During my fourth year I asked my peers to submit questions they received on the interview trail. Some (most) were banal. Some were bizarre.

Doing my best to keep the list short and readable, here are some results.

Overall, the take home message is this: if you have a bad experience on interview day—when both you and the program are putting your best face forward—maybe that says something about the likelihood of a good residency experience.

Single most painfully common question on the trail:

• What questions do you have for me?

Every single time:

• What’s your story?
• Tell me about yourself
• What kind of things do you like to do for fun?
• Tell me about [random thing on your CV]
• Ten years from now, what do you see yourself doing?
• How did you become interested in medicine?
• When and how did you decide to become a [blank]
• What are you looking forward to the most in residency? The least?
• What was your most memorable patient? (yes, what; not who)
• Why this program?
• What are you looking for in a program (cue list of program’s description)
• What fellowship do you want to do?

Brain-busters (time for some BS):

• What has been your biggest disappointment in medicine?
• How do you think the changes in health care policy will affect you in the future?
• Describe a disappointing event in your life and how you coped with it?
• What did you find hard during medical school?
• What would you say is your greatest strength? Weakness?
• Tell me about a time when you made a choice that ended with a good result.
• Tell me about a time when you made a choice that ended with a bad result.
• What accomplishment are you most proud of that’s non-academic?
• When you look back at your career, how will you be able to tell if you were successful?
• What person have you met in medical school who has inspired you?
• What do you want me to know about you that didn’t fit in your application?
• Tell me about a situation in which you have had to work with someone you didn’t like. How did you handle it?
• Tell me about an ethical dilemma you experienced as medical student.
• What do you think we should look for in our applicants? (I think this is actually a really good question)
• Tell me about your best and worst residents.
• What do you think is the biggest health issue in America today?
• What do you want me to remember about you at the end of this interview?
• How would your best friend describe you?
• Describe your ideal day.
• Tell me about a time someone on your team was not pulling their own weight?
• If you were chief resident on a service and one of your interns forgot to or just didn’t place an order which compromised patient care, how would you handle the situation with the faculty who expects the order to be completed, and how would you address the intern?

Extremely narrow:

• If you could have dinner with any 3 cardiothoracic surgeons, dead or alive, who would they be and what are their greatest contributions to the field?
• How do you know that you have the hand skills to be a good surgeon?
• Ortho trauma is a very busy service. How are you sure you can handle it?
• Who is Brad Aust?

Awkward or obnoxious or both:

• What is your class rank?
• Tell me about medicine in your country.
• What is something unique about you that will help me remember you amongst the other applicants?
• Can you explain any small problems on your application that could bring you down on our rank list so that I can explain it to the committee?
• Tell me your impression of this program
• Are you ready to move away from [X]? (clearly entertaining the idea…)
• What is one thing you do not like about this city based on what you know? (city was not Baltimore, haters)
• What are the CXR findings in heart failure?
• Tell me you how you work up a GI bleeder
• Describe the technique for putting in an arterial line.
• Tell me how you would work someone up for chest pain.
• A colectomy patient becomes tachycardic the night after the operation. All other vitals are normal. What is your immediate workup and differential?
• You are interested in [X] research. We don’t have any active projects like that. What are your research plans if you come here?
• What do you plan to do with your MPH? (nothing of course, I just like collecting degrees!)

Unapologetic Match Violations:

• Where are you going to rank us?
• Tell me what you thought about program X.
• You did an away rotation at X school. Where do you feel you fit in better, here or there, and why?
• Would you really come here?
• Which other places have you interviewed at or are you going to?

Oddest set (came from PM&R, by the way, not psychiatry):

• Who do you like better; Tigger or Eeyore?
• Would you say Eeyore is happy?
• Would Eeyore say he is happy himself?

The AAMC has their list of 40 frequently asked questions, which feels about right.

Residency programs generally require three letters of recommendation (LOR) in addition to your Dean’s Letter (MSPE). Some programs/fields will request four, and some programs will have stipulations concerning their make-up: one may need to be a so-called “chairman’s letter” or come from an outside institution or research mentor.

