EMRA and CORD Student Advising Guide, 2023

Ch. 10 - Making the Most of Interview Day

Interview day gives you a firsthand look at the programs you have been researching. This is an important day for the programs as well. In fact, the interview day score is one of the most important factors programs consider when ranking residents.¹ Make a good impression and understand it’s equally important for you to interview the program and determine how well it fits your needs and goals.

The COVID-19 pandemic introduced a new aspect to the interview process — virtual interviews. This has had both advantages and disadvantages. On one hand, you can save a lot of time and money by not physically traveling to another city for an interview. On the other hand, it can be more difficult to get a sense of the prospective city, program, and emergency department where you will be working. As noted in Chapter 9: Interview Season Logistics, since we do not yet know how recommendations regarding the format for interviews may change over the years, you must reach out to your medical school and advisors to understand the expectations for in-person vs. virtual interviews for each interview season.

Preparing for Interviews

Interviews can be stressful, but adequate preparation leads to success. Practice answering interview questions with a friend, mentor, advisor, etc. Think through ways in which you’ll describe yourself, your hobbies, and your reason for choosing EM. Plan standard questions for every interview, with specific questions for individual programs. This will allow for a more natural conversation, and you won’t have to do all the talking. Take a look at the EMRA Interview Guide for ideas of questions that might be asked.²

Most important: Be yourself on interview day. You have made it thus far in your career, so you’re clearly a bright, intelligent, and successful individual. The interview is the time to let your positive qualities shine, even if you’re naturally introverted. Residency interviews help the program faculty and residents get to know you as a person, and they also help you decide if the program is a good fit for you.

Do Your Research

One of the best ways to put yourself at ease and impress your interviewers is to do your research beforehand. Be sure you have reviewed the program’s website and other readily available information.

1. Know the program leadership — particularly the chair, PD, assistant/ associate program directors (APDs), clerkship director, chief residents, and the program coordinator. This can help you tailor your questions to the individual who may answer them most effectively. You can reach out to the program coordinator ahead of time and ask who you will be interviewing with if you want to further investigate their particular interests.
2. Review basic program demographics — class size, required off-service rotations, and secondary training sites. You should come to every interview with questions written down that are important to you. Don’t ask questions easily answered by visiting the program’s website.

Take Notes

Interview season can be a long road — by the end, some of the program details and your memories of them will begin to blur. Notes on who you met, whom you interviewed with, the questions you asked, the answers to your questions, or general conversations with key members of the program will be an important reference when the time comes to make your rank list. It will also be useful if you need to reply to the program and its members.

Pre-Interview Events

Most institutions host pre-interview “hang-outs” (either virtual or in-person) with the residents; take advantage of these opportunities whenever possible. Of note, some newer programs may not have enough residents yet, so you’ll get a chance to speak with the faculty informally. Occasionally travel plans and other interview schedules may interfere with your attendance at these events, but try not to miss them. The more direct face time spent at a program, the greater the potential benefit for you and the program. Applicants have ranked “personal experience with residents” as one of the most important factors when making a rank list.³

Just as with interviews, the more face time you can obtain with a program, the more likely you are to make an impression and stand out among the crowd. These events are generally run by the residents and are typically less formal than your interview day. However, keeping some professionalism would be wise. Consumption of alcohol is generally accepted in moderation at social events — but remember every interaction with a program is an extension of the interview day, and residents will likely report back to their administrators about any concerning behavior. If the social is scheduled for the evening before your interview, keep in mind you have a busy day scheduled for the next morning, and most interview days begin early.

During the social events, inquire about specific questions you have about the city and program (eg, Where does everyone live? Is it a safe area? What rotations does everyone like/dislike?). It can be challenging to share screen/face time with the other interviewees, especially if you tend to be quieter. If you are worried you might fade into the background, come prepared with 2-3 questions that you want answered during this time. These can be related to the program or your hobbies/interests, which might spark more organic conversation. If you fall on the opposite end of the spectrum, try to keep in mind that taking too much of the shared time might make you seem like less of a team player.

