How to crush the residency interview
Updated: Aug 13, 2020
Residency interview season has begun. Here is a comprehensive, step-by-step guide on how to crush your residency interviews.
Understand the importance of interviews
While USMLE Step 1 scores, letters of recommendation, clinical grades, and your MSPE are the most important determinants of getting offered an interview, the top 4 factors that determine how you are ordered on a program's rank order list all are determined by the interview.
If you have been offered an interview, congratulations!
Being offered an interview offer is an honor. It means a program has thoroughly reviewed your application and is very interested in having you in their residency program. So, if you've been offered an interview, congratulations! You earned it.
When does the interview begin?
"The interview" begins once you are offered an interview invite. Residency programs are trying to weed out people who will be difficult to work with, unprofessional, or excessively needy. Exhibiting these red flags in your email correspondence to the program coordinators could undermine your chances at a successful match. So, be prompt, polite, and respectful to the program coordinators in your email correspondence.
See our blog post for tips about how to respond to invites as soon as possible by tweaking the settings on your smartphone.
Prepare for the most common interview questions
Before interviews are underway, make sure you're set up for success. Practice answering a few of the most common questions you'll be asked.
You'll have to tailor your answers to your field, specialty of interest, and the specialty/expertise of the person interviewing you. Be economical in your responses, aiming to give the interviewer the big picture first (you can provide more details if asked for specifics).
1. "Tell me a bit about yourself."
By far the most common question you'll be asked. The open-ended nature of this question may be intimidating, but you can use this to your advantage by giving a broad and brief (1-2 minute) overview of your life story leading up to a career in your field of choice. Touch on where you were born and raised, where you went to college, what you studied, post-graduation activities, where you went to med school, and some of the interesting activities you're most proud of that you've been involved with along the way. Try to follow a theme if you have one (e.g., pediatrics interest, global health interest, cardiology interest), or try to briefly connect the dots if you don't have a clear theme.
Here's roughly how I answered this question.
I was born and raised in Cleveland Ohio. I got interested in math and teaching in high school due to a really amazing calculus teacher, so I went on to study math at Ohio State. At the same time, I wanted to go to med school, so I did a lot of computational systems biology research as an undergrad. After graduating, I spent a year and a half in Boston doing systems biology research at a cancer pharmaceutical company. After this, I did some global health research at a pediatric cancer unit in Guadalajara, Mexico, for 3 months, and moved to Durham to start med school at Duke. I knew I wanted to be an oncologist at this point, but didn't know about radiation oncology at all! Based on a great research and clinical experience with [my research advisor] during my research year, I decided to go into radiation oncology.
A good answer to this question will naturally lead the interviewer to ask more questions about your story in a way that allows you to highlight your strengths. The most common follow up question is:
3. "Why did you choose a career in [our field]?".
When answering the follow-up questions, refer back to your first story to help provide context to your answer.
For example, in response to the question "Why did you choose a career in radiation oncology?", I might start by saying "When I was doing computational systems biology research at Ohio State, we largely focused on systems implicated in cancer pathogenesis. While my work was pretty abstract, I was awarded a cancer research scholarship for my work in my junior year. As part of this scholarship, I had to partake in a cancer research fundraising bike ride. This bike ride was a huge community event, and riding alongside survivors and researchers alike, I felt really connected to the community of cancer patients and researchers, and started thinking of being an oncologist. I decided upon rad onc during my research year. My project involved a lot of imaging, and even allowed me to program an automated workflow for contouring serial MRI-brains. I realized that rad onc, being such a technical field, is a great fit for my background in math/programming and interest in caring for patients with cancer."
4. "Tell me more about your research on X".
Understand that interviewers can and will ask you questions about anything you mention in your application, including your research. If you're very familiar with the research study, try to give a brief one paragraph oral abstract covering the background, methods, results, and conclusions in about 1 minute. Try to talk about your research in non-technical terms any doctor would be able to understand. Mention your specific contribution to the project if it is something you're proud of.
E.g., here's how I might verbally describe one of my research projects I know quite well.
"We did a study on the effect of temozolomide on pseudoprogression in adults with low grade gliomas. Pseudoprogression means transient MRI changes following chemotherapy or radiation that are initially concerning for disease progression but which eventually resolve. We retrospectively looked at 130 patients with grade I, II, or IDH mutant grade glioma who received proton radiotherapy, and asked the question "Do patients who receive temozolomide have more pseudoprogression? I performed a chart review and contoured out the volume of enhancing and nonenhancing lesions on serial MRI for each patients, totaling about 500 MRIs. We found that ...".
5. "What questions do you have?"
Of course, if you have specific questions about the program, now is the time to ask. However, the powerpoint presentation given will usually answer most of your questions! Therefore, my favorite answer to this question was "As a future resident in radiation oncology, what advice do you have for me?". It totally turns the question back on the interviewer, often leads to great, relaxed discussions, and most importantly, allows you to pay attention to the valuable advice of a future colleague.
