Sunday, December 30, 2012

Interview Trail - Part 1: First Impressions

I hope everyone's had a happy holiday so far and looking forward to the New Year!  Almost as soon as 2013 starts, I hit the interview trail again.  But before that, some first impressions on Part 1.  There are things I've come to realize that are personally important to me when choosing a residency program, as I'll be stuck where I match for at least the next 3 years.  So in no particular order:
1. Location
Location, location, location.  This is huge.  More so than I initially thought.  You want to be in a city and an area of the country you can see yourself living in for the next 3+ years.  Weather and geography are major filters for many people.  Some people really want to live on the west coast, or the east coast, or NYC in particular (not entirely sure why . . . no one can survive there on a resident's salary).  Others, like me, cast a wide net over huge swathes of the country to see what might fit best.

2. Hospital
The hospital you'll be working in is very important.  Is it old?  Recently renovated?  New?  Does it have readily accessible computers?  Does it use an EMR (electronic medical record)?  Are there good ancillary staff (nurses, pharmacists, etc)?  What is the patient demographic?  One of my filters is that I only chose free-standing children's hospitals because I felt that I'd get the best pediatric training at those tertiary referral centers.  Also, children's hospitals are all so colorful and friendly!  Adult hospitals are dull and depressing in comparison (particularly the VA).

3. Residents
You'll be working up to 80 hours/week with your co-residents.  You'll interact with them more than you do your friends or family.  They will become your family.  What kind of residents are at the program?  Do you mesh and fit in with them?  What kind of person are you?  While everyone in pediatrics is universally nice, I can definitely see myself fitting in with the residents at some programs more than others.

4. Curriculum
The ACGME dictates the fundamental curriculum for all residents.  The money is in the details.  Some programs are well designed, with a ward structure that residents are happy with, and a ton of flexibility to explore interests.  Other programs are rigid or else in so much flux it makes one anxious.  I've definitely come across some interesting and innovative ward structures.  Also the size of the program can be important.  There are small (1-9 residents) programs, medium (10-19 residents) programs, large (20-29 residents) program, and ginormous (30+ residents) programs.  In what environment might you thrive?  Does it matter to you at all?

5. Benefits
A residency is a job, and it behooves the applicant to have some inkling of the benefits.  How much do they pay their residents?  Does the hospital cover medical/dental insurance, or do the residents pay a portion out of pocket?  Amount of vacation/sick leave?  Is there free parking?  IS THERE FREE FOOD?!  I didn't realize how important the latter was to me until I encountered a program that did not feed its residents.  All the applicants looked at each other and were like, "What is this? An adult program?"

6. Gestalt
At the end of the day, trust your gut instinct about a program after you've visited it.  Some of my friends have created Excel spreadsheets to "objectively" score programs to determine their rank order list.  But the gestalt of a place trumps all that.  I've walked away from programs feeling very good about them - they treated the applicants well, I enjoyed my interactions with residents and faculty, they gave a nice tour of the hospital, they answered all our questions and more - whatever it might be, it's definitely a good sign when you walk away from a program feeling really good.  I've also walked away from programs where I'm like "Hmm . . . not sure what to think about this place" or "I really can't seem myself working here."
I'm only in the middle of mine.  I've heard from many other applicants that after about the 4th one they're just like, "Okay, I'm tired of this now.  Everything's blurring together."  But here I am after my 6th one and I'm still excited to go on my remaining 5 interviews and each hospital stands out fresh in my mind (we'll see if that changes later, lol).

I think the reason why is because I listened to my advisor's advice (that's what they're for, right?).  And he said that I'll get competent training anywhere because the ACGME demands it, so it's more about how I feel about the place.  Thus I try to explore the city a bit the day before the interview and really feel out the residents and see what makes them tick and whether I "belong."

Residency interviews are so much better (and more fun) than med school interviews (at least for pediatrics/internal medicine - not as much for surgery I've heard).  You are selected for an interview because they want you there.  The interviews are mostly a get-to-know-you and to convince you to go there.  To be honest, it's weird to be complimented and feel wanted, that what you've done outside the classroom and outside rotations mattered.  I can't even count how many times I've been told that the whole process favors the applicant (as long as the applicant isn't a dick).

P.S. The hospital in the picture above is very nice on the inside.  And the people are amazing.


madmanMD said...

those are good criteria. my spiel when i talk to applicants are as follows:
location, case variety, didactic education, ancillary staff/support, fellowship/career opportunity, and gestalt.

good luck with the second half. it's hard to have energy to do this going into january but you seem to be going strong.

fan of casey said...

The tangible factors, you can score and compare between places and locales. If the programs are competitive, those tangibles (pay, benefits, etc.) should be similar because hospitals know how they are being judged and evaluated. It's those intangibles, how they treat applicants, the buzz from prior residents, the reputation, how they go above and beyond to support their residents is what will make the difference. With all this online information, i would think there's sources where people can speak candidly about their prior experiences and that is what will make the difference for you. As you probably are aware, both sides (you and the interviewing hospital) are going to put on the most positive face forward so you need to be cautious about the answers you get, it will be all rosey. Ask the people in charges what are their weaknesses, and how they are addressing them. Ask them what challenges do they see down the road. Ask them to explain what are the factors in the past that allowed people to succeed and what have been hindrances. Just as you are doing due diligence, you want the hospital to give you honest answers because things cannot be perfect every where.

naturgesetz said...

Hope you get a residency that turns out to be ideal for you.

Aek said...

@madmanMD: Hey thanks! I keep forgetting about didactic education, but it does stand out to me when it's mentioned (or not). Most programs I've seen so far are pretty standard (but a couple did stand out, not all positively). Case variety I'll get at any free-standing children's hospital almost by definition. And the programs I'm looking at have about 50/50 of residents going into primary care vs fellowship, which is what I want.

@fan of casey: A lot of what you say I can sense from the way the residents/faculty answer or evade my questions. I try to word it in a nicer way to see where they're going. Some programs have given me a round-about and that raises a flag in my head. One of my interviewers spent the majority of the time telling me all the negatives of the hospital/program, but only 1-2 things really impacted residency education (and they were fairly minor things to me anyway).

R said...

Wow so many things to consider hey! I didn't have much of a choice, but I'm still SUPER happy with where I'm gonna do my PGY1. And in Australia each year you have the opportunity to move to another hospital - very different from US/Canada post-grad medical training. Which is a good and bad thing. Good because you can see new places and experience new things and leave the year after if you end up somewhere you don't like. Bad being you might have to relocate every single year, and I hate moving. Hope all goes well with you and you get what you want!

Biki said...

I think you are doing the wise thing by seeing if you like the city, that can really make or break the next 3 years. If it wasnt for the cold weather I could totally move to St Paul/ Minneapolis, its my kinda town.

One hospital doesnt feed you? Whats up with that? Wow! What a silly place to cut costs.

It looks like you have the right ideas and the perfect attitude to find your residency program.

Good Luck!

E said...

So happy for you! I hope that you land into a good fit.