be a competent physician, and should be well-set-up to be a competitive fellowship applicant if that's your thing.

Thanks, this is helpful. The confounding factor in all of this for me is, as you implied, there probably in reality isn't a huge difference between all the programs I'm considering. The fellowship placement lists are pretty much identical, with the exception of the top program keeping basically all their residents as fellows.

Later on I'll be asking my preceptors (and probably SDN) if there are any notable outliers among my top 7-8 or so programs, either positive or negative, in terms of reputation. I know I'll get a quality education at any of these places, but I also know the strength of name recognition, and need to determine how much value to attribute to it.

 

[Redpancreas]

I'm applying, but for me;

1: Moonlighting. How much? How many residents utilize it? Earliest you can start?
2: Location. Anywhere that makes me pay for parking is gone. Am I going to murdered leaving a shift?
3: Benefits. How much is insurance? Shared or paid? Food allowance?
4: Shifts (EM). 12s are out. 9-10s are fine. Overlap is even better.
5: Volume. Is it going up or down. ESI breakdown is even better.
6: Gut feeling? 7 II deep and have only had programs drop to the bottom of my list. Still waiting for that magical feeling of love.

Pretty much nothing else matters to me and is all fluff.

What about years, haha? 3 vs. 4 is huge I'd imagine.

 

[throwaway1939]

You need to write down your actual goals and make a decision.

If you are after an 80/20 position (research to clinical), you need to go to the best program possible, full stop. If you want to do competitive subspecialty training(eg cards, GI, heme/onc), you should go to the best program possible. If you just want to be a hospitalist or PCP, most mid-upper tier programs will be fine.

Fit is overrated, at least for IM. You will essentially never interact with people you meet on the interview trail. Attendings run the gamut from dinguses to amazing. Go to the program that fits your goals.

 

[throwaway1939]

While true, lots of programs manage to get similar people year after year so that the program culture (for lack of a better word) remains similar. This is especially true if you meet residents from each year and get along well with all of them.

That's mostly because most medical students fit into like three categories. Medicine, in general, attracts a small subset of personalities and clinical years force is into safe boxes. It's not a surprise that most residency classes are similar.

 

[rjosh33]

I think you should perceive places you interview at just like they perceive you. Their rank list is based off of USMLE Step 1, Clerkship Grades, and the MSPE. Yours should be based off location and name brand if you want fellowship. Likewise, the interview should only be perceived as a chance to identify if the program is normal. Any noise you hear on the spreadsheets, SDN, etc. needs to be validated with multiple in-person sources before you can trust it. That said, I'm just an intern.

MS4 here. I just wanted to point out that while the above is true for many programs, it is NOT necessarily true for plenty others. I've spoken with a number of program directors and senior residents for my given specialty that have specifically stated the interview day has an enormous impact on their rank list -- oftentimes it is the most important factor. Yes, they want to see if you're normal and/or personable -- but that's kind of the bare minimum. They also want to see your enthusiasm, intelligence, preparation, balance of confidence/humility, and ability to think on your feet. Be yourself, but be the best version of yourself -- this your chance to distinguish yourself from the others, Step 1 and 3rd year grades be damned.

 

[Rekt]

What about years, haha? 3 vs. 4 is huge I'd imagine.

Haha woops. Yeah all four year programs were immediately axed. Haven't been to a place yet that has had a good justification for having one. Especially with how common it is for many people to do more than two aways, it kind of makes that old adage about the three and half year crap obsolete.

 

[GoSpursGo]

They also want to see your enthusiasm, intelligence, preparation, balance of confidence/humility, and ability to think on your feet. Be yourself, but be the best version of yourself -- this your chance to distinguish yourself from the others, Step 1 and 3rd year grades be damned.

So basically, they're looking at fit? 😉

 

[rjosh33]

So basically, they're looking at fit? 😉

Well, yes, which is different from being normal. 😉

 

[mvenus929]

It can be hard to make a decision based on interactions with the residents, but I think there are other things about the interview day itself that can provide some information. How coordinated the coordinator is in getting you information (how much time they spend working on resident issues), what other support staff there are (only a coordinator? or are there other people in coordinator like roles? what extra programs do they have available for residents?), how your interactions with the faculty are (who will more than likely be in charge of you during your residency, even if the residents you interact with aren't there), how visible the PD is, etc.

I based a huge part of my decision on my gut feeling, but I had culled my list pretty good from the start, so most of the places I was looking at were fairly similar in terms of academic rigor, schedules, class size, etc. I also had a hunch that I wanted to do a non-competitive fellowship, so it wasn't the end of the world when I matched at an unranked program.

 

[NickNaylor]

Things that mattered to me:

1) Did the program give off an academic vibe? In other words, was teaching and, potentially, exposure to research emphasized?
2) Did residents seem happy? Did they speak positively about the program? Were they satisfied with the quality of their training?
3) Did the program leadership and faculty seem responsive to resident feedback? Are residents involved in shaping a program and making changes?

These are hard things to get a sense of after a single interview day, and honestly I relied heavily on my gestalt impression of a program when creating my final rank list. I think that, in general, the quality of your training is unlikely to vary all that much because of ACGME requirements. Consequently, things like location, culture of the program, and whether you can see yourself being happy at that program become much more important IMO.

 

[mrbreakfast]

Thanks all. What I've heard on the trail from residents is that location and gut feel seem to be the major factors. Pretty tough to do based on a handful of hours.

Also, I'm going into neurology, meaning I'll never work with most of the residents I've met on interviews. I've had interviews where I met just one or two PGY1/2s, and the best pitchmen have been the PGY4s.

I've been trying to balance between academics, schedule (early electives/outpatient), gut feel, location, and special features each program offers, but each has so many relative strong points, and they're all different.

I had culled my list pretty good from the start, so most of the places I was looking at were fairly similar in terms of academic rigor, schedules, class size, etc

I did too, but I also thought I'd only get 2-3 invites from my top grouping of programs, making things obvious. I'm pleased with my luck, but now have the good (yet stressful) situation of having to compose most of my list from programs I didn't think I'd get invited to.

 

[DrSnips]

What specialty? Depends on what your career and life goals are. If you're doing IM, interested in GI and a high powered academic career. I'd lean towards the biggest name IM program over fit, unless the program felt awful and toxic. But if you're interested in hem/onc and want to work part-time at a small-town academic hospital, then that changes things. Fit and comfort does matter, but program prestige (for fellowship especially, even academic career) matters as well. Gut feeling, fit, location, etc. are all important factors, but it's very individual and has to be weighed against your personality, goals, interests, etc.

Heme/onc might not be the best example of a less competitive IM subspecialty -- maybe not quite as competitive as cards and GI, but no cakewalk for sure. Renal would have been a better example. But I agree with the overall sentiment.