Questions to Ask at Your Residency Interview

[KLXAnesthesia]

Hey all-

I haven't posted on here since my med school days, and actually had to open a new account. I am finishing my anesthesia residency at a nationally recognized program with multiple attending physician who are in editorial positions in several high impact factor journals. Although it is considered a "top program" I wish that I had asked a few more questions about it, and every other program I interviewed at, to make sure that national recognition correlated strongly with good teaching. Although these questions are geared toward anesthesia residency interviews, they probably can be applied to any specialty to some degree.

1. Did you have any spots in the scramble last year? Why?
-Don't be afraid to ask this question. An honest and unoffensive response by an interviewer means they recognized the problem, and are taking steps to fix it. Offense could mean the program probably didn't have enough applicants rank them for what ever reason, or that they think very highly of themselves, or are just very selective in who they rank. It's not always a negative thing, a program may just be well staffed and doesn't need to fill their class year in year out if they are not happy with their applicant pool.

2. How many hours a week do your resident work? Is the work-hours rule ever violated?
-This is pretty obvious. Ask every program. Write it down. Find out per clinical year. It may really vary with certain years being much busier than others. This may be one you want to ask a semi intoxicated resident at a dinner. Start to get an idea of what the national average is and then decide if a program is working too little/much for you. Remember you still will need alot of reading time in residency (see #6 below). Attendings in a program (especially if they trained at the same program) are notoriously bad at knowing just how the hours of their own program stack up against the national average.

3a. How many days a week do residents take call and what time are you getting out on call AND non-call days?
3b. How many weekends per month?
3c. How many calls have the potential to be overnight? What happens if I work overnight the next day?
3d. Which calls have pre and post call days?
3e/4e. See below
-These also are questions for which you want to write the answers down and compare directly to other programs. Many programs have a pre-call day before a long call days. Some do not. Pre-call and Post-call days are a huge perk if a program has them. Some programs may seem like they have great call schedules, but have more OR's running past 5pm than a program with a call schedule that looks painful, but in reality finishes the day earlier. Remember the revision of the hours rules this year have essentially left it up to the program director to work you as much as they want after your first 2 years of training.

4a. What is the night schedule like? 1 week at a time? q4? Etc...
4b. How many residents are on overnight? How many OR rooms are staffed at night?
4c. How is work divided at night?
4d. Are there CRNA's that are on at night as well?
3e/4e. Is there a late shift that comes in the afternoon and leaves late in the evening?
-Nights can be great or horrible. It can be wonderful learning or boring babysitting, or work to the bone busy. Your personal preference as to scheduling obviously takes precedence, but don't underestimate how important it can be as both a day call resident trying to get out or a late/night resident coming in to have a resident/CRNA late shift to help wrap up busy days.

5a. How often are rooms 1 on 1 resident to attending?
5b. Do the attending physicians teach in the OR on a daily basis?
5c. How often do resident relieve CRNA's and why?
-These are VERY telling of a programs goals. If a program is well staffed then the answer to a will be at least sometimes, and not just in complicated case rooms. These 1 on 1 situations is where great teaching and learning happens. A good teaching program will have attending physicians that direct you to articles on your cases the night before, and then teach in the OR on the day of. Ask the residents how often this happens.
-You should rarely relieve CRNA's in my mind. My logic is that CRNA's are employed to make money for the program, and when you take a room over from them did the room somehow magically becoming a learning case? Hardly. Be VERY wary of programs that consistently have residents relieving CRNA's at the end of the day, no matter what the excuse is.

6. Is there a structured lecture schedule that has integrated board/ITE review from a major anesthesia text (i.e. Miller)? What is expected on the ITE for each clinical year?
-Ask this question the residents the night before, and then again the next day with an interviewer. Ask the residents how much reading/cramming they feel they need to do to perform well on the annual in-training exam with the lectures/teaching they receive. This is an important one to write down and compare when making your rank list.

