Strategy,Competitiveness,& The Interview

Michael A. Gisondi, MD, FACEP, FAAEMResidency Program DirectorNorthwestern University@mikegisondi

SAEM Medical Student Symposium - 2015

Topics to Discuss:

1. Strategy

2. Competitiveness

3. The Interview

Strategy

“A plan of action designed to achieve a major aim.” Synonyms: Game Plan, Action Plan, Master Plan

“The art of planning and directing military operations in battle.”Synonyms: The Art of War, Tactics

Effective Advising Programs = Strategic Success!

The best advisors:- Understand how the game is played- Know your strengths relative to peers- Discuss your goals ahead of time- Set realistic expectations - Are someone that can be trusted- Help develop a strategy

Biggest Potential Strategic Mistakes

TRYING TO DO THIS BY YOURSELF•Not seeking an advisor•Not seeking multiple sources of advice•Not meeting with your advisor•Not being prepared •Not listening the advice of senior advisors• LISTENING TO THE WRONG PEOPLE

Getting Good Advice – Who can you trust???

Residency LeadershipSeek out faculty members who regularly advise

students and help run the program

ResidentsPay attention to their impressions of programs

Do not rely on their assessment of your “competitiveness”

Warnings

Be Wary of Advice from Non-EM PhysiciansThe same rules don’t apply to all specialties!

Interview Trail Rumor MillBe careful what you hear from other students!

Don’t Trust the Blog SitesNever log on! Just say no!

ALiEM EM Match Advice www.aliem.com

Topics to Discuss:

1. Strategy

2. Competitiveness

3. The Interview

How competitive is the EM Match?NRMP© Data for Emergency Medicine, 2007-2014*

Mike Gisondi, Jill Craig – Northwestern University

# EM Residency Programs

(allopathic)

# EM Positions Offered

(allopathic)

# EM Positions Filled in the

NRMP© Match(allopathic)

# EM Positions Filled by LCME

US Seniors(allopathic)

% EM Positions Filled by LCME US Seniors

# EM Positions

Available** for SOAP©

# EM-bound unmatched

LCME US Seniors†

# EM-bound unmatched

Independent Applicants†

2014 170 1786 1772 1388 77.7 12 44 114

2013 165 1743 1740 1428 81.9 1 90 188

2012 153 1668 1668 1335 80.0 0 65 149

2011 150 1607 1602 1268 78.9 5 94 196

2010 147 1556 1540 1182 76.0 16 68 151

2009 141 1472 1459 1146 77.9 13 69 182

2008 133 1399 1370 1083 77.4 29 36 117

2007 127 1288 1282 1027 79.7 6 78 150

* Data from National Resident Matching Program, Results and Data Main Residency Match® reports 2007-2014. Available at http://www.nrmp.org/match-data/main-residency-match-data/ .

Any discrepancies between the above numbers and cited NRMP ® source reflect typographical or data entry errors for which the above authors assume responsibility.

**SOAP data was available for the first time in 2013. Numbers for 2007-2012, before the SOAP existed, reflect positions listed as “Unfilled.”

†Reflects applicants that ranked only one specialty

Specialties with 100% Fill Rates in 2014

• EM / IM• Pediatrics / Primary • Dermatology (PGY-1)• Physical Medicine & Rehabilitation (categorical and advanced)• Plastic Surgery (integrated)• Psychiatry / Family Medicine• Radiation Oncology (PGY-1)• Thoracic Surgery • Neurological Surgery• Otolaryngology

• Emergency Medicine was a ‘100% filled specialty’ in 2012.• Emergency Medicine fills > 98% of available positions annually.

Specialties > 90% Filled by LCME Grads in 2014

• Radiation Oncology (PGY-1):100%• Radiation Oncology (PGY-2):93.8%• Otolaryngology: 94.6%• Dermatology (PGY-1): 100%• Plastic Surgery (PGY-2): 92.3%• Orthopedic Surgery: 93.4%• Neurological Surgery: 91.7%

• Emergency Medicine has not yet made this list.

Old paradigm: Many students underestimate their ability to

match in emergency medicine.

New reality: Some students overestimate their ability to

match in emergency medicine.

Why do students not match?

Many LCME seniors who don’t match in EM, or match low on their list, didn’t listen to the advice they were given or they weren’t really suited to the specialty.• Didn’t apply to ‘enough’ or a ‘mix of programs’• Had severe geographic limitations• Wanted it to fit, but EM really wasn’t the best

choice for their interests, personality and strengths in the first place

What kind of applicant am I?

