Interviewing to Match Into a Competitive Residency

by Alec Palmerton, MD in Residency, Yousmlers

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So much of medical school focuses on building our residency application. Our scores, letters, and grades are critical for getting an interview. However, once we get that interview, what do we do? How do you impress the program directors from top programs so that they rank you highly?

Here, Grateful Student gives his recommendations for interviewing to match at top programs. He had a lot to overcome including being a non-US IMG and attending med school in the Caribbean. As such, his advice is valuable for ANY student seeking ANY specialty.

He matched in one of the top family medicine programs in the country. Some of the issues are specific to people interested in primary care. However, most of the principles are universal. Whether you aspire to Harvard Derm or a surgical prelim, your interview is critical.

Here is Grateful Student:

About Me

I am a non-US IMG from the Caribbean. I had above average scores with a genuine interest in primary care. (> 240 on Step 1 and Step 2 CK). I applied in Family Medicine (FM) and matched into a competitive program.

I wanted to share my perspective after completing the interview trail. At the end of each section, I provide a “To Do” checklist that you can use. My hope is you will be better prepared when you hit the interview trail so you can match into your dream residency.

Before You Start: What is Your Application’s Biggest Weakness?

No residency application is perfect. For you, it may be a less-than-stellar USMLE score. Or few/no publications going into a competitive field. Or perhaps some mixed clerkship evaluations. Whatever your wart, to maximize your chances you should know your application’s weaknesses.

Family Medicine has a reputation for being “IMG-friendly.” Here are the top 5 residencies by % filled by IMGs in the 2018 Match.

However, what I didn’t realize when I started was how different it was to apply as a non-US IMG, rather than a US IMG. For me, one of my most significant limitations was my nationality (I’m Canadian). Specifically, the need for a visa to work in the US. As you can see in the table above, a large percentage of FM residents are IMGs. However, it’s also clear that a much larger percentage comes from US IMGs, rather than non-US IMGs.

(To read The IMG’s Guide to Obtaining Residency in the United States, click here.)

As I scoured lists of “IMG-friendly” programs, it was clear that my options would be limited by my need for a visa. I settled on a list of programs that I felt wouldn’t penalize me unduly for being a non-US IMG.

(To learn how to generate an “IMG-friendly” program list in ≤ 5 minutes, read this article.)

Getting an Interview vs. Matching in a Program

Every two years, the NRMP (the organization that administers the “Match”) surveys residency program directors. The list of questions is extensive. A massive point of interest is how program directors screen applicants for interviews. (Hint: a big part of it is your USMLE scores).

(To read Get Into a Top Residency: 5 Things You Need to Know, click here.)

Here are the top 5 factors for receiving an interview invitation, from the 2018 survey.

1. USMLE Step 1/COMLEX Level 1 score
2. Letters of recommendation in the specialty
3. Medical Student Performance Evaluation (MSPE/Dean’s Letter)
4. USMLE Step 2 CK/COMLEX Level 2 CE score
5. Personal Statement

Notice how many of these things are score and grades. Remember, program directors are busy, so they use things like Boards scores to “screen” applicants.

Your Interview Determines Whether You Match at a Program

But what about once you’ve gotten that critical interview? Programs’ criteria to make their rank list are different from what they use to decide who to interview. In other words, your USMLE scores will get your foot in the door. However, to close the deal, they’re looking for more than just a high Step 1 score. They’re looking for a “good fit.”

Here are the top 5 factors for generating a program’s rank list, also from the 2018 survey.

1. Interactions with faculty during interview and visit
2. Interpersonal skills
3. Interactions with housestaff during interview and visit
4. Feedback from current residents
5. USMLE/COMLEX Step 1 score

What do you notice? What you need to get an interview is different from what you need to match. Your interview matters a lot.

Scores, grades, and LORs are critical for getting an interview. Your interview largely determines your rank list position.

Getting your residency interview is the first step. But how do you close the deal? Once you land the interview, it is up to you to show:

1. Genuine interest in the specialty
2. You are a good fit with the program
3. You have a vision for the future
4. Being authentic

Next, I’ll detail actionable steps so you can “fit” with your dream program.

1. Demonstrating Genuine Interest

Demonstrating genuine interest is critical for any specialty. However, showing real interest in FM programs is particularly important.

Why might dedication to the field matter so much in FM? I suppose program directors care about this because many applicants use it as a “back-up.” This was especially true at the interviews for the more competitive, well-known programs. Was I committed to going into FM? Or was I one of the countless IMGs with high scores applying to it as a backup?

If you’re interested in primary care, how do you show it? For one, I had done activities which demonstrated my interests. This included volunteering with my school’s Family Medicine Interest Group.