7. Of those residents that match into fellowship, how many get there first choice?
-This can tell you a lot about the program you are interviewing at. Also if getting into a highly competitive fellowship program/job market is your goal, it can be the most important question you ask. Consistent 1st or 2nd choice fellowship results mean the program probably has a strong network and nationally recognized faculty.

8. What are the off service months (ICU) like? How many are there?
-Ask the residents, not the attendings. Some programs have LOTS of ICU time these days. Some up to 6 months! This makes up a large part of your training and can make or brake your decision on a program. Write this stuff down. Properly run ICU are enormous learning opportunities. Open units run by the surgery services can be horrible.

9. Are you happy you matched here? Ask first what don't you like about the program, and then what do you like?
-At the dinner and then the next day at lunch ask as many residents are you can if they are happy they matched there. Don't just ask those resident with the bubbly personality who are in your face at dinner, and then again at the lunch on interview day. They probably have some sort of emotional investment in the program which is possibly not shared by all the residents, and will gloss over alot of things that are important to a properly adjusted resident such as yourself.

Alright that is it. Good luck everyone. Tell your friends to read this. Programs that feel they there national reputation outweighs the duty to teach their residents deserve to scramble. Feel free to respond with comments or questions.

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[Cathyran]

Thanks for posting. That's really helpful.

 

[givesmegas]

Much appreciated.

And if any other residents/attendings/med students want to add to the list, it would be helpful.

 

[PMPMD]

Hey all-

I haven't posted on here since my med school days, and actually had to open a new account. I am finishing my anesthesia residency at a nationally recognized program with multiple attending physician who are in editorial positions in several high impact factor journals. Although it is considered a "top program" I wish that I had asked a few more questions about it, and every other program I interviewed at, to make sure that national recognition correlated strongly with good teaching. Although these questions are geared toward anesthesia residency interviews, they probably can be applied to any specialty to some degree.

1. Did you have any spots in the scramble last year? Why?
-Don't be afraid to ask this question. An honest and unoffensive response by an interviewer means they recognized the problem, and are taking steps to fix it. Offense could mean the program probably didn't have enough applicants rank them for what ever reason, or that they think very highly of themselves, or are just very selective in who they rank. It's not always a negative thing, a program may just be well staffed and doesn't need to fill their class year in year out if they are not happy with their applicant pool.

2. How many hours a week do your resident work? Is the work-hours rule ever violated?
-This is pretty obvious. Ask every program. Write it down. Find out per clinical year. It may really vary with certain years being much busier than others. This may be one you want to ask a semi intoxicated resident at a dinner. Start to get an idea of what the national average is and then decide if a program is working too little/much for you. Remember you still will need alot of reading time in residency (see #6 below). Attendings in a program (especially if they trained at the same program) are notoriously bad at knowing just how the hours of their own program stack up against the national average.

3a. How many days a week do residents take call and what time are you getting out on call AND non-call days?
3b. How many weekends per month?
3c. How many calls have the potential to be overnight? What happens if I work overnight the next day?
3d. Which calls have pre and post call days?
3e/4e. See below
-These also are questions for which you want to write the answers down and compare directly to other programs. Many programs have a pre-call day before a long call days. Some do not. Pre-call and Post-call days are a huge perk if a program has them. Some programs may seem like they have great call schedules, but have more OR's running past 5pm than a program with a call schedule that looks painful, but in reality finishes the day earlier. Remember the revision of the hours rules this year have essentially left it up to the program director to work you as much as they want after your first 2 years of training.

4a. What is the night schedule like? 1 week at a time? q4? Etc...
4b. How many residents are on overnight? How many OR rooms are staffed at night?
4c. How is work divided at night?
4d. Are there CRNA's that are on at night as well?
3e/4e. Is there a late shift that comes in the afternoon and leaves late in the evening?
-Nights can be great or horrible. It can be wonderful learning or boring babysitting, or work to the bone busy. Your personal preference as to scheduling obviously takes precedence, but don't underestimate how important it can be as both a day call resident trying to get out or a late/night resident coming in to have a resident/CRNA late shift to help wrap up busy days.

