Effective Interviews - Part 2: What's Hot?

In part 1 of "Effective Interviews" we covered the basics of how to get the most out of your interview days.  In part 2 we are going to raise your interview game with a discussion of what topics are "hot" in Emergency Medicine in the fall of 2013.

While on the interview trail you are discovering the "hot topics" to talk about from your fellow applicants.  This is the default topic.  The one you go to when you are out of other questions or because everyone says you should ask about it.  For a long time this was Trauma, as in: "What is your Trauma experience like?"  For a few years now Ultrasound has usurped this spot.  This year, another shift is likely upon us: "What role does Social Media have in your education program?".  The most mainstream of EM publications, the Annals of Emergency Medicine, just published an article about Twitter.

Twitter is a great window into what is being discussed and debated in EM.  All you have to do is follow a few of the disseminators of #FOAMed (@emlitofnote, @njoshi8, @emcrit, @CriticalCareNow, @srrezaie, @precordialthump, @LWestafer, just to name a few) and you will quickly be caught up on the discussion.

But if none of the preceding paragraph made any sense to you, here are some of the big topics under discussion in 2013:

• Social Media in Education - you should probably have an opinion or stance on this.  Many of your interviewers will.   Though you shoudl be ready for otherwise wonderful and enthusiastic educators to be very skeptical of the whole concept.  They may also be more interested in your understanding of professionalism as it relates to Facebook/Twitter/Snapchat/etc.
• Thrombolysis for Acute Ischemic Stroke - this is being debated vigorously in EM with ACEP releasing a policy statement that has led to much consternation from many practicing Emergency Physicians.  This has recently been discussed really well on the ERCast podcast.  The LITFL blog also did a good discussion to review as well.
• Video vs. Direct Laryngoscopy - This is being hotly debated in EM right now with very knowledgable people on both sides of the "Is direct laryngoscopy dead?" debate.  As someone about to begin your training, knowing the programs philosophy on airway management is going to be really important to your education.  What do they do?  What do they teach?  This is way more important to your eventual career than how they get Trauma experience (A comes before T, after all).

Other topics of recent discussion also include:

Transexamic Acid (TXA) in Bleeding Trauma Patients - Review by Napolitano et al.

Novel anti-coagulants and newly approved treatments - Dabigatran, Rivaroxaban, Prothrombin Complex Concentrates

And just this past week, the value of Therapeutic Hypothermia (aka Targeted Temperature Management [TTM]) in Cardiac Arrest came under renewed scrutiny.

So much to know.  Maybe you should get that Twitter handle after all...

Effective Interviews - Part 1: The Basics

The interview process is a huge expenditure of precious resources on both sides.  If you are going to go to the trouble and expense of interviewing at a residency program, you owe it to yourself to come prepared.

The Program Director will almost invariably give you some kind of overview of the program or "sales pitch".  This may even include perceived weaknesses and plans for improvement.  Even if their presentation seems balanced, they are still emphasizing the programs strengths, just as you did with your application.  You will have an opportunity to talk individually with the Program Director and other members of the residency and you owe it to yourself to dig deeper.

Since you are reading a blog about getting into EM, you have likely encountered lists of "must ask" questions.  I think there is no such thing as the "right questions" to ask.  I would much rather discuss topics that the applicant has a genuine interest in.  Answering the same questions over and over again is not enjoyable for either side.  Instead, ask about what really matters to you.  Find out if this is a place that is going to meet those needs.  If you have made it this far without deciding what really matters to you in your future training program, now is a great time to start thinking about it.

The questions you ask should be thoughtful enough that you cannot just answer them from going on the programs website for 5 minutes.  Though this is a great way to find things to discuss.  Make your question a level deeper than the website goes.  For example:  Don't ask, "What kind of rotations do the interns do?".  That is invariably on the website.  But you can ask what the experience is like on specific rotations, and if they have any concerns about the objectives being reached.

If you are going to put all this effort into coming up with good questions, you should feel comfortable asking the same questions of all of your interviewers.  You may get different answers depending on who you ask.  For example:  the Program Director and the Pedi EM Fellowship director may have very different perceptions of the EM residents pediatric experience.  You will have to decide whose opinion to put more stock in, but this information can be incredibly valuable.

