How to Ace the NBME Shelf Exams, In-Training Exams and Your Boards.

Ok, now that I have your attention, let me share something with you. I’m going to show you how to maximize what you learn from the “school” we call rotations in medical school and residency so you can be an awesome master clinician. And, yes, it’s going to help you with your exams, so stay with me.

Clinical rotations are a strange blend of learning and work. You learn from the work, but we all forget that the work is not the purpose of these clinical experiences. The purpose of rotations is to be able to “practice” medicine (as a student) and then master the art of your specialty (as a resident.)

There are six basic principles to learn medicine, and then learn your specialty …and on the way ace the exams:

  1. Remember it’s school.
  2. At the beginning of each rotation, decide what topics you need to learn during the rotation and make a list.
  3. Take notes. All the time.
  4. Figure out how you will store your notes so you can find them quickly and organize them for review.
  5. Go through the notes you make every day to review them and then store them in your system.
  6. You can’t learn medicine from a review book (yes, including UWorld)

Somewhere around the beginning of my third year of residency, I was sitting in the “dome” (the chief resident’s “office” above OR 1 in our County Hospital) when Fred, one of my fellow 3rd years, walked in. He sat down and started to look through a stack of 3×5 cards so I asked him what he was doing. We all knew that he had scored the highest in our class on the ABSITE (the surgery in-service exam) and I was about to find out why.

REMEMBER IT’S SCHOOL

Fred figured out from day one that there was no way he was going to be able to study like he did in college and during basic sciences. Instead of hours to sit and read, it had to be flexible “on the job” learning.

This mindset is probably the single more important thing to cultivate. It’s the thing that drives you to constantly ask questions about why things are done the way they are and then go look up the answers.

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AT THE BEGINNING OF EACH ROTATION, DECIDE WHAT TOPICS YOU NEED TO LEARN DURING THE ROTATION AND MAKE A LIST. 

Your list can be pretty simple, or more complex, but it needs to be enough.

First hint – There is a curriculum that has been defined for your rotations. Everything your professors have decided should be taught should absolutely be on your list.   (By the way….If it’s in the curriculum, it has to be part of an objective. If there is an objective, it has to be linked to a test question)

Second hint – There is no way in medical school that “surgery” (or any specialty) can be covered in 8-12 lectures. The same is true for your rotations in residency. You have to do more.

This is one time that an example may be better than a formula. Let’s say I’m a brand new clinical student on my core surgery rotation….

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 Step 1. Find a textbook of Surgery and make a list of the topics from the chapters. A spreadsheet may be best for this, but any kind of list will do. 

For example, our library has Sabiston’s Textbook of Surgery (20th edition, 2017) on line:

 

 Step 2. Breathe deeply. There are 72 chapters and no, you are not going to read all these pages.

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Step 3. Create a schedule to SKIM every chapter during the rotation. Look only at the “big picture” i.e. headings, section titles, diagrams, tables. Your schedule should leave the last week or two free. So, for example, if your rotation is 2 months long, plan to SKIM 12 chapters a week to get them done in 6 weeks.

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 Step 4 – Now we get to the real deal (remember, this is graduate school and/or specialty training).

List the sections on your spreadsheet.

As a student, you won’t read every section – unless they are very general (Acute Abdomen, for example) or if you have a patient with that particular problem. Here’s what it might look like:

 

TAKE NOTES. ALL THE TIME.

After I learned Fred’s system, I always kept a stack of blank 3×5 cards in my pocket. Like him, for the last 3 years of my residency, I made notes ALL the time.  Here’s the kind of notes we are talking about:

  1. Reading textbooks or other curricular readings. Take the time to make the notes and make them well so you never have to go back to the chapter to review it.
  2. On rounds when someone teaches an important point (e.g. the 7 things that keep a fistula from closing)
  3. During Grand Rounds
  4. During conferences
  5. When you look up a paper to read about a patient
  6. And – most important – what you learn from specific patients. Do NOT put the name of the patient or their MRN (HIPPA). But, do put specifics that help you remember the patient (e.g. pt that always wore a red baseball cap and had a tattoo of a dragon)

As you can imagine, once I started this system, I was making 10-20 notes a day. It is remarkable how much you learn in a given day… and how it’s almost instantly gone if you don’t write it down.  In three years I filled up two boxes with cards. These cards were the only thing I reviewed for my Board exams.

 

FIGURE OUT HOW YOU WILL STORE YOUR NOTES SO YOU CAN FIND THEM QUICKLY AND ORGANIZE THEM FOR REVIEW

This is why using a notebook isn’t the best way to keep notes on rotations. You’ll take them chronologically and, unless you have an amazing index at the back with all the key words and pages listed, you’ll never be able to find a specific note.

The key is being able to “file” the notes so you can find them.  For the 3×5 system, leave a blank square at the top to put the topic you’ll use to file them.

I used anatomy as the basis for my filing system. So I would use a pencil (so I could change it later if I needed to) to put the topic in the box.  For example

Pancreas, pancreatitis

Appendix, neoplasms, carcinoid

This is very old-fashioned (but very effective) system.. I personally think there are better ways to do this now using scanning, cloud storage, key words and tags.  For some ideas, check out this post.

What doesn’t work well is to try to type notes on your phone.  What REALLY doesn’t work is to make notes and then decide to copy them, type them or somehow redo them later. (It never happens).

