whats important

[COhiker]

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I'll take the bait.

What do you think we should be looking for (or should have looked for)? What is important to ask and how would you suggest we interpret the answers? (Do residents or faculty have enough perspective to give information which would allow you to really compare places?)

If the interview is so important from a program's perspective, should it be equally so from our own? This question relates to the above: how should we be gathering info as applicants?

 

[stephew]

I'll take the bait.

What do you think we should be looking for (or should have looked for)? What is important to ask and how would you suggest we interpret the answers? (Do residents or faculty have enough perspective to give information which would allow you to really compare places?)

If the interview is so important from a program's perspective, should it be equally so from our own? This question relates to the above: how should we be gathering info as applicants?

Its a fair question.
Ill answer this on another thread.
steph

 

[RadOncMan]

Another thing I note is what people perceive as important. I noted this on the interview thread as well. I note applicants continually underweight the role of interview.

WHILE I AGREE THAT THE INTERVIEW CAN MAKE OR BREAK A CANDIDATE, I WOULD BE VERY SURPRISED IF CANDIDATES WERE RANKED SOLELY ON THE BASIS OF THE INTERVIEW. I WOULD THINK THAT THE INTERVIEW PROBABLY SCREENS OUT A FEW CANDIDATES BASED ON INCOMPATIBLE PERSONALITY, POOR KNOWLEDGE OF THE PROGRAM, OR LACK OF SINCERITY AND LOCKS IN A FEW THAT COME ACROSS WITH A CHARMING, SINCERE, AND EXTREMELY LIKEABLE PERSONALITY. FOR OTHERS, THERE MAY BE PARTICULAR QUALIFICATIONS THAT SUPERSEDE THE INTERVIEW UNLESS THE CANDIDATE COMPLETELY BOMBED OR KNOCKED THE SOCKS OUT OF EVERYONE, I.E. HAVING COMPLETED AN ELECTIVE ROTATION AND IMPRESSING THE CHAIRMAN ON THAT ROTATION, FIRST AUTHORSHIP ON A SEMINAL PAPER ON A RADIATION ONCOLOGY ORIENTED TOPIC IN THE NEJM, OR INCONSISTENT PERFORMANCE ON CLINICAL ROTATIONS. THEN FOR THOSE CANDIDATES IN THE MIDDLE OF THE PACK WHO ALL LOOK SIMILAR ON PAPER, THE INTERVIEW WILL PROBABLY BE THE DECIDING FACTOR. IS THIS PERCEPTION CORRECT STEPHEW?

I DON'T KNOW ABOUT YOU, BUT I WOULD HAVE BEEN HAPPY WORKING WITH OVER 80% OF THE CANDIDATES I INTERVIEW WITH, AND I REALLY DIDN'T THINK THERE WAS THAT MUCH TO DISTINGUISH AMONG THEM JUST BASED ON THE INTERVIEW. MOST PEOPLE I MET WERE FRIENDLY, SINCERE, AND LAID BACK. THEY ALL COULD "TALK" AND I FELT A PERSONAL CONNECTION WITH MOST OF THEM.

 

[stephew]

reading all caps is difficult-
i never said that people were ranked "Solely" on their interview. but you would be very surprised I think to know how much movement there is based on the interview. Its not merely screening out a few candidates as you say. In fact the more competitive the field I think the more important the interview becomes. And Ive seen people who have academia not at all unlike your NEJM example who were ranked quite low (effectively off the list) because of the interview. They weren't bad personalities necessarily per se, but qualities the program put an emphasis on were lacking.

Essentially Id leave it at this; in this day and age in radonc, the interview can make or break you and its not just a matter of "outliers" somebody really odd who looks good on paper, or someone who just made the cut academically who wows you. The whole list is really an amorphus blob until the interview. There is no way you could "prerank" the candidates prior to interview and be even close to right. I think its increasingly clear to me that candidates dont appreciate the personal dimensions evaluated-accurately or not- come interview time. This has now been something ive observered at more than one place and at a few rounds of interview season. Id be curious if nay-sayers feel differently after they've been on the other side of the fence for a couple of rounds.
Steph

 

[stephew]

I'll take the bait.