5a. How often are rooms 1 on 1 resident to attending?
5b. Do the attending physicians teach in the OR on a daily basis?
5c. How often do resident relieve CRNA's and why?
-These are VERY telling of a programs goals. If a program is well staffed then the answer to a will be at least sometimes, and not just in complicated case rooms. These 1 on 1 situations is where great teaching and learning happens. A good teaching program will have attending physicians that direct you to articles on your cases the night before, and then teach in the OR on the day of. Ask the residents how often this happens.
-You should rarely relieve CRNA's in my mind. My logic is that CRNA's are employed to make money for the program, and when you take a room over from them did the room somehow magically becoming a learning case? Hardly. Be VERY wary of programs that consistently have residents relieving CRNA's at the end of the day, no matter what the excuse is.

6. Is there a structured lecture schedule that has integrated board/ITE review from a major anesthesia text (i.e. Miller)? What is expected on the ITE for each clinical year?
-Ask this question the residents the night before, and then again the next day with an interviewer. Ask the residents how much reading/cramming they feel they need to do to perform well on the annual in-training exam with the lectures/teaching they receive. This is an important one to write down and compare when making your rank list.

7. Of those residents that match into fellowship, how many get there first choice?
-This can tell you a lot about the program you are interviewing at. Also if getting into a highly competitive fellowship program/job market is your goal, it can be the most important question you ask. Consistent 1st or 2nd choice fellowship results mean the program probably has a strong network and nationally recognized faculty.

8. What are the off service months (ICU) like? How many are there?
-Ask the residents, not the attendings. Some programs have LOTS of ICU time these days. Some up to 6 months! This makes up a large part of your training and can make or brake your decision on a program. Write this stuff down. Properly run ICU are enormous learning opportunities. Open units run by the surgery services can be horrible.

9. Are you happy you matched here? Ask first what don't you like about the program, and then what do you like?
-At the dinner and then the next day at lunch ask as many residents are you can if they are happy they matched there. Don't just ask those resident with the bubbly personality who are in your face at dinner, and then again at the lunch on interview day. They probably have some sort of emotional investment in the program which is possibly not shared by all the residents, and will gloss over alot of things that are important to a properly adjusted resident such as yourself.

Alright that is it. Good luck everyone. Tell your friends to read this. Programs that feel they there national reputation outweighs the duty to teach their residents deserve to scramble. Feel free to respond with comments or questions.

Good list.

You don't need to ask IF the program had to scramble since it's public information, but asking WHY could be helpful.

I would direct the questions about hours/call/etc to residents since they will know more closely.

Also:

Board pass rate

If you're feeling bold, you could ask what citations the program got on their last RRC review, and what they did to fix them.

Moonlighting opportunities? Esp. internal

 

[Surfer]

Forget that list. IF you ask those questions you will be seen as a whiny little....

Just ask if the residents are happy. IF so, why? If not, why? That's it my friends. None of that other crap matters. Residency is pretty hard no matter where you go. But will you be happy living/working/learning there? The rest of the details you will find out throughout the interview day. Asking details about the call schedule or post-call days is totally unnecessary because RRC guidelines mean everybody gets post-call off, etc.

find out what kind of environment the residency is, the rest is just the details...

 

[KLXAnesthesia]

Forget that list. IF you ask those questions you will be seen as a whiny little....

Just ask if the residents are happy. IF so, why? If not, why? That's it my friends. None of that other crap matters. Residency is pretty hard no matter where you go. But will you be happy living/working/learning there? The rest of the details you will find out throughout the interview day. Asking details about the call schedule or post-call days is totally unnecessary because RRC guidelines mean everybody gets post-call off, etc.

find out what kind of environment the residency is, the rest is just the details...

