Interview Etiquette: The No Show

A comprehensive collection of Interview Resources is coming soon, just in time for phase 2 of the interview season (the time when interview spots really start to open up). There is one topic, not previously covered in detail, that I wanted to give more attention to: the Interview Day No Show.

The short version... This is a terrible idea and reflects badly on you, your advisors, and your school. 

The longer version... First a qualifier: a true Interview Day No Show is when an applicant who has scheduled an interview does not show up without notifying the program in a meaningful way. Programs understand weather-related travel delays and family emergencies. They don't mind you canceling your interview - there are plenty of other applicants who actually are interested in the program to take that spot. The program director will actually appreciate you giving someone else the opportunity. That reflects well on you.

However, you create an entirely different perception of your character if you cancel with so little notice that finding a replacement is impossible. Or, even worse, if you just do not show up at all with no attempt to contact the program and explain your circumstances.

Many reading this are horrified that anyone would have such an egregious lapse in professionalism. Though there are likely a few who are thinking, "well, I did not want to train at the program anyway, so what is the big deal?"

Here is a list of who the aggrieved program director will likely be notify of your No Show:

1. Your dean
2. The residency director at your home institution
3. Anyone who wrote a SLOE or a LOR
4. Your mom (okay, probably not your mom... unless she wrote one of your letters)

You may not care about the program you just No Showed. However, your home program director, and those at any away rotation that provided you with a letter, are going to care. Inferences will be made about your sense of responsibility, duty to your patients, and overall professionalism. This is a huge professionalism Red Flag. All it takes is one Red Flag to sink your chances.

Adam Kellogg is an Associate Residency Director and former Emergency Medicine Clerkship Director.  He has never personally hunted down a "No Show" to give them a piece of his mind. Yet.

Diagnosing the Match

We are in the heart of EM residency interview season here in the United States. This has been an anxiety provoking year for all involved.

Applicants and their advisors are worried because they do not have as many interviews as they expected.

Residency programs have unprecedented numbers of applications this year and are worried they are not interviewing enough candidates.

The Council of Residency Directors (CORD) Student Advising Task Force and the Emergency Medicine Residency Association (EMRA) worked together to try to shed some light on these events. The result of this collaboration, written by Zach Jarou (@zachjarou), a resident at the Denver Health EM Residency, and myself, was just published on EM Resident. We looked at recent match data and a survey of residency program directors to figure out how we got here and what we can do going forward.

This is a long article, with a lot of data, but after reading it you should have a better idea of where you stand in the application process AND what you can do now to improve your chances.

http://www.emresident.org/emergency-medicine-match/

As the Trail Begins

As you get ready to go out on the interview trail, you need to know what will allow you to shine to maximize your match. 

Scheduling
Realistically you can only do two interviews each week. If you try to make swings into areas, doing back-to-back interview days, you are going to miss out on getting to know the places you visit. Instead of hopping about the country a la Planes Trains and Automobiles, leave yourself extra time. Plan to get in for your interview at least mid-day, the day before. This will allow you to fully participate in the whole interview experience. This means you need to be judicious in choosing interviews if you have been offered more than 10-12. You simply can’t fit more in and do them justice. 

The Night Before
The evening prior to your interview the program will host a social event, usually a dinner or cocktails with residents, interviewees, and possibly some attendings. This is a great opportunity for you to see how the program is from the resident perspective, and observe the groups interactions. You can get many questions answered from different viewpoints, and this is a great time to see how you fit with each group. On reflection, many applicants find this to be the most useful part of the interview when making their decision about a program. Do not miss it just so you can pack another interview in.  

Look Professional

Avoid checking baggage when you fly to an interview.  It will get lost and you will show up to interview day in jeans. While this happens to a few folks every year, it is easily avoidable by sticking to a carry on.

On interview day, arrive early so that you guarantee not to be late. You should be wearing a well fit suit. Men should wear suits with a tie, and women should wear either a dress, skirt, or pants with a matching jacket. Try your suit on now and have it altered or get another, if it no longer fits you well. While it may seem superficial you never want to loose favor because of perceived lack of preparation. The shabbily dressed student might end up being the ill prepared resident. You have a limited amount of time to make an impression, make it a good one.