You need to talk to a trusted advisor who can and will give you a realistic assessment of your candidacy.- Are there issues in your academic record that

should or will come up? How were they addressed in your ERAS application?

- Performance during the EM clerkship- Other rotations/Dean’s Letter- Geographic or Program preferences

Assessing Your ‘Competitiveness’

• It depends what you are competing for!

•You need your advisors to give you a sense of which programs are likely to be the most highly selective

•You already know if your file is ‘average’ or ‘above average’ ... Though it is getting more competitive, the ‘average LCME medical student’ can match!

Comparing ‘Average’ to ‘Above Average’ in a World of Over-Achievers

CLASS RANK

TOP QUINTILE

2nd QUINTILE

MIDDLE QUINTILE

4th QUINTILE

BOTTOM QUINTILE

Your class rank is above average.(Congratulations. Don’t be cocky.)

Interview at 10 programs, max.Apply to 20 or so, max.

Your class rank is average. (You will very likely match!)Interview at 15 programs.

Apply to approximately 30 programs.

Your class rank is below average. EM is not a guarantee.

Comparing ‘Average’ to ‘Above Average’ in a World of Over-Achievers

STEP 1: a criterion-referenced exam…

> 271

250 - 271

228 - 249

207 - 227

< 206

Mean: 228SD: 21

> 1 SD above the mean. Very competitive.

Statistically speaking,your Step 1 score is average.

< 1 SD below the mean is below average.

> 2 SD above the mean. WOW.

How many programs should I apply to?

•The magic numbers (how many programs to apply to and how many interviews to take) are dependent on:

(a) where you want to live(b) the types of programs that interest you (c) the overall strength of your application

•Need to talk to an advisor and also get several opinions

•Most students will be turning down interviews

Topics to Discuss:

1. Strategy

2. Competitiveness

3. The Interview

Interviewers Are NOT Looking for Reasons to Reject You!

MYTH

Interviewing = A Talent Search

This is a job interview!

PLAY THE PART!

Dress Appropriately

Firm Handshake

Be Mature

Say Thank You

Don’t be overly familiar!

What are we looking for?

Professionals

Goal-oriented

Self-starters

Evidence of achievement

Learners who can pass the tests

Employees who won’t complain

What is the 3am Test?

Who is interviewing you?

•The program coordinator when you call to schedule (and re-schedule) your interview.

•The receptionist who sits in the lobby with you during your interview day.

•The resident who is giving you a tour of the ED.

•The nurses on your ‘second look’ day.

•Everyone.

The ‘optional’ pre-interview social is not truly optional.

The ‘Pre-Interview Social’: What to expect

•Occurs the night before or the night of your interview

• Some residents will be there (not all of them!)

• Faculty or alumni may be there

•There may or may not be food and alcohol

•You will learn a lot about the program

Before your interview…

•Read the website

•Read the information sent to you about the interview day

•Know who runs the program (PD, APDs, Chair)

•Ask your advisor what they know about the program

•This is a job interview…do your homework!

There are lots of stupid questions.

True Story.

Some general rules….

•Do not ask the program director about shift length, vacation requests, days off, etc.

•Do not ask the residents questions exclusively about shift length, vacation requests, days off, etc.

•Do not waste your interview with the program director by asking questions that you could have answered by carefully reading the program website.

•Have good reasons for your questions.

Always ask a question!

•No Questions = Disinterested

• Some back-up questions:

1. What do you like best about this program?

2. Why did you come here/why do you stay here?

The illegal and inappropriate questions to anticipate

• Arrest history

• Ethnicity

• Religious preference

• Rank Number

• Marital Status

• Dependents

• Sexual Orientation

• Personal Health

Methods of Post-interview Communication

• ‘Thank You’ notes

• The Second Look

• “I plan on ranking you highly….”

• “I am ranking your program #1….”

• Phone calls from program staff

Never ‘no-show.’

(Late cancellations are unprofessional too!)

A lot of effort goes into your interview day….

What to anticipate:

5-8 hour interview dayPre-interview social the night beforeContinental breakfast and lunchTour of facilitiesConferenceNumerous interviewsTime with the residents

DO NOT:

Cancel less than 2 weeks ahead.

Cancel via the ERAS website only.

No show.

Topics to Discuss:

1. Strategy Find an advisor!2. Competitiveness Set realistic goals!3. The Interview Prepare for a job interview!