Another way to show your interest is to demonstrate knowledge of specialty-specific challenges. You can gain an understanding of this if you start reading some of the journals. I stuck with the AAFP and Annals of Family Medicine. When things like “continuity of care” came up, I could discuss them in greater depth. I didn’t have to keep repeating “I like working with the whole family!”

It’s also worthwhile to join professional organizations related to your specialty. If possible, attend their annual conference. Not only can you network, and get to know some of the decision-makers. You can also connect with residents and others with insight into specific programs.

Lastly, you also want to have persuasive letters from faculty in your desired specialty. A bonus: clearly stating that you will make a great physician in that specific specialty.

To Do:

• Build up activities that show your interest in your desired specialty
  • Ex: Are you interested in Neurology? What other activities demonstrate this? Research? Published work? Quality improvement projects as a med student?
• Join student groups for your desired specialty
• Join professional societies for your specialty
• If possible, attend conferences
• Start learning about the challenges facing your specialty
  • Was there some change in guidelines recently?
  • What are “hot issues” in your specialty at the moment?

2. A Good Fit

I can’t emphasize this enough. Scores/numbers get you an interview. “Fit” is what closes the deal for matching.

A big part of demonstrating fit is the pre-interview dinner. Here you are being judged on how well you fit in with the culture of the program. Think about it. You’re meeting in a non-clinical setting, with your potential future co-residents. It may not seem like it, but many are watching like a hawk for the proper fit. (Side-note from Alec: at MGH, feedback from residents was always welcome. Even if we didn’t interview you, we could always put in a good – or bad – word that the committee would keep in mind).

• Are you sociable?
• Do you have interests outside of medicine?
• What do you know about the city? What more would you like to know about the city?
• Most important: would they want to work with you at 3 AM on a night shift?

Remember, though: the idea of a finding a “good fit” goes both ways. As much as the program is evaluating you, keep in mind that you are also evaluating them. There were a couple of dinners that I had where things didn’t flow at all. The best way I can describe this is that things didn’t “feel right” even though everyone was nice and polite. Listen to this “gut feeling.”

To Do:

• Be yourself at the pre-interview dinner. Be friendly and have a good time.
• Come with questions that you want to ask residents.
• Practice being comfortable in a setting where you are being interviewed. (Even if it’s a “casual dinner”).

3. A Vision for the Future

This is the best advice I received before starting interviews. They asked:

Do you have enough insight into yourself/your journey such that you know what you are worth?

I found great value in reflecting on this question. Embrace this challenge to know yourself. In other words, can you prove to yourself why a particular program should hire you? If you can, then you can show this to the interviewer too!

(Alec side-note: I journaled for hours on this very topic. For most of us, it’s hard to “brag” about ourselves. We’re used to downplaying our accomplishments. Be realistic, and recognize what makes you stand out. Trust me: it will come through in your interviews.)

If your answer is “I have high scores,” then that answer is very one-dimensional. That response also doesn’t provide much depth to you as an interviewee.

A clear response to the question makes it easier to think about why you want to do a particular residency. In turn, it’s easy to answer the dreaded “what’s your vision for yourself for the future?” question. By knowing your value, you’ll see what you want to gain from training for 3 years (for FM) at a particular place.

To Do:

• Reflect on the question above
  • Journaling can be an excellent resource for this.
• Think of how you want to convey what you have come up with after reflecting on the question.
• Try to align a program’s strengths with your vision of the future.

4. Being Authentic

Finally, you want to strive to be as authentic as possible.

The reality is that this is an interview and you are putting your best foot forward. You know that, and more importantly, the programs know that.

The upshot: don’t lie and don’t fabricate past activities or accomplishments. You want to convey a sense of genuineness and authenticity to your goals and aspirations. The best way to accomplish this is to be honest and share what you want to do and why.

Closing Thoughts

Residency feels like one of the most important decisions you’ll make in your career. As such, interviews can be daunting. My goal is to help guide you in having the most successful experience possible.

Finally: Practice! Practice! Practice!

A quick Google search for “residency interview questions” provides many resources. The importance of practice here is not just making your way through those questions. Instead, it is using those questions to show the four points above.

Show you’re a good fit for the program with a genuine interest in your desired specialty. Finally, clarify your authentic vision for yourself and future.

(Aside: you can also Google search for “residency interview questions pdf.” By adding the pdf at the end, you can pull up more documents related to sample questions).

Practice with your mentors, friends, and select family members.

Best of luck!

– A Grateful Student

Sources: National Resident Matching Program, Charting Outcomes in the Match: International Medical Graduates, 2018. National Resident Matching Program, Washington, DC 2018.

National Resident Matching Program, Charting Outcomes in the Match: U.S. Allopathic Seniors, 2018. National Resident Matching Program, Washington, DC 2018.

National Resident Matching Program, Data Release and Research Committee: Results of the 2018 NRMP Program Director Survey. National Resident Matching Program, Washington, DC. 2018.

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