Your Emergency Medicine Interview
By Francis DeRoos, MD
University of Pennsylvania
EM Residency Director
You are about to participate in one of the
most fascinating and tiring processes; "the Match."
This is an amazing fusion of your medical school academic
record, your personality and personal achievements, your
commitment in an emergency medicine career, and variables
you have little or no control over. In order to best prepare
for this, it's vital to understand the procedure and how
to best maximize your opportunity to train at the program
you'll be happiest at. Emergency medicine is a competitive
specialty, for all the reasons you're interested in it,
and our ranks are filling with some of the best and brightest.
This makes it particularly stressful because of the quality
of the candidate and makes it even more important to present
yourself as well as possible.
I think the overall process of matching in
emergency medicine consists of three parts:
- "Building a solid foundation"--your
medical school performance
Academic commitment, boards
Extracurricular -- service, administration, research,
Understand the specialty -- EMIG
- "Selling the product"--
putting together your ERAS application
Personal statement, CV
Who to get letters from
The other side of the process--what the program does with
- "Closing the deal"--
the interview process
Evaluating EM programs
Setting up your interview calendar
Previous meetings have covered
the first 2 points and this presentation will focus on the
3rd part of the overall process.
Before you get on a plane and fly to
an unknown city and meet a dizzying number of wonderful
people with similar interests, its important to do some
ground work, so your interview day consists not only of
letting people get to know you but also of "filling
in the blanks" about that program. Probably the best
thing that's happened to the residency match process has
been the Internet. It's allowed for the development of ERAS
(much easier than the "old way") and easy access
to volumes of specific program information. The
best place to start your search is at the SAEM Residency
This not only provides standard information
such as location, contacts, curriculum, and length of training,
but it has specific links to many programs' individual web
sites. The specific links may be biased or possibly incomplete
but will probably highlight the program's real strengths.
However, the only way to really assess a program is in person.
This should be done before, during, and possibly even after
your interview day.
Below is a list of some areas that are important
to focus on. Keep in mind that much of this assessment must
be in the context of your personal career and educational
goals and how that program may prepare you for that journey.
- ED Experience
Patient population - acuity, population diversity, clinical
variety, pediatrics, trauma.
Procedure competence, resuscitations, progressive responsibility.
Teaching - does it happen?, who does it?, students.
Relationship with other housestaff.
EM experiences - how much, where, variety (community vs.
Quality of off-service rotations.
Unique or "high value" requirements - ex. ultrasound,
Electives - diverse opportunities.
5 hrs/wk required.
Lectures - Variety! Mixture of faculty, resident formal
presentations, case discussions, interactive sessions,
Board preparation - oral and written.
Diversity of interests/training
Academic interests similar to yours
Relationship with residents.
- Resident wellness
Do they seem happy? - attitude, energy, camaraderie
Involved in interview process
Benefits - money for educational resources, meetings,
- Residency program
Departmental status - most important in big university
Overall institution reputation - you'll be working with
and learning from the other services.
Leadership - program director, chairman/director.
Does it really happen there?
Will you learn how to read/critique literature - journal
club, other didactics.
You can live anywhere for 3 or 4 years in order to get
the best training that will be the basis for your professional
Your family /significant other.
"Escapes" - recreation, entertainment, cultural
- Duration of training - 3 vs.
4 year program.
There is no doubt that you can get great training at a
program regardless of the years of training and the reverse
is also true. The real question you need to ask yourself
is whether or not there is value in that extra year of
training. Do you have more elective time or flexibility,
do you have unique required rotations and how long are
they? Does this extra time just consist of more EM shifts?
I can tell you that I did not even consider this a factor
when I applied. I just wanted to train at the best program
- Scheduling your interview
"When is the best time to interview?"
This is a commmon and probably overrated question. I think
the key is to be rested, focused, and prepared. What date
to do it on is much less pertinent. I do think that the
first few are often the most difficult because of nerves,
information overload, etc
so plan a few "warm-ups"
before you go to your favorites.
Communication with the program coordinator is key. Don't
be rude or pushy, and get back to them in a timely manner.