What do you think we should be looking for (or should have looked for)? What is important to ask and how would you suggest we interpret the answers? (Do residents or faculty have enough perspective to give information which would allow you to really compare places?)

If the interview is so important from a program's perspective, should it be equally so from our own? This question relates to the above: how should we be gathering info as applicants?

Ok, so first let me reiterate that this is a fuzzy topic and i'm just offering my view, which is from the standpoint of someone just over the fence.

I think you need to look for things from the standpoint of resident happiness; not do they feel proud of their program, but are they happy? and "listen" in between the lines. Is there a lot of whining if you tune your ear to that frequency? Do they feel intimidated? Scutted? Are they taught? Do they learn independent behaviors? As for technology, new technology is cool and fun BUT beware the place that gets every new gadget- two reasons; the first is that you want a place that has throught through the different advantages and disadvantages to each new toy; remember, novalis, cyberknife, tomo, gamma knife, triology, etc, all these things are concentric circles that overlap a bit. You as a med student probably dont know all the dimensions involved in making a choice, and often attendings dont either. You are more interested in if they have the reasonable mod cons, have vision, and have thoughtfulness. Dont ask me how you figure that out at this point. I've no idea.
Should the interview be "as important" from your own perspective. Ideally? Yes of course. Realistically? Its a buyers market-the programs are making the choice. If you have any choice youre fortunate. But yes, go into it with your eyes open. Decide if a place is so malignant you wont go there and will risk not matching.

You ask a very interesting question; do residents or faculty have enough perspective to give you a comparison. Probably, often, they dont! But you, going from place to place, cal really listen to the residents and see which impresses you most. Where do they seem taught, happy, hardworking but not overwhelmed.

I think you're gathering info as best as anyone can. but i would say listen very closely to others also gathering info. Usually, when you get enough people commenting about a place, the truth is teased out. One varying view should be seen as just that. Thus please, everyone, add more to the Rankings list.
stpeh

 

[Ursus Martimus]

Realistically? Its a buyers market-the programs are making the choice. If you have any choice youre fortunate.

I would tend to disagree somewhat with this statement. And if it was true there would be limited utility to making a "feelings about programs list", as we wouldn't have much a choice anyway. As well, this tends to be a discouraging statement for the next cycle of amplicants, regardless of how though the match may seem.

That aside, I would still be interested in seeing a compilation of objective measures of each program, as described in a previous thead. Seems like someone can argue about the dynamics in different departments or reputations, but things like # of faculty members, equipment, research activities are hard to argue about. Just some thoughts.

 

[stephew]

I would tend to disagree somewhat with this statement. And if it was true there would be limited utility to making a "feelings about programs list", as we wouldn't have much a choice anyway. As well, this tends to be a discouraging statement for the next cycle of amplicants, regardless of how though the match may seem.

That aside, I would still be interested in seeing a compilation of objective measures of each program, as described in a previous thead. Seems like someone can argue about the dynamics in different departments or reputations, but things like # of faculty members, equipment, research activities are hard to argue about. Just some thoughts.

That may be true but I dont really see how that contradicts my point. Obviously if you have choice, your feelings regarding a program are very important. Your feelings about what's going on around you are always important. The point of my statement that you quote is simply that many people do not have a choice. This is unfortunate but true. If only one program is going to rank you high enough for you to match, your feelings -again unfortunately- only come into play insofar as they direct whether you rank them at all. Obviously how happy you'll be going there the big question. So should we not post our impressions because for some its of limited utility? Well i guess if you want to take a pig in a poke then it wouldnt be worthwhile. I'd still think its worth knowing.