In-Person Interviews

The less rushed you are in the morning, the more relaxed you will be. Give yourself plenty of time to get dressed, as well as pack your bags and head to the interview for in-person interviews. Ideally, check out from your lodging should be later in the day or the following day, giving you time to explore, or at least change and pick up your bags. However, this may be impractical in terms of cost and travel plans, in which case you’ll need to factor checkout time into your schedule. Most programs can keep your bags safe for you during your interview day, although space may be limited.

Arrive a little early, giving yourself a window for any delays (getting lost, traffic, parking, etc.). Although most programs are reasonably understanding of delays, being late gets you off on the wrong foot. The food and breakfast options provided by a program on in-person interview mornings may vary significantly (full meals to very little), so grab a meal before you arrive if time permits, or plan on bringing something with you.

The interview day generally begins with an overview of the program, typically delivered by the PD. This will answer many questions, though the focus usually will be on the strengths of the training experience. A tour of the ED and other parts of the hospital are also typical components of the day.

The interviews themselves tend to be several separate short interviews, usually one-on-one, with members of the program leadership, faculty, and sometimes residents. Programs may have each interviewer focus on a different aspect of the applicant, such as academic record, residency and career goals, or personality fit for the program. Don’t worry about who’s looking for what. Being genuine is more important than trying to cater your answers to what you think each interviewer wants to hear. Most emergency physicians tend to be relatively down-to-earth people who genuinely enjoy having a good, professional conversation with applicants. And remember it is a conversation; don’t be a passive participant simply reacting to questions. The interviewers are trying to get to know you, and they want to hear what you have to say.

Anything you have provided in your application is fair game for interview questions, so know your application. If you listed spearfishing as a hobby, you should be able to hold a conversation about it. (Your interviewer may be a spearfisher, too!) Also, keep in mind a tangent is considerably different from a conversation. Keep your answers concise.

Remember during the interview that you are also interviewing the program. You need to find out if this is the right place for you to spend the next several years. You should be prepared with questions about the characteristics of the program that are important to you. Ask more than one member of the program, as they may have different perspectives on the issue. Also, some potentially important details may not be clear from the website or general program overview presentation (eg, clinical and didactic teaching styles, program goals for the future, recent changes made to the program structure, resident wellness, resident retention and remediation, and changes in staffing). Do not be afraid to ask for contact information for current residents or graduates from their program. There is no better way to assess a program than by talking to someone who has been there.

At the end of the interview day, you may be tempted to grab your things and go. However, after in-person interviews, this is often a wonderful time to stay and observe how the department flows during a shadow shift. Most programs are happy to have interviewees spend time in the ED as an observer. Keep in mind that protocols around having observers may have changed because of COVID-19 safety protocols, but it doesn’t hurt to ask in the weeks leading up to your interview if you can do a shadow shift if in town for an in-person interview or second look. Viewing the interactions on shift can give you a lot of insight. Do the residents and faculty seem happy? Does the team appear cohesive? What kind of patient load is each resident carrying at each stage of their training? Are there pleasant interactions between the ED team and their consultants? Introduce yourself to anyone and everyone, and ask if you can tag along. You can even consider traveling with an extra pair of scrubs. Again, make notes on this portion of the visit.

Virtual Interview Day

Though the process of virtual interviews is still new, early literature from other specialties suggests there may not be a significant difference in match rates between in-person vs. virtual interviewees, and applicants surveyed tended to perceive more advantages than disadvantages to virtual interviewing.^4-5

Just as with in-person interviews, preparedness will only help calm your nerves and therefore improve your performance. Some residencies offer a choice between morning or afternoon interviews, so it is important to consider which would be more beneficial to you. Consider whether or not you will have any other responsibilities the rest of your day that may distract you, such as a lecture or showing up for a clinical rotation. The night before, make sure you check and recheck the interview start time and time zone. Ensure you wake up with enough time to get ready, including eating a meal. Interview day can be long and tiring, so make sure you grab a couple of snacks, water, coffee, etc. — anything that will help sustain you. Do a sweep of the room to double-check that your background is tidy and professional. Finally, 10-15 minutes before the interview starts, you should log in to the virtual platform and do a quick audio and video check. Remember, attire should be professional — just as you would dress if you were interviewing in person.