One particularly important area to explore, that will not be addressed by the website is the stability of the program.  If there are changes to the size of the residency, the curriculum, the physical plant, or the program director or chairman, find out how these came about and what impact these are expected to have.  Change is often a good thing, but abrupt change is often not.  Particularly when there is not a cohesive forward-thinking plan for the future.

A few other general interview tips.  These may seem obvious, but a remarkable number of students break these "rules", usually to the detriment of their chance to match:

1. Go to whatever they have the night before.  This is essential to getting a feel for the culture of the program. 
2. Be on time for the interview.  In fact, be early.  Leave yourself enough time that even if you get lost, you will still have plenty of time.  Inability to plan ahead is not a sought after trait in Emergency Physicians.
3. Dress professionally.  You do not need to wear your black or funeral-gray suit, however you also should not look like you are going tailgating or clubbing right after the interview.
4. Be respectful to everyone, especially the coordinators.  Especially the coordinators!
5. Be yourself.  The professional version of yourself.

AAEM 2014 Med Student Track

The American Academy of Emergency Medicine has their annual meeting coming up in February.  It will be at the Midtown Hilton in New York City February 11 - 15, 2014.

They are going to have a whole track just for medical students on February 12:

Wednesday, February 12, 2014

7:30am-8:00am	Networking breakfast
8:00am-9:00am	Pearls & Pitfalls of Emergency Medicine
9:30am-10:00am	Finding your Match: Types of Residency Programs
10:00am-11:00am	Program Director Panel
11:00am-11:15am	Break
11:15am-11:45am	Career Paths in Emergency Medicine
11:45am-12:15pm	Ultrasound in the Emergency Department

This is a great opportunity to learn more about the specialty and about navigating the application process.

Blogs are fun and all but getting to interact with actual people is even better.

Where are the interviews?!?

This is an anxiety provoking time of year.  Interviews start soon and right now you fall into one of two groups:

Group A - You have too many interviews (more than 10 - 12) and you are not sure which ones you are going to actually do.

Group B - You don't have enough interviews (less than 10-12) and you are in a panic over having to scramble to another specialty.

Let's deal with Group A first, as they are easy.  Unless you have special circumstances, like a difficult couples match (EM-ortho, EM-EM, EM-Derm), you already have all the interviews you will need.  And as programs start to get into their Wait Lists, you are going to get more offers.  In your Personal Statement you talked about what a great team player you are, now is your chance to prove it.  Politely decline some of those interview offers. Throw them back.  As programs higher on your list contact you with an opening, let another one go.  Most people do not want to do more than 10 - 12 interviews.  No one has stayed sane doing more than 15.  You will match 99% of the time if you rank more than 8 programs.

If you are in Group B, you are nodding vigorously right now.  You are waiting for interview offers because your colleagues are holding on to all of the spots right now.  They will start to give them back.  More spots will become available.  What you need to do right now is make sure that when those spots open up, you get consideration for them.

Make sure your application is complete.  If a letter was not uploaded, many programs will not have even reviewed your application before giving out all of their interview spots.  If your application was completed late for any reason, send a polite email to the coordinators of your most important programs.  Showing a little extra interest, courteously, can make the difference in who on the Wait List gets offered an interview.  This is the most useful thing you can do to increase your interview chances.

What you are thinking about doing is applying to more programs.  The programs will know that you just applied to them.  Most EM programs have the luxury of being picky about who they interview.  They are not going to be interested in looking at the application of someone who only recently became interested in them.  Not when they already had hundreds of more enthusiastic applicants.

Polite interaction with programs that already have your application is your best bet.  Be available on short notice.  Be courteous with whoever you get in touch with.  Be ready to bring your A-game on the interviews you get.  It only takes one program to rank you competitively to get you into EM.

Link: ALiEM Interview Tips

Nikita Joshi (@njoshi8) over at the incomparable Academic Life in Emergency Medicine site recently posted some great tips for the residency interview process.

This is a great list of recommendations.  I would add particular emphasis to "Being interested".  You should have questions ready to go for anyone you talk to.  The benefits are both for you and the program.  You get as much information as possible and impress upon the program how interested you are.  An applicant without any questions is presumed disinterested.  Even if the Residency Director answered every question you had during the "sales pitch", you should still ask about the things that matter to you.  You may even get different answers from a different source.