The so-called objective measures aren't quite so objective. Or they are but dont quite measure anything can actually get your arms around. This isnt to say their not important issues. Number of faculty doesnt imply a better or weaker dept. Equipment actually I think is very easy to argue about, as I previously noted, as are research activities. Take a program like Pittsburg with a top CNS site. It may not be the apex of basic sci resaerch activity but its a top center if you are clinically cns oriented. And so on. Physics is strong at other places, radiobio at others etc. Like radiolabelled targeting? Dont come to the harvard program. Like IORT? Go to Ohio. I know of places sick with RTOG studies. That have some of the most unhappy residents I've ever met who feel neglected. Etc. Which of the above is right for you? It depends on your bent, if you know what it happens to be at this stage in your career. Which would be impressive.

Again this stuff is all extremely important, but I think there a little more relativism involved than is occasionally appreciated.

I agree that someone can argue about reputations and dynamics and I fully qualified my own thoughts with that notion. I think in the end what is most useful is a body of impressions that build up a picture to you. I'm more impressed by 10 people talking about their experince somewhere specially than what an attending told one person at an interview etc. The most impressions/rankings postings, the more useful I think they become.

 

[Ursus Martimus]

Equipment actually I think is very easy to argue about.

I get the impression that you would argue about almost anything. If I said a site just got a tomotherapy unit you, would argue that tomotherapy is not completely validated. By listing the number of faculty members, only a simpleton would translate bigger to mean better, however no one could argue that a dept of 12 is bigger than a department of 5. But then again, you would probably polute the site with some argument to the contrary. A cataloging of program parameters allows people to decide what is truely important to them - no commentary, no biases. Just numbers.

 

[stephew]

I get the impression that you would argue about almost anything. If I said a site just got a tomotherapy unit you, would argue that tomotherapy is not completely validated. By listing the number of faculty members, only a simpleton would translate bigger to mean better, however no one could argue that a dept of 12 is bigger than a department of 5. But then again, you would probably polute the site with some argument to the contrary. A cataloging of program parameters allows people to decide what is truely important to them - no commentary, no biases. Just numbers.

i agree with you. 100%. No argument.

 

[COhiker]

I quickly learned on the interview trail that there is no matrix one can create to figure out the best place for you. Even if you use hard number (faculty, toys, book fund...) all that disappears when you show up to interview and the residents are all glum. I expected this going into the interview process. Therefore, I made up post-interview sheets which I would fill out allowing for on-the-spot impressions to be recorded along some standard axes. I truly believed this would allow me to uniformly and reliably record impression. I then imagined returning to my excel sheet and dutifully inputting all the “data.” Following my last interview, I would merely tabulate the info and presto, my rank list would be created.

Needless to say, the plan fell apart immediately. I found that my impression of a place was usually based on intangibles – things I didn’t have the vocabulary for (as one can note if they read my previous post in the “rankings” thread). These were usually so nebulous that I couldn’t quantify them into an excel sheet. So I tossed the sheets, relaxed, and decided that my gut would lead the way. Who knows if this was the “right” way to do it.

I bring this up only to say that while indisputable facts about programs would be helpful at a baseline, it becomes drastically less important post interview (for me anyway). I can convince myself that UNC for example – a program I thought was great – was the perfect place for me one day, and the next, that Stanford is and going to such a small program in Chapel Hill would only hold me down. Everyone makes decisions differently and I think the more information we can all have at our disposal the better.

 

[RadOncMan]

Stephew,

Any insight into the "qualities" programs look for when evaluating applicants based on the interview? It doesn't seem like applicants can do a whole lot to improve their standing at this stage as it appears that much of the subjective evaluation is by nature subjective.

 

[stephew]

Stephew,

Any insight into the "qualities" programs look for when evaluating applicants based on the interview? It doesn't seem like applicants can do a whole lot to improve their standing at this stage as it appears that much of the subjective evaluation is by nature subjective.

I think cohiker is right about the interview experience. Its a tough thing.

As for qualities. Well i can only speak for what became salient in the places I've been but at least that was fairly consisnent.