Other helpful answers to this question include 1) "How are residents given feedback?", 2) "Are there any formal routes for residents to provide feedback?. If so, may I ask what kind of feedback have residents recently given, and what changes have been made based on that feedback?". Answers to these questions may tell you a lot about the culture of the program.
6. "Tell me about a time where [difficult scenario]"
The key to answering such questions is to pause to think, and to tell a good story - one with four clearly defined things: background, problem, solution, and outcome.
For example, "Tell me about a clinical situation where you felt uncomfortable".
Frame the story with some background info. When/where did it happen? Who/what was involved? "About a year before I started med school, I spent a half day each week for three months shadowing in a neuromuscular clinic with an attending and a fellow."
Describe the problem. Paint a picture for the interviewer. "One afternoon, A middle aged man with a chronic progressive neuromuscular disease came into clinic with his brother. The fellow and I went to see him together. When we entered the room we saw him sitting down, frail and cachectic, in stark contrast to his brother who was built like a linebacker. The brother was in his mid thirties, at least 6 foot 3, 280 pounds, balding, and had a thick boston accent. He told us that the patient had gotten worse - he was no longer able to speak, and now needed his assistance for everything. He was extremely frustrated with the care the patient had been receiving from "the system". I stood silently in the corner as he shouted his complaints at the fellow. The fellow was defensive: he shook his head "no", held up his hands, and attempted multiple times to reassure the patient that he actually was getting good care. This further infuriated the brother. He stood up and pointed at the fellow, and started shouting physical threats at the fellow. The fellow said "Just one minute!", opened the door into me, and vanished, leaving me in the room. Still in the corner, I stood there, having no idea what to do or say, and saw the brother turn his gaze towards me."
Describe the solution. Also, this is a true story. "I motioned to a stool between me and the patient, rolled it my way, sat down, and let out a deep sigh. I sat there in silence for what felt like a long time but was probably only 5 seconds. I felt bad for him, shook my head, and said something like "It sounds really frustrating having to deal with the system".
Describe the outcome. "He sat down. I no longer felt threatened. He told me he had to take his brother everywhere and lost his job because how how many appointments his brother had. He kept on talking. As I kept on listening, his tone of voice eased up from angry, to sad, to sarcastic, to calm. He just needed to talk. By the time the attending entered the room, he was cracking jokes."
The pre (or post) interview dinner
Interview dinners are a fun way to get to know a program's current residents (and sometimes, faculty) in a more relaxed setting. These are super helpful, so try to go to each dinner if you can make it (your interview/travel schedule may make you miss several - just give the program a heads up via email if you're going to miss one).
Dress is typically casual or business casual. If unsure, go with business casual, and err just slightly more on the side of more formal than more casual, knowing that it's easier to dress-down a pair of slacks than it is to dress-up a pair of jeans. Men: khakis, leather shoes, and a button up without a tie. Women: nice blouse and slacks or an appropriate skirt.
It's just a dinner. Ask questions. Smile. Be interested. Relax, but be professional and well-adjusted. Get to know the residents. Talk to your wonderful co-applicants. Follow the lead and tone set by the residents. Don't drink too much.
Introductions and the art of the perfect hand shake
You will introduce yourself to many people over the course of interview season. Meet eyes with the person you'll introduce yourself to. Smile briefly, say "Hi, I'm Firstname Lastname", and shake hands. Maintain eye contact during the hand shake.
With a relatively rigid wrist, grasp hands firmly enough to prevent the other hand from slipping away, but not too firm as to cause harm. Grip with your full hand, not just the fingers.
Look up the distinguishing features of the program
Is there a built in research year? Is there structured mentoring of residents by faculty members? Is the patient population mostly underserved?
What are the biggest strengths of the program?
Is it world renowned for gastroenterology but weak in rheumatology?
Geography. Would your significant other be able to easily find employment there? Do you have any geographical ties to the program? Especially if you have no obvious geographical ties to an area, it's helpful to research why you might want to live in the area, as you'll likely be asked something like "I see you grew up and attended college and medical school in Florida. What makes you want to come to Minnesota to train?".
Consider Googling your interviewers (optional)
You may have the opportunity to meet a large number of future colleagues during interview season. Knowing a bit about their professional background can help you make the most of the short time you get to spend 1:1 with them. Therefore, if you have time and know beforehand who your interviewers will be, consider googling them to see what their areas of expertise are. Note that knowing too much can seem disingenuous or creepy.
Dress in modest professional attire on interview day
Your goal is to be noticed for your personal qualities, not what you wear.
Men: A dark (black, grey, charcoal, or navy blue) suit that fits you well, a light colored shirt, a modest tie, a dress belt, matching black or brown dress shoes, and modest dress socks. Unless you always wear bow ties, I would not recommend wearing one. Pocket squares and tie clips are an unnecessary flare that will likely make you stand out.
