The Fourth Year Everything you need to know to have a successful interview season and Match!

The Fourth YearEverything you need to know to have a successful interview season and Match! With love, from the residents (mostly Courtney Wilson, MD)

Outline • Timeline • Away Rotations/Schedules • Letters of Recommendation • Personal Statement • Where to Apply • Staying organized • Interviews: scheduling, travel, questions, how to make a good impression • The Rank Ordered List • The Match

Timeline • August: Personal statement done, request letters of recommendation, hone list of programs you like, meet with advisors • September: ERAS and NRMP applications in, follow up on letters of rec • September: ACEP 2010 ScientificAssembly--Las Vegas, 9/28-10/1Go if you can!Great opportunity to talk to & meet residency directors--they will remember you in interviews • November: Start getting interview invitations, schedule this month if poss! • December: Talk to your advisor if you haven’t gotten any invitations yet • January: Finish up interviews, write thank you notes early, think about second looks, start ranking your list • February: Rank ordered list is due, call your top 3-5 programs, tell your top program--and only your top program--that they’re #1 (this might give you an idea about where you stand on their list) • March: Try to relax! Match day usually around the 15th - 20th

ACEP 2010 • Sunday, September 26 in Las Vegas • EMRA Medical Student Forum & Lunch • Opportunity to mingle with PDs and ask ?s • 8am-1pm • EMRA Residency Fair • More networking, learn about programs • 3pm-5pm • Free to medical students • You should go

Away Rotations • These really matter! Prepare and take them seriously • Many program directors say they care more about your away rotation grade than your home institution one • If you are rotating at one of your top choice programs, this is your chance to shine! Stay positive, be outgoing and be yourself. • Work hard, try to get to know the residents and faculty, and let them know you are serious about wanting to come to their program

Away Rotations Cont’d • If possible, meet with the program director(s) • Pay attention to the details of the program--what are the things that you like and dislike (figuring out what you don’t like is arguably more important than the opposite) • Ask lots of questions! Find out what other programs the residents liked, and why they decided to rank that program highly • Try to get to know at least one faculty member fairly well--you’ll need a strong letter of recommendation • **The above principles also apply at your home institution

Letters of Recommendation • This can be one of the most challenging and intimidating parts of the process, but remember your attendings are used to it • Ask those who know you relatively well for a “strong” letter • Ask early, ask often! The worst that can happen is that they say no--better this than that they write you a weak letter • Send reminders, and have back ups. People are busy, and you don’t want to be caught without a letter. • SLORs: Request a Standardized Letter of Recommendation formatted by CORD (Council of Emergency Medicine Residency Directors) for all ED rotations you do • If you have more than the allowed # of letters, bring extras with you to your interviews

The SLOR

The Personal Statement • Start writing now! The earlier you get this done the better • Many say that the personal statement can only hurt you: don’t write anything you’re not prepared to defend or talk about in an interview • Definitely have someone, preferably a mentor, read it • Reread it yourself many times • DO NOT allow spelling or grammar errors • Make sure that it is a reflection of yourself and your beliefs, and be honest.

Personal Statement:What to put in it (a suggestion) • Try to open with something catchy: an inspiring story • Explain why you have chosen EM • Describe experiences you have had that helped you make your decision • Tell your reader why you would be good at EM • Describe what you are looking for in a training program • Describe your future career goals

Personal Statement Cont’d • Some add a paragraph at the end referencing particular programs • This is probably not necessary, and could be bad if you attach the wrong document to the wrong program • It should be no longer than one page, single spaced • Remember, the personal statement should be personal • There is no right or wrong way to do it, just make sure that it reflects your personality and your goals

Where to apply? Criteria:Here are some suggestions to help guide you • Location • 3 vs. 4 years • Size of program • Academic vs. Community vs. County • Reputation? FREIDA!! The best online resource for learning about programs… google: FREIDA or **http://www.ama-assn.org/ama/pub/category/2997.html

