The Art and Science of Interviewing

(or tricks to the ERAS application)

Sheilah Bernard, MD
Associate Program Director, Medicine Residency
Chair, Internship Recruitment and Clinical
Competence Committee
 Objectives
• Understand the role of the interview
• Reflect on how to determine if you would like
to work with that candidate (or just socialize)
e.g can this candidate care for my loved one?
• Familiarize yourself with interview Do’s and
Don’ts
• Review for the experienced and stimulate the
novice
 The process….
• Candidates apply to many schools 12-50
• Many ERAS (Electronic Residency Application Service)
applications are received
• All are screened
– MSPE (Medical Student Performance Evaluation) or Dean’s
letter –where do they rank in the class?
– DOM letter: where do they rank amongst IM applicants
from that school?
– IM Clerkship/IM SubIntern grades
– USMLE scores: are they coachable?
– Extracurriculars: what could they contribute to program?
• Only 10% are selected to interview; 10% of these
match
 Know who “we” are (High Value Care)
• Come to Infosession, email to follow if you can’t
• Socially responsible, academic municipal hospital in
Boston serving diverse patient population (98% insured
state-wide) with a VA experience
– Triad of education, research and patient care
– Exceptional Care Without Exception, or The Right Care, no
more, no less
• Block schedule (ambulatory distinct from inpt)
• Entirely electronic (Epic experience appreciated!)
• Opt into tracks as PGY2
• Successful matches into subspecialties
 The “pre-interview”
• Frequent complaint is “the interviewer did not
read my application”
– Program will try to match interviewee with both a
faculty/junior faculty sharing similar birthplace,
college, med school, fields of interest (in and out of
medicine)
– Last minute changes occur, we try for Friday
distribution prior to interview week (M/W)
– Look for an underlying theme linking personal
statement, work experience, research, or
extracurriculars; ask open-ended questions to explain
 The interviewer should…
• Maintain professional atmosphere in a quiet
room, avoid interruptions; turn beeper over
• Limit discussion to issues related to candidacy for
residency position
• Ask only for information necessary to make a
sound decision
• Use proper terminology: we interview residency
“candidates” for further training, in business we
interview “applicants” for variable skill sets
 Identify Red Flags
• Misdemeanors
• Typographical errors
• Gaps in education (buried in transcript or Dean’s
MSPE)
• “Nice, punctual” are not flattering adjectives
– “Will develop”, “Made strides”, “gaining confidence”
• Special considerations
– Needs to be in Boston
– Couples matching, Visa are a tick box
• Information provided on application is subject to
questions
 Identifying Key Words
• Every school is different, interpret in quartiles
or quintiles or sextuples
• MSPE: Outstanding > Superior > Excellent >
Very good > Good > Capable
• DOM: “We will be recruiting him/her to stay at
our institution”
• Integrity of LOR: From researchers, mentors
or family acquaintances; “in my 30 (vs 2)
years’ experience”
 Guiding Principles for Interview
• Be time sensitive
– 2 interviews plus tour: 30 minutes limit/interview
• Introductions
– The applicant may have Google’d you (do they know
you more than you know them?)
• Be aware that online Residency Interview Tips on
YouTube are popular this time of year
• Always observe
– Composure, fluidity of thoughts/language
– Motivation, “fit” at BMC, Talk the talk or walk the
walk?
 The interviewer should…
• Approach the interview as s/he would a
patient encounter
• Ask open-ended questions
• Avoid interrupting the candidate
• Use silence or pauses to encourage the
candidate to speak candidly
• Ask the same questions of all candidates
regardless of gender or ethnicity
 The interviewer should…
• Focus the interview on the candidate’s expressed
capabilities and attitudes in relationship to the
residency or fellowship appointment
• Avoid stereotyping candidates; use gender
neutral terms
• Try to get feel for candidate’s humility, intellectual
integrity and willingness to work
• Use nondiscriminatory language to identify
special needs (are there any reasons you would
not be able to perform expected duties?)
