Why do elite psych residency programs interview so many applicants?

[wellbutrin.girlfriend]

Can anyone offer a look behind the curtain on this? Why would an elite program interview ~10x the number of spots they have available? I can't imagine they drop very low on their rank list.

As an applicant, it feels like getting an interview at an elite program is less meaningful and less reflective of actually having a chance to match there than at other less desirable programs. While this may be true, I think understanding programs' reasoning or objectives for interviewing so many applicants will help me feel less pessimistic about it.

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[mistafab]

I think you're misunderstanding what it means to be interviewed.

At the elite program I was at, everyone who was interviewed would generally be enough on paper to match there. The interview meant a lot in terms of shifting your position on their rank list.

Basically, before even interviewing you, they have a general idea of where you are positioned in the rank list. Then the interview becomes the major factor in shifting people up or down based on multiple factors as well as 'fit.' The most important area for the program to discern rank list becomes "the bubble" - aka, the area on the threshold of matching or not matching. So, if they end up always filling in the top 35 ranked spots (for example), that means that numbers 25-45 is a fierce competition, and they spend a huge amount of time trying to make that order as accurate as possible.

If you're interviewed, you can match.

 

[comp1]

So there's no standardized test that reflects well how someone will do in psychiatry residency. I'm not saying pass. Almost everyone passes, but DO, like interact with other people. Letters of rec can be useful, but they tend to be grossly generic and you never know how many people declined to write the letter. They interview so they can weed out, as best as possible, people who are going to have serious interpersonal issues.

 

[wellbutrin.girlfriend]

I think you're misunderstanding what it means to be interviewed.

At the elite program I was at, everyone who was interviewed would generally be enough on paper to match there. The interview meant a lot in terms of shifting your position on their rank list.

Basically, before even interviewing you, they have a general idea of where you are positioned in the rank list. Then the interview becomes the major factor in shifting people up or down based on multiple factors as well as 'fit.' The most important area for the program to discern rank list becomes "the bubble" - aka, the area on the threshold of matching or not matching. So, if they end up always filling in the top 35 ranked spots (for example), that means that numbers 25-45 is a fierce competition, and they spend a huge amount of time trying to make that order as accurate as possible.

If you're interviewed, you can match.

It's just hard for me to imagine that an interview can make such a vast impact that it warrants interviewing 160 people for a program that fills within their top 35 ranked spots. It doesn't seem realistic that someone ranked near the bottom of their 160-person pre-interview rank list could interview well enough to bypass over 120 people.

They interview so they can weed out, as best as possible, people who are going to have serious interpersonal issues.

I think my suspicion especially applies when I've heard the above so often-- that an interview primarily serves to disqualify people with obvious interpersonal red flags.

 

[mistafab]

It's just hard for me to imagine that an interview can make such a vast impact that it warrants interviewing 160 people for a program that fills within their top 35 ranked spots. It doesn't seem realistic that someone ranked near the bottom of their 160-person pre-interview rank list could interview well enough to bypass over 120 people.

I think my suspicion especially applies when I've heard the above so often-- that an interview primarily serves to disqualify people with obvious interpersonal red flags.

The 35 example is just an example. Each program has their own range they typically rank at. The interview is the most important factor for shifting people up or down. A lot ends up being "fit" that comes out during the interview (up or down), and major flags that shoot people down. The interview is VERY important for matching psychiatry.

I will reiterate again that if you are offered an interview - you have what it takes on paper to match there.

 

[TexasPhysician]

First - you don’t want to go unmatched.
Secondly - Top students interview at many top programs.
Third - the numbers aren’t as good as you think. Say you have 6 spots. Even a pretty good program can drop 30-60 spots to fill. To be sure you don’t go unfilled, err for caution and interview 90.

 

[calvnandhobbs68]

First - you don’t want to go unmatched.
Secondly - Top students interview at many top programs.
Third - the numbers aren’t as good as you think. Say you have 6 spots. Even a pretty good program can drop 30-60 spots to fill. To be sure you don’t go unfilled, err for caution and interview 90.