1) while research guys are attactive on paper, every year I see a lot dropped considerably on the list at interview because it became clear that their interest in medicine and taking care of patients was secondary at best. They no doubt will contribute to the field in their way, but programs want *physicians* who will contribute to the field, not lab guys who "have" to see patients.

2)Ever-elusive character. Save to say its hard to describe but we know it when we see it in life. So without going into specifics which I think ultimately will take us further away from getting at the kernal of it, Id say its the stuff that makes you call a person a "mench" or "decent" or "solid" or "a great guy/gal". Poeple who've been able to radiate that wind up on top. Also usually, you see it cooborated in letters of rec which we worry about if they only regurg a candidate's concrete accomplishments. We can see that on the cv. When they go more into the wonderfulness of the person, it stands out. On the flip side, someone who is arrogent, presumptuous, seems to solicit only the people he feels are "important" and treats others indifferently gets knocked down far. No one wants that around. The negatives seem to be much easier to list.

3)warmth. Probably part of the above, but this is something I think is valued. Coupled with someone who can honestly articulate themselves, this is prized. Someone who is clearly bright but sort of a stick doesnt move in the list. Others move around him. Someone who is bright and warm will move up. Again this gets back to the clinical side of things. We all want the universal solider; the Md-Phd who will create some transitional marvel and bring it to the bedside, who bonds with patients and is a great clinician. What happens at interviews is that this 2nd half really moves you. Everyone we see now adays is a top student. Someone who is a great person is noted.

I think at this point Im being redundant. Save to say that even if you dont believe my emphasis on the interview, what harm is there in at least taking it to heart when your time comes?

 

[stephew]

something some one said to me at my interview came back while musing this thread over; Radonc is a very *very* small field. You really know just about everyone after while, particularly in academics. Never forget that. You of course can like or dislike anyone, but it behooves you to keep it to your self and act graciously to all. One really shouldn't need to be told that; after all, that's what being a professional is all about and we expect this, or would like to, from doctors in particular. But again, if the morality of it all doesnt appeal to you, remember, its a small field. On your interviews, don't bad-mouth other people or places. Even if your commentary doesn't manage to insult anyone's friend, remember that people are happy to hear gossip about others on the one hand, while dinging you for being a gossip on the other.

 

[RadOncMan]

There is definitely a big dilemma with anyone interested in going into research - particularly basic/translational. To do both clinical and research work well is almost impossible, and there are very few if any Radiation Oncologists that have done it well - at least on par with clinicians in other specialties. Personally I can't think of any Radiation Oncologists that have been successful in obtaining HHMI research funding and very few that have produced work of sufficient merit that would warrant admission into the National Academy of Sciences based on such work. There are certainly many that think they do both well and also many that publish "token" research that will never impact how Radiation Oncology will ever be practiced in the future. Not only does such token research take time away from their own clinical responsibilities, but also it takes away important resources from those that are truly commited to furthering our understanding of the field.

I think there is a big misunderstanding in the Radiation Oncology field regarding the time commitment required to pursue research of any potential to affect the field in paradigm shifting ways - research of sufficient novelty, rigor, depth, relevance, and general interest to those outside the field (essentially a paraphrasing of the criteria for submission to journals such as Nature Medicine, Science, and Cancer Cell). While I think it's important for Radiation Oncologists to become as clinically competent as possible, anyone who thinks they can spend less than 80% of their time doing research is kidding themselves if they think their research will ever be of any significant impact. From speaking with various Nobel Laureates as well as distinguished physician-scientists that have been successful in completing both clinical and research work, I would also seriously question their interests in research if they did (seriously, how many applicants to academic radiation oncology programs honestly admit they have no interest in academia even if they don't? isn't it frightening how many of us in medicine lack the integrity to tell the truth when we purposely sidestep a question by stating that I'm not sure yet or I'd be willing to consider it when we know deep down that is not the case?). Does this mean that future physician-scientists who are not satisfied with the current standard of care and are interested in realizing a vision where one day cancer will be eradicated lack commitment to taking care of patients? No, it's simply being realistic and having a deeper understanding of the commitment that's necessary to not fall into the trap of a jack of all trades/master of none situation that typifies many currently in the Rad Onc field. While I think it's possible to become an exceptional clinician doing 20% clinical work/80% research work (who do you think will know the protocol better than the person that created it and has asked serious questions about why one protocol will be better than another?), I think it's virtually impossible to become an exceptional researcher - even with 50% research time.