 

GO THROUGH THE NOTES YOU MAKE EVERY DAY TO REVIEW THEM AND THEN STORE THEM IN YOUR SYSTEM

The key to learning (as opposed to memorizing for a test) is review. Simply filing the cards means you are reviewing them. Plan to pull them out to look at them (and all the work you accomplished!) every week or two.

More importantly, when you see a patient with pancreatitis 5 months from now on a different rotation, pull the cards you made on this rotation. You’ll find you have 20 or so cards (or card equivalents) on pancreatitis … a review of the Surgery textbook, notes from Grand Rounds, the 3 patients you saw with pancreatitis that taught you about the disease and a few pearls you learned on rounds from your chief resident.

 

YOU CAN’T LEARN MEDICINE FROM A REVIEW BOOK (YES, INCLUDING UWORLD) 

I’m really serious. Not only will you suffer when you are taking care of patients, you won’t do as well on the tests (despite what the upper level students or residents tell you).

Remember the last two weeks of the rotation that you saved?  Now’s the time to pull out the review books.  It’s a wonderful way to review what you have learned from your skimming and patient oriented reading.  It’s also a great way to identify gaps and look up information.

p.s. Take more notes while you are doing this.

p.p.s Review all your notes, including the ones you make from the review books.

p.p.p.s Review them again.

Link to the Wikipedia article about the forgetting curve

We All Need a Compass

I was delighted to be asked to be the AOA visiting professor at the University of Miami Miller School of Medicine this week.  The following is the speech I gave at the induction banquet.  For those who are not in medicine, Alpha Omega Alpha is the “Phi Beta Kappa” of medical school, an honor society that recognizes students who are at the top of their class… but who have also demonstrated service, leadership and professionalism. 

 

What an honor that I have been asked to be here tonight for this celebration!  I am in the company of superstars and great friends, both new and old … what could be better?

I want to start by congratulating the junior AOA, resident and faculty inductees.  For the junior AOA inductees, you are clearly on a strong path to excellence which will serve you well.  Although I’m going to address my remarks to the graduating seniors, please know that I haven’t forgotten you or what it took for you to be here tonight.  For the resident and faculty inductees, you have been singled out for this very particular honor because you are amazing clinicians, educators and role models.  Thank you for what you do.

I thought I’d start with a short description of what it means to be inducted into AOA from the AOA website.

“Election to Alpha Omega Alpha is an honor signifying a lasting commitment to scholarship, leadership, professionalism, and service. A lifelong honor, membership in the society confers recognition for a physician’s dedication to the profession and art of healing.”

Induction into AOA is a major milestone in your career and, based on your predecessors in the organization, it also represents the beginning of a remarkable journey.  It’s a journey that you won’t take alone.  If history is a guide, you represent the future leaders of medicine, which means you’ll be guiding others on this journey as well.

That’s the reason I decided I should talk about how to use a compass.

 

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I suspect that you have all used a compass before but, like me, you probably haven’t given it much thought.  A traditional compass works by aligning a needle to the magnetic pulls of the north and south poles.  Although we really could use either north or south as a reference point, by convention we use north. I’m not going to get into the differences between true north and magnetic north*… suffice it to say that because a compass lets us know where north is, we can calculate the difference between “true north” and where we are heading, which in nautical terms, is called our “absolute bearing”.

So where am I going with this?  Why is it important to have a point of reference, a “true north”, as you start your journey through residency into the practice of medicine?

I know you’ve already been on services where the focus seemed to be more on checking the boxes on the scut list than on caring for the patients… and you had the feeling that there was something missing.

That’s why you need a “true north”.

You’ve also been on committees or in organizations that seemed to worry more about policies and procedures than how to use those policies and procedures for the better good.

That’s why you need a “true north.”

And I know that you have experienced days where you manifested one or more of the three cardinal symptoms of burnout, days when you lost enthusiasm for your work, felt that patients were objects rather than people and/or decided everyone around you could do a better job than you could.

That’s why you need a “true north”.

Unless you know where your “true north” is, you can’t navigate… you can’t make the adjustments that keep you on course.

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The single most important piece of advice I can give you as you start on this journey is to make sure you know where “true north” is for you.  As each of you define your own personal “true north”, you will share things in common.  For example, loving your family and friends, being kind, and trying to make a difference.  But even though there will be common themes, “true north” will be a little different for each of you.  This is not as abstract a concept as you might think. It is not only possible to articulate your goals, what gives you meaning and how you define your own integrity, it’s important to do so. And, yes, I mean write them down, think about them, and revise them when necessary.  When you hit the inevitable days of stormy weather, having a compass that it true is critically important.

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In reading about compasses, I also learned that the traditional compass has to be held level to work.  I learned that “when the compass is held level, the needle turns until, after a few seconds to allow oscillation to die out, it settles into its equilibrium orientation.”

What a great image.  You have to be still to let the compass equilibrate.  You have to be mindful to look at the needle to calculate your absolute bearing.  And then you have to take that information and apply it to correct your course.  And to do so, you have to hold the compass level, which I think is a great metaphor for taking care of yourself – physically, emotionally and spiritually.

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There is not a lot in the day to day life of an intern, resident or practicing physician that teaches us the skill of focusing on that still point, on getting our bearings to make sure we don’t veer off course.

