Medical School Admissions and Residency Applicant Rankings: It's Not Personal

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn't personal. He likened the situation to Boston traffic - how drivers lean on their horns for little cause because they are simply frustrated about their days. 

It's not personal, he said.

I say the same to those I mentor. Candidates get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix applicants up with one another. Some turn up wholly unprepared - reading students' applications for the first time during the interview itself. Remember: It's not personal. This process is arduous and long, and most candidates, faculty, and program coordinators are tired and doing their best. 

When things are rough, give others the benefit of the doubt. It will help you get through this stressful process with your sanity intact. 

Your Residency Application: Program Directors Don't Want Headaches

If you were a program director (PD), you'd be trying to avoid two big headaches as you assessed a residency candidate:

First, a PD doesn't want to field complaints from patients, faculty, or other services about his/her residents. Therefore, every far-seeing PD asks him/herself the simple question: Will this person be competent and collegial?

Second, a PD doesn't want to see the day when s/he's scurrying around to fill a residency slot and the consequent open call schedule. So, the oracular PD asks the simple question: Will this person leave the program prematurely?

As you approach your interviews, consider how you can demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extracurricular activities that demonstrate teamwork, and - if asked - hobbies and reading materials that demonstrate your personality. For the latter, highlight research projects in the specialty, sub-internships, and knowledge about the program and city.

Just making sure the PD knows you are not going to cause him/her pain is half the battle.

Emergency Medicine: A Career That's Currently Taking a Lot of Hits

Having been in the field of emergency medicine since I started my residency in 1996, I can tell you that the discipline has had its ups and downs. Currently, the specialty is facing a lot of challenges: COVID has driven some physicians out (to utilization review, administration, research) and has adversely affected others emotionally. Additionally, there's a tremendous dearth of positions currently for emergency physicians. I've had friends and colleagues lose promised hours or their jobs entirely in the last 18 months. 

Here's a short piece on the job scarcity issue. Those choosing a specialty must consider the atmosphere of the job market (while recognizing it might improve in a few years).

You Don’t Have to Go to Every Party You’re Invited to, or Taking the Fifth

The goal of every medical school, dental school, residency, and fellowship interview is to distinguish yourself from everyone else to demonstrate you're worthy of a competitive spot.

So what happens when you get this (ugly) question:  

If there were one reason not to accept you, what would it be?

When a (salty) faculty member asks you this interview question, her motivation might be to determine whether there's a weakness in your application that she's missing. Or she may be assessing how you manage stressful situations by posing a question that is unpleasant.

While you need to be honest throughout the entire application process, you do not need to volunteer information that might harm you. So, for a charged question like this one that opposes your goal, you might answer, “While every candidacy has room to improve, I have a strong application." Then you can use the question as an opportunity to mention the strengths of your candidacy. Remember: You have a duty to further your candidacy, not damage it. 

Contact me for mock interview help. I still have some October slots open, as of this writing.