Yeah, OP this is why there's random program "surprises" every year in most specialities where some program will seemingly randomly not fill all their spots or matches way lower down their rank list than usual. A lot of people are interviewing at all the same programs and they can all only match at one place. I wouldn't get discouraged by the fact they interview so many people at all, it's wayyy better to interview and rank a bunch of people than to have unmatched spots you have to fill in SOAP.

 

[HaileyMed]

It's just hard for me to imagine that an interview can make such a vast impact that it warrants interviewing 160 people for a program that fills within their top 35 ranked spots. It doesn't seem realistic that someone ranked near the bottom of their 160-person pre-interview rank list could interview well enough to bypass over 120 people.

I think my suspicion especially applies when I've heard the above so often-- that an interview primarily serves to disqualify people with obvious interpersonal red flags.

To the bolded... It can.

Especially at top schools where they're trying to find diamonds in the ruff.

Obstacles overcome, social connections, interpersonal skill and predicted life trajectory (with and without support) all matter. They want people who will be most successful (to reinforce their branding) and to support them in getting there to make the school/program look good and have clout. That takes a lot of work to find and you need a lot of potential candidates to do it well.

 

[Stagg737]

To the bolded... It can.

Especially at top schools where they're trying to find diamonds in the ruff.

Obstacles overcome, social connections, interpersonal skill and predicted life trajectory (with and without support) all matter. They want people who will be most successful (to reinforce their branding) and to support them in getting there to make the school/program look good and have clout. That takes a lot of work to find and you need a lot of potential candidates to do it well.

I'd have believed this 5 years ago. I'm not convinced any of these places can get a good enough feel of an applicant via a 30 minute Zoom interview to make this a reasonable practice. I'm not saying some places don't do this, but expecting that 30 minutes on Zoom is somehow going to truly clarify the picture versus an in depth application is naive. A LOT is lost through wifi and I say this as someone who does a fair amount of telehealth.

 

[thelastpsych]

I'd have believed this 5 years ago. I'm not convinced any of these places can get a good enough feel of an applicant via a 30 minute Zoom interview to make this a reasonable practice. I'm not saying some places don't do this, but expecting that 30 minutes on Zoom is somehow going to truly clarify the picture versus an in depth application is naive. A LOT is lost through wifi and I say this as someone who does a fair amount of telehealth.

That is my take as well...aside from obvious red flags, is it truly revealing a 30min interview? What is the evidence that it can select the most fitting candidates? From what I recall, job interviews and such fail to select the best workers, and mostly rely on the interviewer biases.

 

[Stagg737]

That is my take as well...aside from obvious red flags, is it truly revealing a 30min interview? What is the evidence that it can select the most fitting candidates? From what I recall, job interviews and such fail to select the best workers, and mostly rely on the interviewer biases.

To clarify, I agree with @mistafab that it can absolutely shift people up and down a few places or move a great interviewer 5 spots over a terrible interviewer. I don’t believe that it’s going to move someone 80 spots up from barely making the list to a near rank-to-match position though. It certainly doesn’t where I’m at (mid-tier academic).

 

[J ROD]

Scores are less important in psychiatry than other specialties. We preferred to rank folks we would want to work with and fit with the program. I can remember someone with all the numbers and weird as hell. Did not rank them. Blackballed. Rather go unmatched than have that person in the program. What is a "top" program is relative as well. But I digress......

 

[psych_0]

I'd have believed this 5 years ago. I'm not convinced any of these places can get a good enough feel of an applicant via a 30 minute Zoom interview to make this a reasonable practice. I'm not saying some places don't do this, but expecting that 30 minutes on Zoom is somehow going to truly clarify the picture versus an in depth application is naive. A LOT is lost through wifi and I say this as someone who does a fair amount of telehealth.

30 min? Lol. Our interview slots are 15 minutes, and STILL people end the interview early. Seems like at least 1 applicant every interview days has connection issues which lead to video/audio issues. I might be in the minority, but I personally HATE virtual interviews.

 

[Stagg737]

30 min? Lol. Our interview slots are 15 minutes, and STILL people end the interview early. Seems like at least 1 applicant every interview days has connection issues which lead to video/audio issues. I might be in the minority, but I personally HATE virtual interviews.

That’s not even an interview, lol. I also hate virtual and I would have loathed them as an applicant.