 Areas to avoid
• Although questions about social, personal or
family issues may put a candidate at ease, one
should not ask about age, marital status,
pregnancy, family planning, number of
children and childcare issues, religion, physical
disabilities or race
• Ask questions that the Selection Committee
would need to know
 Recommended questions
• “Are there any current or foreseeable family
obligations or health considerations that
might make it difficult to work as a resident at
BMC?” Open ended, can be asked of all
candidates
• “Are there any questions I can answer about
community life outside the medical center?”
Allows candidates to ask about childcare, etc.
 Types of interviews
• Structured
– Standard panel of questions each candidate must
answer
– Allows us to train and standardize interaction
– Less spontaneous and more formal
– May put off candidates
 Types of interviews
• Structured
• Semi-structured or unstructured
– Allows the interviewer to individualize the contact
– Allows more critical evaluation of weaker
candidate; allows more inviting format for
stronger candidates
– Interviewer evaluates interviewee while
interviewee is evaluating interviewer
– Allows the flexibility to scrutinize or recruit the
candidate
 Types of Interviews
• Individual (standard)
• Panel
– A panel of interviewers evaluates a single candidate
• Group
– Interactions with program coordinators
– Watching interactions during Meet & Greet
– Feedback from tours
– Board games for down time
• IPSC, leadership, assertiveness/passiveness
 Establish rapport
• What would you do if not medicine?
• What do you think makes a good resident?
• What do you do to relax (in application)?
• What motivates you?
• What are you looking for in a training
program?
• What is important to you?
 Ask about past performances
• Tell me about your research project. Why did
you choose that hypothesis?
• What areas do you think you can improve on?
How have you worked on them in the past?
• Tell me about an interesting or inspirational
patient (personal statement) and why.
• Tell me about a challenging patient. What did
you learn from it?
 Ask about past performance
• At the end of a “good day”, what makes it
good?
• How would you like to be remembered by
your medical school?
• What was your most challenging goal and how
did you achieve it?
• What was your most difficult decision in
medical school and what influenced that
decision?
 Assess interpersonal skills/stress
management
• What kind of person has been difficult to work
with, and how did you deal with it?
• What do you think constitutes teamwork?
• Describe an unpleasant or stressful situation in
medical school and how you dealt with it.
• What gets you going, what keeps you going?
• What will be your biggest challenge as resident?
• What barriers would keep you from coming to
our program?
 Assess character and personality
• What single quality distinguishes you from other
candidates? What should I know about you to
help us decide if you were a good candidate for
our program?
• How have you changed over the past 4 years?
• What in your life are you most proud of?
• What do you like to read?
• Describe your weaknesses
• What are your goals during residency?
 Clarify understanding
• What are your 10 year goals? Your 3-5 year
goals?
• How would you describe the ideal physician?
• Who is your role model? Whom do you emulate
inside or outside of medicine?
• What 4th year electives are you taking and why?
• What will you like most/least during residency?
• How would you change your medical school
curriculum? What are its strengths?
 Clarify understanding
• What are your reservations about IM
residency or our program specifically?
• Tell me what interested you about our
program today.
• Can I clarify anything you heard or saw today?
 Challenging questions
• Ask candidates to tell you how they do
something at which they are adept (e.g.
cooking a dish, golf swing, jigsaw puzzle). See
how well they convey information
• (Ask riddles/brain teasers)
• (Present challenging clinical cases)
Review notes and finalize impressions
• Standard interview sheet
– Objective grades/scores
– Letters of references (MSPE, DOM, others)
– Extracurriculars and level achieved
• Volunteerism
• School activism/civic duties
• Research
– Interview x 2
– Exit interview
Review notes and finalize impressions
• Quickly jot down feelings and impressions
• Document concerns (Red Flags)
• Document the context and who initiated if
sensitive topics discussed
• Document items for discussion by Selection
Committee
– VIP candidates, current residents’ friends/opinions
– Need to be in Boston, Visa issues if not already
documented
 Post-Interview Communications
• A national headache
• Communication with candidates after the
interview regarding their competitiveness
should be forwarded to the Program Office.
• Thank you’s are being discouraged; you can
respond to the interviewee that you enjoyed
talking to them and you wish them
professional success; bcc program office.
