Your interview day

[ampaphb]

To applicants who seem to put a lot of stock on how well organized your day is, how nice is the lunch spread they put out, the number of residents who show up after work to encourage you that this is the program for you, or the cost of living of a particular city:

1) The dog and pony show doesn't matter. At best, it is a reflection on the organizational skills of the coordinator and perhaps the current chief resident, but has almost nothing to do with the quality of training you will receive.

2) The best-respected programs don't need to suck up to you. Well organized interview days are like flashy ads, and when you see a program that feels the need to promote itself, you should take a step back and wonder why, rather than allowing them to pull the wool over your eyes by making you feel important for the day. And when they pull out the pain-fellowship director or the cancer rehab specialist, maybe you should wonder why they didn't focus on other more relevant areas to your residency training?

3) Almost none of the residents you meet will be in any way relevant to your time at that program. the chiefs will graduate that same year, and the third years will be graduating when you finish your internship. So the only residents that matter at all are the second years, who usually are too tired and too inexperienced to have much to say.

4) Interview day is the most important day in YOUR career. Most residents and attendings involved have patients they have to go see, notes they have to write, or families they are taking time away from to met with you. They read your CV five minutes ago. Far from being the most important thing they do today, you are probably close to the bottom of that list. Plus, they know you are going to recite the same canned answer you gave to Mayo last week, and RIC next week. You are just not that important.

In short, pay attention as much to what is not said as what is. Focus on the broad strokes of the day and your future training, not on the minutia like how far you had to walk, or whether they validated your parking.

Oh yes, one last thing - you are all going to make plenty of money. If you can't live on 200k per year, go to business school. Whether it is an expensive city to live in or not, unless you are a pauper, should pale in comparison to whether, at the end of your 3-4 years there, you will be a well-trained physiatrist. Residents in NY and Chicago make proportionately more, and have the option of staying in subsidized housing during their residency. You are worried about your debt? the difference between living in Rochester, MN and NYC for 3 yrs will likely amount to 10K, and we all know your current debt is orders of magnitude greater than that.

The only relevant question you should try to get answered on interview day is the quality of instruction you can expect to receive at that particular institution. All the rest is just smoke and mirrors. You all grew up in a media savvy world - don't be fooled by the spin, and try to keep your eye on the prize.

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[OMMFellow06]

Well said.

I know when I was applying I let my interview experience affect my ranking. I knew that it wasn't as good a program as some of the others that were on my list, but the interview day made me really want to go there over some other places.

I know that most of us equate the interview day with many things about the program b/c sometimes we don't have much else to go on. You make a good point in that we shouldn't let how well organized the interview day and how nice the lunch was make us think that is a reflection on the quality of the teaching.

It is, however, really difficult as a medical student to not get caught up with a nice lunch and facilities. I do think that programs should make an effort to make the interview experience enjoyable. But as you said, as an interviewee, you should focus what your training will be at that program, not how great/horrible your interview day was.

 

[Sandooski]

i disagree....

in our society, no matter what profession you are in or what type of educational program you are applying to, how one presents themselves matters. Thats the reason we were a white coat with shirt/tie when we see patients or people in the business world wear a suit to work. If the program does not take the time/effort to put their best face forward and has a poorly organized day, I relate that to one of the interviewees showing up late, not clean shaven, and wearing a jeans/t-shirt. When we make sure that we are clean shaven and wear a suit to our interviews, I am a better/smarter applicant? No, but your appearance is often a reflection over how you deal with other issues/responsibilities. A sloppy interview day/a sloppy applicant gives the impression that the program/applicant will handle the residents' issues/job responsibilities sloppy. It is true that programs with a poorly set-up interview day may offer great training and the applicant that shows up late inappropriately dressed may be the smartest/best applicant to interview, but I will take my chances with people/programs that care enough to take the time to respect my time.

and in terms of cost of living, I am not sure where you have lived but the difference between nyc and rochester, mn is a lot more than 10k over 3 yrs (even when you live in a old 500sqft studio in nyc). Applicants who have families and/or other responsibilities do and should take cost of living in consideration..... also by your post, it seems as though you are suggesting that you cannot be a well-trained physiatrist unless you go to a big city program.

Applicants should pick a program using all factors that will be affecting their lives, including factors outside of the programs but relevant to living in a certain area for at least several yrs.

 

[Disciple]

From the perspective of the applicant, as stated by the OP, a residency candidate should be most concerned with the quality of training they will receive, but I can understand how an applicant might extrapolate their interview experience to how he/she would be treated as a resident.

For the good of a specialty in general on the upward slope, it's definitely not a good thing for programs to present themselves less than favorably to interviewees.

 

[drusso]

I think that it does matter and for these reasons:

By and large, residency training is a standardized package of goods. The specialty boards, the ACGME, etc all work hard to ensure that the educational experience is more similar than different across various training venues, that essential knowledge and skills(?) are delivered, etc. In this way, picking a residency is like picking a pack of cigarettes: With which brand do you most identify? Are you rugged lonesome cowboy? Or, are you a suave, sophisticated urbanite? Either way, smoke-em up.

