Residency Interview Basics

The residency match has become more and more competitive in recent years. There is no shortage of excellent candidates and each year, thousands of applicants fail to match.

The interview has always been an important part of the process, but as competition increases, programs become even more reliant on interview impressions in determining which candidates to rank.

After all, when so many candidates look great on paper, the interview provides the best chance to evaluate fit on a human level.

You get invited to interview based on your academic performance, your USMLE scores, your letters of reference, and your research experience.

Lots of candidates get invited to interview. Once your foot is in the door, it’s up to you to stand out from the rest of those qualified applicants. The interview is your opportunity to shine.

The data from program director surveys consistently show that the residency interview is the most important factor when deciding how to rank a residency applicant. This is true across all specialties, though research and rotation experience are also important factors for some specialties.

So let’s talk about how residency interviews work…

Let’s start with how the residency interview fits into the match timeline.
After applications are submitted in early September, programs take time to review and then send out interview invitations to selected applicants.

Many interview invitations go out in October, with interviews scheduled to take place through January.

Additional interview invites continue to go out as the season progresses.

After all, interviews are completed, program interviewers compare notes and develop their rank order lists for the main match, which are due in February.

In March, match results come out and those who didn’t match may then be eligible to enter the Supplemental Offer and Acceptance Program (SOAP).

For both programs and applicants, the interview stage is about gathering key intelligence to make very important decisions.

Let’s look at the goals of both sides:

For interviewers, the goals are to confirm and expand upon the information that you provided in your application.

There’s nothing like a face-to-face conversation to evaluate communication and interpersonal skills, get to know more about your goals and motivations, and judge general professionalism.

They are also trying to determine how you would “fit” into the culture of the program.

Meanwhile, just as you are trying to put your best foot forward, the representatives of the residency program want to show their program in the best possible light, “selling” it in the hopes of being top-ranked by top applicants.

Bottom line: the interview is how they gather intelligence to shape their rank order list of candidates for the Match.

For you, the interview provides the opportunity to learn more about the program and to meet potential colleagues and mentors.

You’re trying to balance two very important goals:

• To determine which programs will be the best fit for you and your goals; and
• To make a great impression in every interview to give yourself the best odds of a happy match.

It’s kind of like going on a first date, but with much higher long-term stakes — you’re trying to get to know the program while simultaneously “wowing” them in case it turns out to be your dream match.

All of this while still being yourself.

You can see why so many people, even the best applicants, struggle with residency interviews. They’re not easy.

You have a very small window of time to connect with the interviewer, convey your qualifications, and get a sense of the program fit for your own purposes.

That’s why preparation and practice are so helpful when it comes to interviewing skills.

It’s not about faking or performing, it’s about planning enough to be the most focused, polished, personable, and eloquent version of your true self.

It’s about giving your interviewers a sense of who you really are in the manufactured format of the interview. We’ll come back to how to do this in an authentic way in future lessons.

Now let’s move on to talking about…

Different residency programs conduct interviews in different ways.

Typically, your interview experience will include:

1. The Social Event

Often, there will be a dinner or cocktail party scheduled the night before the interview day. This is usually an opportunity to meet current residents in a social setting.

Definitely plan to attend if you can. It’s a great way to learn about the program and to connect with residents, who often weigh in on the ranking list. While this is generally meant to be a social event, remember that it’s still part of the interview process and your behavior will be observed.

2. The Interviews

For each program, you will likely meet with at least 3 people, often in separate one-on-one interviews of 20-30 minutes each.

Some programs will ask you to interview with 2 or more interviewers at the same time.

You will likely be meeting with the program director, faculty members, and residents.

You may also meet other staff members.

Usually, the program will send you an itinerary in advance with the names of your interviewers.

3. The Tour/Presentations

Many programs provide a tour of the facilities and/or the opportunity to sit in on a conference, morning report, or presentation.

These are great opportunities to learn more about the program and the resident experience.

Again, remember that this is also part of the interview process.

Your attitude and questions may factor into their overall impression of you.

When it comes to the more informal portions of the interview experience, look for opportunities to make connections. Prepare questions to show your interest and enthusiasm.

You don’t have to be an aggressive schmoozer. In fact, that can work against you, depending on the culture of the program.

Be professional and enthusiastic. Make an effort to connect and learn as best you can.

During the formal interviews, there will be more focus on learning about you.

As discussed, you will likely be meeting with at least 2-3 different people for approximately 15-30 minutes each.

You’ll find that the tone and style of your interviewers will vary greatly.

Some interviewers will be very conversational and just want to chat about your background and goals in an informal way.

Other interviewers will be more structured, with a prepared list of questions and topics to cover.

In general, program directors tend to be more structured. They likely have more training and experience in interviewing and this is a key part of the program director’s job: selecting residents who will make the program proud.

He or she has probably thought a lot about what qualities are most important for a successful resident and what makes someone a good fit for their program.

As a result, the program director is more likely to ask probing and behavioral questions.

Faculty members and residents may be more conversational. Most programs don’t give detailed instructions to interviewers regarding what to ask, though many provide some general guidance.

Some interviewers may have specific ideas about good questions to ask, while others will just want to get to know you.

This is why there is such variation in residency interview questions.

Despite the wide range of possibilities, there are some questions and topics that you are almost certain to get, especially if you go on a number of interviews.

For lots more info on questions to prepare for, please see our Residency Question Guide; a powerful, free resource that covers all of the basics of Residency Interviewing.

OK, so now let’s talk about what happens AFTER the interview.

After the interviews are done, it’s time for the program to evaluate applicants and create their rank list.

While all programs do this a bit differently, we have some information about trends from the annual surveys of program directors conducted by the American Association of Medical Colleges.

According to the most recent survey, most programs develop an initial rank order list based on interviewer evaluations.

Many programs ask each interviewer to assign numeric ratings after each interview — with some programs asking for an overall rating and others asking for separate ratings on different competencies and/or different components of the application.

In other programs, it’s less formal and the initial list is based on discussions during faculty rank order meetings.

Changes are then made to the initial rank order list based on more group discussion and other factors.

Top influencing factors named by program directors included informal resident or staff feedback, completion of a successful rotation at the institution, referral from a trusted colleague or faculty, and creating a diverse cohort.

Program directors have also shared their most common reasons for deciding not to rank an applicant.

The #1 reason was a poor interview day.

Rounding out the top 3 reasons were “poor fit” and “concerns about professionalism.”

And let’s face it, the interview day also has a huge influence on their opinions about your fit and professionalism.

We have custom designed Big Interview Medical to train you for interview day using a proven step-by-step approach to breakdown the toughest interview questions and make sure you hit it out of the park.