It’s not a trivial problem.  Veering off course can result in doing something we don’t want to do or, more importantly, becoming someone we don’t want to be.  More importantly for those of you just starting on this journey, a small error in navigation at the beginning of a journey results in a very large error when you arrive.  That’s why, as you start this journey, it’s so important to know what “true north” is for you.

As you articulate what your “true north” is, I would also urge you to translate it into something that is easy to remember for those times that you are making a decision in a difficult moment.   For me, my “true north” as a physician has been distilled into three rules that I try to follow and that I teach my trainees.

Rule 1:  Do what’s right for the patient.

Rule 2:  Look cool doing it.

Rule 3:  Don’t hurt anything that has a name.

Let me expand just a little…

Rule 1 means always do what’s right for the patient.  Even if you are tired, even if others disagree, even if you don’t get paid, even if it’s not technically “your” patient – do what’s right.  It also means developing an life-long method to deliberately read and study so you know the right thing to do.  And it means doing all of this with compassion and integrity.

Rule 2, “Look cool doing it”, means practicing your art until you look cool.  If you are surgeon, make sure your movements look like Tai Chi and that you have no wasted motion.  If you are a pathologist, learn all the variations on the themes that cells can create. No matter what your specialty, read about each of your patients, prepare for all cases, procedures and conferences deliberately and diligently. “Look cool doing it” also means don’t lose your cool.  Be professional, which at its core is just another way of saying kindness and integrity matter.

Rule 3, “Don’t hurt anything that has a name”, certainly means don’t cut the ureter if you are doing a colectomy, but it means more than that because…

You have a name.

Your significant other has a name.

Your institution, your friends, your family all have names.

You are about to embark on the amazing and challenging journey of residency… I know you have a sense of trepidation and also a sense of incredible excitement.  Everyone in this room who has been there remembers and, to be honest, is probably a little jealous. What an amazing time to start a career in medicine.

Congratulations on all you have accomplished so far. I wish you smooth sailing and a compass that is true.

 

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*Because I am using “true north” as a metaphor, the scientists will have to forgive me.  There is a difference between “true north”, which is the actual north pole and “magnetic north” which is what a compass shows.  Here’s a great link that explains this further:  Magnetic North vs Geographic (True) North Pole

 

 

 

Applying for Your Residency

The following guest post was written by Daniel Fox, MD with the help of other residents in ENT  for medical students applying to otolaryngology.  I thought it was so outstanding that I asked his permission to publish a minimally edited version that would apply to all medical students applying in the NRMP match. 

The application process starts with knowing and understanding the rules.  The following are the websites that will help in this process:

Match Statistics hhttp://www.nrmp.org/data/index.html This will give you an idea about the qualifications of candidates that match into each specialty.

ERAS https://www.aamc.org/students/medstudents/eras/.This website is for applying to residency programs.

NRMP http://www.nrmp.org/.This website is for submitting your rank list.

FREIDA https://freida.ama-assn.org/Freida/user/viewProgramSearch.do. This website gives some very basic information about individual programs, but overall is not very useful.

Residency Program Director Survey (38% response rate) http://www.nrmp.org/data/programresultsbyspecialty2010v3.pdf.  This gives you an idea about what program directors value.

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Applications (in General)

  1. Talk to as many individuals as possible (MS4s, residents, and faculty) about the field you are thinking about.  This will help you obtain the most accurate overall information.
  2. Get ERAS completed and submitted the first week it opens (September 15th).
  3. You are able to resend your transcript when you get rotation grades back.
  4. You are able and should update schools on your AOA status.
  5. When you are invited for interviews is really dependent on the specialty.  For example,  ENT programs typically have a later timeline so you might only have 3 interviews at the end of October while one of your friends applying for pediatrics has 15.  They will come in time!
  6. Ask around the department, both at your own medical school and on your aways, to help find out which programs you should apply to.
  7. For competitive programs, an average applicant can probably expect interviews from 15-25% of the programs to which they apply.  The very good applicant may receive 50%, and the outstanding applicant may receive interviews from 75-90% of the programs to which they apply.  If you are applying in on of the very competitive specialties, recognize that many applicants applying have taken an entire year off to do ENT research, have a 270+ Step 1, have an additional degree (MBA, PhD), are former Rhodes Scholars, Olympic medalists, etc.  Don’t overestimate your qualifications as an applicant.
  8. There is no rhyme or reason to interview selection.  Even if you did an away at a program and were told that you would have an interview, this does not mean that you will have an interview.
  9. It is very hard to get interviews with schools in California. Most require Step 2 scores to apply (which means you need to take Step 2CK no later than the 1st two weeks of August)
  10. You should utilize program websites to construct a list of desired interview dates prior to being contacted by a program.  It is not a bad idea to have preemptive emails written to each potential program with your desired interview date, so that you can respond promptly when offered several interview dates.  This sounds entirely unnecessary and neurotic, but if you do not respond within the first couple minutes of receiving the email, your preference and possibly spot may be gone.  If you have a logical flow of interviews based on location, this can also save you a lot of money when coordinating travel.  Some programs do offer more interviews than they actually give, so if you don’t respond immediately, you may be wait-listed.  During the months of October-December you should not go anywhere without immediate access to email during the hours of 7am-8pm.  Be conscious of when you schedule Step 2 CS/CK as well because I know applicants that were not able to respond while in the exam and did not receive an interview as a result.
  11. I definitely recommend checking your “Junk Mail” box from time to time as one of my colleagues happened to check it one day and found an interview offer that they would have never seen otherwise!  An alternative to this is to change the settings on your “Junk Mail” folder temporarily so that every email goes to your inbox.
  12. Regardless of your personal competitiveness, be sure to apply broadly to programs. Don’t rule any programs out as being “above you” and don’t rule a smaller or medium sized program out as “below you.” Even your instincts on location may steer you wrong and you might be surprised by places you thought would be “too big city” or “too small town” for you. Exactly who various programs choose to interview is a strange process with strong applicants sometimes seemingly randomly being refused interviews at less competitive programs and moderately-competitive applicants landing interviews at those same programs. Often, it comes down to the “intangibles” of your personal statement and/or LoRs that may tip a program toward or away from offering you an interview.

