Crushing the EM Interview: program edition

This year’s interview season is in full swing, so it’s hard to even contemplate next year. And yet—being in the thick of the process makes it a good time to consider potential spots for improvement, and the stakes are high enough to make the pursuit worthwhile. In the immediate application/interview period, the average applicant will have laid out an estimated $5000-$8500 in pursuit of an EM residency. Programs, too, expend significant resources on the process, with one study reporting that a program will spend over $200,000 per year on the effort, and that the combined total spend of candidates and programs on the interview process is roughly $66 million per cycle for emergency medicine alone.[1],[2] And so, most programs constantly attempt to refine the process, out of respect for the applicants and in order to match the best—and best fit—candidates to their programs. 

And yet: the vast majority of information and advice to be found regarding success in the EM residency interview process is aimed at the candidates—who, after all, will likely engage in the affair but once. For those for whom Fall perennially means files, there exists surprisingly little evidence-based guidance on what programs can do to maximize their own interview success.  

There are some fundamentals: a smooth-running process that includes early and careful consideration of logistics—parking permits, meeting space, luggage storage, and faculty availability—is essential.  At this level, the process is often institution-specific, and it’s worth taking notes this year on any wrinkles that show, so they can be smoothed out next year. In addition, it’s worth formally reviewing with interviewers each year the questions that are considered inappropriate and discriminatory (regarding race, color, religion, sex, national origin, veteran’s status, disabilities, age, pregnancy/family status or sexual orientation), as evidently these questions are still frequently asked—in one study approximately 90% of candidates said they’d been asked at least one such question during the interview season.[3]

Although there doesn’t seem to be a relationship between late versus early interview and the likelihood of a candidate matching into your program,[4], it does appear that timing of interviews matters in at least one respect: Lewis et al found that a candidate who visits on a didactic day (versus a day in which there are no didactic or group activities) is more likely to match with that program. [5]

Given the benefit of inviting candidates on conference days, it may follow that which topics are covered there are important.  Candidates are often admonished to consider every interaction to be part of the interview; programs should likely take the same advice, avoiding speakers unknown to the program and topics that may devolve into grousing. 

On the other hand, it may be that the true reason for the better match rate when candidates interview on a conference day is that they get to see more of what is important to them in their decision process—which, according to Deiorio et al are (in descending order of importance): 

  • How happy the residents seem
  • Faculty-resident relationships
  • How well the residents work together
  • Resident and faculty values matching the candidate’s own
  • Residents spending time together outside of work
  • Residents sharing the candidate’s outside interests

In the end, no matter how good the food and how smoothly the interview day runs, it may be that the best way to recruit great new residents is to ensure that the current group are happy, and that candidates get plenty of opportunities to witness that happiness.[6]

Author: Shannon Moffett, MD @BrickCityEM; Emergency Medicine Clerkship Director at Rutgers New Jersey Medical School and Director of Undergraduate Medical Education for the Department of Emergency Medicine at University Hospital–Newark, on behalf of the CORD Advising Students Committee in Emergency Medicine (ASC-EM)

[1]Blackshaw AM, Watson SC, Bush JS. The Cost and Burden of the Residency Match in Emergency Medicine. West J Emerg Med. 2017;18(1):169–173. doi:10.5811/westjem.2016.10.31277

[2]Van Dermark JT, Wald DA, Corker JR, Reid DG. Financial Implications of the Emergency Medicine Interview Process. AEM Educ Train. 2017;1(1):60–69. Published 2017 Jan 19. doi:10.1002/aet2.10011

[3]Santen SA, Davis KR, Brady DW, Hemphill RR. Potentially discriminatory questions during residency interviews: frequency and effects on residents’ ranking of programs in the national resident matching program. J Grad Med Educ. 2010;2(3):336–340. doi:10.4300/JGME-D-10-00041.1

[4]Avasarala S, Thompson E, Whitehouse S, Drake S. Assessing Correlation of Residency Applicants’ Interview Dates with Likelihood of Matching. South Med Journal. 2018 Feb111(2) 83-86

[5]Lewis J, Dubosh N, Rosen C, Schoenfeld D, Fisher J, Ullman E. Interview Day Environment May Influence Applicant Selection of Emergency Medicine Residency Programs. West J Emerg Med. 2017;18(1):142–145. doi:10.5811/westjem.2016.10.31245

[6]Deiorio NM, Yarris LM, Gaines SA. Emergency Medicine Residency Applicant Views on the Interview Day Process. Acad Emerg Med. 2009; Dec 16. S67-70

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