COMMENTARY

Applying to Residency in a Pandemic: 5 Virtual Interview Tips

Jillian Horton, MD

Disclosures

November 12, 2020

What's more stressful than going through the Match? Doing it during a pandemic. The only good news: Some of the usual stressors have disappeared this year.

Chances are, you'll save on travel expenses. Compared with normal years, your scheduling should be a piece of cake. You can even tape notes with talking points for your virtual interviews on the wall behind your computer monitor. Best of all, application committees will be questioning you on your own home turf. Still, those silver linings probably haven't relieved much of your anxiety about facing a residency admissions committee digitally.

We're all increasingly aware of the technical aspects that must be considered for any virtual meeting. This includes things like having a quiet space with appropriate lighting, doing test runs with peers or family, using a hardline connection instead of WiFi, and having a backup plan if things go wrong. Everyone — from doctors performing telemedicine to teachers conducting classes online — has spent months adjusting to the spike in internet-based interactions. No doubt you have as well. So, what I'd like to offer you are meaningful content tips that will help you turn your virtual residency interview into real success.

During my time as an associate dean, I coached hundreds of students through the interview process. The most important thing I've learned: Although there are wrong ways to answer questions, there is no universal right way. Here are five tips to help you avoid pitfalls and make the most out of residency application interviews unlike any that have come before.

Tip 1: Use Positive Anchors

In an era of digital interviews, finding authentic ways to stand out is more important than ever. Too often, students use their precious first impression to regurgitate dry information that's already included in their CV. From the start, focus on how you want to be remembered. You can make yourself more memorable by using a strategy I call "positive anchoring."

Identify three things that will most give people a window into who you are as a person. These pillars are now your positive anchors. How do you settle on those three things? Perhaps you received a service award for volunteering. In that case, one of your anchors would be your "commitment to community." If you're an athlete, a possible anchor could be your belief that "physical fitness is a key to one's sense of well-being." If you grappled with some measure of societal disadvantage, which could range from having a disability or belonging to a group that endures systemic injustice, one of your anchors would be your "deep understanding of oppression and marginalization, and a commitment to social justice."

How do these positive anchors work in practice? When prompted to introduce yourself, don't say something like, "My name is Tammy, and I attend the University of Rochester." Instead, start with something like, "I can think of three things that best give you a window into who I am as a person. I'm a person who is committed to my community. I'm also a person who believes that physical fitness is a key to one's sense of well-being. Finally, I am a person who has a deep understanding of oppression and marginalization, and a commitment to social justice." You then elaborate on each point.

Why is this approach superior? Because it allows you to cast your personal history as a narrative with key positive associations. We all have a U-shaped curve of attention: It will be highest for your interviewers at the beginning and at the end of your interview. Don't let those precious first few minutes slip through your fingers. Work hard to frame who you are using aspirational, high-concept, positive anchors that will leave your interviewers wanting to know more.

Tip 2: Issue a Retraction (If You Have To)

In life and during interviews, your mouth may suddenly develop a mind of its own.

During your interview, you may say that you would handle a situation in a way that is completely discordant with what you would actually do. You may give factually incorrect information. You may blurt out something painfully stupid. Great — now there's an elephant in the room ready to trample your hopes and dreams. What do you do? You do what medical journals do: Issue a retraction.

Just say something along these lines: "I'd like to go back to something I said a few minutes earlier that doesn't accurately reflect my beliefs/knowledge base/personality. I need to clarify that I would never do X. If I were in that situation, I would do Y. I apologize. My nerves hijacked my brain for a minute."

Have you ruined your interview by doing this? Absolutely not. In fact, you've demonstrated a critical quality in any trainee: the ability to correct yourself when you are wrong. You've also demonstrated real-time cognitive flexibility and a high degree of maturity. Simply put, it takes character to admit that you've made a mistake. By admitting your error, you've done more good than harm.

As someone who has sat on countless interview committees over the past two decades, I can tell you that this type of retraction, handled with authenticity, is something that has actually endeared me to candidates and has made me their champion. I get a real sense of how they might respond to a mistake in real life. That knowledge is priceless.

Tip 3: Deploy the Triple Threat

Almost certainly you will get a question similar to "Why did you choose this specialty?" For an elegant response, think "triple threat." That refers to people, place, and thing. How does this work?

Let's say you are applying to pediatrics. Who are the people that you work with in that specialty? Describe them and what it is about them that means something to you. In this specialty, you work with infants all the way up to teenagers. They have as diverse an array of problems as you can imagine. They are both vulnerable and resilient, and their futures are partially determined by their earliest experiences with health.

What is the place? Ground yourself in the details of where you have been and where you see yourself. It can be an outpatient clinic where you might follow a baby until their 18th birthday, or a NICU where you're intubating a child the size of the palm of your hand. Be specific.