Have Questions

At the interview you will want to have a list of questions. Everyone is going to ask what questions you have, if you have none - you look disinterested. Don’t fall into this trap. It is easy to have questions. First, have some basic questions you ask at all programs. These should be what matters to you and what is helping you stratify programs. Next, look at the residency website and come up with 3-5 specific question for each program. If you know ahead of time who you will interview with, look them up and have questions about their interests or role within the program. Everyone, absolutely everyone, enjoys talking about themselves. If you don’t know ahead of time, ask what your interviewer’s role is, then ask some follow ups specific to that role. 

Engage

Keep up your energy and interest level throughout the interview. Lean forward, listen, and smile. Avoid slouching, leaning backward, and swearing at all cost. If you do any of these things you will be perceived to be disinterested, and unprofessional. As interviews go on this will get harder than it sounds. Despite your current fervor, after a few months of interviews you will be tired, bored, and ready for a break. You will begin to show disinterest just from the monotony of it all. This is one of the reasons you should focus on 10-12 interviews at a variety of programs you are interested in. 

If you go on more you will have a quickly diminishing return on your investment of time and money. Your chance of matching with eight programs on your rank list is >90%. Your chance of matching passes 99% with twelve programs on your rank list. More programs will not increase your chance of matching: you already maxed it. Remember, you have more control than you think: more than 50% of you will get your first choice and 80% of you will get within your top three. As you move forward think about both the time, effort, and money going into each interview, and compare this with the likely outcome. If you have 10-12 interviews at places you want, you have no need to do more. 

Cancelling

Canceling interviews with enough time for the program to get another applicant in, is courteous to the program, and generous to your fellow applicant. If you realize that you have enough interviews for your rank list, you can begin canceling those that would go to your bottom. The key is canceling early enough, that the program can get another applicant in for that day. Generally the longer lead time, the better. A few days and even a week is difficult to re-arrange, so ideally cancel more than two weeks ahead of time. If you are worried the programs will be insulted, remember they want to maximize their match list as well. Give them enough notice and there will be no hard feelings. If you are one of the many great candidates that doesn’t have enough interviews, you should consider freeing up January. There will be more cancelations as the interview process continues and you will need flexibility to accept on shorter notice.  

Quantity and Quality

Interviews are your opportunity to try out a variety of programs and see how they will fit you. With a reasonable plan you can schedule, travel, and arrive at 10-12 spots ready to shine, and succeed in the match. Remember to maximize this opportunity by focusing your energy on a selection of interviews, with questions and observations that matter to you and your learning.

Lucienne Lutfy-Clayton is a Clerkship Director and Associate Residency Director, and has had her luggage lost too many times.  

#ACEP14 is upon us... "Should I go?"

The American College of Emergency Physicians (ACEP) is the largest EM organization in the United States.  Their largest annual meeting, the Academic Assembly (#ACEP14), starts this weekend.  Thousands of Emergency Physicians, and other acute care providers, from all over the world will be descending on the McCormick Place convention center in Chicago.

As part of this event the Emergency Medicine Resident Association will be hosting a week of events as well.  For students pursuing a career in EM the highlights are the Student Symposium and the Residency Fair, both happening on Sunday, October 26.

If you are in the 2015 match, you can make an argument that there is little value in going to this now as most of the interview offers are out already.  That is a good point.  Many of the Program Director's have already made up their minds about their interview offers and wait lists.

Another viewpoint would be that this is the MOST important Residency Fair to go to for someone in this years match.  Especially if you do not have the 10-12 interviews that correlate with a 99% match rate.  With the increased number of applications that each program is receiving (without an increase in the overall number of applicants), most program directors are expecting to make more use of their "wait list" than ever before.

A nice introduction and conversation with the program leadership staffing the Residency Fair may very well impact your spot on that wait list.

Adam Kellogg is an Associate Residency Director and former Emergency Medicine Clerkship Director.  He is currently training residents he met at the EMRA Residency Fair.  

Where are the interviews?

This is an update to last years post on the same topic.  The mismatch appears to be worsening between the number of programs applied to AND the number that an applicant needs to apply to...

This is an anxiety provoking time of year for both sides in the EM residency match process.  Most residency programs start interviews by early November, and they are worried that in the increased numbers of applications they are receiving, they are not going to invite the right applicants to fill their classes.  But right now, we are not worried about the residencies. They are going to be fine.