Obtaining a LOR:

The most important thing in choosing your letter writers is to choose someone who knows you well (and has worked with you clinically). Most people agree that a detailed and specific letter from a lesser-known faculty is superior to generic one from a more distinguished one. If a letter doesn’t say anything special about you that a reader can’t find from your grades or CV, then it doesn’t mean anything. Generic is a wasted opportunity.

Feel comfortable asking directly if your potential writer is comfortable writing a strong letter for you (awkward as that may be). You should generally have an idea who loves you enough to write you a good letter. You can ask graduating students at your school if they have worked with particular attendings that wrote good letters and attempt to work them early during the fourth year if possible.

You will provide each letter writer with a folder containing:

• Your Name
• Your ERAS Letter Request Form (LRF) (available when ERAS opens in June)
• CV
• Personal Statement
• Photograph

This means that you should have your personal statement and CV ready by July.

Give them advance notice (ask as early as possible) and don’t be afraid to disclose the relevant deadlines when the time comes. July is earliest date letters can be submitted. It is ideal to have all letters in by September 15 along with your application. Some letter writers will require gentle reminders. Do not be too afraid to do so politely, as your application and future are more important than the awkwardness of writing and sending an email. How early you get your application submitted can and does make a difference, particularly in fields that interview early (e.g. psychiatry, pediatrics, medicine, transitional years).

Letters of Recommendation and ERAS:

• Your letter writer uploads their LOR into ERAS via the Letter of Recommendation Portal (LoRP). Historically, your school would upload the LOR on behalf of the writer, but this middleman step just resulted in more delays.
• A maximum of four (but nearly always three) can be submitted through ERAS. Do not send 4 to programs that request 3. (That means that you should actually check the websites of all programs you apply to.)
• You can collect as many letters as you want and then choose which LOR to send to each program. This can be insurance against a flakey faculty member. No one will know if you don’t use their letter.
• Letters of Recommendation should mention your specialty. If you are applying to more than one, then you should have slightly different letters for each (can be nearly the same). “So-and-so will make a fine pediatrician” is an awkward line to read if you are the program director of a psychiatry program. ERAS allows you to pick and choose so don’t squander it by sending the wrong letter.
• You should always check the box saying you waive your right to see the LOR. It implies a level of trust and confidence in your writer that both programs and especially writers appreciate (if you are worried about the quality of the letter, then you should be asking someone else).

Maybe.

Away rotations are generally done for three purposes:

• For fields that require or generally prefer Letters of Recommendation from institutions outside of your home school: Emergency Medicine, some surgical sub-specialties (e.g. neurosurgery)
• Audition rotations (especially helpful for marginal candidates trying to “come off the page” or when trying to break into a specific out-of-your-region program)
• For fun!

There are caveats:

• Rarely will an away rotation get you an interview you are not qualified for. An away rotation may get you an interview you might otherwise not get. Needing a LOR or wanting to see a particular program out of your region is a good reason, but being “accepted” for an away rotation is not an indication of acceptance for residency or even a guarantee of a future interview.
• Don’t let success stories drive you to do more aways than you want or need to do for your residency goals. Most spots nationwide go to applicants whom programs meet for the first time on interview day. The positive anecdotes exhibit strong confirmation bias.
• The reverse is probably truer: there are sadly many people who didn’t get interviews at programs they did aways at because the away was out of their reach academically. Or, they are simply interviewed as a courtesy. Don’t expect a miracle because you are pleasant and hard-working. Most people are pleasant and hard-working.

You will apply through VSAS (the Visiting Student Applicant Service), which opens in Feb/March for the coming academic year. You will need a professional-looking photo for both VSAS and ERAS in a suit/tie, nice dress, etc. You want this to be done professionally, as it will be the first thing people see every time they open your application. Leave the loud ties or deep v-necks at home. Your school probably has an on-campus photographer with reasonable rates. Not everyone can look good all the time (or even most of the time), so don’t be too embarrassed to let them touch you up, as long as they have a relatively subtle hand with Photoshop.