 

[HaileyMed]

I'd have believed this 5 years ago. I'm not convinced any of these places can get a good enough feel of an applicant via a 30 minute Zoom interview to make this a reasonable practice. I'm not saying some places don't do this, but expecting that 30 minutes on Zoom is somehow going to truly clarify the picture versus an in depth application is naive. A LOT is lost through wifi and I say this as someone who does a fair amount of telehealth.

I 100% agree with you that an interview (virtual nor in-person for that matter) isn't going to get you the most aligned accurate representations of an individual. However, my only point was that these are the reasons ranks can sway so much. And yeah, definitely can swing a person significantly. In my old program people could swing wildly in our rank meetings depending on how things went (especially if they had also rotated with us and had attending attestations). I'm sure it's program dependent, but yeah, people swinging significantly is possible in interviews and rank meetings. I'm sure it depends on the university.

 

[psych_0]

At our program, interviews are highly weighted. If someone comes off as incredibly weird or antisocial, they can drop to the bottom of our rank list, or even be taken off the list completely during the rank list meeting. And we are not a competitive program by any means...

 

[Justice1071]

At our program, interviews are highly weighted. If someone comes off as incredibly weird or antisocial, they can drop to the bottom of our rank list, or even be taken off the list completely during the rank list meeting. And we are not a competitive program by any means...

Anything in particular that moves them up the rank list?

 

[psych_0]

Anything in particular that moves them up the rank list?

Honestly, just being able to have a regular conversation moves you up the list. It's wild how many absolutely dull and painful interviews I've sat through. Some look miserable and disinterested. When I ask if they have any questions, some people just say no. This is YOUR opportunity to learn whether or not you want to spend the next 4+ years of your life here, I expect that you at least have 2-3 pre-thought out questions. You can even ask them to multiple people who interview you so you can compare answers.

Some people dress like they're in a theater play or clown show. We're talking bright pink glasses, obnoxious lipstick, or men hair not even combed looking like they just rolled out of bed. Some people list research activities and when I ask about it, they can barely explain what it was about. Idk, I could go on and on. If it looks like you put zero effort into this interview, I am going to put 0 effort into scoring you highly on our internal ranking system.

What stands out the most is applicants who just come off as normal human beings. Someone you can tell isn't putting on an act or seems genuinely interested in matching at the program and not just running through the motions of virtual interview #14 of 30.

Lastly, our program puts weight into thank you notes and attending our second look events. Personally, I think this is a joke, but I'm not the PD and I don't get the final say on our rank list.

 

[Justice1071]

Honestly, just being able to have a regular conversation moves you up the list. It's wild how many absolutely dull and painful interviews I've sat through. Some look miserable and disinterested. When I ask if they have any questions, some people just say no. This is YOUR opportunity to learn whether or not you want to spend the next 4+ years of your life here, I expect that you at least have 2-3 pre-thought out questions. You can even ask them to multiple people who interview you so you can compare answers.

Some people dress like they're in a theater play or clown show. We're talking bright pink glasses, obnoxious lipstick, or men hair not even combed looking like they just rolled out of bed. Some people list research activities and when I ask about it, they can barely explain what it was about. Idk, I could go on and on. If it looks like you put zero effort into this interview, I am going to put 0 effort into scoring you highly on our internal ranking system.

What stands out the most is applicants who just come off as normal human beings. Someone you can tell isn't putting on an act or seems genuinely interested in matching at the program and not just running through the motions of virtual interview #14 of 30.

Lastly, our program puts weight into thank you notes and attending our second look events. Personally, I think this is a joke, but I'm not the PD and I don't get the final say on our rank list.

Thanks for the thorough reply. I see this gets asked a lot, but the answers are pretty general. This is one of the best answers I've seen and I appreciate it!

 

[Merovinge]

Honestly, just being able to have a regular conversation moves you up the list. It's wild how many absolutely dull and painful interviews I've sat through. Some look miserable and disinterested. When I ask if they have any questions, some people just say no. This is YOUR opportunity to learn whether or not you want to spend the next 4+ years of your life here, I expect that you at least have 2-3 pre-thought out questions. You can even ask them to multiple people who interview you so you can compare answers.