What makes a training program good is the extent to which it goes beyond teaching the basics. This is not easy to do. As ampaphb alludes, academic medical practice is busy. There's a lot to do. And, realistically, teaching and residency training is only *part* of what any academic physiatry department must do. Some departments consider it more essential to their mission than others. When was the last time an academic physiatrist was appointed department Chair solely on the basis of their teaching evaluations?

How on earth are you going to assess that commitment to education in just one day? Board score pass rates? Percentage of graduates getting fellowships/private practice/academic appointments/research training grants? Biased and incomplete information from Internet chat-boards? All are imperfect sources of useful information to make your decision. Furthermore, the dog-and-pony show carnival barkers you meet on your interviews will pretty much tell you the same thing at every program.

So, I suggest that you need to look for "the finishing touches." Like most things in life, love, and business, the devil is in the details. You need to look for evidence that whoever is pulling the levers around the joint is really invested in your residency education beyond what the Dean, the institution's graduate medical education committee, and site surveyors tell them to do. I argue that the extent to which your interactions with the program are professional, courteous, timely, respectful, and responsive are good proxies variables for assessing that program's commitment to a quality educational experience.

Some common mistakes to avoid:

a) Believing bigger is better. A program with 30 residents might have more trouble ensuring there is enough quality experience to go around compared to a smaller one.

b) Falling for the lore of legacy. A program that has been around 50 years is not necessarily better than a more recently established one. Programs wax and wane. In fact, legacy programs can suffer from the burden of institutional inertia and develop an aversion to innovation.

c) Location, location, location. This is mostly a matter of personal preference. But, realistically, you will likely not settle down and live where you do your residency training. In the grand scheme of things, 3-4 years down in the swamp, up in the frozen tundra, in the thick of the hood, or in the middle of corn field is not going to make a difference in your professional life. Your psychological well-being on the other hand...

d) Overvaluing elective time. Too much elective time in a program may signal a lackidazical attitude toward residency training. A quality program should have certain core experiences available and not expect residents to "proactively" fend for themselves.

e) Undervaluing elective time. Too little elective time in a program may signal a narrow-minded attitude about residency training. A quality program should alllow you certain "breadth" in shaping your interests.

f) Being duped by theories of adult learning. "Adult learning" means recognizing that adults learn differently than adolescents. It does not mean that you are solely responsible for the quality of your education. It means that educational experiences need to be formatted differently for adults and are, in turn, assimilated differently by mature learners. It is not a "get of jail free" card for programs.

g) Being fooled into believing that residency is a sacrament. It's not. It's mostly just a job. For many applicants, residency is their first real job. Those with a little more experience prior to medical school understand that residency is indeed mostly just a job. You do your job and then you go home. Unless you're being "cut in" on the equity of your work, making you an actual owner of your productivity, (which, as an aside, I think would be a very innovative arrangement for academic health centers to experiment with...) you're an employee and your employer has certain duties to you: Providing a safe work-place free from danger and harrassment; providing essential tools to accomplish your assigned tasks, etc. A good program should provide at least the same benefits, protections, and resources to its resident physicians that it provides to its barely educated high-school educated minimum wage workers...

 

[Ludicolo]

I agree with the basic gist of what the OP is trying to say. The interview day is just one factor of the equation, and candidates should not place undue emphasis on the bells and whistles presented on one particular day. Thus one of the benefits of doing an “audition rotation” or taking a “second look”. Students/residents really should start “looking at the big picture” – a skill that will serve them well not only in rehab, but in life in general.

That being said – from the program perspective why wouldn’t we try to put on our best appearance? Don’t you try to straighten up a little before inviting people over for dinner? We are trying to attract the best residents for us, just like residents are trying to match in the best program for them. A well organized interview day can be indicative of a well organized residency coordinator and a well organized residency program. Programs (well, most of them anyway) do understand that interview day is important for the candidates, and want to treat them with courtesy and respect. We expect the same treatment from candidates as well.

Pulling out the pain or cancer rehab specialist can demonstrate to the interviewee the breadth of education that he/she might receive. Can’t speak for other programs but our program director tries to provide a good representation of attending interviewers from all of the affiliated institutions. Also – you’re not sure what is relevant for a particular applicant. Yes, you should look for a well rounded program but we were all attracted to PM&R for different reasons. You never know if an aspiring peds rehab candidate connects with a interviewing peds rehab attending, and the possibility of working with that attending influences one’s rank list. I think it would be more informative to sit down with that particular attending rather than have the chief resident try to explain the rotation during the obligatory tour. To be honest though - there is usually a more mundane reason for speaking with any given rehab doc – we just happen to be available that day for interviews. As an aside I think most interviewers tend to be junior faculty with relatively less administrative or clinical responsibility (and thus more availability for interviewing), or attendings who honestly do have an interest in teaching.

