Recently, I’ve been pretty active on Twitter. It’s been fun to post GIFs everywhere and interacting with really cool people.

However, more so than that, I’ve been able to find out about topics which are really important to the target demographic of my blog, namely, pre-meds, medical students, and residents.

Since we’re in the middle of match, and interview invites are starting, I felt it was important to talk about residency interviews.

Here’s a thread from @mcsassymd (Sassy, (future) MD) with an excerpt of:

“So my PS is “be boring” and interviews are “don’t stand out” and my CV doesn’t stand out so…”

Responses were varied, such as: @pagerkryponite (PK)

“whatever. I tried that once, didn’t work.”

and @DrSadieHawkins (Emily Brumfield)

“as we used to say in residency, “all you gotta do is show up and not take a dump in the corner””

and me, of course @ResidentSensei (Senior Resident, MD):

“Unfortunately, I think residency interviews are more about “not standing out” than they are about “standing out”.”

A good discussion ensued and I felt it deserved a little more in depth evaluation, so I decided to write this post for Medicine Mondays.

I tried to sum up my advice in two tweets:

“Let me put it this way: getting interviews is a numbers game, the interview itself is to make sure you’re “ok to work with.”” Tweet 

“I honestly think ranking is based on whether you made it to interview, are normal, and how much they think you want to be there.” Tweet

I want to take the time here to try to expand on this a bit, as a continuation to my prior post: 4th year, ERAS and the NRMP Match

So it’s October, and you probably have a few interview invites or will be getting some soon.

@mcsassymd reminds us that only 16% of interview invites come before October with this infographic

***Note that this specialty dependent, some specialties are later than this, some are earlier. However, I don’t think October is panic mode.

So now you start stressing out about what to wear, how to pack, how to travel, how to act, etc. I’ll try to ease your fears a little bit here. First of all, full disclosure, I was not a chief resident at my residency program and did not have any say in how ranking decisions were made. However, I think I have pretty good insight on how things are done (in general) when it comes to residency interviews.

Residency interviews are stressful, but they don’t have to be. Truthfully, I would venture to say most residency programs are not looking for the next Osler to walk through their doors. Additionally, they are not expecting you to wow them with your physical examination knowledge of S3 heart sounds or wax poetic on the 5 most common etiologies of Wolff-Parkinson-White (WPW) syndrome. You’re 4th year med students, you have residency to learn all that stuff which will be important to your careers. At this point in your career you have acquired very superficial knowledge from a variety of rotations done during 3rd year. You may have already done a sub-I or a few electives in your residency of choice, but make no mistake, a medical student is not a resident. 

A few weeks on a specialty can not substitute for 3+ years of 80+ hour weeks.

Ok, have I lowered the expectations a little? Good.

Now, what really matters is, are you teachable. Are you pleasant to be around? Medicine has a huge knowledge base, and each subspecialty has its own separate knowledge base. For much of residency, it’s like drinking from a fire hose while swimming in a pool of knowledge, hoping to grasp this knowledge by immersion and diffusion. I had a surgery attending who used to tell me “I can teach any monkey to remove a gallbladder.” Note: he said this to me after I helped him remove a gallbladder laparoscopically.

His point was that you have to be teachable. If you are resistant to learning and simply can’t be taught, then that will make residency not very fun for you (or your attendings).

What? How is that even possible, these are 4th year medical students, obviously they’re teachable! 

I disagree. You can get through the first two years of medical school through book learning alone where you sit in lecture and listen, just like the previous 10 years. The 3rd year of medical school, you might be able to hold it together for a few weeks at a time while you rotate between different attendings with these superficial interactions. However, none of this means you are teachable.

Residency is less of a “teacher-student” relationship and more of a “master-apprentice” relationship.

This is what the residency interview hopes to accomplish. Attempts will be made to tease out whether you are teachable or not.

Ok… what about “pleasant to be around”?

This is a “feel” kind of thing. Do you mesh with the current group of residents/attendings? Is there “chemistry”? Whatever terminology you want to use.

Every residency has its own culture. This will change with the times of course, but do you fit with the current culture? For example, if the current residents/attendings all talk about Star Wars all day long, and you HATE Star Wars, maybe you guys won’t mesh so well. Obviously that example is an exaggeration, but you see my point. A more “real world” (but still exaggerated) example might be that you go to an interview at Ivory Tower U where everyone wears heavily starched, bleached white coats. All the girls wear their hair in pony tails, out of the way and every guy is clean shaven. Perhaps if you have a fantastic mustache or magnificent hair down to your ankles, you may not fit in with this particular group. And that’s ok!

Back to my original tweets:

Once you have the interview, you can consider yourself to be on a level playing field with everyone else. In reality, the playing field ISN’T level.

Someone in your group has the higher USMLE score. That program is someone’s home program. Someone did an away rotation at that program. Someone is first author on a paper. etc. etc. Honestly, the most nerve-wracking part of the interview process was making small talk with other anxious 4th year medical students as everyone tried to gauge how competitive we all were. Please don’t do this, you’ll just make yourself more anxious. Talk about anything other than your research on doppler ultrasound on snails or your first author publication on Southwestern Equine Encephalitis.

It’s hard, but try to remember that none of that should matter to you.

Everyone might seem like a “rock star” who is better than you, with better chances than you. However, how many “rock stars” can there really be? Maybe this “rock star” is going on 30 interviews, or maybe 40, or whatever. If you read StudentDoctorNetwork (StudentGunnerNetwork), you might think the whole country is full of 25 year old, 260+ Step 1 geniuses, with 3 first author publications and a cure for cancer in Stage III clinical trials. Trust me, while there are a good amount of “rock stars”, they can only match at one place each. Which is why the other advice still holds true:

It’s ok if you don’t “stand out” as much as you think. Just don’t stand out in the wrong way.

Control the things you can control: Be teachable. Be pleasant. Show them how much you want to be there.

This post kind of got long quickly. I have more to say I think so I’ll try to continue this next week:

We’ll talk about interviews more: Specifically, how to treat an interview at a “reach place” or “one I don’t deserve”.

I’ll also talk about how to travel for interviews on Whatever Wednesdays.

TL;DR

Be teachable.

Be pleasant.

Show them how much you want to be there.

There aren’t as many rock stars as you think.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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