Some people dress like they're in a theater play or clown show. We're talking bright pink glasses, obnoxious lipstick, or men hair not even combed looking like they just rolled out of bed. Some people list research activities and when I ask about it, they can barely explain what it was about. Idk, I could go on and on. If it looks like you put zero effort into this interview, I am going to put 0 effort into scoring you highly on our internal ranking system.

What stands out the most is applicants who just come off as normal human beings. Someone you can tell isn't putting on an act or seems genuinely interested in matching at the program and not just running through the motions of virtual interview #14 of 30.

Lastly, our program puts weight into thank you notes and attending our second look events. Personally, I think this is a joke, but I'm not the PD and I don't get the final say on our rank list.

We had an applicant that took of his shoes in all the interviews. Almost everyone commented on it. Oh what is lost in Zoom.

That said, it's certainly the case that there is still something to be said about looking for people who can have regular conversations. I was a really mediocre applicant based on overall grades/scores but repeatedly was told that my ability to have a regular conversation is what helped me match. We just now need to filter out how much is being awkward on Zoom versus overall conversational skills.

 

[Stagg737]

We had an applicant that took of his shoes in all the interviews. Almost everyone commented on it. Oh what is lost in Zoom.

That said, it's certainly the case that there is still something to be said about looking for people who can have regular conversations. I was a really mediocre applicant based on overall grades/scores but repeatedly was told that my ability to have a regular conversation is what helped me match. We just now need to filter out how much is being awkward on Zoom versus overall conversational skills.

Not to derail, but that reminds of a story from a neuro colleague. Pre-COVID during an in-person interview they had to use the bathroom between applicants. When they walked back in the next interviewee had taken her shoes off and had her feet kicked up ON THE INTERVIEWERS DESK. Apparently, she didn't even take them off until my colleague asked her to, never apologized, and just went on about the interview like she didn't do anything wrong. Oh the things we've lost through virtual days...

 

[Candidate2017]

What stands out the most is applicants who just come off as normal human beings. Someone you can tell isn't putting on an act or seems genuinely interested in matching at the program and not just running through the motions of virtual interview #14 of 30.

That said, it's certainly the case that there is still something to be said about looking for people who can have regular conversations. I was a really mediocre applicant based on overall grades/scores but repeatedly was told that my ability to have a regular conversation is what helped me match.

The more I do this, the more I realize people "who come off as normal human beings" and "able to have a regular conversation" are abnormal. They are far ahead of everyone else.

 

[LeaveNoTrace]

Scores are less important in psychiatry than other specialties. We preferred to rank folks we would want to work with and fit with the program. I can remember someone with all the numbers and weird as hell. Did not rank them. Blackballed. Rather go unmatched than have that person in the program. What is a "top" program is relative as well. But I digress......

I'm curious: do these weird people get straight up blacklisted if they decide to try their luck a second or third time, or do they get a nominally fair shot?

 

[comp1]

If someone had severe interpersonal issues during an interview, I can't imagine them getting another interview unless there was a major mitigating factor that was fully described in a second application. Even then...there are plenty of other applicants.

 

[thelastpsych]

Not to derail, but that reminds of a story from a neuro colleague. Pre-COVID during an in-person interview they had to use the bathroom between applicants. When they walked back in the next interviewee had taken her shoes off and had her feet kicked up ON THE INTERVIEWERS DESK. Apparently, she didn't even take them off until my colleague asked her to, never apologized, and just went on about the interview like she didn't do anything wrong. Oh the things we've lost through virtual days...

I cannot comprehend someone having this little prefrontal cortex to pull something like that, ESPECIALLY someone who spent years and years studying to become a doctor. Only way she would have been accepted was if the interviewer was Quentin Tarantino 🤣

 

[HaileyMed]

If someone had severe interpersonal issues during an interview, I can't imagine them getting another interview unless there was a major mitigating factor that was fully described in a second application. Even then...there are plenty of other applicants.

Do most programs even keep a log of how someone's last interview was? lol

 

[comp1]

Do most programs even keep a log of how someone's last interview was? lol

Yes.

 

[LeaveNoTrace]

We just now need to filter out how much is being awkward on Zoom versus overall conversational skills.