If you have been fortunate enough to have been offered
or scheduled too many interviews, and you are going to
cancel a few, do it early so those spots can be filled
by other medical students. If, by the end of November,
you still have not heard from a program that you're really
interested in, it might help to send a short, polite email
to the program director and coordinator explaining your
interest. Don't be offended if you do not get a response.
We get a lot of emails/letters like this but I don't think
it hurts and it may very well help.
Remember it's a small world of academic emergency medicine
and the program directors meet together twice a year
Before you visit a program, it's probably helpful
to study their web site again. Often there will be faculty
pictures posted so you know whom you are meeting with
and seeing. I have a great memory of sharing idle, small
talk about a new pair of magnifying glasses with a really
nice faculty member while waiting for an interview. That
person was Dr. Peter Rosen (of textbook fame) and after
I found out, I was mortified because I had no idea who
he was. You can also find out about personal and research
interests of the faculty.
- A "typical" interview
Try to participate in any "extracurricular events"
that you are invited to. These are often the evening before
or the evening of the interview. You should think of this
as an important part of the process. You will get a real
sense of the residents, their personalities and a much
more real perspective of the training. Also, if you're
really interested in the program, spending an evening
or returning another day will really give you great insight
into the program.
A typical interview day consists of a welcome, a teaching
conference of some sort, a program, location overview,
interviews with faculty and sometimes residents, informal
lunch, tour of facilities. Many of the curriculum and
other administrative questions can be answered during
the program overview section. The tour, lunch, and between
interviews are more informal and are ideal for talking
to residents. Definitely go out of your way to talk with
some of the residents if time is not specifically provided
for this. Their insights are invaluable.
Finally, don't just ask a question for the sake of asking
it. If you don't have a specific question and an interviewer
asks if you have any just reply something like "Thank
you for the offer but no, all my questions have been answered
so far. If one comes up, I'll be certain to ask."
- Fatal mistakes
Don't be a "no show" - may hurt your chances
not only at that program but others.
Don't fall asleep
Don't over or under dress (we embrace individuals, but
Be polite to everyone - including secretaries, the coordinator
and the residents
Don't be something you're not
Don't be negative.
- Following up
Many candidates now send a very generic/standard "thank
you card" shortly after the interview. I personally
think that this is a waste of paper. Much more powerful
is to identify your top 2 or 3 programs when you are done
with interviewing and send them a very specific letter
explaining this. Do not be deceitful and tell a program
that they are your first choice when they are not. Remember
academic EM is a very tight knit group and we will talk,
particularly about things like that.
I also think that it's a great idea to revisit your top
few choices if you have the time, energy, and finances,
and spend an evening in the ED. You'll really get a much
better feel for the program and you'll be indirectly expressing
your genuine interest.
- What are the programs doing during
While you are sorting through this mountain of information
on the programs they are doing the same. Often programs
will have a scoring system that incorporates your academic
record, your letters of recommendation, and your interview
day "scores." This is not any easy process but
it is meant to make the process as fair as possible. This
is also when programs may call letter writers for clarification
or the "the real story" on candidates so keep
communicating with your advisors and letter writers. A
simple email or thank you card to them letting them know
how you are doing and what programs you really liked would
be appropriate. A huge opportunity is missed if one of
your letter of recommendation writers gets an inquiry
phone call or just happens to be speaking with a faculty
member from your #1 program, and they have no idea whether
you like that program or not.
Please remember that matching in emergency
medicine is far too competitive and difficult for you to
become emotionally invested in a particular program. It's
just not worth it! Many programs rank candidates based on
academic achievement and other objective criteria so your
desire or "need" to train at a particular program
is not factored in. Now that doesn't mean you shouldn't
let them know how much you like that program, but simply
that it may not influence anything. I'm certain every year
some students feel personally hurt by some program because
they did not match there, particularly if it's their own
institution or they rotated there. Remember this is not
personal, it's just reality.
Now all this is not meant to discourage you
but rather to let you know the realities of the process.
On a positive note, you should all know that U of Penn students
have been very successful in matching at excellent EM programs,
and I expect that tradition to continue. Remember you are
completing training in an outstanding medical school that
has prepared you well for residency and this fact is not
lost on program directors. In addition, I truly believe,
the vast majority of EM programs provide excellent training
so it's hard to go wrong. The trick is simply ending up
at the one that's best for you.