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ERAS

  1. Extracurriculars are important in ERAS, and you can put anything that you did into the CV section.  Some college activities like research are acceptable, but mostly put medical school activities.  Please note that there is some disagreement on this topic.  I actually put nearly all of my undergraduate activities on ERAS.  You can also just choose a few that required that were especially impressive, time-consuming, or representative of your overall character.  Remember, if anything you have done can be positively spun in a way put it on ERAS, but don’t misrepresent your activities.
  2. You need to have an actual CV and not just what ERAS generates.  Ask for help with the format and appearance of your CV.  It’s important to start making the transition from a “student resume” to a “professional CV”.  Away programs and LOR writers will want your CV.  Also carry a copy of your application with you to interviews.  Though very rare, there are cases where the interviewer changed at the last minute because the intended interviewer was stuck in the OR.

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Personal Statement

  1. Have several people read your personal statement, including an attending.  Also have a non-medical person read it.
  2. Have it done in time to give to your letter writers.  Start early and revise multiple times.  This was something that a few of us wished we would have had done earlier to make it easier for our letter writers.
  3. This is a very, very important part of your application that can help set you apart from the other applicants.  Remember, for competitive specialties, program directors receive 200-300 applicants who all have mostly Honors on clinical rotations, mostly Honors in Basic science courses, and 235-250 Step 1 scores. Your personal statement is your opportunity to talk about what is important to you and what differentiates you. The goal is for the program director to finish reading your personal statement wanting to meet you.  However, do not exploit trite writing techniques (e.g. “I knew I wanted to be an ENT as I climbed that mountain peak in the Rockies”). If you play an instrument, talk about it and how it has improved your manual dexterity.  If you’re a parent, talk about how it has challenged you to be a team player and balance work and personal life; etc.  The ideal is to mention some personal things that demonstrate something positive about you.
  4. The personal statement is also a place where mentioning what you are looking for in a program is appropriate.

Letters of Recommendation (LORs)

  1. Ask the faculty member in person.
    1. All faculty members know how painful and difficult it is to ask for an LOR, so don’t be bashful in asking.  The consensus is that you should generally work with the person for the better part of a week before asking.
    2. A suggestion of how to ask: “I have really enjoyed working with you…Would you be able to write a strong letter of recommendation for me?”
  2. Give the letter writer a packet of information, including:
    1. Cover letter telling them about yourself
    2. Transcript
    3. USMLE Step 1 scores (probably not mandatory, but some will want it)
    4. Personal statement-It would be ideal to have your personal statement done as early as possible because your writers will ask you for this.
  3. Send everything electronically to both your letter writer and his/her administrative assistant.  The assistant will make it happen.  Thank them with something appropriate – a thank you note, a small gift like chocolate, a Starbucks card or a small bouquet.
  4. It is probably best to have a mix of LOR types.  Ideally you will have at least one nationally well-known writer and at least one that is very personal and speaks toward your character.  Every field expects variations on who should submit letters, so make sure you understand these expectations.
  5. Residency directors like to read letters from other residency directors.
  6. Any faculty member who knows you very well can write a personal letter.  Senior faculty will always have more “impact” than junior faculty for an equivalent letter.
  7. Away rotation residency director/chair.  If you have an away early enough and can procure a letter, it is a good idea because programs like to see that you impressed people outside of your institution.  It is not the end of the world if you don’t get a letter an your away though.  The organization of away rotations can make it impossible to obtain a letter.  If you want to get a letter, it is very beneficial to set up a meeting with the appropriate faculty member or chairperson at your away rotation during the 2nd or 3rd week of your stay and make your interest known that you would like a letter of recommendation.   Ask what you can do to facilitate this.  This will allow you to schedule time to work with him/her if you haven’t already so that they can decide whether or not to support you in your application process.
  8. Letters should ideally be uploaded by September 15th when ERAS opens to the programs.  Every program knows that some faculty procrastinate.  Don’t hound the faculty (although one or two gentle reminders are ok).  Programs will decide to interview you even if all the letters aren’t there when they are making their interview lists (mid to late September).
  9. All schools require at least 3 LORs.  You can submit up to 4 at most programs and should try to get 4 if you can.  You have to individually assign each LOR to each program, so you can use any combination of LORs you wish for a given program.  The same is true for personal statements, if you desire to write multiple personal statements.