Does that imply that any motivated person could just spend a bunch of effort and time on Zoom-specific skills and make their way through that way? I suppose it tests conscientiousness and perhaps personal or family resources...or ingenuity.

 

[LeaveNoTrace]

We had an applicant that took of his shoes in all the interviews. Almost everyone commented on it. Oh what is lost in Zoom.

Is this an example of poor interpersonal skills...or some type of chronic, painful, difficult or impossible to treat foot problem that is greatly exacerbated by shoes? Maybe the applicant didn't have the funds for treatment, orthotics, or bespoke shoes that would fit his feet.

 

[TexasPhysician]

Is this an example of poor interpersonal skills...or some type of chronic, painful, difficult or impossible to treat foot problem that is greatly exacerbated by shoes? Maybe the applicant didn't have the funds for treatment, orthotics, or bespoke shoes that would fit his feet.

Struggling on whether this is sarcasm or not? Which painful foot condition can tolerate shoes through site tours and stairs but becomes intolerable in seated interviews?

 

[clausewitz2]

Struggling on whether this is sarcasm or not? Which painful foot condition can tolerate shoes through site tours and stairs but becomes intolerable in seated interviews?

And is consistent with being able to work in a professional setting where you have to wear shoes for hours?

 

[Merovinge]

Does that imply that any motivated person could just spend a bunch of effort and time on Zoom-specific skills and make their way through that way? I suppose it tests conscientiousness and perhaps personal or family resources...or ingenuity.

I actually think everyone could benefit from a Zoom-specific social skills course. If it was done by someone with a strong empirical basis (e.g. using cameras to grade things and give feedback), I would actually pay good money for a few hours of such a course just to help with my occasional Zoom sessions. Nothing was stopping anyone from hiring a British butler to teach decorum prior to old interviews, would be very reasonable to learn skills for our video conferenced based world now.

 

[Stagg737]

Struggling on whether this is sarcasm or not? Which painful foot condition can tolerate shoes through site tours and stairs but becomes intolerable in seated interviews?

Restless foot syndrome, obviously…

 

[FlowRate]

Lastly, our program puts weight into thank you notes and attending our second look events. Personally, I think this is a joke, but I'm not the PD and I don't get the final say on our rank list.

Apparently I never clicked post on the reply I had queued up for this thread originally. But PD's doing weird things can definitely be a factor, even at top programs. I think some of them place ego into how low on their match list they go, hence this sort of odd behavior that IMO emphasizes and/or conflates "wants to be here/really likes us" over "will be a quality resident."

Our overall rank list was very significantly determined by the APD. Post-interview position on the list was very heavily based on interview day feedback. The APD ranked someone 1/100 (top of rank list) on the interview form if she "felt a spark" with the person. And 100/100 if not. So she applied a binary ranking when every other interviewer was actually thoughtful about where on the 1-100 scale they would put an applicant. Plus the PD+APD ratings were weighted more heavily than other interviews. Thus, she basically determined the top and bottom halves of the rank list, which I found really frustrating since a lot of great potential candidates who were top 1/3 for everyone else sometimes ended up in the bottom 1/3 due to APD rating 100.

 

[LeaveNoTrace]

I actually think everyone could benefit from a Zoom-specific social skills course. If it was done by someone with a strong empirical basis (e.g. using cameras to grade things and give feedback), I would actually pay good money for a few hours of such a course just to help with my occasional Zoom sessions. Nothing was stopping anyone from hiring a British butler to teach decorum prior to old interviews, would be very reasonable to learn skills for our video conferenced based world now.

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[wellbutrin.girlfriend]

Apparently I never clicked post on the reply I had queued up for this thread originally. But PD's doing weird things can definitely be a factor, even at top programs. I think some of them place ego into how low on their match list they go, hence this sort of odd behavior that IMO emphasizes and/or conflates "wants to be here/really likes us" over "will be a quality resident."

I interviewed at a well-regarded program, and in a private conversation with a resident involved in the ranking committee, the resident said that the PD will only highly rank people who send letters of intent, and when they rank their top 4 people, they know with near certainty that those are the people who will match there on Match Day. Was disappointing to know that I basically won't have a chance of matching there unless I decide they're my #1, and it does seem to speak to a strange ego component, only wanting applicants who want them over every other program.