Staying Organized Make 2 spreadsheets • Programs with details of interest: location, program director’s & coordinator’s names, website, 3 vs 4 yrs, #residents, etc. • Application Status: programs you applied to, status of application, interview date, thank you note • Google Calendar!!www.google.com/calendarThis is an invaluable tool to help you stay organized, and to help your loved ones keep track of you and your schedule • Use it for keeping track of flight info, accommodations, rental cars, interview dates…

Interviews: outline • Where to stay • What to pack • Resident Social • Shifts while on interviews • Interview day • Second looks • Communication • When to do them • How to schedule them • When and how to cancel them • Booking flights

Communication • Your go-to person is the program coordinator • They really don’t like to be called “secretaries” • Most importantly: BE ON YOUR BEST BEHAVIOR with every interaction you have with program coordinators--this really matters

Interviews:When to do them • Earlier is better: Start in November if you can • It is a myth that programs will forget you if you interview in November! • Also, if you schedule an interview in January, there is a good chance that you will be too burned out/broke to go by then--trust us, it happens • Try to schedule a “practice” interview first at a program that’s lower on your list • You’ll likely be more comfortable and perform better on the ones you really care about

How to Schedule Interviews: It’s time to be a bit obsessive… • It pays to check your email frequently • Try to schedule ASAP! • Most programs only offer a certain number of interviews • If you haven’t scheduled and the spots fill, you’re out of luck • Be obsessive, B-E obsessive

How to Schedule Interviews: • Try to group interviews geographically--it is possible and will save you $ and time • Don’t be afraid to politely contact program coordinators directly • Let them know you’re interested in their program, and that you’ll “be in the area” at such and such time • This often works, and you can sometimes avoid extra travel and interview earlier

How to Reschedule Interviews • Don’t panic, this happens more than you think it might, especially if you are couples matching • Contact the program coordinator ASAP, preferably by phone, to explain the predicament • Have an alternate date in mind, and try to be creative and flexible--it usually works out

How and when to cancel interviews • If you are fortunate enough to be in this position, first recognize your fortune and hard work(pat on the back) • Next, consider your future colleagues waiting to hear from the programs you’re not that interested in • CANCEL EARLY!At least one week in advance, preferably two. This gives programs more time to fill the spots (imagine getting an interview offer for the next week across the country! $$$$) • Call or email the program coordinator (not the director) and politely decline, they usually won’t ask any questions

Canceling Interviews Example: “Dear _____, I am writing to inform you that I will no longer be able to attend my interview, as scheduled on ___. I thank you very much for you time in reviewing my application, and I wish you a successful interview season. Sincerely,” “Dear _____, I am writing to inform you that due to time and financial constraints I will not be able to attend my interview as scheduled on _____. I appreciate your interview offer and the time you spent reviewing my application. I wish you this best this interview season. Sincerely,”

Scheduling Flights • Try to schedule interviews in geographic blocks • Avoid scheduling cross-country flights with layovers in the midwest • You can count on bad weather-you might get stuck, be late, or miss an interview • Strongly consider booking flights with Southwest and JetBlue when possible(you can easily cancel and rebook flights online, and there’s no penalty, they just credit your account for use anytime) • If it’s worth it, use miles - these are also cancellable (altho for a fee)

Where to stay • Consider staying with residents,you’ll save money and get to know each other better • Staying with residents can be a little stressful, it can be hard to relax when you’re trying to make a good impression, but you’ll save lots of money, and get a more personal look at the program • Many programs have deals on hotels around the area, it pays to book something close to the interview • Some, very few, programs will pay for your stay • If you have friends and family around, this can be a great opportunity to reunite

What to pack • Try not to check a bag--you’ll be happy you didn’t • Time to invest in a large garment bag to carry on • Consider getting a travel steamer--very handy though not an absolute must • Bringing a laptop, PDA, or cell phone with internet access is virtually essential for looking up phone numbers, checking into flights, reading about programs, etc. • If you’re interviewing on the East coast, bring warm clothes--hat, scarf, gloves, overcoat, consider a small umbrella • A camera is a good idea if you have a spouse that can’t come along, or just for jogging the memory on week 8

What to Pack • Bring a small notebook for taking notes(try to spend 15 min at the end of the day writing down your thoughts before you forget) • If you’re bringing a carryon, consider getting a cheap electric razor since you can’t bring razors on • Bring “nice casual” clothes for resident socials • Pleasure reading is nice--this is fourth year after all! (Also, they might ask you what you’re reading right now) • You really can live for a month out of a carry on!