To make the most of the virtual interview day, remember these interviews should be just as professional as in-person interviews. You should set up or create a space specifically for your interviews that is organized, clean, and quiet. Having a messy room or a dog barking in the background may be distracting for you and your interviewers. The background you choose should also be intentional, as any objects in your background may be fair game for conversation. If you are unable to find a suitable space in the comfort of your home, try looking for a study space in your medical school library or borrow a friend or family member’s office space.

The dress code is also the same as for in-person interviews, and that includes bottoms. You don’t want to be the person everyone remembers because they were wearing pajama pants! So wear a suit or other business dress, as it may help you get into a professional mindset for the day.

Virtual interview formats are generally similar to in-person interviews, plus or minus a virtual tour of the ED. You will likely have a general introduction to the program followed by several short interviews or even one long interview with several interviewers at once. Some programs may place you in a virtual room with other faculty, interviewees, or current residents while you await the next interview. Though you are generally not expected to stay on screen for the entirety of this waiting period, it is a great opportunity to get to know the people at the program and ask any further questions you have about the program and/ or city. If you do choose to take an off-screen break during this time, keep in mind your mute button may not always be trustworthy! Lastly, test out your equipment before the interview day. The last thing you want is for your time to be eaten up by a technical malfunction.

Red Flags

The interview is an opportunity to explain any red flag(s) in your application. At least one interviewer will ask you about it. Remember, if anything in your application was disqualifying, they would not have invited you for an interview. Avoid making excuses. Briefly explain the red flag(s) and do not dwell on negativity — remember there is something to be learned from every negative event and strength in recovering from such.

The Second Look

In the era of virtual interviews, many residency programs are hosting optional, formal second looks. This will usually be a weekend with tours of the hospital you will work in, sightseeing, and meeting your potential future co-residents at a lunch and/or dinner. Attire can be clinical, including badge and white coat, or business attire, depending on the scheduled events. They typically will occur from January to late February, ideally after the program solidifies its rank list and before you submit yours to allow for equity, so be on the lookout for an email invitation.

The second look is another way to gain additional insight into a program, especially when having difficulty with deciding among the programs at the top of your rank list. Second looks can be a considerable added expense and are not expected. Visiting every program where you interviewed is completely unnecessary; second-look trips are only beneficial if you are having difficulty choosing between programs. You are there to get a better idea of how and if you fit into the day-to-day interactions at that program.

Remember, just as with pre-interview hangouts, consumption of alcohol at second-look social events is generally accepted in moderation — but remember every interaction with a program is an extension of the interview day, and residents will likely report back to their administrators about any concerning behavior.

Scoping Out the Area

When traveling to a city or region that is new to you, explore the area. Finding a location where you will be happy spending your free time is important to your future wellness. The pre-interview events are also a great opportunity to find out more from residents about the area.

When evaluating a new area, consider what is important to you. Would you prefer to live in a house with a yard, a condominium, or an apartment? This is determined not only by the region (a house with a yard may be less obtainable in a larger, urban setting) but also by your personal needs (family, children, pets) and the prospective duration you might be there (3- or 4-year program, fellowship, employment goals). You also need to think about which of these choices is affordable on your income. Resident salaries are fairly consistent across the nation — unlike the cost of living, which varies dramatically. Finding out what areas of the city the residents and faculty live in can be helpful.

In addition to housing options, learn what there is to do in the area. Are there local parks? How varied are the dining and entertainment choices, and are they affordable? Where do the residents go to unwind? If you have children, you’ll want to know how the schools rank, if they are close by, and (if you’re evaluating private schools) whether they’re affordable. What amenities and activities does the area have for children? If you have a significant other, it might be beneficial to have them scope out the area with you. If you find yourself more impressed than expected by a program or its location, consider coming back for another visit for a second look before submitting your rank order list (see The Second Look, above).

As you’re planning your visit, research the hotels near the program. Often, the closer, the better — although many hospitals with thriving emergency departments can be located in less safe areas, so keep that in mind. Also, consider the area around the medical center may have a very different atmosphere than the surrounding city, so make sure to explore the city before making a final impression. Additionally, some programs offer on-site lodging and will usually inform you of this. It has become increasingly common for residents to invite interviewees to stay with them, giving you a window into the resident lifestyle in that area.