Finally, what is the thing? This refers to the intellectual content of the specialty to which you are drawn. For something like pediatrics, maybe this concept is "generalism;" you'll have to deal with everything from how to talk to parents who are worried about vaccines to doing a spinal tap on a terrified child. This is where you discuss the bread-and-butter of what you'll be learning and convey your passion for the content itself.

Providing specifics can be useful in this last part of the triple threat. When I think back to how my passion for internal medicine developed, I remember my joy when I finally understood the physiology of pulsus paradoxus. I didn't feel that way about memorizing criteria for major depressive disorder or learning the principles of laparoscopic surgery. Most specialists have a similar memory. Find yours and include it in your triple threat, and you'll get the bonus of creating yet another positive anchor.

Tip 4: Show That You Can 'Label and Learn'

Everyone dreads questions about a time they made an error. You will almost certainly get that question. Again, there are no right answers, but a wrong answer here is a "safe" one. Use something compelling and important. If you give a lame example or something that is actually a humblebrag, you've blown the opportunity to demonstrate insight.

All of us in medicine have made and will make real errors. What defines us is what we learn from that experience. That's why I like coaching people to use what I call "label and learn." Here's an example of what that looks like. When asked to describe a mistake, say something like this:

During my surgical rotation, I was involved with a case that demonstrated the danger of premature closure (label). The patient had gallstone pancreatitis. One night, I was called several times to help assess his low-grade epigastric pain and indigestion. I suggested lipase assessment and an abdominal x-ray; however, I never considered other diagnoses and didn't review the case with a fellow. The next morning, an ECG was performed to rule out other causes of epigastric pain. It revealed that the patient was having a non–ST segment elevation myocardial infarction. This case taught me the importance of maintaining a broad differential, even when a diagnosis seems straightforward. I learned to always ask, "What else could this be?"

For a deeper background on labeling, read the classic article on cognitive error by Pat Croskerry, MD, PhD, who famously introduced that final, key question mentioned above.

The "label and learn" approach can also apply to questions dealing with interpersonal conflict or team difficulties. Before your interview, reflect on times when you've experienced these situations. Try to give them a name (label). Talking about the deeper lessons you learned during these conflicts will show the kind of self-awareness that we hope every trainee will cultivate during the course of their medical education.

Tip 5: Be Transparent in Your Thinking

Students often despise being given scenarios that fall under the umbrella of professionalism or interpersonal themes. For example: "You are covering the respirology consult service and need to insert a chest tube. You call your attending physician so that you can do the procedure together. When they arrive, they appear intoxicated. You are sure you smell alcohol on their breath. How would you handle this situation?"

Any answer to a scenario like this is best served by starting with an editorial statement that shows, without a doubt, that you understand the main themes that the interviewers are trying to get at. This is what I like to describe as demonstrating "transparency of thinking."

What does this look like? You can say something like, "This is a scenario that really comes down to two critical themes: patient safety and professionalism." Boom. You assured the interviewers within just a few seconds that not only do you know this is bad, but you also know why it is bad. Remember the U-shaped curve of attention? Even if they fade out on everything else you say in your response to the scenario, you've already assured them that you're thinking about this problem thematically and will act accordingly.

Here's another way to use transparency of thinking. Let's say you're in an anesthesia interview and are asked how you would manage a situation in which you were having difficulty intubating a patient. If their saturations are dropping and you don't have an airway, you want to say these words in response: "This is a medical emergency." This assures your interviewers that you are on the same page. You may even specify that you need immediate backup because a patient's welfare is at stake.

As a long-time coach for residents preparing for their specialty exams, it is remarkable how rarely learners will use these words without specifically being advised to do so. Situational awareness is a priceless skill for a trainee. Using this technique shows that you understand the concept and bring a superior level of metacognitive skill to the table.

Although you may be anxious about the technical aspects of this year's interviews, remember that everyone is dealing with the same challenges. Keep bringing yourself back to the core principles that have been the focus of every interview cycle since this process began: Focus on what you are saying and how you are saying it.

Oh, and just to turn the tables a bit: Do remember that this is also about deciding where you want to invest the next several years of your precious life. A good interview committee should also do its share of the work by convincing you why you should want to partner with them. Here's hoping that these tips help you find the best match for your residency.

Jillian Horton, MD, is associate head of the Department of Internal Medicine, director of the Alan Klass Program in Health Humanities, and a former associate dean of undergraduate student affairs at the University of Manitoba in Winnipeg, Canada. She was recently named the recipient of the 2020 Gold Humanism Award from the Gold Foundation Canada and the Association of Faculties of Medicine of Canada. Her memoir about medicine and medical education will be released by HarperCollins Canada in February 2021.

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