Granted – by the time you get to your PM&R residency 2/3 of the residents you met on interview day will be gone. And you won't remember the other 1/3. However, you can still assess the morale, camaraderie and the overall psyche of the group (hopefully there is a mix of PGY 2-4 to meet), and decide whether or not you fit that psyche. Drusso has a point – programs do wax and wane. But as we all know in academia things don’t wax/wane that quickly. The general spirit of the residency program as a whole shouldn't change all that rapidly.

It all matters. What matters more will vary from person to person. I agree with what drusso said – while it is important to look at the big picture, “the devil is in the details”. An applicant asked me at the end of our interview if I were him, where should he rank. I told him I know where I would rank, but then again bring a different set of biases to the table. I told him, based on his application, his interests, and his personality he would likely match at a strong program, and he would likely do well wherever he went. But which strong program was BEST FOR HIM? I told him there was no way I could answer that question – too many unknown factors – his geographical preference, his lifestyle, his financial or familial concerns, etc. Questions I'm not necessarily allowed to ask during a job interview. He knows himself better than I do - or he's supposed to anyway.

 

[specepic]

I did put a lot of stock in the interview day and I still feel like that was a good idea. If a program is too busy to read my application or think of insightful questions based on my individual experiences then how much time will they have for teaching? Do they care who they get for residents?

Don't get me wrong, just b/c Univ. of Crapstick had a slick powerpoint and delish muffins and swedish cheerleaders doesn't mean I rank them #1, but when one top teir program stands out in their interview day compared to other top tiers and they are otherwise comparable, and I feel like I fit it, they got me.

 

[Disciple]

I think alot of applicants think (either consciously or subconsciously), "If I'm mistreated during my interview, will I be mistreated and miserable as a resident?".

Right or wrong, it's human nature.

 

[LTS6776]

I come from a program which traditionally did not put much effort into its interview day. The decision to really improve our interview season really came from our residents, who put in a ton of effort and extra time re-vamping the day and communicating with our applicants. I think it really paid off- people seemed to have a more favorable view of the program and we got to know a lot of great med students that were going into our specialty, even if they didn't match with us.

That being said, our program is no better than it was last year, so I'm not sure it says a whole lot as to the quality of the program! At a lot of programs, program coordinators (rather than Program Directors or Chiefs) run the interview process, so the quality of the day is often a reflection of them. And usually the quality of the program coordinator is not going to make or break your residency experience.

Also, keep in mind when interviewing around the Christmas and New Years holidays, you might not get the best representation of a program, as many attendings and residents are away and the others are covering for those who are away.

 

[Sandooski]

For the majority of applicants, the interview day is the only time that they can see what the program is about and what it has to offer first hand. Yes, we all hear everyone elses opinions on what the "best programs" are, but generally, the interview day is the only time we see/get tangible evidence.

So if we don't see the "quality" of the training/program during the interview day, am I really just supposed to accept the opinions of strangers or people I barely know?

The programs have a full eras application filled with our own words, numerous evaluations/recommendations, and even a picture to put a face the whole package. They get all the information we could possibly give, so why shouldnt they offer the same? I was confident that I was a strong applicant (as most applicants should be), and I wasn't looking to impress the programs during the interview. However, I was looking to be impressed by the programs.

A interview day should have a welcome meeting in the morning (continental breakfast items are a plus not a necessity) where the program director/chief resident should run and explain how the day is set-up. Most programs have a overview presentation and tour, but this is where I saw the biggest variation. The better interview days gave a powerpoint presentation with every aspect of the program explained including yr-by-yr structure, call schedule, electives, locations, research, didactics, traveling to and from locations, vacation, where most residents live, overview of surrounding location for the applicants not from the area, payscale and benefits, resident alumni and what fellowships that get, board scores, how they prepare residents for the boards, and etc. Basically, they should answer all of our possible questions before we ask them. They give this talk 10+ times/yr and doesnt change that much from yr to yr, so they should be able to get it down right. The tour should not be too extensive but just show what the general layout of the buildings, call rooms, and rehab service facilities.
Next is lunch..... It doesnt have to be a fancy lunch, but the biggest point is to have residents at the lunch. Not just 1-2 residents for the 8 interviewees, but hopefully, 1 resident for every interviewee. This is not just to ask the resident questions but I think this is necessary to see the typical personality of the residents in the program and how "I" would fit in with these people. I know, I know that most of them will be gone (so it would be nice to see the PGY2s there) but we all know that programs typically continue to choose people with similar personalities.
Interviews are interviews so take them for what they are worth, but it would be nice if the interviewer has a question or two that is related to me personally (as in, they read at least a part of my application) and not just the "why pm&r," "what do you tell people pm&r is," "where do you see yourself in 10 yrs." It doesnt matter who interviews me (although the chairman and program director should be involved) as long as they are a potential person that I will be working with. The end of the day should include a wrap-up for final questions and info on who to contact later for further questions (Its always nice if residents offer their email). Outside of the day's structure, everyone dealing with the applicants should be welcoming and not abrasive (including the interviewers).

Its really not that hard to do, so when a program can't do this, it reflects badly (in my eyes). Its not a be-all-end-all but as written in an earlier post, its part of the package. (just like how they view our interview day in their evaluation).