I recently developed three questions that I am asking all my interviewers. They are designed to get a feel of what it would be like to be a resident in each program. One evaluates the long-term decision making strategies of a program and the other helps me assess individual clinical decision making. The third helps me see what the program values, and helps me create a list of things that I hope to bring to my future program and any programs that I help start (i.e. in Hawaii, if needed).
Since EM interviews are usually friendly and conversational, I do not want to surprise or challenge my interviewers. Therefore, I am listing the questions and my rationale below.
1. The Resident Swap
Imagine that—in the name of academic cooperation—every EM program in the nation has agreed to swap half of their residents. You will receive a random assortment of replacement residents from the national pool of residents. You get to choose who stays.
How would you decide which of your current residents to keep?
What are the main concerns for the program that would influence your selection process?
(Please list 3-5 criteria/strategies that you would use to make your decision and why.)
The replacement residents will be arriving in a month. How will this affect the program’s culture and what would the program have done to address these concerns ahead of time?
2. The Deer
You are driving on a rural road when a deer jumps in front of your car and is hit. You pull over in a safe place to check on the deer. It is laying off the road and appears to be paralyzed, but is alert, moving its eyes and ears. It is slightly tachypneic and tachycardic but is otherwise hemodynamically stable and does not have any other obvious traumatic injuries. You are alone in the car but have good cell signal. You’re not in any danger and you’re not late for anything. You have access to any resources you might need/want/imagine in your car. What do you do and why?
3. Unique Things about your program:
Are there any unique processes or traditions that you are proud of at your program?
Are there any important innovations that you’ve seen implemented at your program?
My overall approach to the interview process has been very experimental. I would like to believe that I will match somewhere, which makes all of this much less stressful. Therefore, I figure that the benefit of experimenting may be the difference between finding a good fit and a great fit. My ranking system of schools includes quantitative measures such as the number of times nurses in the ED smile at residents as they walk by giving the tour and whether residents know any of the nurses’ or social workers’ names.
The Resident Swap
With my questions, I am not attempting to weasel out a definition of your ideal resident. Instead I want to understand the logical thought processes that determine how the program leadership makes decisions. As my future leaders and mentors, are you unified in your goals and methods? How do you choose when things get difficult? What will you do when there is a conflict of interest or a hard choice? Additionally, I am assessing how well the residents understand and agree with the decision-making dynamics of the program directors and assistant directors.
The second question is designed to assess empathy and pragmatism. In the ED, we primarily see people brought in by their pain. How is that addressed? When a cure is illogical or impossible, what do you do? There are no right answers to either question. They are open-ended, so that you have the ability to answer in your own way, bringing your own experiences and knowledge to bear. Please show me how you think! The best answers I’ve gotten so far are the ones that either make me pause, change my perspective or change the questions.
The deer question in particular has unusual origins. When I was ~7 years old, our cat brought a badly injured mouse into our living room. My step dad, an anaesthesiologist, felt that it was cruel to let it suffer. In a small container, he first tried to euthanize it with the gas from a whipped cream canister. When that was too dilute, he exposed it to the exhaust from the car. That was the first time I remember seeing something die, and we later talked about the importance of preventing suffering. Empathy. The second modifier to the question came after string of news articles about racehorse deaths at Santa Anita and Del Mar for leg injuries sustained during the races. Even an ankle fracture could be a death sentence for a racehorse. The “deer” is a chimera of the mouse and the racehorse, intended to simultaneously assess empathy and pragmatism in clinical decision making.
The third question is useful to assess people’s values, their opinions of the program and is a great way to build a long list of innovations that I hope to bring to whatever program I end up in (see the list of Unique Things page, which I attempt to keep updated). Additionally, if I am called to help start a program in Hawaii or elsewhere, I plan to have this list to draw from as well as detailed notes on which programs/people to contact as potential leadership role models, research collaborators or sources of sage advice.
Why am I writing all this where you might be able to see it before the interview and therefore come prepared with the perfect answers? I assume that most interviewers will not have time/interest to read all this before we meet. If you have read this in its entirety, I will respect you immensely for that as well. I intentionally send out my “heads up” email only a day before my interview because too much time to ponder might dilute the honest simplicity of the answers I receive. If you have read all this, then I’d encourage you to check out some of the other parts of this site like the writing, art (Elmer’s glue and food coloring paintings, iPhone microscope pictures, sewing and other projects) or research posters so that we have something interesting to talk about when we meet.