by Helen Loeser, M.D., M.Sc., Associate Dean for Curricular Affairs and H. Gene Hern, Jr., M.D., M.S.

Our fourth-year students are in the midst of a series of interviews with residency programs across the country. These interviews offer a unique opportunity to flesh out the two dimensional application information programs receive. Many first-, second- and third- year students will be taking part in interviews over the next year too, either as interviewers (eg. medical school applicants or patients) or as interviewees (eg. summer jobs or research fellowships). Whatever your level, the best interviews require planning, with particular forethought to strategies, logistics and challenges. The specifics below relate to residency interviews, but the principles apply to any planned interview.

* Planning
Schedule wisely. Interviews provide important information. Additional components, such as geography, community, peers, educational priorities and culture, will inform your decision too, so be sure to leave time to consider these. Interview broadly. Interviewing is a great opportunity to learn, to initiate a lifelong networking process, and to validate your final selection.

Use the UCSF network. UCSF graduates in programs you are considering offer invaluable insight. Try to get a sense of the “gestalt” of the program from the current residents. However, beware of the change-over-time factor, listen selectively, and always go see for yourself.

* Logistics
These can affect the quality of your interview experience immensely. Pace interviews. You may need time to absorb what you have learned, explore an unexpectedly interesting discovery, or make travel changes due to inclement weather.

Cast of characters: Spend time with peers-to-be, arrange housing with students or residents, shadow a resident. Meet the chief residents, the program coordinator, the program director. Keep track of the people you meet; this is often helpful for follow-up, and again, anchors a lifelong professional network.

* Strategies
Be informed. Make sure you know where an interviewer is starting from, eg. has s/he read your file? Know the published basics about the program (Web, brochure) and use the interview to explore beyond those facts.

Talk with any UCSF graduates in the program. Formulate your own set of critical issues and inquire about them in every interview. Ask for specific examples. Key questions might include: “How is residency training prioritized relative to other teaching, research and service commitments of the department?”

Apply your clinical skills. Take time for introductions, arrange the chairs so you are face-to-face, make good eye contact, ask open-ended questions and summarize what you have heard.

Be prepared. You should be able to answer with substance and detail general questions like, “Tell me about yourself,” or “Why are you interested in this program/location/specialty area?” or “What are your strengths and weaknesses?” or “Tell me about your most interesting case.” Answer thoughtfully, but also consider turning the question around graciously to probe the program’s strengths and weaknesses.

Know your agenda. What is it that you want to present about yourself and what do you want to learn about the program? Strike a balance between allowing an interviewer to set the agenda and taking charge of it yourself. Do not necessarily shy away from personal and tough questions. You do want to know how the program responds. For example, you might want to know if flexible scheduling or individual tailoring of the curriculum is possible. Do they offer electives in a particular area that interests you if it is not covered in the published curriculum? Above all, recognize that your interviewer is likely to be experienced, and can see through a rote or rehearsed response.

* Etiquette
You represent UCSF, and your performance reflects on UCSF students and on the UCSF community. Many of your behaviors do get noticed and may have a large impact on your application, such as: your attentive engagement in all aspects of the interview, including your collaborative interactions in any groups; your posture and attire; the respect with which you interact with administrative staff, etc. If you do not plan to, or cannot keep an appointment, be sure to contact a program representative directly.

* Challenges
You may face questions which may be inappropriate or illegal. Remember, residency interviews are still employment interviews and are covered under federal law. The Federal Equal Employment Opportunity Commission (EEOC) (http://www.eeoc.gov/) is charged to protect job applicants from bias and potential discrimination. Questions related to marital status, family planning, age, ethnicity, religion, or sexual preferences are illegal.

In 1990, the AAMC Medical Student Graduation Questionnaire reported that more than 35% percent of students were questioned regarding family planning or marital status.1 That study revealed that 38% of women were asked questions about pregnancy during residency. In 1996, these numbers had increased to 45% 2 In 1993, the Bioethics Task Force of the American Medical Student Association surveyed their members’ experiences and found that over half of the residency applicants experienced questions during residency interviews which they felt were “inappropriate, uncomfortable, or possibly discriminatory.”3 More recent unpublished work suggests that the percentage of applicants who face potentially illegal questions is even higher, and that questions about family planning are more frequently directed to women, while questions about sexual preference and religion, are directed to men.

The interviewer may not be aware that these are illegal questions and may just be trying to “get to know” the applicant by asking questions such as “Do you/When will you have kids?” or “What does your husband/wife/partner do for a living?” On the other hand, they may be probing to see how likely you are to come to their program or if your intentions may jeopardize the program’s responsibilities to the institution.

If you receive such a question, you may gently redirect it by replying, “While I don’t plan on having children right now, what provisions are there in the residency if a resident has a broken leg/bad car accident or other illness that takes them out of commission for an extended period?” You might also respond to this type of illegal question by saying, “I’m pleased with the job I’ve done thus far balancing my personal and professional life. There shouldn’t be a problem with it in the future.” If they persist, then you can respond with some version of, “At UCSF we are taught that this area of questioning is personal, and distinct from the kind of professional assessment this interview represents.” Prepare for the worst type of question and be pleasantly surprised if it is not asked. If your interview or visit does not go well, consider contacting your career advisor at UCSF for advice. Your options include going back to the program leadership to discuss your concerns, and possibly requesting an additional opportunity.

Best wishes interviewing!

1. Proceedings of the 1990 AAMC forum on the transition from Medical School to Residency. Washington DC: Association of American Medical Colleges, 1990:11-13.
2. Proceedings of the 1996 AAMC forum on the transition from Medical School to Residency. Washington DC: Association of American Medical Colleges, 1996:25.
3. Ciesielski-Carlucci C; Hern, HE Jr; Kushner TK. Avoiding discriminatory medical school admission and residency interviewing [letter]. Academic Medicine, 1994 Dec, 69(12):975.
4. Highland Interview Project. ACMC – Highland Hospital, Emergency Medicine. 2000-2002 data.
H. Gene Hern, Jr., MD, MS is the Assoc. Residency Director of the Emergency Medicine Residency Program at ACMC – Highland in Oakland, CA. He is a 1996 graduate from the UCSF – UC Berkeley Joint Medical Program.