Thank-You Notes and Further Communication

It is common courtesy to thank your interviewers for their time; however, the overall value of the thank-you note varies greatly among program leaders. Generally, an email is just as acceptable as a handwritten letter, although there is likely some variation in this belief. There is no rule on the timing of the note, but it is best to send it immediately after the interview — before it moves too far down your to-do list. Sending a note is unlikely to significantly change the way a program ranks you, although it cannot hurt and is a common professional courtesy that will be noticed as your career continues.

After interviews, you will be faced with a decision on communicating with programs regarding where they stand on your rank list. This is a much-debated subject without a clear answer. It is very important to note that you are not required to divulge a program’s order on your rank list, even if directly asked by any member of the program. In fact, NRMP guidelines specifically state “program directors shall not solicit or require post-interview communication from applicants, nor shall program directors engage in post-interview communication that is disingenuous for the purpose of influencing applicants’ ranking preferences.”6 This guideline is interpreted differently by each program. Some take a hard line and completely abstain from any initiation of contact with applicants. Others may feel that notifying their highly ranked applicants regarding their status is not “soliciting” or “disingenuous.” And some programs will initiate a discussion of the applicant’s rank list, despite these guidelines.

Be diplomatic yet honest in all post-interview communication. You should not feel compelled to divulge your rank order information to programs, and programs should not be asking. Likewise, you should never ask a program where you fall on their rank list, and do not rely on the information a program might voluntarily give you about your order on their rank list.

However, the NRMP does not stipulate guidelines for applicants regarding post-interview communication. You may freely disclose to a program where it is ranked on your list — but be honest. The most common practice is to notify your top-ranked program of its position. A program’s response to such information will vary greatly, from no response to a purposely vague response, all the way to a definite answer of your ranking by them. Do not read too much into any response (or lack of response); each program takes a unique approach to comply with NRMP rules.

• The interview season should be fun! Do your research and prepare, but don’t forget to be yourself. In addition to the program trying to decide if you’re the right fit for them, this is your opportunity to figure out if the program is the best fit for you.
• Take advantage of pre-interview events to get to know the current residents. They are the ones most likely to give you an unbiased view of what it’s like to train at the program. If consuming alcohol, do so in moderation.
• Be sure to take plenty of notes to help you make ranking decisions between programs.
• Second looks are only beneficial if you are having difficulty choosing between 2–3 programs.
• Don’t spend too much time worrying about thank-you notes. There are no rules, and it’s unlikely to significantly change the way a program ranks you; however, it can’t hurt, and it’s a common professional courtesy.
• Do NOT play games with any post-interview communication (ie, don’t tell every program they’re your No. 1 program); it’s a small world and it could be very awkward the next time you see a PD to whom you sent a disingenuous message.

References

1. Negaard M, Assimacopoulos E, Harland K, Van Heukelom J. Emergency Medicine Residency Selection Criteria: An Update and Comparison. AEM Educ Train. 2018;2(2):146-153.
2. Garmel G. Residency Interview Guide for Med Students. EMRA. https://www.emra.org/embark/medical-students/interview-prep/residency-interview-guide-for-med-students/. Published September 27, 2022. Accessed January 25, 2023.
3. Love JN, Howell JM, Hegarty CB, et al. Factors that influence medical student selection of an emergency medicine residency program: implications for training programs. Acad Emerg Med. 2012;19(4):455-460.
4. Domingo A, Rdesinski RE, Stenson A, Aylor M, Sullenbarger J, Hatfield J, Walker S, Hervey S, Singer J, Cois A, Cheng A. Virtual Residency Interviews: Applicant Perceptions Regarding Virtual Interview Effectiveness, Advantages, and Barriers. J Grad Med Educ. 2022 Apr;14(2):224-228. doi: 10.4300/JGME-D-21-00675.1. Epub 2022 Apr 14. PMID: 35463161; PMCID: PMC9017272.
5. Vadi MG et al. Comparison of web-based and face-to-face interviews for application to an anesthesiology training program: a pilot study. Int J of Med Ed. 2016;7:102-108.
6. National Resident Matching Program. Match Communication Code of Conduct. https://www.nrmp.org/intro-to-the-match/the-match-agreement/match-codes-of-conduct/. Accessed October 5, 2022.