Keep in mind:

• Rotation dates may not overlap perfectly with your school’s schedule. You may need to take vacation time to make your away rotations jive with your underlying schedule.
• You may need additional liability insurance depending on the demands of the institutions you wish to visit. The coverage is usually required 30 days in advance of your rotation.
• Some states that typically require more liability insurance on top of that which your school provides are Indiana, Kansas, Louisiana, Nebraska, New Mexico, Pennsylvania, South Caroline, and Wisconsin.

You may also be able to pursue international rotations (through your school or independently) but keep in mind that there are times (roughly September through January) that you will want to be around and available (Obtaining LOR, taking Step 2 CK/CS, interviews, submitting your ROL). If you’re gone around ROL time, you at least want to make sure you have reliable internet access.

The NMRP puts out the results of the match every year, allowing you to see what programs fill their spots, average step scores for different fields, numbers of programs ranked per candidate, etc. The numbers can be overwhelming, but it’s a good way to get a realistic picture of what your dream looks like on paper. Of course, supplement your research with knowledge from faculty mentors, your local program director, residents, and fourth year students.

Keep in mind that residency is not medical school (where all qualified applicants are pursuing the same goal); residencies are divided by both specialty and geography. The kinds of grades, board scores, and gold stars you need to pursue the field of you choice vary by not only what field you want but also where you’re willing to do it.

Charting Outcomes 2011

This document breaks down applicants by specialty, showing you the characteristics (step score, research experience, etc) for both those who did and those who did not receive spots in the match for a particular specialty. A must read.

2012 NRMP Program Director Survey

The NRMP asks residency directors what factors they care about, what things negatively impact applications, etc. The survey includes the bottom score at which residencies interview, the minimum score that usually guarantees you an interview, and much more. Also a must read.

Results and Data: 2012 Main Residency Match

Match rates, programs needed to rank, and even positions offered/filled by residency. This document tells you every program that existed last year, what residencies they offered, how many spots they have, and how many were filled. This document is the basis for “Charting Outcomes” (which is much more readable).

2011 Applicant Survey

See what people in your shoes from the previous year used to pick programs for both interviewing and ranking.

The rest of the NRMP data is found here (and is updated consistently).

FREIDA

Contains detailed information on every residency program (pay, avg hours worked, size, etc), which can be sorted by both specialty and state. A very helpful bird’s eye view of all of the options out there. FREIDA is an indispensable tool for picking potential programs once you know what you want to do.

Careers in Medicine

Contains an overview of the various options for specialties (but not individual programs). Helpful for learning about compensation, average hours, etc for different fields, as well as what further training and fellowship options/requirements exist.

The CV (curriculum vitae) is an essential professional summary of your qualities as a candidate for residency, and there is no better time to start on it than as soon as possible. Not only do you need it for ERAS itself, but you’ll also need it for away rotation applications and for the faculty writing your letters of recommendation (and having your materials ready gives you the best chance of getting your LORs back promptly). Do a good job on it now and it’ll be easy to update as time goes on to reflect your latest endeavors. The Careers in Medicine CV webpage (login needed) has an excellent point-by-point summary that you should consult as you work on your CV.

The general categories on a CV generally include:

• Contact and personal info (use your full legal name)
• Education (all college level and beyond)
• Honors and Awards (if applicable)
• Work experience (especially if there are gaps in your timeline; also can include non-paying volunteer and leadership activities done during medical school)
• Research (if applicable): Publications & Presentations and conferences (often listed separately)
• Professional Memberships (if applicable, can be put with extracurricular activities)
• Extra-curricular activities (feel free to tailor the list to prevent it from being over-long and having less important activities overshadow significant ones)
• Hobbies and Interests (this grab bag is often interview fodder and sometimes are the only factors that differentiate an applicant from the pack)

One common point of contention amongst students and even mentors is whether to include activities performed before enrolling in medical school (especially college). The stance of people I agree with has been that there are two very good reasons to include an “old” thing in your CV:

1. It explains a gap in time. You want to account for all time between high school and your application. If there are years between college and medical school, you need to state what you were doing.
2. It coincides with a long-held or continuing interest. Examples include peer advising, research, etc. If it helps explain you as a person and you’re not simply padding the length, then don’t be scared to include something.