What to wear • Everyone wears a suit • If you don’t wear a suit, just be prepared to stand out, which may not be a bad thing • Whatever you wear, make sure it’s clean, wrinkle-free, and represents you and your personality

The Resident Social You should try to go to this… • Free food! • This is your chance to interact with the residents socially, and to see how they interact with each other--are they friends? • Ask questions you don’t want to ask attendings, eg: scheduling, shift length, vacation time, benefits, etc. • Find out what to do for fun, where people live, if they buy vs rent, if they actually have lives outside of the residency, etc. • This may be the most important part of the interview!!

Interview Day • BE YOURSELF! • Try to relax and be confident • Answer questions truthfully • Don’t badmouth other programs or people • Remember that the best program for you will be a good match

Interview Questions Questions we have been asked:Practice these with a friend • Teach me something non-medical • What’s the most responsibility you’ve had? • What’s the hardest you’ve ever worked? • Name an aspect of your interpersonal life you would change. • Name an embarrassing/funny medical school experience. • Tell me what your career goals are. • Tell me what you’re looking for in a program. • Tell me about a mentor.

Interview Questions Cont’d • Tell me which of your volunteer experiences made the most impact on you. • Will you miss home? • What’s the most creative thing you’ve ever done? • What do you want us to remember about you? • Tell me about your biggest success and failure. • Why Emergency Medicine? • What are you reading for pleasure? • What would you tell us about yourself that’s not well represented in your application?

Interview Questions Cont’d • What would you bring to this residency program? • Tell me about a patient you’ve been most empathetic with. • What event or person has most defined/shaped who you are? • Why do you think you got ___ award? • What would you do if not medicine? • Tell me about a medical error/mistake that you were a part of/witnessed. What did you learn from it? • Tell me about your best and worst moment of medical school.

Interview Questions Cont’d • You can’t practice this enough • Whichever questions make you feel the most uncomfortable, should be the questions you practice the most • Utilize someone who has interviewing experience if you can • Think about the major points you’d like to convey about yourself and find a way to incorporate those into your answers and practice it • WARNING: You will be really sick of yourself by the end of this process

Questions to Ask your Interviewer • What kind of residents thrive in your program? • What are your program’s best attributes and distinguishing characteristics? • How do you envision your program changing over the next 5-10 or 3-4 years? • What are some short and long-term goals that you have for your program as a whole, and for the residents? • What things do you do to foster balance in your resident’s lives? • What are your program’s weaknesses and how are you working to improve them?

Questions to Ask your Interviewer • What percentage of your graduates pursue fellowships or go on to academics? • What electives are available? • Do you have financial/loan advisors? • How are your ED shifts organized (eg circadian organization)? • Describe the radiology and ultrasound training. • What are your average wait times? Boarding times? • How are traumas and codes managed? • How comfortable are your residents in treating children?

Questions to Ask your Interviewer • Are conference times protected off-service? • What, if any, simulation labs do you have? • How do you incorporate feedback from your residents? • Why is your curriculum structured the way it is? • Is moonlighting allowed? • Do you offer maternity/paternity leave? • Where do most of the residents live? • What is your story? Why did you come here? Do you have any plans to leave?

