Go with your gut

Interview season is winding down for many applicants which means you are actually going to have to start thinking about your rank list.  No more stalling.  It will be okay.

In all likelihood, if you have made it this far in medicine, you take pride in thoroughness and attention to detail.  This is a case where you may be over doing the analysis.  Right now this feels like a monumental decision with repercussions for the rest of your career.  That perception brings out your "inner internist" and makes you want more time to decide, and more data.

In the end, you are likely to make some decisions on your rank list that your scoring system won't agree with because of intangible factors that may be hard to put a point value or letter grade on.  In other words, you are likely to go with your gut.  Some applicants entrust the entire process to their "gut feeling", trusting in the ACGME to make sure that the program teaches everything needed.  These may not be the types of applicants seeking guidance on a web blog.  However, since Malcolm Gladwell re-named "going with your gut" as "thin-slicing", it is no longer perceived as being irresponsible.  Your gestault on how well a program fits your needs will often be more accurate than even a well designed scoring and ranking system.  Going with your gut is going to serve you well in this process, and in your future career as well.

I don't believe that I just convinced anyone not to over-analyze their rank list.  If you are going to spend a lot of time thinking about your list then you should know the most common misperception on how the match works.  How much a residency program likes you, expressed in how high they rank you, is not nearly as important as you think.  The mysterious match algorithm is "student weighted".  You will match to the program you rank highest that reaches your position on their list.  Here is an example:

Your rank list is Residency X #1 and Residency Y #2.  Both programs put 100 people on their list.  Residency X ranks you #50 (sorry), but Residency Y ranks you #1 (congrats!).  You will still match to Residency X (you ranked #1) so long as they go to spot 50 on their list.  That Residency Y ranked you higher has no effect on this.  This is why the match is considered "student weighted" and why most average to above applicants go to one of their top 3 programs.  

How many is too many?

When it comes to interviews we each have a limit on how many we can physically, emotionally, and financially stand to do.  What I want to address is not how many you can do, but how many residency interviews you should do.

The objectives of your entire interview process is to consume as much information about your residency options as possible and to interview frequently enough to match.  If you are thoroughly enjoying the process then by all means check out as many programs as you can afford.  If your resources are more limited, you need only do as many interviews as it takes to make sure your envelope is full on match day.

There is no magic number that guarantees matching in EM, but it is exceptionally rare to not match if you complete 8 - 10 interviews.  And many people successfully match after less than that.  It only takes one Program Director who feels you are the right fit.  Each program, and sometimes each interviewer, has a different idea of what the ideal applicant "looks" like.

There are, of course, exceptions to the 8 - 10 rule.  The first is that if you give truly awful interviews, but look good on paper, you could get a lot of interviews and not be ranked highly by anyone.  A truly awful interview is not nervous and sweaty, or unprepared, or falling asleep during the Program Director's pitch.  Truly awful is where you meet the interviewers diagnostic criteria for Personality Disorder.  

The other circumstances, besides carrying an Axis II diagnosis, in which you should break the 8 - 10 rule are circumstances where you need to be exposed to more programs.  The best example is the couples match.  One of you is "the anchor", the half of the couple in the more competitive specialty and thus the one who will pull you both down your rank lists.  As the partner applying to EM there is a good chance that you are the anchor and thus do not need to do extra interviews.  Conversely, if you are matching with a future dermatologist, orthopod or another EM applicant you may need to do a few more to feel safe.

The number of interviews you go on is important to more than your physical, mental, and financial fatigue.  Every interview you cancel at a program you do not really want or need to rank is an opportunity for someone else who may need that interview a whole lot more than you do.  And according to your Personal Statement, you are interested in helping people in their time of greatest need.  

There are no bad questions...

...but some are better than others.  EM interview season is now in full swing, so something interview related makes the most sense for a first post.  Just today I was asked for one piece of advice for someone going to an interview.  My answer was to have "good" questions.  Sounds bland and useless but I really think this is important.  If you get me rolling on your questions I may never get around to my standard list of tough questions.
So what is a "good" question?  This is best summed up as a question that truly matters to you.  Interviewers often get generic, safe questions, answerable by perusing the website.  Less appealing are the "stalker questions" targeted to get the interviewer rambling about their professional interests and activities.  If you want to create a favorable impression with the interviewer, challenge them with a question you actually want to know the answer to.  Ask about something you are passionate about.  Or something you are really concerned about.  Your genuine interest will show through in a way that does not happen when asking about something you have been told you are supposed to ask about.  And it is perfectly fine to ask every interviewer the same question.  You may get some insightful variation in their answers.  
Nothing shows disinterest more than having no questions.  Generic is certainly better than none at all.