Away Rotations

  1. Try out programs you think you might like.  It is a chance to unofficially audition before interviews; You can either impress them or destroy your chances for an offer, so work hard!
  2. Do away rotations early so you can get letters and try out programs before interview season, which centers around November-December. Be cautious about doing two aways in a row.  Even if you think that you are a machine, you will be very tired by the end of these 2 months, and that can come across poorly to programs.
  3. Aways are not required, but can help your chances at a program if you do well during your stay.  Aways, however, will not help you with any program other than that one.  In fact during interviews, you may be asked why you did an away at one program and not where you are currently interviewing.
  4. Keep in mind that doing an away rotation does not guarantee you an interview with that program.  If that is important to you, look for programs that automatically offer you an interview.
  5. If you know you want to get out of your state, do an away rotation far away.  It will show programs that you are an applicant who is mobile and could really be interested in their program.  You’ll be surprised on the trail how large of a part the “How interested are you really in coming to join us?” factor plays.
  6. Get your VSAS info in ASAP, and make sure you know what each program requires; VSAS is the website used to apply for away rotations.  Some programs have very complicated requirements like having titers drawn and drug tests, and they will not consider your application until you submit all of the necessary info.  Some of these processes take time (i.e. you may have to have 2 negative PPDs 7-10 days apart.)

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What to Look for in Programs

This is a very individual decision but here are some brief suggestions (not in any order):

  1. Location, cost of living
  2. Resident-faculty relationship
  3. Friendly, happy residents and faculty.  One way to assess this is talking with chief residents who have little invested interest in which applicants match.  If a chief is still a strong cheerleader for his or her program, that is a strong positive.   Keep in mind that these are the people you’re going to be working with day in and day out and will probably become you’re closest friends, especially if you’re moving to a new location.
  4. Faculty covering all sub-disciplines in your field, particularly if you think you will be interested in subsequent fellowship training.
  5. Faculty that love to teach and are dedicated to their residents.  Getting jobs and fellowships is very dependent on who you know and how willing these faculty members are to support you in pursuing career goals.
  6. Surgical or procedural volume; clinic volume; exposure to a breadth and volume of complex patients.
  7. Adequate autonomy afforded to residents.
  8. Fellows vs. no fellows.  There are pluses and minuses to both.  Doing an away at a place with fellows might help you determine your preference.
  9. Budgets for books, loupes, meeting travel.
  10. Clinic/OR locations.  Are you going to have to travel to cover multiple hospitals at night?  Are there away rotations?
  11. Mission trips.  Many residents have the opportunity to go on trips with faculty members within or outside their program.  Will you have to use vacation time to do this?  What about funding?
  12. Significant, quality research and faculty willing to mentor you with research projects.
  13. A place that will provide reasonable benefits.  THERE IS A LOT OF VARIATION IN BENEFIT PACKAGES SO READ CAREFULLY.  Also, there are many states that do not have a state and/or local income tax.  Family health insurance can vary from almost free to more than $6000/year.
  14. “Moonlighting” possibilities. Moonlighting counts in your 80 hour limit on weekly duty hours and must be approved by your program director.  That being said, within those parameters, it’s something that is possible in many programs.  Most students are afraid to ask this question.  Only ask residents about this and not faculty members.  If you ask, you will find that about 75% of the programs allow moonlighting.  You can find some of this information in the resident compacts posted on department websites.  For the most part, a lack of moonlighting is not a big deal for single residents, but can be important for applicants with growing families and a spouse that stays home.
  15. Program stability.  Looking at past department newsletters that have faculty listings can give you a good idea about faculty turnover.
  16. Home call versus in-house call. Home call isn’t necessarily better, especially if you are frequently up all night and don’t get to go home early the following day.  Also, how many hospitals are you covering?  Are they in the same location or spread throughout the city?

What Programs Want

Try to figure out what you would want in an applicant and be able to give examples of how you display these qualities.  Always be yourself though.  It is not beneficial to anyone to be a chameleon and take on whatever role you think the interviewer wants you to play.  You expect programs to put their best foot forward but also want transparency and humility.  Likewise you want your personality to come through so that they can evaluate you.

Some components of the “perfect” applicant are as follows.  Clearly, this comes from an applicant perspective, but after doing 100-150 individual interviews, you will develop sufficient insight into the interview process.  There aren’t many people outside medicine that do this many interviews in a career.

  1. Intelligent-don’t emphasize this in interviews.  Everyone granted an interview is intelligent.
  2. Excellence-someone that has a built-in desire for excellence in all areas of life and doesn’t need external motivation to excel.  Try to demonstrate this by giving examples outside of medicine.
  3. Team Player-someone that can work will with others. You will be asked multiple times about an experience where one member of a team was dysfunctional and how you handled it.
  4. Self-sacrificial-someone that recognizes that medicine is not about them but the patient.
  5. Learner’s spirit-you will be asked multiple times about a mistake you’ve made in the past and how you’ve learned from it.
  6. Thoroughness/Organization-this can be demonstrated by mentioning something about the interviewers background indicating your prior research about the program/interviewer.
  7. Personable-if this is true, it will come across in the LORs and interviews.
  8. Good Hands (for procedural or surgical fields)- a faculty member told me about a resident that made purses as a hobby and conveyed manual dexterity through this story.
  9. Mature/Responsible-evident through life experiences and decision-making processes.
  10. Contributor-someone that contributed to their medical school or a department and wasn’t simply a consumer.
  11. Initiative-be able to give examples of how you take initiative and are self-directed.
  12. Leadership-you will be expected to be a community leader.
  13. Interest in educating others- The root of the word “doctor “ is “to teach”
  14. Honesty-this is almost assumed, though you may be asked to tell about a time that you lied.
  15. Work experience-residency is not only a training experience but also a job.  Past work experiences can show a willingness to work hard, how to submit to superiors, and knowing how to fit into a team.  Programs will want someone that is a hard worker and hasn’t been given everything on a silver platter.
  16. Good communicator: practice responses so that they are succinct.
  17. Self-reflective-applicants that know themselves well, can articulate goals, personality.
  18. Attitude-someone that is positive, enjoyable to be around, and not an Eeyore.