Illegal Interview Questions • There are certain topics that are “illegal” for your interviewer to ask • If you bring these things up, anywhere in your application, then they’re fair game for discussion • If you get asked one of the following questions, you are not legally required to answer • How you respond is up to you, but be aware that your interviewer is breaking the rules…

Illegal Interview Questions • Ethnicity • Sexual orientation • Religion • National origin • Birthplace • Age • Disability • Marital/family status (this includes having/planning to have kids)

Shifts on Interview Day • This is a great opportunity to meet and work with attendings and residents • You can get a sense of department flow and pt population • People will get to know you better • This is essential if you really like a program but didn’t rotate there • Time and energy permitting, you should do this at every interview (good luck!) • Several hours in the department is better than nothing

Choosing a program:one size does not fit all Criteria: how to avoid depression during residency • Supportiveness of the residency director • Proximity of family/ease of travel home • Shift length/call schedule • Vacation time • Personalities of other residents • Atmosphere in ED/hospital • Commute time/bike commuting • Feeling excited to start • Proximity of activities that you like • Potential for spouse satisfaction

Program Details: Things to pay attention to • Shift length • Ultrasound training • Elective time--how much and what you can do with it • Number of ICU months, ward months and ED months • How far in advance schedule is made • Who makes the schedule--chiefs? Is it flexible? • Dictation versus EMR • Integrated peds • Peds sedation • Procedural sedation • Service excellence • Pain control • Patient population: underserved, Spanish-speaking, etc. • Graded responsibility (managing flow) • Teaching opportunities • Trauma/Airway Management • Radiology training

Perks to Consider • Orientation month • Retreats • National/Int’l Conferences paid for • Educational stipends • Parking • Food • Insurance Benefits • Cost of Living vs Salary

Making Your Rank List:the way the match works www.NRMP.org(National Residency Matching Program) • “The process begins with an attempt to place an applicant into the program indicated as most preferred on that applicant's list.” • “If the applicant cannot be matched to this first choice program, an attempt is then made to place the applicant into the second choice program, and so on, until the applicant obtains a tentative match, or all the applicant's choices have been exhausted.”

Making Your Rank List:the way the match works • Some program directors might say things like, • “If you want to come to our program, then you have to rank us first.” • Does this make sense?…

Making Your Rank List:the way the match works • The NRMP uses the applicant’s rank ordered list (ROL) preferentiallyto match • If you want to go to a program that you think may be a “reach” for you, you should still rank it #1 • If your #1 program ranks you at the top of their list, that’s where you go-- if you’re at the bottom, you probably won’t go there • If your first choice program ranks others above you, but those people don’t rank that program at the top of their lists, and they match somewhere else, then you can still match at your first choice program

Making Your Rank List:the way the match works • It’s true that if you want to go to a program you should rank it #1 • But if you rank a great program 2, 3, etc you could still go there if you are high on their list and you don’t get your first choice • NRMP statistics show that if you rank 10 programs, you will almost assuredly match, though maybe at #10. • Therefore, aim to interview at 12-13 programs so that you don’t have to rank programs that you really dislike to get to 10 • DO NOT rank a program at which you wouldn’t be happy. If you’d rather not match than go to a particular program, then don’t rank it

Making Your Rank List:the way the match works • Remember rank your first-choice-dream program #1!!

Second Looks: When to do them • Some say doing a second look at your first choice program is necessary (eg. shows commitment) • This is probably not true • Second looks are expensive and take time, for both you and the program • Doing a second look makes sense if… • You are bringing a spouse along for the first time • You really can’t decide where you want to go

Second Look Etiquette • If you really feel you need to go back to show your commitment, contact the program director, let them know you’re thinking about doing a 2nd look to show your enthusiasm/commitment • They will most likely tell you this isn’t necessary If you do go… • Do not request more time (eg no extra interviews or meetings with director) • Shift shadowing is ok • Remember, you should be doing this for yourself! • Play it cool, you don’t want to seem like a pain

Beware the False Love… • You may get VERY positive emails, letters, phone calls after your interviews • This is very flattering and exciting • Just remember, every program’s main objective is for you to rank them highly • Try not to let praise influence your rank list--do what’s right for you!

How to Decide • Everyone has different values and criteria • It doesn’t matter what is most important to you, just that you figure out what that is, and make your decision using this as your compass • Truthfully, you will get a good education where ever you go ** Our advice: go where you think you will be happy!

The Fourth Year Everything you need to know to have a successful interview season and Match!