The Rationale

I am writing this to you, the interviewer at my future program, your program, although I don’t yet know who you are.

You are looking for us.

You are currently in the process of interviewing an endless stream of fresh-faced highly qualified applicants. You are looking for the ones that stand out from the crowd because you want them in your next class of innovative, motivated, compassionate interns that will grow up to be your chief residents, your friends, your peers and your program’s future leaders and teachers. You are looking for loyal team players, empathetic doctors and fearless students. The ones that you look forward to working with at 3 am on a Tuesday. You are seeking people who have the curiosity, humility, open-mindedness of confident free thinkers and the efficiency, pragmatism and kindness of logical decision makers.

We–the future residents of your next intern class–are looking for you too.

You offer us the autonomy, respect and patience that will help us learn and grow. You consider the hardships we will encounter, and you tell us how you will help us survive them. You show us the calm strength of your leadership and the wisdom in your approach to the difficult decisions of running a residency program. In that fateful interview day, you do your best to prove to us that will listen to us and that you will be our role models, mentors and leaders. In a few short hours, you ask us to trust you, respect you and put our lives in your hands.

We are interviewing you too.

We know who we are. We are proud to be doctors. We were drawn to EM because we care deeply about people. We strive to provide the best care possible, without bias, to everyone that walks through our doors. We are resilient, active, and independent but we are cognizant of our limitations, so we travel to every corner of the nation looking for you, our future mentors and role models. We come to you with our entire lives bundled into our ERAS application, hoping that you recognize us as well, hoping that you will pick our faces out of the sea of applicants and know that we are meant to be yours.

We know that we do things unconventionally and that we have always been adrenaline junkies and risk-takers. We are pushing the norm because we hope that it will pay off in the end. We hope that you will hear us when we say that we are looking for you. Only you. We want to find that “perfect fit,” the place that we knew was ours as soon as we walked through your doors, but we are afraid that all the programs will be filled with wonderful people that we respect, admire and strive to be.

We know that we will match to a program somewhere. We are comfortable in the tired discussion of diminishing returns after twelve interviews. We are in the safe zone and we breathed a sigh of relief. Now we are interviewing you because we know that if we ask the right questions and pay attention at the right times, you will distinguish yourself from the rest. I don’t know exactly how my future co-residents are tackling their interview trails, but I hope that you will choose all of us because of something that we did, choices that we made or words that we said.

For me personally, there is a reason behind everything I do. I have approached this process as a giant social experiment, and I am trusting that you will appreciate that side of my nature. I innovate, question, streamline and reassess constantly. I’ll try anything once, but I (hopefully) only repeat the things that work. I am flying to my 11th interview now, and I am writing this because I want to give you the tools to interview me well, so that you will stand out as I interview you. I want to tell you how I assess your character, your decision-making strategies, and the nature of your ED. I want to show you my rubric for how I take my notes during our interview day, so that you know that I count the number of times ED nurses smile at the tour group, because I believe that indicates a strong working relationship between the staff and the residents, and that I compare your answers to the Resident Swap question to your residents’ answers to assess the cohesiveness of your program and the level of autonomy that residents have. I compare between interviewers to examine the leadership dynamics and the respect that the faculty have for their residents and each other. I ask the program coordinator how long he or she has been with the program, because it seems like the strongest programs share the common feature of a dynamic, well-respected program coordinator, often one that has been with them since their inception.

I take notes during the PD lecture because I want to remember when a program has a vision and when the PD does an outstanding job of communicating it. I jot down the ratio of in-state to out of state applicants because a program that limits itself to only the local students, I assume, will also limit the scope of that program’s ability to innovate.

I ask each interviewer’s opinion about a unique strength or feature of their program. I explain that I am compiling a list of all the unique strengths that I found at each program because I want to bring those to my future program, your program, and give you the gift of all these other programs’ strategies for success. It also tells me how the interviewer feels about their program, what they are proud of, what is important to them. I want to see whether everyone has the same answer or different ones. Is there widespread ownership or are changes made at the behest of a few?

There are things that are noticeably absent from my rubric. These are things like salary, hours per shift and shifts per month, benefits, food quality and perks. Perhaps I will regret making my decisions without regard to these elements, but I cannot bring myself to base such an important decision on such trivial things. I want to work hard, I want to be tired and I want to push myself to my absolute limits. I want to be alongside people that will do the same without complaint, so how could it possibly matter what the cafeteria serves? Again, perhaps I will regret this at some point, but I have never lived my life seeking comfort and I don’t intend to start now.  

I believe that I will match into an EM residency program somewhere. I believe it will be a good fit and that I will emerge with the skills and knowledge necessary to be an strong, competent EM physician. All the rest of this effort is an attempt to find the best fit. I believe that it is my duty to step up and prepare myself to act whenever I see a significant unmet need. That philosophy is what brought me to medical school in the first place. If there is not an EM residency program in Hawaii by the time I graduate, then I believe it’s my duty to help create one. Therefore, I want to emerge from residency with the skills, mentorship and leadership capacity to fill that role.

Beyond assessing whether your program will be a good environment for me, I am looking at whether your program leadership is made up of people that act with honor and pragmatic intention, always keeping the best interests of the program as their focus. Your program will inevitably be a model for any future programs I attempt to create. Can you help guide me in that?

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