Tactful and respectful question asking never in my opinion comes off as whining. It conveys a genuine interest you are looking for the best possible education. If you are more concerned about appearances to a bunch of people you don't know than how the next 3-4 years of integral training are going to shake down, then stay quiet. But, and this is a BIG BUT, you must convey that you plan on working very hard. And the only way they will believe it is if you actually plan on working hard.

Also residents who attend mixers with med students are not always a good representation of the entire program. I have found that those willing to criticize their program choose to avoid the dinners. But they come to the lunches. Trusting any program to reveal the "details" to you throughout out the day in my POV is putting a lot of trust in people you just met.

And in my program, as in others I am sure you do not always get post call days off. It is in no way a rule according to the new ACGME guidelines for upper level residents and is at the discretion of the program director. That is why you ask.

 

[Harrison486]

So these questions seem geared more towards residents and finding out the details of programs.

What type of questions should I be directing towards PDs and Chairmen?

 

[KLXAnesthesia]

I believe that most of these questions can be asked to the PD's, and then contrasted against those answers of the residents. Be tactful, positive, and respectful when asking. PD's will have all the answers to these questions and should be very willing to fill you in on any questions you have.

I found and continue to find that the majority of chairpeople, if they even interview you at all, are not as knowledgeable as the PD and may not have all the answers. Their focus is not the residency per se and have bigger fish to fry on a daily basis.

What type of questions are you concerned about asking the PD or chairperson?

 

[Harrison486]

I believe that most of these questions can be asked to the PD's, and then contrasted against those answers of the residents. Be tactful, positive, and respectful when asking. PD's will have all the answers to these questions and should be very willing to fill you in on any questions you have.

I found and continue to find that the majority of chairpeople, if they even interview you at all, are not as knowledgeable as the PD and may not have all the answers. Their focus is not the residency per se and have bigger fish to fry on a daily basis.

What type of questions are you concerned about asking the PD or chairperson?

I just didn't want to annoy the PD/chair with questions that I shoul be asking residents to get those answers. I do see your point in being able to compare answers.

As far as specific questions directed toward the PD/chair, I was assuming there would be some questions worth asking them about the program/hospital that maybe the residents wouldn't know or deal with on a daily basis.

 

[KLXAnesthesia]

ttt. Timely.

 

[imfrankie]

Forget that list. IF you ask those questions you will be seen as a whiny little....

Just ask if the residents are happy. IF so, why? If not, why? That's it my friends. None of that other crap matters. Residency is pretty hard no matter where you go. But will you be happy living/working/learning there? The rest of the details you will find out throughout the interview day. Asking details about the call schedule or post-call days is totally unnecessary because RRC guidelines mean everybody gets post-call off, etc.

find out what kind of environment the residency is, the rest is just the details...

Agree wholeheartedly. Senior people had no 80 hr rule, nor CRNAs to get them out for naptime or study break, moonlightlighting was "you get to do another case or two before you go home." Believe me they will not take kindly to questions that can be construed as "how hard will I have to work?" They'll offer that stuff up voluntarily. Act like you want to work hard and be dismissive of getting out early. Doing lots and lots of cases start to finish is the way to get good.

 

[fakin' the funk]

So these questions seem geared more towards residents and finding out the details of programs.

What type of questions should I be directing towards PDs and Chairmen?

It may not feel like it, but keep in mind that you are interviewing them as well. So (respectfully and tactfully) you can ask probing questions if you want. In general I would shy away from ACGME issues though.

What are your research opportunities?
Where do grads go?
What kinds of specialties do grads tend to go into?
What are the program's weaknesses?
How is the program improving those weakness?
What kind of residents do you look for?

 

[KLXAnesthesia]

Agree wholeheartedly. Senior people had no 80 hr rule, nor CRNAs to get them out for naptime or study break, moonlightlighting was "you get to do another case or two before you go home." Believe me they will not take kindly to questions that can be construed as "how hard will I have to work?" They'll offer that stuff up voluntarily. Act like you want to work hard and be dismissive of getting out early. Doing lots and lots of cases start to finish is the way to get good.