Cheap_Flights_Travel_Cheap_Tips

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Travel/Expenses

  1. Look for alumni of your medical school (particularly recent graduates who just went through this process) that would be willing to house you for interviews.  If they do, take flowers, chocolate or memorabilia from your medical school as a thank you present!
  2. Stay with family and friends in surrounding areas.
  3. Take advantage of family member’s frequent flier miles.
  4. Develop a strategy to increase flexibility and decrease cost for your airline travel.  Look for flexibility in buying and changing tickets.  Many of your interview dates will be changed at the last minute.  Southwest airlines is probably the most flexible about this (and has no change fees).
  5. Use priceline.com’s name your own price for hotels and rental cars.
  6. Most hotels offered by programs are overpriced.  You can priceline the same hotel recommended by the program for half the price.
  7. Look into whether your car insurance and credit card provides collision, loss of use, and liability insurance.  Most should not have to buy the supplemental rental car insurance.
  8. Rather than flying directly into your destination city, consider flying into nearby cities and getting a rental car.  If you have the time, you can save significant amounts of money.
  9. Check out MegaBus, train schedules or other mass transit (more prevalent in some parts of the country than others)
  10. Consider asking family members to help you drive.  This can cut down on the number of flights you have to take.
  11. Be strategic about which suitcase you have (and make sure it’s not shabby) and how you pack it. Never check any bags when flying.  You get 2 carry-ons (suitcase and interview clothes).
  12. Use the same packing list.  Make sure to include:
  13. Printouts on program/residents
  14. Maps/Directions to campus, hotel, airport
  15. Umbrella
  16. Keep a travel expenses log to get more federal loan money.  There is some debate about whether you can deduct travel expenses for tax purposes, but several CPAs I have spoken to say you can.

dressing for interview copy

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Interviewing Tips (General)

  1. If wait listed, write an email indicating your continued interest.  This actually works!
  2. Email the residency coordinator about places residents live.  This will show genuine interest and will allow you to evaluate the area. Exploring each city not only gives you full disclosure but also shows the program that you would seriously consider moving to their city.
  3. You should probably buy an interview portfolio and a nice pen.
  4. Make sure your clothes are professional and appropriate.
  5. Carry a toothbrush and mints on you.
  6. Allow for time to iron clothes.
  7. Don’t forget to get your hair cut and to clean your fingernails.
  8. Concise replies that answer the question are usually better than rambling.
  9. Ask clarifying questions when presented with uncomfortable questions
  10. Have $25-50 in one dollar and five-dollar bills so you have easy cash access to pay tolls when driving through big cities or for parking at hospitals if it is necessary.  Not all programs will validate parking. If there is a parking attendant, remember how little money they make and think about leaving them a little something for a cup of coffee, too.
  11. Obtain a schedule of the interview day beforehand when possible.
  12. Maximize the “down time” to see other aspects of the program. (i.e. cafeteria, library, resident rooms)
  13. Plan to be at each program 1-2 hours later than expected.  Interviews often go long.
  14. Know the entire faculty by name prior to meeting them.
  15. Know in general faculty research interests.
  16. Google them, look up their publications on PubMed, etc.  Don’t flaunt this, but if the door opens to use this information it will make you look great.
  17. Have a bio printed out (or at least notes) with you on each faculty member!
  18. Know all the residents by name and medical school/undergraduate.  This may seem like overkill but the residents will remember that you took a specific interest in them.  It will also serve as a conversation starter.
  19. Know what the program is proud of and be enthusiastic about those points.
  20. Know how to pronounce the name of all those with whom you interview.
  21. If you’re given a question that you can’t answer easily, you can always say that you’ll have to think about that.  Can we come back to that later?
  22. Bring several copies of your research work if published.
  23. Bring copies of written core evaluations to counter any questionable grade.
  24. Many interviewers will ask why you don’t have an honors in the major core rotations, particularly if its in your chosen field.
  25. Reflect on each interview day
    1. What went well?
    2. What could have gone better?
    3. What do I still not know?
    4. Did I sell myself?
    5. Make notes the day of the interview – it’s too easy to forget the details if you wait.
  26. Plan to send an email or written note after you interview that emphasizes the following:
    1. Thank you for opportunity to interview
    2. Strengths of the program
    3. How you fit into the program and why you would be an excellent choice

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Questions you are Likely to Be Asked During Your Interview

These questions are compiled from both actual interview questions and possible questions.  Many of these questions you will never hear, but going through this list will help you know yourself better and be able to more fully communicate it.  You should practice the answers to questions with another person listening.  Also, one crucial skill is to figure out why an interviewer would ask a question.

Introductory questions

  1. How are you today?
    1. Great, glad to be here, great program, great area, great people GREAT!  It is very clear who is interested in a program and who is going through the motions.  If you spent hundreds of dollars on an interview than you should be enthusiastic.
  2. Tell me about yourself
    1. Brief biographical outline
    2. Strengths
  3. What makes you stand out from all the others?
  4. WHAT ELSE WOULD YOU LIKE TO KNOW? Don’t ramble and don’t guess what the interviewer wants to know—ASK.