If you think an activity is relevant, makes you look good, or informs the reader as to who you are as a person, then don’t feel guilty about including it. Just remember the important adage: the more you write, the less they read.

Examples of properly formatted and phrased CVs can be found at the CiM CV webpage. There is no formal length requirement, but chances are it’ll fit on 2 pages unless you’ve been publishing a lot. Generally, it is organized by category and items appear in reverse chronological order (most recent first). Use one font (or two—one for headings and one for text). Use bullets, bold, italics, and/or indentation to keep things organized.

Keep in mind that you will put your CV into ERAS item by item, so the formatting/appearance of your CV will only be seen by your letter writers or rarely during interviews if requested.

Don’t forget to include a few hobbies/personal interests. In many most nearly all cases, these items will be the only interesting thing you and your interviewers will talk about it.

Have your CV vetted by your specialty and faculty mentors.

The personal statement is occasionally a chance to “make” your application, but it’s always a risk to “break” it.

Keep in mind: it’s only 1 page (literally—it should fit on no more than one page when printed from the ERAS application, which is somewhere around 750-800 words on the longer end; 600-650 is a better goal; mine was around 500). On one interview, I was told that the program’s main criteria for evaluating personal statements was not noteworthiness but rather inoffensiveness.

Questions to ask yourself in approaching the PS:

• What are the reasons for choosing the specialty?
• What are my career plans?
• What accomplishments do I want to emphasize?
• What outside interests do I have?
• What contributions can I make to the specialty and the residency program?

You don’t have to answer all of these questions, but answering one or two will help you get the point of view you need to get a draft going.

The personal statement is a chance to state why you are choosing a specialty (and a location or a specific program) and to try to convince the reader that you are a good fit. While you are trying to say that you are awesome, you cannot simply say you are awesome. Like fiction, you should show, not tell when possible. This is not a CV in paragraph form. You must be more subtle.

Things to do:

• Give yourself plenty of time to write; start now.
• Write more than one. Tell your story from multiple angles and see which one comes out on top.
• Often your first essay is not the best.
• Consider explaining gaps in your application (leave of absence, course failure, low Step 1)
• If there are particular programs you are desperate for, you may consider tailoring your statement for them. The individualized approach is obvious and is unlikely to make the desired impact. If you tailor, don’t be a sycophant (it’s too transparent). The most important time to individualize your PS is if you discuss, for example, your desire to be part of a big bustling academic center: make sure to change that if you are applying to a small community program.
• Be straightforward in your writing
• Edit and proofread your work carefully. Then do it again. And again. And then one last time for good measure.
• Be concise. Edit down until every word counts. I personally subscribe to the common reviewer adage: “The more you write, the less I read.”
• Ask for second opinions and feedback; you don’t always have to listen but it’s important to receive.
• Your parents and significant others are wonderful readers, but they are generally insufficient. They love you too much. Have your PS vetted by your Specialty and Faculty Mentors.

Things to avoid:

• Self-Congratulatory Statements
• Self-Centered Statements
• “Emotional” Stories (give it a try, but be wary). Telling your reader about your feelings directly often makes the feelings themselves feel contrived.
• Reality embellishment (anything you write is fair game as interview fodder; if you can’t discuss it at length, then it shouldn’t be there)
• Using tired analogies (or any analogies, really)
• Quotations (you couldn’t think of 500 words of your own?)
• Remember, your reader has a stack of applications. Don’t make your essay hurt to read, overly cutesy, or sappy to the point where it’s no longer convincing.

For most people, your personal statement will not/cannot stand out in a good way (standing out in a bad way, though, is entirely possible). Why you pursued medicine may have been an interesting story (hint: it probably wasn’t), but why you chose your specialty is likely even more banal. If you don’t feel like you have anything special to say, it’s because you don’t. That’s normal. Aim for competence.

There are sample essays available for perusal on medfools. I think even the “good” ones are pretty painful in general, but your mileage may vary. Here are some good tips from UNC. The AAMC Advisor also has some quick advice. If your remember your login, Careers in Medicine also has similar stuff.