Another point that deserves a little more emphasis is "Remember that you are interviewing the program as well".  Once you have cleared the hurdle of getting an interview they want to like you.  You have met their academic standards and something about your application drew their attention. No one will sour on you for asking insightful questions.  Ask about the factors that matter most to you, from an educational perspective.  Both sides benefit from you making sure that this is going to be a good fit.

Assessing Competitiveness - Part 2

In Part 1 we introduced how to assess your own competitiveness.

An even more difficult task is determining competitiveness of the programs you are considering spending your application dollars on.

The most important thing to remember about assessing programs is that "perceived competitiveness" has little to do with how good your training experience is going to be at that program.  "Perceived competitiveness" determines how hard it is to get an interview at the program.  Your experience training at the program is going to be determined by the educators, the clinical environment, your class mates, etc, etc. (as addressed in "Where to Apply").

What follows are some characteristics that may help you predict which programs have a high degree of "perceived competitiveness" = "harder to get an interview."

In descending order:

1.  Is the program in a region that is highly desirable and where there are not many other programs?  For example: many people in their 20's prefer big cities to small ones.  Another example: there are many more programs on the East Coast than on the West Coast, so West is even more sought after. (Last note both the Northeast and West Coast want letters and rotations from their own coast, if you did not rotate in their region this will be a hale mary for you.)

2.  Does the program have "EM-famous" faculty?  Prominent figures in the world of EM, particularly those who would be visible to students (i.e. #FOAMed > past-presidents of ACEP).
Is there a popular blog or, podcast out of this program. Were you dying to hear a lecture by an attending? Is one of the attendings an author of a book you keep handy?

3.  Academic affiliation with a University that sounds impressive?  If your mom would be impressed with the affiliation, that counts.

4.  Age of program?  Older, very well established programs are often more competitive than their newer neighbors, especially if they played prominent roles in the history of EM.

5.  A multitude of fellowships, especially the ACGME approved ones (Toxicology, Pedi EM, EMS, Sports Medicine, Hyperbaric)? More fellows can be a surrogate for more academic stuff going on.

The mistake often made by applicants is to only apply to programs with high degrees of "perceived competitiveness".  If you are an average or below average applicant, you should be applying to programs across the spectrum.  This will ensure that you get enough interviews to not be a sweaty mess on Match Day.


You need to do the math:

The number of interviews you will get is a product of your competitiveness times the perceived competitiveness of the programs you apply to:

Above average candidate X Uber only = some interviews :|

Average candidate X Full Spectrum = Uber interviews :)

Average candidate X Uber only = few interviews :(

Below Average candidate X Uber only = no interviews :((


Lastly remember this is advise so you can maximize your application and interviews. There is nothing wrong with applying to a program you have always dreamed of joining, even if you are not an above average candidate, just realize the interview may not come.

Assessing Competitiveness - Part 1

Step 1 is to figure out how competitive a candidate your are.  Your advisor's should be able to help you sort yourself into one of three "buckets":  the average candidate, the above average candidate, and the below average candidate.

Above average candidates have:

• Honors in everything clinical
• Board scores that are above average (>240)

Above average candidates have little to worry about and should not be reading blog entry's on how to get a residency. Make a list of spots you like and would like to train (15-20).

An average candidate is going to match in EM if they make a reasonable list of programs to apply to.

The average applicant has:

• Board scores that are in the neighborhood of average (~220  >220).
• EM grades and letters that sum up as: going to do well in EM (Honors or High Pass with a supportive letter, & hopefully followed by Honors on the second rotation).
• No red flags.

Goal is a diverse list in different regions of the country (25-40).

If you fall short on any of those criteria you should consider yourself to be a below average candidate and plan appropriately.  This means applying to lots of programs (40-50), not wasting money on the most competitive programs, and having a back-up plan for not matching in EM.

This is additionally complicated if you are an Osteopathic or Foreign Medical Graduate looking to join an Allopathic EM program.  Only some programs (68%) will even consider your application.  The programs open to you have their pick of candidates and they are looking for the cream of the crop.  If your not at least an average candidate AND you are from an Osteopathic or non-U.S. school, your chances are slim and you need a back-up residency plan like IM or Family Medicine.

Fortunately, the receptive programs are easy to find by going to their website.  Look at their "residents" pages and see where their residents came from.  If you see residents who are D.O.'s or are from your country/med school, they will probably give your application a fair review.

Now that you have a sense how competitive you are, you can try to figure out the programs...