 Why review interview process?
• Helps add your voice to our candidates’
application
• Struggling residents had evidence of struggles
recognized in the application process
• We will endorse a candidate’s application if we
feel we can support him/her
• Your interviewees are seeing all these
questions on the internet, YouTube so be
prepared!
 Present concepts
• The Behavioral Interview
– Behavioral interviews are based on the premise
that a person's past performance at “work” is the
best predictor of future performance
– Interviewer asks how candidate acts and reacts in
certain circumstances; how one handles a
situation rather than just gathering information
• Give specific "real life" examples of how candidates
behaved in situations relating to the questions
• Give an example of a goal you achieved and tell me
how you achieved it
 Future directions
• Multiple Mini-Interviews
– Started at McMaster University with 6-10 timed stations
through which applicants rotate
– Each station has a scenario, task or question
– Medical schools seek to admit individuals who will make
not only excellent students, but ultimately become
outstanding physicians. The best physicians are those who
are not simply repositories of information; they are ethical,
caring professionals and excellent communicators.
– The MMI was created as a potentially more effective
means of assessing qualities that lie outside the realm of
grades and test scores
 MMI
• Standard interview questions may not reveal an
individual’s communication skills, problem-
solving abilities, level of professionalism or other
skills important for the practice of medicine.
• The MMI approach uses a series of stations to
assess specific skills and qualities and assigns the
same interviewer to rate all applicants at a station
in order to address some of the weaknesses of
the standard interview format
• Used at the medical school level, technique is
filtering into residency programs
 MMI stations
• Ethical dilemmas or questions about policy or
social issues.
– The instructions describe a situation and then ask
the candidate to discuss the ethical or other issues
involved.
– The interviewer may follow up with questions
designed to probe the applicant’s response
– Obamacare supports care for all over care for the
individual. Discuss.
 MMI stations
• Standard interview questions.
– An MMI may include one or more stations with
traditional interview questions such as “Why did
you apply to this school?” or “Describe an
obstacle that you have overcome.”
• A task requiring teamwork.
– Since the ability to work as part of a team is
essential to medicine, some stations involve two
applicants working together to complete a task.
 MMI stations
• Essay writing.
– Some schools include an essay component as part of
the interview process so a station may involve
responding to a prompt in writing.
– This station may be longer than the others to allow for
the applicant to formulate and write the response
• A rest station.
– An interview takes a lot of energy, since the applicant
is “on” the whole time and being presented with
challenging tasks at every station.
– Many MMIs include a rest station. The applicant can
clear their mind and get ready for the next station.
 MMI stations
• Interactions with an actor.
– At these stations, the applicant is provided with a
scenario involving an individual who is played by
an actor.
– The applicant may need to give the individual bad
news, confront the person about a problem or
gather information e.g. catching a friend cheating
– An observer present in the room will rate the
applicant based on his or her interaction with the
actor
 Does applicant personality influence multiple mini-
interview performance and medical school acceptance
offers? (UC Davis)
• Looked at 5 traits in 444 applicants in 2010-11
(agreeableness, conscientiousness, extraversion,
neuroticism, openness) undergoing MMI
• Extraversion was associated with MMI
performance, whereas both extraversion and
agreeableness were associated with acceptance
offers.
• Adoption of the MMI may affect diversity in
medical student personalities, with potential
implications for students' professional growth,
specialty distribution, and patient care.
Acad Med. 2012 Sep;87(9):1250-9
 Objectives
• Understand the role of the interview
• Reflect on how to determine if you would like
to work with that applicant (or just socialize)
e.g can this applicant care for my loved one?
• Familiarize yourself with interview Do’s and
Don’ts
• Review for the experienced and stimulate the
novice
 Motivational Interviewing
• “...a collaborative, person-centered form of guiding to
elicit and strengthen motivation for change.”
• MI is a particular kind of conversation about change
(counseling, therapy, consultation, method of
communication)
• The style of MI is calm and focuses on drawing out
motivation to change from the interviewee rather than
trying to force the interviewee to make positive
changes
• Used in addiction patient encounters
• Used in mentoring/coaching to change behaviors