 

[Butch]

I would like to make a few comments with regards to prioritizing Radiation Oncology residency programs and the previous comments of RadOncMan. I was a recently accepted applicant (starting PGY-2 in 2006), so my views/opinions are backed only by a limited experience.

First, it seems to me that many of the "objective" measures of programs are flawed. Honestly, the quantity of papers put out by a department will not affect your residency one bit.

SO, the considerations (not in rank order) ...

1. Location, location, location. Just like real estate. You have to like the area of the program where you will live for four years.

2. People. The radiation oncology training model is one-to-one instruction in the clinic and slightly larger groups for conferences. You will be working with the faculty and other residents directly and spend a lot of time with them. Although faculty at the places I interviewed at all seemed easy-going, I tried to discern who I would really love working with for four years. Also, look at the other residents.

3. Equipment is over-rated. I saw many applicants on the interview trail making extensive inquiries into the exact technologies that various programs had. Given that a program has the basics, the exact nature of the equipment should be relatively unimportant. As a resident, it is far more important to learn about principles of treatment, medical physics, and the pathophysiology of the various human malignancies. If these principles are mastered, the specifics of equipment are not particularly difficult to figure out. There are obvious exceptions to this rule. If one's passion is cyberknife research, the presence of a cyberknife is important.

4. Character and leadership. The leadership of the department sets the tone and tempo. The chairman and program director will guide you during residency and help you find a job. I looked at the individuals in these positions closely. It is to your advantage to figure out if they are planning on staying. The character of the department reflects its goals. Research. Clinical. A balance. RTOG-oriented, high or low patient volume, and degree of collaboration with other departments. Character and leadership matter. I would advise future applicants to consider whether or not you fit into a given department and whether there are shared goals.

5. Research. I am an MD-PhD and pursuing research is an important goal. I agree with the previous comments about the difficulties of doing research. I found that the attitude towards research varies widely amongst programs. Some programs are relatively hostile towards applicants interested in basic science research. I do not blame them (many are exceptional programs when it comes to clinical radiation oncology).

I ended up matching at a great program that almost never appears on the top research programs in this forum. However, they are very supportive of research (considering Holman and extended research options) ... more so than many of the supposed top research programs. Also, I would wonder about a program has outstanding basic scientists but will not give you time to work with them.

6. Ranking is not that important. Again, ranking is not that important. Lots of discussion and critical thought has gone into the ranking blog on this forum. I do not mean to take away from it. However, one should go to a program where one fits in and will excel rather than one that has the highest name recognition. I think the tier system is a superior way of thinking about programs in comparison to a 1-2-3-4 ranking system.

7. The intangibles somehow come across on interview day. Listen to you gut. It is telling you something. Although all of the psychology studies suggest that these first impressions can be flawed, I felt that I was able to learn a great deal about a program on the interview day(s). I would advise future applicants to have frank (NOT antagonistic) discussions with the current residents. If a program does not give you a lot of opportunity to interact with the resident, be careful ... be very careful.

8. Connections are critically important. Somehow, very little attention has been given to this point, but it is true. To future applicants, this is more important than you realize. It is a competitive field and there are many qualified applicants.

 

[stephew]

I have to say that butch makes some very good points.
In a more articulate way that I did actually.

And he raises excellent point number 8. Now, of course if you are in a low profile program, that's not a death knell; you just do an away rotation in residency or get to know folks at astro or whatever and cultivate connections. but its easy when these guys are your PD or chairman.