EKG/ECG instruction is a mixed-bag nationwide. Every physician is supposed to know how to read an EKG, though for many students, EKG interpretation is a skill one is supposed to somehow pick up naturally (magically) on the wards. No one seems as confident in their abilities as they’d like. And while EKG machines themselves can and do identify many abnormalities, part of the challenge of real life is to know when to ignore the machine reading.

There is a basic subset of foundational EKG knowledge that (second or) third-year medical students should acquire, and many of the resources below will easily get you there. Also note that a strong background in cardiology informs your knowledge of EKGs and vice versa.

When it comes time to learn, do the following three things:

1. Pick a source and read it thoroughly
2. Pick a system/routine of interpretation (your source should detail) and stick to it. Use it every time until it becomes natural.
3. Do examples. Do more examples. Wait until you’re feeling rusty and do some examples again.

If you’re looking for dead trees to hold, then these are the two entry-level EKG texts I recommend:

The most famous and popular EKG book around is hands down Dale Dubin’s Rapid Interpretation of EKG’s (often just called Dubin’s for short). The early portions utilize the same “programmed” learning as Felson’s, which is both effective and makes you feel like a child. Unfortunately, Dr. Dubin has also spent time in jail for making and owning child pornography, so let that information color your reading accordingly. His quite good 14-page summary (taken from the book) is also available for free online and in many ways is all you need to learn the basics or freshen up, depending on your background and the demands of your coursework. Dubin’s website itself also has some good information, but it’s very poorly designed.

Another one stop shop for basic EKG for medical students and non-cardiology-bound residents is The Only EKG Book You’ll Ever Need, which is more of a traditional text, extremely readable, and surprisingly quick. I personally prefer it to Dubin, though Dubin’s is absolutely the more popular of the two.

Your school library will probably have copies of both, but Dubin was always a bit hard to get a hold of at ours.

If you don’t mind the screen, then you can probably get away with a subset of these free resources:

ECGWaves has a free e-book and online course.

Learntheheart.com has what amounts to a complete standalone EKG online coursebook, which is broken down into the basic, topic review, cases, quizzes, and tons of example EKG tracings. The design could use a refresh, but the content is stellar and could easily replace a purchase. There’s also a lengthy review of cardiology.

The University of Utah runs an ECG Learning Center, which includes an “Outline” which is pretty good and also available as a free 88-page pdf.

The University of Wisconsin also has an online ECG course, though I’d say it’s not quite as good as Learn the Heart’s.

ECG Teacher has nice video tutorials: well-produced content, clear illustrations, good sound quality. Probably better than you’ll receive in the classroom.

ECG Made Simple requires a simple free registration but is quite good once past that hurdle. Lots of tutorials (including videos, for those so inclined)

SkillStat has a what seems like most of their The Six Second ECG Workbook available as free pdf chapters online from their website, which would make a nice addition to your iPad or other electronic reading device. They also have a nifty EKG simulator/generator for review and for testing. Either the software generates a tracing for the rhythm you select, or it generates a tracing and you identify it. Sorta fun. For those with ACLS on the horizon, it also has a nice little ACLS testing tool.

Quick ECG highlights and plenty of samples can be out at Online ECG Interpretation for Emergency Physicians (thanks, Paul).

If you’re still looking for some more sample tracings, then look no further than EKG’s for EM Physicians, which has 100 tracings with answers in addition to a succinct “How to read an EKG” section. ECG Wave Maven is a massive collection of cases. ECG library also has a good collection of tracings, though the picture quality leaves something to be desired.

Whether to help yourself or your classmates practice, produce learning materials for your students, make money, or perhaps to create a large free question bank the likes of which have never been seen, knowing how to write a USMLE-style board may be a skill you’re interested in cultivating.

In fact, even for students who only plan to take—not write—the USMLE, understanding the qualities of a Step question may help one understand how to approach (and hopefully guess/answer correctly) the ones on the actual exams.

The NBME actually has an extremely detailed Item Writing Manual (181 pages!). It’s quite long (but full of lots of examples), so I’ve compiled some highlights below. Read More →