As an applicant for EM residency you find yourself in one of two groups:

• Group A:  The Fortunate Few - You have too many interviews (more than 10 - 12) and you are not sure which ones you are going to actually do.  You may even have 15 or more and think that you are going to want to do that many.  
• Group B:  Everybody Else - 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 the name suggests, theirs are good problems to have.  Unless you have special circumstances, like a difficult couples match (EM-ortho, EM-EM, EM-Derm), at 10 to 12 offers, 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 20.  You will match 95% of the time if you rank 10 or more programs.  If you look at the graph below (from the NRMP's Charting Outcomes from the 2014 Match), having a number of interviews beyond 8 - 10 does not really prevent someone from not matching.  There is a no 100% guaranteed number.  If the quality of your interviews are poor, it does not matter how many you do.

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 interview spots.  They will start to give some of 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 (i.e. a SLOE came in late), send a polite email or call the contact person 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.

Don't waste your time and money applying to more EM programs.  This seems tempting, but it will not help.  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.  And they have already offered most of their interviews and created a Wait List.

Open up your January.  Interviews opportunities are going to become available, especially in January. Applicants with a lot of interviews in November and December will realize they are good and will cancel January interviews.  You may get short notice offers to come interview and you want to be ready to respond.  You may have had your heart set on that Beach Medicine elective in May, but you are better off moving whatever you are doing in January to a later block.

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.

Adam Kellogg is an Associate Residency Director and former Emergency Medicine Clerkship Director.  He thoroughly enjoys polite emails that provide new information about a residency applicant. 

Dropping dead over Application Deadlines

For students applying to EM for the 2015 match (2014-15 Interview season), this is a very stressful time.  September 15 has become a terrifying deadline.  The idea has emerged that your application must be "complete" on September 15th or you will be behind the rest of the applicant pool and end up scrambling.  The blame for this resides on well-meaning advisors, Dean's, blogs, and the pervasive fear of failure that highly motivated people use to keep themselves highly motivated.

Here are the actual deadlines that are set in stone:

• September 15th - ERAS opens and you can upload the portions of the application you have control over
• October 1st - the "Deans Letter" (MSPE) comes out
• February 25th - Rank List deadline for both sides
• March 16th - Yes/No day for applicants and beginning of SOAP
• March 20th - Match Day

You will notice a LARGE gap in there between 10/1 and 2/25.  That is because every single residency program has a different timeline for when they start reviewing applications, offering interviews, and conducting interviews.  There is no hard and fast deadline by which you must have your application "complete" (MSPE and 3 LOR's, plus PS, boards, and ERAS app).

However, there is some consensus among EM program directors (the people who are actually making these decisions):

1. Applicants should have everything within their control uploaded Sept. 15
2. A single EM SLOE is needed for application review and consideration for interview
3. Very few applicants will have more than one EM SLOE uploaded on Sept. 15
4. Most interviews of outside applicants (those who did not complete their clerkship) will be OFFERED in the second half of October and early November

These are NOT absolute rules.  You may know someone who gets 5 interview offers by October 1.  Feel free to hate them, but remember that there are very few of these folks and they are undeserving of your scorn. 

The biggest variable between programs is how many letters need to be submitted before they will review your application.  Some insist on 3 letters before they will review.  Others only care if there is at least 1 EM SLOE.  This becomes an individual judgement call.  That second SLOE that won't be in until mid-October may raise the quality of your application.  But settling for one SLOE and two other letters will have your application in front of more eyes sooner.  This is where you need a local personal advisor, or SAEM e-advisor.  Or you can ask us in the comments.

Get your personal statement written (15 drafts is more than enough).  

Gather all your resume stuff and write brief descriptions of your roles.

Confirm your letter writers.

Choose your programs.

Good luck! 

Learning Resource: FOAMcast

The world of FOAMed (Free Open Access Medical Education) is over-flowing with resources discussing cutting edge, controversial, and high risk topics.  This is why we use it.

However, much of the popular and best FOAMed content is not ideal in the early stages of assimilating the broad knowledge base required for Emergency Medicine.  You should try walking with EMbasic, before you go running with EMCrit and Smart EM.

A new addition to the list of resources for EM learners at all stages is the FOAMcast podcast by Lauren Westafer (@LWestafer) and Jeremy Faust (@jeremyfaust).  These short, easily digestible podcasts summarize a recent piece of hot new FOAM and pair it with a review of core content material that every emergency provider should know.

Recent episodes have covered Anaphylaxis, Neonatal Jaundice, and First Trimester Bleeding.

Have a listen.  You won't be disappointed!

FOAMCAST

Why FOAM it alone?