It's this sort of attitude that is ruining programs that are unwilling to get with the current market landscape and eventually end up having to scramble multiple spots like UCSF did in 2005. Respectully, please spare us the old pre-ACGME walking up hill both ways in the snow talk.

I belive that my fith point is by far the most important question I listed and probably should have placed it at the top. The list is in no way listed in order of importance. The entire focus of my post is to ensure that potential applicants are getting the best educational opportunity possible, and are not a bridging service that keeps money making ASA1 rooms available when the payed providers need to leave before the group has start paying them overtime. I do not encourage anyone to ask how hard they have to will be expected to work. Instead make sure that the amount of work equals the amount of education. Doing lots of ASA1 cases start to finish does not make you a good anesthesiologist, nor does doing lots of ASA3 cases without adequate instruction. That type of training will not make you competitive in a VERY competetive market.

Ask generic questions and you will get generic answers.

 

[Cardio2b]

It's this sort of attitude that is ruining programs that are unwilling to get with the current market landscape and eventually end up having to scramble multiple spots like UCSF did in 2005. Respectully, please spare us the old pre-ACGME walking up hill both ways in the snow talk.

I belive that my fith point is by far the most important question I listed and probably should have placed it at the top. The list is in no way listed in order of importance. The entire focus of my post is to ensure that potential applicants are getting the best educational opportunity possible, and are not a bridging service that keeps money making ASA1 rooms available when the payed providers need to leave before the group has start paying them overtime. I do not encourage anyone to ask how hard they have to will be expected to work. Instead make sure that the amount of work equals the amount of education. Doing lots of ASA1 cases start to finish does not make you a good anesthesiologist, nor does doing lots of ASA3 cases without adequate instruction. That type of training will not make you competitive in a VERY competetive market.

Ask generic questions and you will get generic answers.

I see your point, but I would try to gain work hours, call schedule information from the residents, and even then try not to look like a whiner.

Recently we had an interviewee who kept asking obvious questions about work hours, numbers of patients we carry during intern year etc. etc. Those are fair, and good, questions for residents, but even so this "candidate" was over the top to an extent that all of the residents, including myself, noticed this in its excess.

I think you need to get a "feel" for a program and work hours and call are very important to know. But, if a program doesn't volunteer that information (say during the chit chat with the PD) readily, and the residents don't bring it up, just be strategic and somewhat careful how you approach those subjects because the reality is that people will form opinions if you come off as a slacker.

 

[loveumms]

I disagree with this:

-You should rarely relieve CRNA's in my mind. My logic is that CRNA's are employed to make money for the program, and when you take a room over from them did the room somehow magically becoming a learning case? Hardly. Be VERY wary of programs that consistently have residents relieving CRNA's at the end of the day, no matter what the excuse is.


At my program, CRNAs work 40 hours a week. That is what they signed up for and that is their contract. They occasionally would relieve us however, most of the time we would relieve them. Bottom line, residents and attendings take call (our CRNAs did not). So, it happens that sometimes the residents are relieving the CRNAs b/c they have to go home and the resident is taking call.

EVERY single case you do is a learning case, whether you see it at the time or not. The more cases you do, the slicker you get and the more expansive your experience. Even those healthy lap appys are learning cases. If you are naive enough to think that you are only learning from the sick patients or the complex cases then you still have quite a bit to learn. Every single patient has something to teach you. Just look a little deeper and think outside the box.

Let me just put this out there and some of you may disagree. I realized this late in my CA-1 year and wish I had discovered it earlier. You have three years to learn the language of anesthesia, what you need to know in order to become a consultant. If you are being relieved every day at 3pm by CRNAs you are losing time a lot of time. Time that is important to your training and development. Just a few hours every week adds us to quite a bit of time over three years. Yes, you need time to read and learn the concepts however, it's just as important to get the on the job experience.