Background Questions

  1. How did you choose undergraduate, medical school?
  2. What are your three biggest accomplishments?

Medical School Questions

  1. How did you do so well as a medical student?
  2. What kept you from doing better during medical school?
  3. Why did you do an away at … and not here?
  4. What did you like about the program(s) you did away(s) at vs. your home program?
  5. Why didn’t you get letters of recommendation from your aways?
  6. What is your favorite surgery/patient/day at work?
  7. Tell me about the most interesting case/patient you’ve seen.
  8. Tell me about a particularly satisfying or meaningful experience during your medical training.
  9. Why don’t you have any publications?
  10. What is the greatest sacrifice you have had to make to get where you are?
  11. Tell me about your research—often a specific project.
  12. Why did you get not get an honors in surgery/medicine/pediatrics/etc?
  13. Which patient did you learn from the most?

Values/Personality Questions

  1. Tell me about your strengths and weaknesses.
  2. Strengths-see above and give in the context of a story.
  3. Weaknesses-focus on something that is an “acceptable” weakness
  4. Tell me about a time that you failed at something?  What did you learn?
  5. Tell me about the most difficult challenge you’ve faced in your life?
  6. Tell me about how you’ve grown and changed as a person during medical school.
  7. How have you been able to maintain a work-life balance?
  8. Three adjectives that best describe you?
  9. How would your best friend, parents describe you?
  10. If I gave you $5000 what would you do with it? $50,000? 1 year?
  11. What is your energy level like?
  12. How well do you function under pressure?
  13. Tell me a story about yourself that best describes you.
  14. Tell me about an obstacle that you’ve had to overcome.
  15. What would you want on your tombstone?
  16. Tell me one thing that I wouldn’t know about you from this packet?
  17. What was the most difficult decision in your life?
  18. What is the most difficult stand you’ve ever had to take?
  19. What have been your biggest failures in life?  How do you ensure this won’t happen again?
  20. With what type of person do you have trouble working?
  21. How would you handle a situation where a senior resident or attending asked you to do something you thought was wrong?
  22. Give me an example of when you have disagreed with a superior and how you handled it.
  23. Most useful criticism you ever received?
  24. What did you do to prepare for this interview?
  25. How do you make decisions?
  26. If your house were burning down, what three objects would you grab?
  27. If you could have 3 wishes, what would they be?
  28. What in your life is most important to you?
  29. Who are your heroes?
  30. What is the last book that you read?  You will be asked this question 10+ times.
  31. What is your favorite movie?  You will also be asked this question repeatedly.
  32. What do success and failure mean to you?  How do you measure these?
  33. Interests outside of medicine?
  34. If you could do anything for a day, week, month, what would you do?
  35. What’s on your bucket list?
  36. Describe your best friends?
  37. Single most valuable thing that you have ever learned?
  38. Life goals?
  39. What was the most important event in your life?
  40. Why do others see you as a leader?
  41. What has been the most difficult thing you’ve ever done?
  42. How have you changed since high school? College?
  43. What might give me a better picture of you than your resume?
  44. Pet peeves?
  45. How well do you take criticism?
  46. What motivates you?
  47. Tell me a joke.  You will definitely be asked this so have a quick, clean, funny joke on hand.
  48. What has been the most traumatic event in your life?

Specific Questions about your specialty

  1. Why [specialty]?
  2. Why surgery over medicine? Medicine over surgery?  Children over adults?
  3. Do you see yourself in academics or private practice?
  4. Do you think you’ll do a fellowship?
  5. What do you want to accomplish as an [specific specialist]?
  6. Career Goals?
    1. 5 year
    2. 10 year
    3. 20 year
    4. 30 year
    5. 40 year
  7. Most enjoyable part of [specific specialty]?
  8. Toughest aspect of [specific specialty]?
  9. If [specific specialty] didn’t exist, what would you do?
  10. If medicine didn’t exist, what would you do?  You will be asked this many times.
  11. What will be the biggest issues our specialty faces over the next five/ten years
  12. Do you play a musical instrument?  Did you play on a competitive sports team ever?  These are 2 of the 3 “predictors” for who will be a good surgeon per a recent paper.  The third is the quality of medical school attended.  Don’t put too much weight on this if you don’t play an instrument or weren’t on a sports team, but several interviewers will ask about this if you are going into a surgical specialty.

Program Questions

  1. Where else have you interviewed?
  2. How would you describe each of those programs?
  3. Other than here, what program has impressed you the most and why?
  4. What are you looking for in a residency program?
  5. Why did you want to come here?
  6. What one thing do you want conveyed to the residency committee?
  7. What if you don’t match?

Why Me Questions?

  1. Why should we pick you over the other applicants?  What will you contribute?
  2. What one characteristic qualifies me more than any other candidate?

Residency Questions

  1. How do you plan to succeed as a resident?
    1. Academically?
    2. Clinically/Surgically?
    3. What are your plans for research as a resident?

Odd Questions

  1. Give an example of a problem you solved and describe how you went about solving it.
  2. Teach me something in 5 minutes.

You will often be asked if you have any questions as the last part of the interview.  Be ready!

Questions to ask faculty

  1. For each faculty member, ask why he or she went into academic medicine.
  2. Where are your recent graduates?
  3. What percent of graduates enter a fellowship?
  4. In what ways do faculty members help residents obtain jobs/fellowships?