Women: A dark (black, grey, charcoal, or navy blue) pantsuit (or skirt-suit (knee length) with neutral or dark tights/leggings/hose), a conservative light colored blouse, and professional looking black or brown heels or flats. Jewelry should be minimal and professional.
Watches are ok, so long as they are not too flashy. Take the time to iron or steam your attire before each interview. Most hotels and Airbnbs have irons available.
A note on hygiene
Be neat and well groomed. Minimize cologne/perfume. Wear deodorant. Brush your teeth.
Plan to arrive about 20-30 minutes early to your interview day.
Know what to expect on interview day
The interview day typically consists of arriving to the lobby of the hospital, department, or clinic, being lead to a conference room where you can leave your things and eat breakfast, a tour, and a number of interviews. There is typically a powerpoint presentation that focuses on the distinguishing features of the institution and program. There may be a lunch, and a full afternoon of interviews as well.
Interview format varies greatly across programs and fields. The most common format is to have a series of brief (5-15 minute) interviews with one or two faculty members or senior residents at a time. You may be asked a series of structured questions, or it may be conversational.
Make a positive impression during your interviews
Be genuine. Be your best self. It's a balance.
Be enthusiastic and energetic, but controlled, calm, and collected. If you're normally shy and introverted, try to come out of your shell a bit. If you're extroverted and super talkative, maybe tone it down just a bit.
Show confidence, not arrogance.
Be thoughtful in your answers.
Communicate clearly and fluently. Minimize the use of "um", "like", "so", etc. Don't use an upward inflection at the end of each sentence like you're asking a question.
Laugh and have a sense of humor when appropriate.
Describe your career goals as clearly as you can. The operative phrase is "as you can". Not everyone is going to be able to say exactly what area they want to specialize in and what they want to research in 10 years. However, an answer like "I'm interested in pursuing a clinically focused career in a procedural specialty like gastroenterology, cardiology, or pulmonology", or "I see myself devoting half of my time to a basic science lab focused on immunology. I'm not sure what clinical specialty I'll decide on but given my interest in immunology research I'm considering oncology or hepatology" is a lot more specific and helpful than something like "I'm not sure at this point but am keeping an open mind!".
Don't make a negative impression during your interviews
Don't be negative. Focus on the positive aspects of experiences. Don't say something like "Well, I was interested in oncology research, but I hated my surgical and medical oncology rotations, so I decided to do a radiation oncology clerkship".
Don't be bored. Fully engage in the conversation to combat boredom. Lean in!
Be cognizant of your body language and tone of voice. Face your interviewer directly. Avoid crossing your arms. Maintain a neutral or positive tone of voice.
Instead of being defensive, acknowledge.
Work with your interviewer
Some interviewers will clearly have just read your application thoroughly. They will ask you questions that naturally arise in the course of reading your application. For example, if you have been involved in many immunology research projects and are interested in oncology, you may be asked if you're interested in immunotherapy research. However, imagine you're interviewed by a leading immunotherapy researcher, and are asked "where did you go to college?" or "what kind of research projects have you done". This suggests your interviewer may not know or remember much about you. That's ok! Your answers should meet the interviewer at their level of detail and, if possible, help steer the discussion towards areas of your application you enjoy talking about, such as immunotherapy.
Take time to think before you speak, especially on "hard" questions
This sounds like common sense. However, if you're asked a question like "What in your life are you most ashamed of?", please don't blurt out an answer. Take your time on hard questions. Your interviewer is expecting that this question will take you off guard. It should! Say "Let me think", or "Wow, that is a tough question!". Pause for 10-15 seconds. Think in silence during this time. Once you collect your thoughts and know a good response, respond.
Save certain questions for the residents, not the faculty
Asking faculty about call schedule, vacation days, benefits, etc, is poor form. Instead, you may feel free to ask such questions to the residents during the tour or at the dinner, if you feel that there is good rapport.
Take notes on the same day of the interview to help plan your rank list
Carry a single folded piece of paper and a pen or pencil. This way, you'll always have something on you to take notes. Jot down notes during the day on the overall feeling you get from the program. At the end of the interview day, when you get back to your hotel, or are sitting in the airport, try to give the program a score out of 10 based on your gut. Write the score down on paper, and summarize your thoughts on the program and what it'd like to be a resident living there for years.
If you don't already have it, download the "The MATCH PRISM" app from the NRMP via your smartphone app store (see below for screenshots). Find your program. Grade the program in each of the listed categories. After grading, each program's average rating helps determine its rank in the app. Put your written summary into the notes box. At the end of your interview season, you can export this data into excel. Obviously this is not your official rank list, but this really helps sort through what is a difficult and incredibly important decision: the order of your rank order list.
Programs that interview you are very interested in you. Be respectful to everyone. Be your best self. Don't be annoying, off-putting, or weird. And remember, when asked "What questions do you have?", your reply should simply be "What advice do you have for me?"
If you're interested in learning more about our interview preparation service, or our USMLE tutoring services, check us out at medschoolgurus.com or contact us via our contact page, medschoolgurus.com/contact.