Questions to ask program director

  1. What is the program’s educational philosophy?
  2. What is the best example in the program of faculty dedication to resident education?
  3. Where do you see the program in 5 years?
  4. What changes have been made in the recent past based on resident feedback?
  5. In training exam scores?
  6. Percentage of residents passing oral and written boards first time?
  7. Mentoring system?
  8. How many residents go to academic meetings?
  9. Do you expect any curriculum changes in the near future?
  10. What does this program see in me and why was I offered an interview?
  11. May I have a copy of this month’s didactics schedule?

Questions to ask residents

  1. Would you choose this program again?  Ask different residents, and look for the blink reflex.
  2. Which parts of the program do you like the best, least?
  3. How would you characterize faculty-resident relations?
  4. For key faculty members, give me 2 positives and 2 negatives about working with them.
  5. Have any residents in the near past left prior to graduation for any reason?
  6. Moonlighting policies, opportunities, and participation?
  7. If a 4th year resident announced his/her intention to pursue private practice, how would faculty view this?
  8. How many times have you been to a faculty members home in the past year?
  9. Have any faculty members been recently added?  How long do you expect the chair and program director to be in their current positions?
  10. Access to books?  Online?  Textbook money?
  11. Do you have time to read?
  12. Midlevel providers (NP, PA) help?
  13. Percent of in house vs. home call?
  14. Percent of time you come in when on home-call?
  15. Taught by residents or faculty members?
  16. Past case numbers (for surgical specialities)?  This is changing to a competency system but past numbers can give you an idea of volume.
  17. Approximate number of hours for each PGY level per week?
  18. Call schedule?
  19. Benefits package: obtain from Graduate Medical Education Office though residents will know too.

Preventing Weight Gain in Residency

This is the time of year when 4th year medical students are winding down and preparing for the “big move” into internship.  Our 4th year students take a special 3 week course to get them ready – a wonderful mix of small groups on professionalism, ACLS training, first night on call beeper emergencies…etc, etc.  It ends with a small group of senior faculty who talk about making the transition to residency.  I wish we’d recorded the talks – they were all really wonderful.  In addition to giving wonderful professional advice,  all of the faculty included advice on taking care of yourself.  It struck me that one of the specific issues that each of them mentioned (well, four out of five) was how much weight they had gained in their internship and residency.

Losing weight is not easy for those that struggle with this issue – but preventing weight gain is not as hard – and should be a goal for every intern and resident!   It’s not hard – you need to increase your activity (a little) and watch out for stupid food choices.   Here’s the “rules” I wish someone had given me before I started my residency (if you have rules you would add, please send a comment!)

1.  No junk food (doughnuts, pizza, hamburgers, etc)

2.  Take healthy food with you to work – especially for call nights.  Keep emergency healthy food in your locker i.e. high quality energy bars, dried fruit/nuts (in appropriate small portions).

3.  Make sure you get an hour of real exercise on days when you are not in the hospital

4.  Take the stairs instead of the elevators.

JAMA. 2010 Mar 24;303(12):1173-9.

Physical activity and weight gain prevention.

Lee IM, Djoussé L, Sesso HD, Wang L, Buring JE.

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA. ilee@rics.bwh.harvard.edu

CONTEXT: The amount of physical activity needed to prevent long-term weight gain is unclear. In 2008, federal guidelines recommended at least 150 minutes per week (7.5 metabolic equivalent [MET] hours per week) of moderate-intensity activity for “substantial health benefits.”

OBJECTIVE: To examine the association of different amounts of physical activity with long-term weight changes among women consuming a usual diet.

DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study involving 34,079 healthy US women (mean age, 54.2 years) from 1992-2007. At baseline and months 36, 72, 96, 120, 144, and 156, women reported their physical activity and body weight. Women were classified as expending less than 7.5, 7.5 to less than 21, and 21 or more MET hours per week of activity at each time. Repeated-measures regression prospectively examined physical activity and weight change over intervals averaging 3 years.

MAIN OUTCOME MEASURE: Change in weight.

RESULTS: Women gained a mean of 2.6 kg throughout the study. A multivariate analysis comparing women expending 21 or more MET hours per week with those expending from 7.5 to less than 21 MET hours per week showed that the latter group gained a mean (SD) 0.11 kg (0.04 kg; P = .003) over a mean interval of 3 years, and those expending less than 7.5 MET hours per week gained 0.12 kg (0.04; P = .002). There was a significant interaction with body mass index (BMI), such that there was an inverse dose-response relation between activity levels and weight gain among women with a BMI of less than 25 (P for trend < .001) but no relation among women with a BMI from 25 to 29.9 (P for trend = .56) or with a BMI of 30.0 or higher (P for trend = .50). A total of 4540 women (13.3%) with a BMI lower than 25 at study start successfully maintained their weight by gaining less than 2.3 kg throughout. Their mean activity level over the study was 21.5 MET hours per week (approximately 60 minutes a day of moderate-intensity activity).

CONCLUSIONS: Among women consuming a usual diet, physical activity was associated with less weight gain only among women whose BMI was lower than 25. Women successful in maintaining normal weight and gaining fewer than 2.3 kg over 13 years averaged approximately 60 minutes a day of moderate-intensity activity throughout the study.

PMID: 20332403 [PubMed – indexed for MEDLINE]